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El Malki H, Morjane Y, Belarbi A, Berkane MT, Moutaouekkil EM. [Une combinaison très rare de thrombose veineuse et artérielle chez un patient atteint du COVID 19]. Ann Cardiol Angeiol (Paris) 2024; 73:101744. [PMID: 38636246 DOI: 10.1016/j.ancard.2024.101744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/10/2024] [Indexed: 04/20/2024]
Abstract
COVID-19 is an infectious disease caused by the SARS-CoV-2 virus. This epidemic has caused serious socio-economic problems worldwide, with a very high mortality rate. Several articles have been published in the literature showing the consequences of this disease on the human body. Among the most serious complications are venous and arterial thrombosis, which are rarely observed together in the same patient. In this article, we report an exceptional case of a patient with COVID-19 with the combination of intracardiac thrombus (left atrium) and venous thrombosis (splenic vein and portal trunk).
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Affiliation(s)
- Hicham El Malki
- Department of Cardiovascular surgery, Mohammed VI University Hospital Center, Oujda, Morocco; Faculty of Medicine and Pharmacy, Mohammed the First University, Oujda, Morocco
| | - Yassine Morjane
- Department of Cardiovascular surgery, Mohammed VI University Hospital Center, Oujda, Morocco.
| | - Adam Belarbi
- Department of Cardiovascular surgery, Mohammed VI University Hospital Center, Oujda, Morocco
| | - Mohammed Taha Berkane
- Department of Cardiovascular surgery, Mohammed VI University Hospital Center, Oujda, Morocco
| | - El Mehdi Moutaouekkil
- Department of Cardiovascular surgery, Mohammed VI University Hospital Center, Oujda, Morocco; Faculty of Medicine and Pharmacy, Mohammed the First University, Oujda, Morocco
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Huffaker T, Pak S, Asif A, Otchere P. Tricuspid mass-curious case of Li-Fraumeni syndrome: A case report. World J Clin Cases 2024; 12:1936-1939. [PMID: 38660548 PMCID: PMC11036521 DOI: 10.12998/wjcc.v12.i11.1936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/30/2023] [Accepted: 02/18/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Li-Fraumeni syndrome (LFS) is a rare autosomal dominant cancer-predisposing syndrome, which can manifest as a polymorphic spectrum of malignancies. LFS is associated with an early onset in life, with the majority of cases occurring prior to the age of 46. Notwithstanding the infrequency of primary cardiac tumors, it behooves clinicians to remain vigilant in considering the differential diagnosis of such tumors in LFS patients who present with a cardiac mass. This is due to the markedly elevated risk for malignancy in this particular population, far surpassing that of the general populace. CASE SUMMARY Herein, we present a case of a 30-year-old female with LFS who was found to have a tricuspid valve leaflet mass. CONCLUSION This case exemplifies valuable learning points in the diagnostic approach for this exceptionally rare patient population.
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Affiliation(s)
- Tyler Huffaker
- Department of Cardiology, University of Texas Health San Antonio, San Antonio, TX 78701, United States
| | - Stella Pak
- Department of Neurology, Albany Medical Center, Albany, NY 12208, United States
| | - Anum Asif
- Department of Cardiology, University of Texas Health San Antonio, San Antonio, TX 78701, United States
| | - Prince Otchere
- Department of Cardiology, University of Texas Health San Antonio, San Antonio, TX 78701, United States
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Sinclair De Frías J, Olivero L, Fleissner Z, Burns J, Chadha R, Moreno Franco P. Intraoperative vascular air embolism and intracardiac thrombosis complicating liver transplantation: a case report. J Med Case Rep 2024; 18:59. [PMID: 38368412 PMCID: PMC10874554 DOI: 10.1186/s13256-024-04376-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/11/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Intracardiac thrombus and vascular air embolism represent rare complications in the context of orthotopic liver transplantation. While isolated reports exist for intracardiac thrombus and vascular air embolism during orthotopic liver transplantation, this report presents the first documentation of their simultaneous occurrence in this surgical setting. CASE PRESENTATION This case report outlines the clinical course of a 60-year-old white female patient with end-stage liver disease complicated by portal hypertension, ascites, and hepatocellular carcinoma. The patient underwent orthotopic liver transplantation and encountered concurrent intraoperative complications involving intracardiac thrombus and vascular air embolism. Transesophageal echocardiography revealed the presence of air in the left ventricle and a thrombus in the right atrium and ventricle. Successful management ensued, incorporating hemodynamic support, anticoagulation, and thrombolytic therapy, culminating in the patient's discharge after a week. CONCLUSIONS This report highlights the potential for simultaneous intraoperative complications during orthotopic liver transplantation, manifesting at any phase of the surgery. It underscores the critical importance of vigilant monitoring throughout orthotopic liver transplantation to promptly identify and effectively address these rare yet potentially catastrophic complications.
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Affiliation(s)
| | - Lorenzo Olivero
- Department of Critical Care, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA
| | | | - Justin Burns
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Ryan Chadha
- Department of Anesthesiology, Mayo Clinic, Jacksonville, FL, USA
| | - Pablo Moreno Franco
- Department of Critical Care, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA.
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Ceruti H, van de Borne P, Mirica DC. Association of endomyocardial fibrosis and minor myocarditis sequelae with intracardiac thrombus and Ebstein like valvulopathy in a patient with Behçet disease: a case report. Eur Heart J Case Rep 2024; 8:ytad631. [PMID: 38173783 PMCID: PMC10762881 DOI: 10.1093/ehjcr/ytad631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/03/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Abstract
Background Cardiac complications occur in 1-6% of cases of Behçet disease (BD) with intracardiac thrombus being the most frequent complication. Endomyocardial fibrosis, less common and occasionally associated with intracardiac thrombus, is reported in <20 case reports of BD, among which, three cases are described to mimic Ebstein disease based on echocardiography. We present the first case in the literature of a 34-year-old man with BD diagnosed with multiple cardiovascular complications, highlighting the challenging diagnosis and treatment of this pathology, especially regarding anticoagulation therapy. Case summary A 34-year-old man, diagnosed with BD, presented to the Emergency Room with haemoptysis. Computed tomography study of the thorax diagnosed pulmonary arterial aneurysm with multiple arterial thrombi, associated with multiple intracardiac thrombi in the right ventricle and atrium. The echocardiography confirmed the presence of voluminous thrombi in the right ventricle and atrium and showed hypertrabeculation of the right ventricle and a high insertion of the posterior leaflet of the tricuspid valve inducing a moderate tricuspid insufficiency compatible with an Ebstein disease. The cardiac MRI later revealed right ventricular fibrosis consistent with endomyocardial fibrosis and sequelae of myocarditis, also described as BD rare cardiac manifestations. The patient had a favourable outcome under anticoagulant treatment and immunosuppressive drugs. Discussion The association of multiple cardiovascular complications can occur in a single patient with BD. The endomyocardial fibrosis in the right heart chambers acting as a substrate for thrombus formation and subsequent pulmonary embolism; fibrosis extending to the tricuspid valve inducing an Ebstein-like morphology.
