Left Ventricular Apical Thrombus Research Articles

A rare presentation of primary spontaneous coronary dissection: Left ventricular apical thrombus associated with ischemic cerebrovascular event

Primary spontaneous coronary dissection is a rare condition. It occurs often in young women and is associated with pregnancy. Initial presentations are most likely unstable angina pectoris, myocardial infarction, and congestive heart failure. The optimal management of spontaneous coronary dissection has not been established, but it ranges from conservative medical treatment to percutaneous and surgical interventions. Here, we present the case of a 72-year-old woman with an ischemic stroke due to a left ventricular apical thrombus, secondary to primary spontaneous coronary dissection.

A Case of Peripartum Cardiomyopathy With Recurrent Left Ventricular Apical Thrombus

Peripartum cardiomyopathy (PPCM) is a disorder of unknown cause in which heart failure occurs during the peripartum period. A 32-year-old woman was diagnosed with PPCM 10 days after delivery. One month after the initial diagnosis, a newly formed left ventricular (LV) apical thrombus was revealed and warfarin was started. One week later, the thrombus became mobile and she underwent surgical thrombectomy. Warfarin was restarted on postoperative day (POD) 1; however, thrombi recurred at POD 3. Intravenous heparin was then supplemented, which subsequently resolved the thrombi without any embolism. Although there is currently no consensus as to whether patients with depressed LV function and sinus rhythm should be anticoagulated to prevent thrombus formation, PPCM presents a higher risk and might need aggressive and pre-emptive anticoagulation once diagnosis is made.

Diagnostic Limitation of Left Ventricular Apical Thrombus by Transthoracic Echocardiography; Three Cases' Report

Diagnostic Limitation of Left Ventricular Apical Thrombus by Transthoracic Echocardiography; Three Cases' Report

Primary cardiac plasmablastic (diffuse large B-cell) lymphoma mimicking left ventricular aneurysm with mural thrombus

Primary cardiac lymphoma is rare and is usually of the non-Hodgkin type. By definition, it involves only the heart and the pericardium, with no evidence of extracardiac disease. Primary cardiac lymphoma accounts for 1% of primary cardiac tumors and 0.5% of extranodal lymphomas [Gowda RM, Kahn RA. Clinical perspectives of primary cardiac lymphoma. Angiology 2003;54(5):599-604]. On the other hand, secondary cardiac involvement can occur in approximately 20% of patients with disseminated extracardiac lymphoma [Gowda RM, Kahn RA. Clinical perspectives of primary cardiac lymphoma. Angiology 2003;54(5):599-604]. The majority of primary cardiac lymphomas are diffuse large B-cell lymphomas with centroblastic or immunoblastic cytologic features. Herein, we describe an exceptional case of a primary cardiac plasmablastic variant of diffuse large B-cell lymphoma (Epstein-Barr virus-positive) presenting in an immunocompetent host with chest pain that mimicked a left ventricular apical thrombus.

Prompt resolution of an apical left ventricular thrombus in a patient with takotsubo cardiomyopathy

This report describes the prompt resolution of an apical left ventricular (LV)-thrombus complicating transient apical ballooning in a 74-year-old woman. The patient was admitted to our emergency department with acute chest pain and ST-elevation on the electrocardiogram. Coronary angiography showed normal coronary arteries and LV-angiography demonstrated the presence of apical ballooning akinesis associated with basal hypercontraction. Echocardiography and MRI studies confirmed the presence of LV-apex akinesis and detected an apical thrombus. Follow-up echocardiography on day 12 before discharge of the patient, revealed a marked improvement of regional contractility of the LV-apex and surprisingly the complete resolution of the LV-apical thrombus. The patient was diagnosed with takotsubo cardiomyopathy.

An unusual presentation of “tako-tsubo cardiomyopathy”

We report a case of tako-tsubo cardiomyopathy, complicated by left ventricular apical thrombus.

Incidental Diagnosis of a Left Ventricular Thrombus through Novel Magnetic Resonance Imaging Technique in a Patient Undergoing Coronary Artery Bypass Grafting

Stroke after cardiac surgery is a devastating complication. We report a case of incidental diagnosis of a left ventricular thrombus in a patient scheduled to undergo coronary artery bypass grafting. The preoperative diagnosis of an apical left ventricular thrombus was assessed by a novel, whole body MRI-angiography technique (TIMRA), which led to alteration of the operative approach as an additional thrombectomy was performed through an apical left ventriculotomy.

