This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Karalis, D. G. Articles by Neri, J. L. Search for Related Content PubMed PubMed Citation Articles by Karalis, D. G. Articles by Neri, J. L.

(Circulation. 1998;97:498.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Left Ventricular Thromboembolism

Dean G. Karalis, MD; John J. Ross, Jr, RCVT, RDCS; ; Joseph L. Neri, DO

From Allegheny University Hospital, Hahnemann Division, Philadelphia, Pa.

Correspondence to Dean G. Karalis, MD, Allegheny University Hospital, Hahnemann Division, Broad and Vine, Mail Stop 313, Philadelphia, PA 19102.

Left ventricular thrombi can occur after acute myocardial infarction or in patients with chronic left ventricular dysfunction. Stasis of blood within areas of akinesis or dyskinesis is thought to be the mechanism by which thrombi form. Cardioembolic stroke is the most feared complication of left ventricular thrombi.

A 37-year-old man with progressive heart failure after myocardial infarction was found to have severe left ventricular dysfunction and a left ventricular posterobasal pseudoaneurysm. The patient underwent patch repair of the pseudoaneurysm and coronary artery bypass graft surgery. Intraoperative transesophageal echocardiography was used to image the heart throughout the surgical procedure. After separation of the patient from cardiopulmonary bypass, left ventricular function remained severely depressed, and a protruding and mobile thrombus was observed to form at the left ventricular apex, a site distinct from the aneurysm repair. The left ventricular thrombus took only several minutes to develop and then embolized from the heart into the peripheral arterial circulation (Figure). Surprisingly, the patient suffered no neurological sequelae. The patient was discharged home without complications on chronic anticoagulation therapy with warfarin.

View larger version (74K): [in this window] [in a new window]   Figure 1. Serial transesophageal echocardiographic images as left ventricular thrombus embolized into peripheral arterial circulation. 1, A protruding and mobile thrombus is seen at left ventricular (LV) apex. 2, Thrombus has embolized and is now floating free in LV cavity. 3, Thrombus is now below aortic valve in LV outflow tract. 4, Thrombus has embolized distally out of heart into peripheral arterial circulation. LA indicates left atrium.

Footnotes

The editor of Images in Cardiovascular . . . [Full Text of this Article]