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Affiliation(s)
- Hélène Ceruti
- Department of Cardiology, Hopital Universitaire de Bruxelles (HUB), Route de Lennik, Hopital Erasme, Route de Lennik 808, 1070 Anderlecht, Bruxelles, Belgium
| | - Philippe van de Borne
- Department of Cardiology, Hopital Universitaire de Bruxelles (HUB), Route de Lennik, Hopital Erasme, Route de Lennik 808, 1070 Anderlecht, Bruxelles, Belgium
| | - Daniela-Corina Mirica
- Department of Cardiology, Hopital Delta, Boulevard du Triomphe Hopital Delta, Boulevard du Triomphe 201, 1160 Auderghem, Bruxelles, Belgium
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Tomari S, Chew BLA, Soans B, Ai-Hadethi S, Ottavi T, Lillicrap T, Kashida YT, Ostman C, Levi CR, Parsons MW, Wu TY, Rinkel LA, Coutinho JM, Garcia-Esperon C, Spratt NJ. Role of cardiac computed tomography in hyperacute stroke assessment. J Stroke Cerebrovasc Dis 2024; 33:107470. [PMID: 38029458 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Incorporating cardiac CT with hyperacute stroke imaging may increase the yield for cardioembolic sources. It is not clarified whether stroke severity influences on rates of intracardiac thrombus. We aimed to investigate a National Institutes of Health Stroke Scale (NIHSS) threshold below which acute cardiac CT was unnecessary. METHODS Consecutive patients with suspected stroke who underwent multimodal brain imaging and concurrent non-gated cardiac CT with delayed timing were prospectively recruited from 1st December 2020 to 30th November 2021. We performed receiver operating characteristics analysis of the NIHSS and intracardiac thrombus on hyperacute cardiac CT. RESULTS A total of 314 patients were assessed (median age 69 years, 61% male). Final diagnoses were ischemic stroke (n=205; 132 etiology-confirmed stroke, independent of cardiac CT and 73 cryptogenic), transient ischemic attack (TIA) (n=21) and stroke-mimic syndromes (n=88). The total yield of cardiac CT was 8 intracardiac thrombus and 1 dissection. Cardiac CT identified an intracardiac thrombus in 6 (4.5%) with etiology-confirmed stroke, 2 (2.7%) with cryptogenic stroke, and none in patients with TIA or stroke-mimic. All of those with intracardiac thrombus had NIHSS ≥4 and this was the threshold below which hyperacute cardiac CT was not justified (sensitivity 100%, specificity 38%, positive predictive value 4.0%, negative predictive value 100%). CONCLUSIONS A cutoff NIHSS ≥4 may be useful to stratify patients for cardiac CT in the hyperacute stroke setting to optimize its diagnostic yield and reduce additional radiation exposure.
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Affiliation(s)
- Shinya Tomari
- Hunter Medical Research Institute, Newcastle, Australia.
| | | | - Barry Soans
- Department of Radiology, John Hunter Hospital, Newcastle, Australia
| | - Sinan Ai-Hadethi
- Department of Radiology, John Hunter Hospital, Newcastle, Australia
| | - Thomas Ottavi
- Department of Neurology, John Hunter Hospital, Newcastle, Australia
| | | | | | - Cecilia Ostman
- Department of Neurology, John Hunter Hospital, Newcastle, Australia
| | - Christopher R Levi
- Hunter Medical Research Institute, Newcastle, Australia; Department of Neurology, John Hunter Hospital, Newcastle, Australia; College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Mark W Parsons
- College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, Australia; University of New South Wales South, Western Sydney Clinical School, Ingham Institute for Applied Medical Research, Department of Neurology, Liverpool Hospital, Sydney, Australia
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Leon A Rinkel
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; This study was performed at John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Carlos Garcia-Esperon
- Hunter Medical Research Institute, Newcastle, Australia; Department of Neurology, John Hunter Hospital, Newcastle, Australia; College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, Australia.
| | - Neil J Spratt
- Hunter Medical Research Institute, Newcastle, Australia; Department of Neurology, John Hunter Hospital, Newcastle, Australia; College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, Australia.
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Carroll K, Goncalves J, Kalimi R, Manvar-Singh P. Hemodialysis catheter-related right atrial thrombus treated with the FlowTriever system. J Vasc Surg Cases Innov Tech 2023; 9:101318. [PMID: 38106355 PMCID: PMC10725059 DOI: 10.1016/j.jvscit.2023.101318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/22/2023] [Indexed: 12/19/2023] Open
Abstract
Tunneled catheters are frequently used in patients with end-stage renal disease who require hemodialysis access. Catheter-related atrial thrombus is a documented complication of prolonged catheter use. The incidence of catheter-related atrial thrombus is 2% to 29%, with a high mortality rate approaching 20%, raising concerns for serious complications and death in the absence of an established universal management plan. This case series demonstrates the successful use of a minimally invasive approach to treat patients with intracardiac thrombus and high perioperative risk factors using mechanical and aspiration thrombectomy with the FlowTriever system (Inari Medical).
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Affiliation(s)
- Kevin Carroll
- Department of Surgery at South Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell Health, Bay Shore, NY
| | - John Goncalves
- Department of Cardiothoracic Surgery at South Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell Health, Bay Shore, NY
| | - Robert Kalimi
- Department of Cardiothoracic Surgery at South Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell Health, Bay Shore, NY
| | - Pallavi Manvar-Singh
- Department of Surgery at South Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell Health, Bay Shore, NY
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Almajed MR, Almajed A, Khan N, Obri MS, Ananthasubramaniam K. Systemic right ventricle complications in levo-transposition of the great arteries: A case report and review of literature. World J Cardiol 2023; 15:542-552. [PMID: 37900900 PMCID: PMC10600789 DOI: 10.4330/wjc.v15.i10.542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/23/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Congenitally corrected levo-transposition of the great arteries (L-TGA) is a congenital heart disease in which the ventricles and great arteries are transposed from their typical anatomy. In L-TGA, the double discordance, atrioventricular and ventriculoarterial, create an acyanotic milieu which allows patients to survive their early decades, however, progressive systemic right ventricle (sRV) dysfunction creates complications later in life. sRV dysfunction and remodeling predisposes patients to intracardiac thrombus (ICT) formation. CASE SUMMARY A 40-year-old male with L-TGA presented with symptoms of acute decompensated heart failure. In childhood, he had surgical repair of a ventricular septal defect. In adulthood, he developed sRV dysfunction, systemic tricuspid valve (sTV) regurgitation, and left-bundle branch block for which he underwent cardiac resynchronization therapy. Transthoracic echocardiogram showed a sRV ejection fraction of 40%, severe sTV regurgitation, and a newly identified sRV ICT. ICT was confirmed by ultrasound-enhancing agents and transesophageal echocardiography. Our patient was optimized with guideline-directed medical therapy and diuresis. Anticoagulation was achieved with a vitamin K antagonist (VKA) and he was later referred for evaluation by advanced heart failure and heart transplant services. CONCLUSION Anticoagulation with VKA is the mainstay of treatment in the absence of conclusive data supporting direct oral anticoagulant use in ICT in patients with congenital heart disease. This case illustrates the natural history of L-TGA and highlights the importance of surveillance and monitoring with dedicated cardiac imaging to identify complications.