Invited commentary

Dr McCarthy discloses that he has a financial relationship with AVBG, LLC. Dr McCarthy discloses that he has a financial relationship with AVBG, LLC. Back to the future? Although highly successful, aortic valve replacement still has a host of problems that need to be managed. These problems include the following: ascending aortic calcification that can embolize or complicate aortic cross clamping or aortotomy closure; a small aortic annulus that may require patch enlargement (a more complex operation with higher risks), or the possibility for patient prosthesis mismatch; possible peri-valvular leak depending on the quality of the aortic annulus and the experience of the cardiac surgeon; heart block; fibrosis and calcification from radiation heart disease; and various problems in patients with patent coronary bypass grafts such as managing proximals attached near the aortotomy, avoiding a left internal mammary artery graft that may be in the midline, and obtaining adequate myocardial protection. Oftentimes primary aortic valve replacement is a low-risk operation. However, elderly patients with comorbidities that lead to high operative risk stimulated the development of percutaneous aortic valve replacement. Just as the advent of stenting pushed surgeons to consider more creative ways to perform coronary artery bypass, the advent of percutaneous valve techniques has stimulated surgeons to consider alternative approaches to conventional aortic valve replacement. The advantages of the aortic valve bypass as described in this article are to avoid the problems of conventional aortic valve replacement in high-risk patients. A strong advantage over percutaneous aortic valve approaches is the ability to use a known commercially available prosthetic valve with a strong track record for durability. Ideal candidates for this type of approach could include patients with ascending aortic calcification, patients who require complex reoperations, and patients with a small annulus. With new strategies and new technologies this can become a very attractive alternative for a significant percentage of patients undergoing isolated aortic valve replacement (i.e., 5.8% in Gammie and colleagues’ [1Gammie J.S. Brown J.W. Brown J.M. et al.Aortic valve bypass for the high-risk patient with aortic stenosis.Ann Thorac Surg. 2006; 81: 1605-1611Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar] experience). However, current state of the art is to modify existing conduits and valves adapted to fit this very different situation. The potential problems with the aortic valve bypass approach include pseudoaneurysm as described in their article, bleeding due to lack of control of the left ventricular (LV) apex, difficulty with the aortic anastomosis in the descending aorta due to extensive calcification of the descending aorta, kinking of the conduit because it is either too long or too short, and theoretical dislodgement of an LV apical thrombus that may not be visible by preoperative or intraoperative imaging. Should cardiopulmonary bypass be required, then it would typically employ retrograde perfusion, either from the femoral artery or a side graft from the aortic graft as described in this article, with a risk of embolization. Theoretical problems may include the nonphysiologic flow from the LV apex to the descending aorta. However, surgeons have grown used to a very successful operation that does not provide physiologic flow in coronary artery bypass. In the same way, bypassing the native aortic valve provides a clever way to work around difficult situations in some of our elderly and otherwise sick patients. With more than a 20-year history in patients, this would seem to be a strategy that has long-term durability and is not something that one would expect to see reproduced with any of the percutaneous aortic valve technologies. For this reason, surgeons should be interested in resurrecting this technique and looking forward to ways to simplify the operation and bring this to a more routine clinical care.

Transesophageal Echocardiographic Bull’s Eye

A 68-YEAR-OLD woman was scheduled for surgery for diverticulosis, but her preoperative electrocardiogram prompted a stress test that was markedly positive for ischemia. Catheterization revealed occlusion of her left anterior descending and circumflex coronary arteries. Her ascending aorta was dilated (3.7 cm), there was mild aortic regurgitation, and there was a question of an apical left ventricular thrombus. Accordingly, intraoperative transesophageal echocardiographic examination was performed during surgery for coronary artery revascularization.

Atypical Presentation of Eosinophilic Endomyocardial Disease

Idiopathic hypereosinophllic syndrome is classically defined as prolonged, unexplained peripheral eosinophilia in a patient presenting with evidence of end-organ damage. The heart is frequently Involved, resulting In eosinophilic endomyocardial disease and eventually restrictive cardlomyopathy. The mortality rate is high because of progressive heart failure or ventricular arrhythmias. We describe a patient who presented with a left ventricular apical thrombus without notable peripheral eosinophilia. Findings from clinical evaluation and extensive diagnostic testing, including right ventricular biopsy, were Inconclusive. Resection of the thrombus and subjacent endomyocardium revealed eosinophilic Infiltration of the endomyocardium, which led to the diagnosis of eosinophilic endomyocardial disease. Clinicians should be aware of the variable presentation of patients with eosinophil-associated endomyocardial disease so that affected patients may benefit from early diagnosis and treatment.

Left ventricular apical thrombus after systemic thrombolysis with recombinant tissue plasminogen activator in a patient with acute ischemic stroke

BackgroundThrombolysis with recombinant tissue plasminogen activator (rtPA) is an established treatment in acute stroke. To prevent rethrombosis after rtPA therapy, secondary anticoagulation with heparin is commonly performed. However, the recommended time-point and extent of heparin treatment vary and are not well investigated.Case presentationWe report a 61-year-old man who developed an acute global aphasia and right-sided hemiparesis. Cranial CT was normal and systemic thrombolytic therapy with tPA was started 120 minutes after symptom onset. Low-dose subcutaneous heparin treatment was initiated 24 hours later. Transthoracic echocardiography (TTE) 12 hours after admission showed slightly reduced left ventricular ejection fraction (LVEF) but was otherwise normal. 48 hours later the patient suddenly deteriorated with clinical signs of dyspnea and tachycardia. TTE revelead a large left ventricular apical thrombus as well as a reduction of LVEF to 20 %. Serial further TTE investigations demonstrated a complete resolution of the thrombus and normalisation of LVEF within two days.ConclusionOur case demonstrates an intracardiac thrombus formation following rtPA treatment of acute stroke, probably caused by secondary hypercoagulability. Rethrombosis or new thrombus formation might be an underestimated complication of rtPA therapy and potentially explain cases of secondary stroke progression.

