Three Rare Cases of the Patients with ARVC Who Suffered from Systemic Thromboembolism

Abstract

It is well known that systemic thromboembolism often occurs in the patients with left ventricular heart failure. In contrast, in the patients with ARVC, in whom right ventricular function is predominantly reduced, systemic thromboembolism is rarely reported. We experienced three cases of the patients with ARVC suffering from systemic thromboembolism (one male and 48∼53 years old at the first thromboembolic event). Two out of three patients had multiple episodes of thromboembolism (obstructions in a retinal arterial branch and that of a radial artery in one patient and multiple cerebral infarctions in the other). At the first thromboembolic event, any of three patients did not have atrial fibrillation documented. Left ventricular ejection fractions measured by ultrasound were 55, 50, and 53% respectively. Two out of three undertook diuretics. The second thromboembolic events occurred even under administration of antiplatelet agent in one patient and under anticoagulation therapy with warfarin in the other. In both patients, patent foramen ovale (PFO) and shunt flow with a right-to-left direction were revealed by transesophageal echo (TEE). In the remaining one patient, in whom thromboembolism does not occur after initiation of anticoagulation therapy, PFO was not detected.