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Affiliation(s)
- Mohamed Ramzi Almajed
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI 48202, United States
| | - Abdulla Almajed
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama 00000, Bahrain
| | - Naoshin Khan
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI 48202, United States
| | - Mark S Obri
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI 48202, United States
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Kwok CS, Abbas KS, Qureshi AI, Lip GYH. Cerebral infarction and in-hospital mortality for patients admitted to hospital with intracardiac thrombus: insights from the National Inpatient Sample. J Thromb Thrombolysis 2023:10.1007/s11239-023-02824-8. [PMID: 37277607 DOI: 10.1007/s11239-023-02824-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 06/07/2023]
Abstract
The factors associated with cerebral infarction and mortality in patients hospitalized with intracardiac thrombus are unknown. A retrospective cohort study was undertaken of nationally representative hospital admissions in the National Inpatient Sample with a diagnosis of intracardiac thrombus between 2016 to 2019. Multiple logistic regressions were used to define factors associated with cerebral infarction and in-hospital mortality. There were a total of 175,370 admissions for patients with intracardiac thrombus and 10.1% patients had cerebral infarction (n = 17,675). Intracardiac thrombus represented 4.4% of primary diagnosis for admissions while circulatory conditions (65.4%), infection (5.9%), gastrointestinal conditions (4.4%), respiratory conditions (4.4%) and cancer (2.2%) were the other prevalent primary diagnoses. All-cause mortality was higher for patients with cerebral infarction (8.5% vs 4.8%). The five factors most associated with cerebral infarction were nephrotic syndrome (OR 2.67 95%CI 1.05-6.78), other thrombophilia (OR 2.12 95%CI 1.52-2.95), primary thrombophilia (OR 1.99 95%CI 1.52-2.53), previous stroke (OR 1.61 95%CI 1.47-1.75) and hypertension (OR 1.41 95%CI 1.27-1.56). The strongest independent predictors of death were heparin induced thrombocytopenia (OR 2.45 95%CI 150-4.00), acute venous thromboembolism (OR 2.03 95%CI 1.78-2.33, p < 0.001) acute myocardial infarction (OR 1.95 95%CI 1.72-2.22), arterial thrombosis (OR 1.75 95%CI 1.39-2.20) and cancer (OR 1.57 95%CI 1.36-1.81). Patients with intracardiac thrombus are at risk of cerebral infarction and in-hospital mortality. Nephrotic syndrome, thrombophilia, previous stroke, hypertension, and heparin induced thrombocytopenia were associated with cerebral infarction, while acute venous thromboembolism, acute myocardial infarction, and cancer were predictors of mortality.
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Affiliation(s)
- Chun Shing Kwok
- Department of Post Qualifying Healthcare Practice, Birmingham City University, Birmingham, UK.
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK.
| | | | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Behzadnia N, Naghashzadeh F, Keshmiri MS. Fatal Large Intracardiac in Situ Thrombus in a Mildly Symptomatic COVID-19 Patient: A Case Report. Tanaffos 2023; 22:268-271. [PMID: 38628885 PMCID: PMC11016922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 02/04/2023] [Indexed: 04/19/2024]
Abstract
Background The coronavirus disease 2019 (COVID-19) has caused a global pandemic with a significant negative impact on health worldwide. Although it primarily involves the respiratory tract system, cardiovascular complications, particularly thrombotic events are increasingly reported and are associated with adverse outcomes. Case Summary We describe a 30-year-old male who presented with exaggerated dyspnea and hypoxia with mild constitutional symptoms along with a positive PCR test for SARS-CoV-2. He was a known case of bronchiectasis and large bullae in the left lung. Transthoracic echocardiography showed a large right ventricle (RV) mass entrapped within RV papillary muscles and apex. Cardiac MRI was suggestive of RV thrombosis. Regarding diffuse underlying lung disease and improving respiratory symptoms with COVID-19 negative PCR test, we decided to prescribe anticoagulation with heparin infusion and then oral anticoagulant with Rivaroxaban 20 mg daily and follow up after 30 days. Unfortunately, the patient died after 2 weeks in his hometown. Conclusion Thrombotic complications are frequently encountered in COVID-19 patients. We report a fatal case of large intracardiac thrombus associated with SARS-CoV-2 infection managed with anticoagulant therapy with a catastrophic outcome.
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Affiliation(s)
- Neda Behzadnia
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farah Naghashzadeh
- Lung Transplantation Research Center, NRITLD ,Shahid Beheshti University of Medical Sciences ,Tehran, Iran
| | - Mohammad-Sadegh Keshmiri
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Yamasaki T, Beroukhim R, Sanders SP, Carreon CK. Tricuspid Valve Blood Cysts Mimicking Thrombus or Vegetation on Echocardiogram in a Neonate. Pediatr Cardiol 2023; 44:245-248. [PMID: 36178496 DOI: 10.1007/s00246-022-02978-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/16/2022] [Indexed: 01/24/2023]
Abstract
A 2-month-old male infant, born premature with a birth weight of 865 g, was found to have a tricuspid valve mass mimicking thrombus and vegetation by echocardiogram on the fourth day of life. The patient was treated with antibiotics and anticoagulation with no change in the size of the mass on serial follow-up echocardiography. The patient died of severe pulmonary vein stenosis and complex neurological disability. Postmortem cardiac examination revealed numerous cardiac blood cysts with two dominant ones (1.6 and 1.5 mm) on the septal leaflet of the tricuspid valve, which based on the location and position corresponded to the suspected vegetation and thrombus on imaging. Cardiac blood cysts on valve leaflets are a common incidental finding during autopsy within the first 6 months of life; however, they are rarely detected on imaging because of their minute size, often < 0.5 mm. In this case, the sizable blood cysts were thought to represent thrombus or vegetation on echocardiogram, which influenced the patient management.
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Affiliation(s)
- Takato Yamasaki
- Departments of Cardiology, Pathology, and Cardiac Surgery, The Cardiac Registry, Boston Children's Hospital, Boston, MA, USA. .,Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Mie, Japan.
| | - Rebecca Beroukhim
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Stephen P Sanders
- Departments of Cardiology, Pathology, and Cardiac Surgery, The Cardiac Registry, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Chrystalle Katte Carreon
- Departments of Cardiology, Pathology, and Cardiac Surgery, The Cardiac Registry, Boston Children's Hospital, Boston, MA, USA.,Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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11
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El Minaoui M, EL Houari A. A huge serpentine embolic intracardiac thrombus: A rare manifestation of Behcet's disease. Radiol Case Rep 2022; 17:4838-4841. [PMID: 36238216 PMCID: PMC9550529 DOI: 10.1016/j.radcr.2022.09.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
Behcet's disease is a systemic vasculitis that can manifest as an intracardiac thrombus, which is rare but a serious complication. We report a case of a young male with a history of diabetes mellitus and erythema nodosum, who was admitted for pulmonary embolism associated with a huge serpentine right ventricle thrombus leading to the diagnosis of Behcet's disease. The patient was managed medically with a favorable evolution. The development of intracardiac thrombus is a life-threatening manifestation of the disease, and its discovery, especially in young subjects must suggest the diagnosis of Behcet's disease even if there is no predisposing ethnic or geographical factor.
