Anaesthetic management in patient with left ventricular clot posted for non-cardiac surgery

Abstract

Cardiovascular disease remains the leading cause of mortality all over the world. Mortality from acute myocardial infarction (AMI) has decreased since the introduction of primary percutaneous coronary intervention (PCI). Left ventricular (LV) thrombus is a common complication after acute myocardial infarction (MI). One of the most feared complications is the occurrence of thromboembolic events (mostly cerebrovascular accidents) due to left ventricular (LV) thrombus formation. We present a 65 yrs old male with right traumatic foot ulcer, scheduled for right foot SSG. His ECG showed anterior wall ischemic changes. Echocardiogram showed akinetic LV apex, EF: 47%, with an organised LV apical clot of 1.5×1.4cm. Cardiologist opinion was obtained and he was put on oral nitrates, beta blocker and statins. Surgery was done under right popliteal sciatic nerve and fascisa iliaca block. Intraoperative period was uneventful. Postoperatively, serial ECG and Trop I was done on 1 and 4 POD and was found to be normal. He was discharged on 4 POD, with advice to follow up with cardiologist.