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European Heart Journal Advance Access originally published online on March 13, 2008
European Heart Journal 2008 29(18):2258; doi:10.1093/eurheartj/ehn110
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Thrombus in left ventricular aneurysm: a change in morphology during echocardiographic follow-up

Jan Vojacek1,*, Rudolf Praus2 and Jan Dominik1

1 Department of Cardiac Surgery
2 Department of Internal Medicine, Faculty of Medicine, Charles University Prague, University Hospital, Hradec Kralove 500 05, Czech Republic

* Corresponding author. Email: vojacekj{at}seznam.cz

A 72-year-old male was admitted with a history of subacute myocardial infarction. On coronary angiogram there was total occlusion of the proximal segment of the left anterior descending artery and non-obstructive disease of the other coronary arteries. An echocardiogram showed a large akinesis of anteroseptal segments with apical dyskinesis. It demonstrated an apical aneurysm with a mural thrombus inside the aneurysm. The size of the thrombus was 47 x 15 mm (Panel A).

The patient was started on full-dose low-molecular weight heparin and aspirin. Unfortunately, 1 week later he suffered a minor cerebral stroke which clinically resolved within another week. Follow-up echocardiograms performed during the following 4 weeks documented a change in thrombus morphology: from mural to highly mobile thrombus with a high risk of systemic embolization (Panels A–C). As conservative management seemed to be unsuccessful, the patient finally underwent urgent cardiac surgery—thrombus extraction (Panel D) with resection of the aneurysm and single coronary artery bypass grafting. The postoperative course was uneventful.

Panel A. Apical four-chamber view demonstrating mural thrombus (size 47 x 15 mm) on admission echocardiogram.

Panel B. Echocardiogram 2 weeks later with early separation of the thrombus.

Panel C. Mobile thrombus on a 4-week follow-up echocardiogram.

Panel D. Older ovoid thrombus sized 40 x 20 mm and small fresh thrombus after removing from the left ventricle.

Formula


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This Article
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