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12
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Fu K, Zhang H, Chen N, Hu Y, Xiao J, Zhang X, Lin Z, Lu H, Ji X. Risk factors for intracardiac thrombus in peripartum cardiomyopathy: a retrospective study in China. ESC Heart Fail 2022; 10:148-158. [PMID: 36130871 PMCID: PMC9871660 DOI: 10.1002/ehf2.14158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/17/2022] [Accepted: 09/08/2022] [Indexed: 01/28/2023] Open
Abstract
AIMS Peripartum cardiomyopathy (PPCM) are more vulnerable to intracardiac thrombus than other types of cardiomyopathies, although explicit anticoagulant strategy is not sure. Too aggressive anticoagulation therapy can lead to severe bleeding events. Hence, we want to construct a risk stratification model for intracardiac thrombus in PPCM patients. METHODS AND RESULTS A total of 159 suspected PPCM cases were initially screened, whereas 123 confirmed cases were enrolled in the final analysis. The study population was randomly assigned as derivation group (N = 83) and validation group (N = 40). The derivation cohort was utilized to develop the model, and the validation cohort was used to internal validate the discriminatory ability of the model. Formation of intracardiac thrombus was detected in 22 patients. After adjusted by multivariable logistic regression analysis, left ventricle ejection fraction (LVEF, OR 0.772, 95% CI 0.665-0.897, P = 0.001), haemoglobin levels (OR 1.050, 95% CI 1.003-1.099, P = 0.038), and thrombocyte counts (OR 1.018, 95% CI 1.006-1.029, P = 0.003) were identified as risk factors independently associated with intracardiac thrombus and were finally included in the tentative risk stratification model with a C-indexes of 0.916 (95% CI: 0.850-0.982, P < 0.001). A score of ≤7 was regarded as low risk, 8-10 defined intermediate risk, and ≥11 defined high risk in our model. Internal validation showed good discriminatory ability of the model with a C-indexes of 0.790 (95% CI: 0.644-0.936, P = 0.017). CONCLUSIONS In our retrospective study, impaired LVEF, elevated haemoglobin levels, and high thrombocyte counts were regarded as independent risk factors for intracardiac thrombus in PPCM. A risk stratification model derived from these risk factors, which was economic and easily applicable in clinical practice, could rapidly and accurately identify PPCM patients with higher-risk of intracardiac thrombus.
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Affiliation(s)
- Kang Fu
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinan250012ShandongChina
| | - Hui Zhang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinan250012ShandongChina
| | - Naiyi Chen
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinan250012ShandongChina
| | - Yue Hu
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinan250012ShandongChina
| | - Jie Xiao
- Department of Critical Care MedicineQilu Hospital of Shandong universityJinan250012China
| | - Xinyu Zhang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinan250012ShandongChina
| | - Zongwei Lin
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinan250012ShandongChina
| | - Huixia Lu
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinan250012ShandongChina
| | - Xiaoping Ji
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinan250012ShandongChina
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13
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Zhang Q, Si D, Zhang Z, Zhang W. Loeffler endocarditis with intracardiac thrombus: case report and literature review. BMC Cardiovasc Disord 2021; 21:615. [PMID: 34961478 PMCID: PMC8713406 DOI: 10.1186/s12872-021-02443-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/21/2021] [Indexed: 12/24/2022] Open
Abstract
Background Loeffler endocarditis is a relatively rare and potentially life-threatening heart disease. This study aimed to identify the characteristic features of Loeffler endocarditis with intracardiac thrombus on a background of hypereosinophilic syndrome (HES). Case presentation We described a 57-year-old woman with Loeffler endocarditis and intracardiac thrombus initially presenting with neurological symptoms, who had an embolic stroke in the setting of HES. After cardiac magnetic resonance (CMR), corticosteroids and warfarin were administered to control eosinophilia and thrombi, respectively. During a 10-month follow-up, the patient performed relatively well, with no adverse events. We also systematically searched PubMed and Embase for cases of Loeffler endocarditis with intracardiac thrombus published until July 2021. A total of 32 studies were eligible and included in our analysis. Further, 36.4% of recruited patients developed thromboembolic complications, and the mortality rate was relatively high (27.3%). CMR was a powerful noninvasive modality in providing diagnostic and follow-up information in these patients. Steroids were administered in 81.8% of patients, achieving a rapid decrease in the eosinophil count. Also, 69.7% of patients were treated with anticoagulant therapy, and the thrombus was completely resolved in 42.4% of patients. Heart failure and patients not treated with anticoagulation were associated with poor outcomes. Conclusions Cardiac involvement in HES, especially Loeffler endocarditis with intracardiac thrombus, carries a pessimistic prognosis and significant mortality. Early steroids and anticoagulation therapy may be beneficial once a working diagnosis is established. Further studies are needed to provide evidence-based evidence for managing this uncommon manifestation of HES.
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Affiliation(s)
- Qian Zhang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Xiantai Street No. 126, Changchun, Jilin, China
| | - Daoyuan Si
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Xiantai Street No. 126, Changchun, Jilin, China
| | - Zhongfan Zhang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Xiantai Street No. 126, Changchun, Jilin, China
| | - Wenqi Zhang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Xiantai Street No. 126, Changchun, Jilin, China.
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14
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Trandafir C, Sandiramourty S, Laurent-Chabalier S, Ter Schiphorst A, Nguyen H, Wacongne A, Ricci JE, Pereira F, Thouvenot E, Renard D. Brain Infarction MRI Pattern in Stroke Patients with Intracardiac Thrombus. Cerebrovasc Dis 2021; 50:581-587. [PMID: 34139688 DOI: 10.1159/000515707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/25/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute infarction patterns have been described in cardioembolic stroke, mainly with atrial fibrillation (AF) or patent foramen ovale. We aimed to analyse acute infarction magnetic resonance imaging (MRI) characteristics in stroke patients with intracardiac thrombus (ICT) compared with stroke patients with AF. METHODS We performed a retrospective study analysing brain MRI scans of consecutive acute symptomatic cardioembolic infarction patients associated with ICT or AF who were recruited and registered in the stroke database between June 2018 and November 2019. Diffusion-weighted imaging performed within 1 week after symptom onset, intra-/extracranial vessel imaging, echocardiography, and ≥24-h ECG monitoring were required for inclusion. Baseline, biological, and echocardiography characteristics were assessed. Analysed MRI characteristics were infarction location (anterior/middle/posterior cerebral artery territory; anterior/posterior/mixed anterior-posterior circulation; multiterritorial infarction; brainstem; cerebellum; small cortical cerebellar infarctions [SCCIs] or non-SCCI; cortical/subcortical/cortico-subcortical), lesion number, subcortical lesion size (> or <15 mm), and total infarction volume. RESULTS We included 28 ICT and 94 AF patients presenting with acute stroke. ICT patients were younger (median age 66 vs. 81 years, p < 0.001), more frequently male (79 vs. 47%, p = 0.003), and smokers (39 vs. 17%, p = 0.013), had more frequent history of diabetes (36 vs. 18%, p = 0.049) and ischaemic heart disease (57 vs. 21%, p < 0.001), and had lower HDL cholesterol levels (0.39 vs. 0.53 g/L, p < 0.001). On MRI, SCCI was more frequent in the ICT group (25 vs. 5%, p = 0.006) in the absence of other differences in infarction localisation, number, size, or volume on MRI. On multivariate analysis, younger age (p < 0.001), history of ischaemic heart disease (p < 0.001), and low HDL cholesterol levels (p = 0.01) were significantly associated with ICT. Results approaching statistical significance were observed for SCCI (more frequent in the ICT group, p = 0.053) and non-SCCI (more frequent in the AF group, p = 0.053) on MRI. CONCLUSIONS ICT-related stroke is associated with acute SCCI presence on MRI. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT04456309.
