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: Case report  Germany

[In Press] Complicated Massive Left Ventricular Thrombus and Surgical Treatment

Challenging differential diagnosis, Management of emergency care, Rare disease

Sedat Pasli1ABEF, Markus Kamler1ADE, Rizwan Malik1CD, Jerry Easo1AE

Am J Case Rep In Press; DOI:   :: ID: 937341

Available online: , In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

BACKGROUND
Left ventricular thrombus formation is a serious complication of cardiac diseases and may result in acute embolic events. Early diagnosis and prompt treatment are crucial steps in preventing complications. There is a lack of consensus when it comes to therapy recommendations such as treatment with anticoagulation, thrombolysis, or surgical thrombectomy.
CASE REPORT
A 74-year-old woman presented with acute peripheral ischemia in the left and right lower limbs. After running a diagnostic workup, we found a history of fatigue and dyspnea in the preceding 2 weeks; and an echocardiographic examination revealed a large floating mass in the left ventricle with a severely reduced LV ejection fraction of 10-15%. Coronary heart disease was diagnosed with stenosis of the circumflex artery and posterior branch of the right coronary artery, but not necessitating acute treatment.
The decision to operate on our patient was based on the acute situation and mobile form of the thrombi as to prevent further thromboembolic complications, and the surgical procedure was performed via a median sternotomy using a left ventricular apical approach due to the size and deep embedment in the ventricular trabeculae.
CONCLUSIONS
To date there is no standardized therapy in the guidelines for treatment of LV thrombi. Surgical thrombectomy can be performed in patients with mobile and protruding thrombi. In such cases surgery should be performed immediately due to the high risk of systemic embolism.

Keywords: Heart Ventricles; Thromboembolism; Thrombosis

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923