Leick J, Szardien S, Liebetrau C, Willmer M, Fischer-Rasokat U, Kempfert J, Nef H, Rolf A, Walther T, Hamm C, Möllmann H. Mobile left ventricular thrombus in left ventricular dysfunction: case report and review of literature.
Clin Res Cardiol 2013;
102:479-84. [PMID:
23584757 DOI:
10.1007/s00392-013-0565-2]
[Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 04/03/2013] [Indexed: 12/14/2022]
Abstract
INTRODUCTION
Left ventricular (LV) thrombi carry a high risk of embolization. Therapeutic recommendations like treatment with low molecular heparin and intravenous unfractionated heparin (UFH), thrombolysis or surgical thrombectomy have failed to reach a consensus.
CASE DESCRIPTION
A 56-year-old female patient presented in cardiogenic shock to the emergency department. Echocardiography demonstrated a dilated LV with a severely depressed global systolic function and a large LV apical thrombus. Treatment with UFH was initiated as well as a treatment with catecholamines for stabilizing the patient's hemodynamic situation. On the follow-up echocardiographic examination, extensive free-floating parts of the thrombus could be documented. Given the high risk of embolization in a now hemodynamically stable situation, emergency surgical embolectomy was performed.
DISCUSSION
A conservative procedure might be useful for bridging till surgical treatment is available and/or the risk due to surgery is acceptable.
CONCLUSION
In absence of evidence-based guidelines for the treatment of LV thrombi, individualized management options concerning surgical, embolization and bleeding risk must be taken into account.
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