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Affiliation(s)
- Cassiana Trandafir
- Department of Neurology, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Shridevi Sandiramourty
- Department of Radiology, Research Team EA 2992, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Sabine Laurent-Chabalier
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nîmes, University of Montpellier, Nîmes, France
| | | | - Hai Nguyen
- Department of Radiology, Research Team EA 2992, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Anne Wacongne
- Department of Neurology, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Jean-Etienne Ricci
- Department of Cardiology, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Fabricio Pereira
- Department of Radiology, Research Team EA 2992, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Eric Thouvenot
- Department of Neurology, CHU Nîmes, University of Montpellier, Nîmes, France.,Institut de Génomique Fonctionnelle, CNRS UMR5203, INSERM 1191, University of Montpellier, Montpellier, France
| | - Dimitri Renard
- Department of Neurology, CHU Nîmes, University of Montpellier, Nîmes, France
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15
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Balakrishnan M, Hutchinson MD. Prevention and Early Recognition of Complications During Catheter Ablation by Intracardiac Echocardiography. Card Electrophysiol Clin 2021; 13:357-64. [PMID: 33990274 DOI: 10.1016/j.ccep.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The effective diagnosis and management of procedural complications remains an important challenge for electrophysiology operators. Intracardiac echocardiography provides a real-time imaging modality with spectral and color Doppler capabilities that integrates directly with electroanatomic mapping systems. It provides detailed characterization of anatomic variants, which allows the operator to optimize the ablation strategy to the individual thereby avoiding the inherent risk of excessive or ineffective lesions. Complications, such as intracardiac thrombus or pericardial effusion, can be detected and managed before the onset of clinical symptoms. Intracardiac echocardiography facilitates the diagnosis and management of intraoperative hypotension.
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16
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Madani MH, Leung ANC, Becker HC, Chan FP, Fleischmann D. Aorto-iliac/right leg arterial thrombosis necessitating limb amputation, pulmonary arterial, intracardiac, and ilio-caval venous thrombosis in a 40-year-old with COVID-19. Clin Imaging 2021; 75:1-4. [PMID: 33477081 DOI: 10.1016/j.clinimag.2020.12.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/20/2020] [Accepted: 12/30/2020] [Indexed: 12/02/2022]
Abstract
We describe a 40-year-old man with severe COVID-19 requiring mechanical ventilation who developed aorto-bi-iliac arterial, right lower extremity arterial, intracardiac, pulmonary arterial and ilio-caval venous thromboses and required right lower extremity amputation for acute limb ischemia. This unique case illustrates COVID-19-associated thrombotic complications occurring at multiple, different sites in the cardiovascular system of a single infected patient.
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17
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İlhan B, Doğan H, Berikol GB, Uçar YG, Sarbay İ. An extremely rare complication of acute pancreatitis: Intraventricular thrombus. Am J Emerg Med 2020; 45:679.e5-679.e6. [PMID: 33272869 DOI: 10.1016/j.ajem.2020.11.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022] Open
Abstract
Acute pancreatitis is a frequent reason for emergency admission, which has seen its numbers increase over the years. This condition has systemic, local, and vascular complications. A 73-year-old male patient presented to our emergency department complaining of abdominal pain, nausea, and vomiting. During imaging, intraventricular thrombus was discovered, and following completion of diagnostic testing, he was diagnosed with acute pancreatitis. Herein, we present the first case of intraventricular thrombus related to acute pancreatitis prothrombotic process in the literature.
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Affiliation(s)
- Buğra İlhan
- Department of Emergency Medicine, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey.
| | - Halil Doğan
- Department of Emergency Medicine, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Göksu Bozdereli Berikol
- Department of Emergency Medicine, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Yasemin Gündoğmuş Uçar
- Department of Emergency Medicine, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - İbrahim Sarbay
- Department of Emergency Medicine, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
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18
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Hira K, Shimura H, Kamata R, Takanashi M, Hashizume A, Takahashi K, Sugiyama M, Izumi H, Hattori N, Urabe T. Multiple cerebral infarction diagnosed as Eosinophilic Granulomatosis with Polyangiitis by autopsy. BMC Neurol 2019; 19:288. [PMID: 31729970 PMCID: PMC6857209 DOI: 10.1186/s12883-019-1515-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/28/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis of unknown cause involving the brain and accompanied by prominent eosinophilia. Intracardiac thrombosis is a major cardiac complication of EGPA that may cause thromboembolism. CASE PRESENTATION A 53-year-old man presenting with abulia (consciousness disturbance) and left upper limb paralysis was admitted to our hospital. His case was complicated by penetrating branches, small vessel infarcts, and endocardial thrombosis in the right and left ventricle. Cardiomyopathy was also observed. Sixteen days after admission, the patient died from intracranial hemorrhage. Brain autopsy revealed two major findings: 1) large hemorrhagic infarction caused by cardiac embolism; and 2) granuloma and eosinophil infiltration. Vasculitis was accompanied by eosinophil infiltration in the cortical blood vessels and granuloma. CONCLUSIONS In this case study, we report autopsy findings of brain infarction in a patient with EGPA and endocardial thrombosis. The brain infarction was caused by the cardiac embolisms and vasculitis.
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Affiliation(s)
- Kenichiro Hira
- Department of Neurology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Hideki Shimura
- Department of Neurology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.
| | - Riyu Kamata
- Department of Neurology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Masashi Takanashi
- Department of Neurology, Juntendo University Koshigaya Hospital, 560 Fukuroyama, Koshigaya, Saitama, 343-0032, Japan
| | - Akane Hashizume
- Department of Pathology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Keiji Takahashi
- Department of Neurology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Mizuho Sugiyama
- Department of Neurology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Hiroshi Izumi
- Department of Pathology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
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19
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Kara M, Güler M, Keskin Yildirim Z, Tekgunduz K, Laloglu F, Ceviz N. Clinical features and treatment results in preterm infants with intracardiac thrombus. J Matern Fetal Neonatal Med 2019; 34:1763-1767. [PMID: 31366253 DOI: 10.1080/14767058.2019.1647530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Thrombus incidence is higher among neonates, especially in preterm infants, due to the associated additional risk factors. MATERIALS AND METHODS The medical recordings of premature infants who had been diagnosed as having intracardiac thrombus between January 2016 and January 2019 were evaluated retrospectively. We use recombinant tissue plasminogen activator when the thrombus is relatively large compared to left atrium, pedunculated, mobile, or snake shaped. RESULTS A total of 13 premature patients were diagnosed as having intracardiac thrombus during the 3-year period. All were diagnosed during echocardiographic studies. Low molecular weight heparin was administered in four patients. In three, recombinant tissue plasminogen activator was started with low dose (0.01 mg/kg/h) and increased gradually to 0.06 mg/kg/h. In three, recombinant tissue plasminogen activators were started with standard dose (0.5 mg/kg/h). In one recombinant tissue, plasminogen activator was started with low dose (0.01 mg/kg/h) and increased to standard dose. Two patients died before treatment, three patients died during treatment, follow-up was not available for two patients, and thrombus completely resolved in six patients. DISCUSSION In preterm babies with risk factors, intracardiac thrombus should be kept in mind during all echocardiographic studies. In our patients, low and standard dose regimens were used, and the treatment results were similar.
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Affiliation(s)
- Mustafa Kara
- Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Muhlike Güler
- Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | | | | | - Fuat Laloglu
- Erzurum Nenehatun Obstetrics and Gynecology Hospital, Erzurum, Turkey
| | - Naci Ceviz
- Faculty of Medicine, Ataturk University, Erzurum, Turkey
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20
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Abstract
Atrial fibrillation is common in patients with congestive heart failure (CHF). Due to reduced left atrial appendage (LAA) emptying velocities and increased sludge formation, a higher rate of stroke and embolism are seen with CHF. Up to 50% of CHF patients are inadequately covered for stroke protection with anticoagulation, and, even while on therapy, CHF patients are at risk for failure to clear LAA or left ventricular (LV) thrombus. Device-based LAA closure (LAAC) alternatives exist. Following intracardiac device closure, an increased rate of device-related thrombus is seen in heart failure patients, which warrants further study to optimize LAAC benefits.
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Affiliation(s)
- Christopher R Ellis
- Left Atrial Appendage Program, Vanderbilt University Medical Center, 5414 Medical Center East, 1211 21st Avenue South, Nashville, TN 37232-8802, USA.
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21
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Allderdice C, Marcu C, Kabirdas D. Intracardiac Thrombus in Leukemia: Role of Cardiac Magnetic Resonance Imaging in Eosinophilic Myocarditis. CASE (Phila) 2018; 2:114-7. [PMID: 30062326 DOI: 10.1016/j.case.2017.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
EM involves acute necrotic, intermediate thrombotic, and late fibrotic stages. Echocardiography is the initial modality for the diagnosis of EM. EMB could miss the diagnosis if the area involved is not biopsied. CMR reliably detects all three stages of EM.
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22
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Saric M, Armour AC, Arnaout MS, Chaudhry FA, Grimm RA, Kronzon I, Landeck BF, Maganti K, Michelena HI, Tolstrup K. Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism. J Am Soc Echocardiogr 2016; 29:1-42. [PMID: 26765302 DOI: 10.1016/j.echo.2015.09.011] [Citation(s) in RCA: 225] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism. It describes general mechanisms of stroke and systemic embolism; the specific role of cardiac and aortic sources in stroke, and systemic and pulmonary embolism; the role of echocardiography in evaluation, diagnosis, and management of cardiac and aortic sources of emboli including the incremental value of contrast and 3D echocardiography; and a brief description of alternative imaging techniques and their role in the evaluation of cardiac sources of emboli. Specific guidelines are provided for each category of embolic sources including the left atrium and left atrial appendage, left ventricle, heart valves, cardiac tumors, and thoracic aorta. In addition, there are recommendation regarding pulmonary embolism, and embolism related to cardiovascular surgery and percutaneous procedures. The guidelines also include a dedicated section on cardiac sources of embolism in pediatric populations.
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Affiliation(s)
- Muhamed Saric
- New York University Langone Medical Center, New York, New York
| | | | - M Samir Arnaout
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Farooq A Chaudhry
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Richard A Grimm
- Learner College of Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | | | | | | | - Kirsten Tolstrup
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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23
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Meti N, Mongeon FP, Guerra PG, O'Meara E, Khairy P. Incessant atrioventricular nodal reentrant tachycardia with tachycardia-induced cardiomyopathy, biventricular thrombosis, and pulmonary emboli. HeartRhythm Case Rep 2016; 2:142-145. [PMID: 28491653 PMCID: PMC5412623 DOI: 10.1016/j.hrcr.2015.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Nicholas Meti
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - François-Pierre Mongeon
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Peter G Guerra
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Eileen O'Meara
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Paul Khairy
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
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Wang H, Guo X, Tian Z, Liu Y, Wang Q, Li M, Zeng X, Fang Q. Intracardiac thrombus in patients with Behcet's disease: clinical correlates, imaging features, and outcome: a retrospective, single-center experience. Clin Rheumatol 2016; 35:2501-7. [PMID: 26753545 DOI: 10.1007/s10067-015-3161-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 12/17/2015] [Accepted: 12/26/2015] [Indexed: 02/06/2023]
Abstract
Intracardiac thrombus (ICT) is a rare but serious complication of Behcet's disease (BD). The study was to report the clinical characteristics, imaging features, treatment, and outcomes of BD patients with ICT in a single tertiary center. A series of 626 BD patients admitted to Peking Union Medical College hospital between April 2003 and April 2013 were reviewed. A total of 12 (1.9 %) BD patients with ICT were included. ICT was presenting manifestation of BD in 5 of the 12 patients (41.7 %) and occurred mostly in men (9/12, 75 %) younger than 40 years. Patients with ICT had more arterial (66.7 vs. 7.3 %, p < 0.001) and venous involvement (75.0 vs. 8.1 %, p < 0.001) compared to those without ICT. Right heart was the most frequent site of ICT (11/12, 91.7 %). Thrombus were hyperechogenic and immobile with a broad-based attachment on echocardiography in most cases (11/12, 91.7 %). Cardiac magnetic resonance (CMR) was performed in four patients. All thrombi showed isointense on T1-weighted image, while all but one were hypointense on T2-weighted image without delayed enhancement. Remission of ICT was associated with therapy of anticoagulant, corticosteroid, and immunosuppressant in most cases (10/12, 83.3 %). There was no death, and relapses of ICT occurred in only one patient after tapering of immunosuppressant during follow-up. A diagnosis of BD should be considered when a young male patient presents with a mass in the right-sided heart accompanied by vascular lesions. Medical therapy especially adequate immunosuppressants might be the first choice for BD patients with ICT.
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Affiliation(s)
- Hui Wang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 1, Shuaifuyuan, Dongdan, Beijing, 100730, China
| | - Xiaoxiao Guo
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 1, Shuaifuyuan, Dongdan, Beijing, 100730, China
| | - Zhuang Tian
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 1, Shuaifuyuan, Dongdan, Beijing, 100730, China.
| | - Yongtai Liu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 1, Shuaifuyuan, Dongdan, Beijing, 100730, China
| | - Qian Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Quan Fang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 1, Shuaifuyuan, Dongdan, Beijing, 100730, China
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25
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Lisitsyna T, Alekberova Z, Ovcharov P, Volkov A, Korsakova J, Nasonov E. Left ventricular intracardiac thrombus in a patient with Behçet disease successfully treated with immunosuppressive agents without anticoagulation: a case report and review of the literature. Rheumatol Int 2015; 35:1931-5. [PMID: 26055535 DOI: 10.1007/s00296-015-3306-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/01/2015] [Indexed: 01/29/2023]
Abstract
Behçet disease (BD) is a chronic multisystem disorder with vasculitis underlying its systemic manifestations. Cardiac involvement and particularly left ventricular intracardiac thrombus are rarely diagnosed in the course of BD and are often associated with poor prognosis. The causes of intracardiac thrombi are unknown. It is plausible that specific proinflammatory pathways resulting in the endothelial cell injury and hypercoagulation contribute to the formation of thrombotic masses in the heart. Known thrombophilic factors such as methylenetetrahydrofolate reductase gene mutations, factor V Leiden mutation, proteins S and C, antithrombin III, activated protein C resistance, and antiphospholipid antibodies may contribute to the formation of intracardiac thrombi in BD. We report a case of a 24-year-old male patient with BD presented with left ventricular thrombus. Transthoracic echocardiography allowed to describe and monitor such a rare cardiac manifestation of the disease. A combination of high-dose corticosteroid and azathioprine successfully dissolved intracardiac thrombus within ten days without anticoagulation.
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Affiliation(s)
- Tatiana Lisitsyna
- Nasonova Research Institute of Rheumatology, Russian Academy of Sciences, Kashirskoe shosse 34A, 115522, Moscow, Russia.
| | - Zemfira Alekberova
- Nasonova Research Institute of Rheumatology, Russian Academy of Sciences, Kashirskoe shosse 34A, 115522, Moscow, Russia.
| | - Pavel Ovcharov
- Nasonova Research Institute of Rheumatology, Russian Academy of Sciences, Kashirskoe shosse 34A, 115522, Moscow, Russia.
| | - Alexander Volkov
- Nasonova Research Institute of Rheumatology, Russian Academy of Sciences, Kashirskoe shosse 34A, 115522, Moscow, Russia
| | - Julia Korsakova
- Nasonova Research Institute of Rheumatology, Russian Academy of Sciences, Kashirskoe shosse 34A, 115522, Moscow, Russia
| | - Evgeni Nasonov
- Nasonova Research Institute of Rheumatology, Russian Academy of Sciences, Kashirskoe shosse 34A, 115522, Moscow, Russia.
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Bouabdallaoui N, Nader M, Leprince P. Uncommon cause of intracardiac thrombus. Eur Heart J Acute Cardiovasc Care 2015; 5:527-528. [PMID: 25746944 DOI: 10.1177/2048872615576220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 02/08/2015] [Indexed: 11/15/2022]
Abstract
We present a rare image documenting direct transit of a thrombus originating from the venous circulation and passing through a patent foramen ovale linked to a malpositioned cannula in the setting of temporary mechanical circulatory assistance in a young patient who underwent a peripheral extra corporeal membrane oxygenation as a circulatory support.
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Affiliation(s)
- Nadia Bouabdallaoui
- Department of Thoracic and Cardiovascular Surgery, University Pierre et Marie Curie, Paris VI, Assistance publique des hôpitaux de Paris, La Pitié Salpêtrière Hospital, France
| | - Marwan Nader
- Department of Anaesthesiology, University Pierre et Marie Curie, Paris VI, Assistance publique des hôpitaux de Paris, La Pitié Salpêtrière Hospital, France
| | - Pascal Leprince
- Department of Thoracic and Cardiovascular Surgery, University Pierre et Marie Curie, Paris VI, Assistance publique des hôpitaux de Paris, La Pitié Salpêtrière Hospital, France
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27
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Jang YJ, Kim JY, Lee KB, Na GW, Lee WJ, Park WI, Lee M. Spontaneous perforation and dissection of the sinus of Valsalva and interventricular septum with intracardiac thrombus in a patient with Behcet's disease. Korean J Intern Med 2015; 30:252-5. [PMID: 25750569 PMCID: PMC4351334 DOI: 10.3904/kjim.2015.30.2.252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/22/2014] [Accepted: 08/20/2014] [Indexed: 02/07/2023] Open
Affiliation(s)
- Yoon-Jung Jang
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jun Young Kim
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Kyung Been Lee
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Gun Wung Na
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Won Jae Lee
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Won Il Park
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Mirae Lee
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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28
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Kato T, Yasaka M, Yabuki T, Adachi T, Toyoda S, Inoue T. Two-week administration of rivaroxaban resolved left atrial thrombus. J Cardiol Cases 2014; 10:238-240. [PMID: 30534252 DOI: 10.1016/j.jccase.2014.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 08/06/2014] [Accepted: 08/22/2014] [Indexed: 11/19/2022] Open
Abstract
An 89-year-old man visited our hospital complaining of palpitation. Electrocardiography showed atrial fibrillation, and transthoracic echocardiography demonstrated a mobile thrombus of 28.6 mm × 20.8 mm in the left atrium. Administration of a direct factor Xa inhibitor rivaroxaban (10 mg/day) was started. The thrombus reduced its size and disappeared completely 2 weeks after the commencement of rivaroxaban treatment. To our knowledge, this is the first case report that rivaroxaban successfully dissolved left atrial thrombus during a short period. Rivaroxaban might have a potential, not only to prevent de novo thrombus formation, but also to dissolve established thrombi by direct inhibition of free and thrombus-associated factor Xa. <Learning objective: The incidence of nonvalvular atrial fibrillation is increasing, and left atrial thrombus is the major cause of cardiogenic thrombo-embolism that we need to prevent. Recently, novel oral anticoagulants have been developed. The effects of these agents on intracardiac thrombus resolution have not been fully elucidated. Data from a large cohort study would be required to assess efficacy of novel oral anticoagulants for thrombus resolution.>.
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Affiliation(s)
- Toru Kato
- Department of Clinical Research, National Hospital Organization Tochigi Medical Center, Tochigi, Japan
- Department of Cardiovascular Disease, Dokkyo Medical University, Tochigi, Japan
| | - Masahiro Yasaka
- Department of Cerebrovascular Medicine, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Taku Yabuki
- Department of Internal Medicine, National Hospital Organization Tochigi Medical Center, Tochigi, Japan
| | - Taichi Adachi
- Department of Cardiovascular Medicine, National Hospital Organization Tochigi Medical Center, Tochigi, Japan
| | - Shigeru Toyoda
- Department of Cardiovascular Disease, Dokkyo Medical University, Tochigi, Japan
| | - Teruo Inoue
- Department of Cardiovascular Disease, Dokkyo Medical University, Tochigi, Japan
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29
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Atas H, Samadov F, Sunbul M, Cincin A, Delil K, Mutlu B. Two cases of acute myocarditis with multiple intracardiac thrombi: the role of hypercoagulable States. Heart Views 2014; 15:22-5. [PMID: 24949185 PMCID: PMC4062986 DOI: 10.4103/1995-705x.132143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In acute myocarditis, thrombus formation is an important prognostic factor. Early diagnosis and treatment of intracardiac thrombus is critical, especially when there are multiple thrombi. When a patient presents with multiple cardiac thrombi not only cardiac disorders, but other diseases such as malignancies, rheumatologic disorders and thrombophilia must be considered in the differential diagnosis. Although the presence of hypercoagulable states does not generally affect the treatment choice, it may have an impact on continuation and duration of the anticoagulant therapy. In this paper, we present two cases of acute myocarditis with multiple intracardiac thrombi. Additionally, these cases had hypercoagulable states which might have contributed to the thrombus formation.
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Affiliation(s)
- Halil Atas
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Fuad Samadov
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Murat Sunbul
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Altug Cincin
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Kenan Delil
- Department of Medical Genetics, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Bulent Mutlu
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
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30
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Budhram GR, Mader TJ, Lutfy L, Murman D, Almulhim A. Left ventricular thrombus development during ventricular fibrillation and resolution during resuscitation in a swine model of sudden cardiac arrest. Resuscitation 2014; 85:689-93. [PMID: 24518559 DOI: 10.1016/j.resuscitation.2014.01.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 01/16/2014] [Accepted: 01/22/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Intracardiac thrombus is a well-known complication of low-flow cardiac states including acute myocardial infarction and atrial fibrillation. Little is known, however, about the formation of intracardiac (left ventricular [LV]) thrombus during the extreme low-flow state of cardiac arrest. OBJECTIVE Using a swine model of sudden cardiac arrest, we examined the sonographic development of LV thrombus over time after induction of ventricular fibrillation (VF) and resolution of thrombus with cardiopulmonary resuscitation (CPR). METHODS This observational study was IACUC approved. Forty-five Yorkshire swine were sedated, intubated, and instrumented under general anesthesia before VF was electrically induced. Sonographic data was collected immediately after VF induction and at 2-min intervals thereafter. Following 12min of untreated VF, resuscitation was initiated with closed chest compressions using an oxygen-powered mechanical resuscitation device. Observations were continued during attempted resuscitation. At the end of the experiment, the animals were euthanized while still at a surgical depth of anesthesia. The data was analyzed descriptively. RESULTS Sonographic evidence of LV thrombus was observed in 43/45 animals (95.6% [95%CI: 85.2%, 98.8%]). Thrombus was detected within 6min in 39/45 (86.7% [95%CI: 73.8%, 93.8%]) animals that developed thrombus. Thrombus resolved within 2min after initiation of chest compressions in 31/43 (72.1% [95%CI: 57.3%, 83.3%]) animals. CONCLUSION Similar to other low-flow cardiac states, LV thrombus develops early in the natural history of VF arrest and resolves quickly once forward flow is re-established by chest compressions. Institutional protocol number: 154600-8.
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Affiliation(s)
- Gavin R Budhram
- Tufts University School of Medicine, Department of Emergency Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, United States.
| | - Timothy J Mader
- Tufts University School of Medicine, Department of Emergency Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, United States
| | - Lucienne Lutfy
- Tufts University School of Medicine, Department of Emergency Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, United States
| | - David Murman
- Tufts University School of Medicine, Department of Emergency Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, United States
| | - Abdullah Almulhim
- Tufts University School of Medicine, Department of Emergency Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, United States
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31
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Ghannouchi Jaafoura N, Atig A, Bouker A, Alaoua O, Ben Jazia E, Khalifa M, Bahri F. [Intracardiac thrombosis during celiac disease]. ACTA ACUST UNITED AC 2014; 39:203-6. [PMID: 24412009 DOI: 10.1016/j.jmv.2013.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 11/20/2013] [Indexed: 02/06/2023]
Abstract
Thrombotic events occurring in the course of celiac disease are frequently reported in the literature. The localization is often unusual, mainly affecting the hepatic veins. To our knowledge, this is the first report of intracardiac thrombosis occurring in a patient with celiac disease. A 32-year-old patient with celiac disease adhered poorly to his gluten-free diet. He suffered an ischemic stroke revealing an intracardiac thrombus, which, on radiological imaging, simulated a multiple myxoma. Histological examination of the resected tumor enabled the correct diagnosis. Biological findings revealed severe protein C and S deficiency. The patient improved with anticoagulant therapy and gluten-free diet.
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Affiliation(s)
| | - A Atig
- Service de médecine interne, CHU Farhat-Hached, 4000 Sousse, Tunisie
| | - A Bouker
- Service de médecine interne, CHU Farhat-Hached, 4000 Sousse, Tunisie
| | - O Alaoua
- Service de médecine interne, CHU Farhat-Hached, 4000 Sousse, Tunisie
| | - E Ben Jazia
- Service de médecine interne, CHU Farhat-Hached, 4000 Sousse, Tunisie
| | - M Khalifa
- Service de médecine interne, CHU Farhat-Hached, 4000 Sousse, Tunisie
| | - F Bahri
- Service de médecine interne, CHU Farhat-Hached, 4000 Sousse, Tunisie
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32
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Tabata E, Yasaka M, Wakugawa Y, Komori M, Mori K, Tsurusaki Y, Kokuba K, Sambongi Y, Maeda K, Okada Y. Increase in the Size of an Intracardiac Thrombus during Dabigatran Therapy (110 mg b.i.d.) in an Acute Cardioembolic Stroke Patient. Cerebrovasc Dis Extra 2013; 3:78-80. [PMID: 23687505 PMCID: PMC3656689 DOI: 10.1159/000351137] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
We report a case of atrial fibrillation in a patient in whom a mobile thrombus in the left atrial appendage increased in size after low-dose dabigatran therapy. A 74-year-old man was admitted to our hospital because of sudden onset of right hemiplasia and dysarthria. On admission, his National Institutes of Health Stroke Scale score was three. Axial diffusion-weighted magnetic resonance images and magnetic resonance angiography images showed hyperintense signals in the left front-parietal cerebral cortex without any intracranial stenotic lesions, and acute cardioembolic stroke associated with nonvalvular atrial fibrillation was diagnosed. Transesophageal echocardiography revealed a mobile thrombosis (1.0 × 2.2 cm) in the left atrial appendage, and dabigatran therapy (110 mg b.i.d.) was initiated to prevent stroke recurrence. Transesophageal echocardiography performed 6 days later revealed that the size of the thrombus had increased to 1.5 × 3.0 cm. Medication was changed to warfarin, and the thrombosis subsequently decreased in size. The patient did not have a recurrent stroke and was discharged with a National Institutes of Health Stroke Scale score of zero. This case demonstrates that low-dose dabigatran may not be effective in reducing the size of a thrombus.
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Affiliation(s)
- Emi Tabata
- Department of Cerebrovascular Medicine and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukukuoka, Japan
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