Thrombus ventriculaire gauche et myocardite toxique induite par la paraphénylène diamine

We showed that the paraphenylenediamine (PPD) poisoning caused myocarditis but there is no data on the echocardiographic features. We report a case of myocarditis induced by PPD poisoning with echographic data. After ingestion of 5 g of PPD, a 18-year-old woman was admitted to the hospital with asphyxia and rhabdomyolysis. An electrocardiogram showed ventricular extrasystoles and negative T waves. The serum concentration of CK was 28 020 UI l –1 (iso-enzyme MB = 840 UI l –1). A transthoracic echocardiography showed significant left and right ventricular hypokinesis (shortening fraction = 20% and left ventricular ejection fraction = 35%) and a left ventricular apical thrombus. Anticoagulation treatment with heparin was initiated. A follow-up echocardiogram performed on the 15th day showed normalization of ventricular function and disappearance of the thrombus. No embolic event was noted. Echocardiography is indicated in the myocarditis induced by PPD poisoning to prove the ventricular function as well as the presence of a thrombus.

Real-time 3D echocardiography with real-time volume rendering enhances detection, characterization and localization of the extension of left ventricular apical thrombi Antonio J. Chamoun, Marti McCulloch, Tianrong Xie, Sangeeta Shah, Masood Ahmad. University of Texas Medical Branch, Galveston, TX

Real-time 3D echocardiography with real-time volume rendering enhances detection, characterization and localization of the extension of left ventricular apical thrombi Antonio J. Chamoun, Marti McCulloch, Tianrong Xie, Sangeeta Shah, Masood Ahmad. University of Texas Medical Branch, Galveston, TX

Apical hypertrophic cardiomyopathy: Echocardiographic diagnosis with the use of intravenous contrast image enhancement

Echocardiographic image enhancement with an intravenous second-generation contrast agent established the diagnosis of apical hypertrophic cardiomyopathy in 2 patients initially thought to have left ventricular apical thrombus. Image enhancement with contrast agent obviated the need for invasive diagnostic tests, underscoring its applicability in patients with suspected left ventricular masses.

Multiple cerebral infarcts from dislodgement of mobile apical left ventricular thrombus: therapeutic implications

Multiple cerebral infarcts from dislodgement of mobile apical left ventricular thrombus: therapeutic implications

Identification of Cardiac Masses and Abnormal Blood Flow Patterns with Harmonic Power Doppler Contrast Echocardiography

Power Doppler is an ultrasound technique that color-encodes the change in amplitude of the ultrasound signal, which reflects changes in the position of scatterers between ultrasound pulses. Power Doppler can be used with echocardiographic contrast agents in a harmonic imaging mode to opacify a cardiac chamber. The opacification of a cardiac chamber can aid in visualizing the silhouette of intracardiac masses and displaying blood flow patterns. Four cases are presented that demonstrate the use of harmonic power Doppler to aid in the identification of a left ventricular apical thrombus, a left atrial thrombus, and a left ventricular pseudoaneurysm. (J Am Soc Echocardiogr 1999;12:871-5.)

Adherence of Albunex to an Apical Left Ventricular Thrombus

A previously unrecognized left ventricular thrombus developed a distinct echogenic rim after intravenous injection of albumin microbubbles despite no visible opacification of the left-sided chambers. Absence of visible left ventricular opacification suggests a low density of microbubbles crossing the pulmonary vasculature and a high affinity of the microbubbles for the thrombus or its endothelial surface. These findings support previous observations that albumin microbubbles demonstrate transient adherence to abnormal endothelium. (J Am Soc Echocardiogr 1999;12:761-2.)

Safety of Dobutamine Stress Echocardiography in Patients With Left Ventricular Apical Thrombus

We demonstrate that patients with left ventricular mural apical thrombi can safely undergo dobutamine stress echocardiography. These patients also have more severe wall motion abnormalities at rest compared with a group of patients with left ventricular dysfunction without evidence of apical thrombus.

Presence of left ventricular apical thrombus predicts lack of myocardial viability: A dobutamine stress echocardiography study

Presence of left ventricular apical thrombus predicts lack of myocardial viability: A dobutamine stress echocardiography study

Improved echocardiographic detection and characterization of left ventricular apical thrombi with a 5.0 MHz short-focus transducer.

Transthoracic echocardiography is a frequently used technique for detecting ventricular thrombi. This study compares the usefulness of a 5.0 MHz short focal length transducer (5-short) with standard frequency (2.5 or 3.5 MHz) transducers for the detection of left ventricular thrombi. In addition, the effect of body habitus on study quality was evaluated. A consecutive series of 101 patients sent for echocardiographic imaging with the diagnosis of myocardial infarction, dilated cardiomyopathy, or recent suspected embolic event were imaged in the apical four-chamber, apical long-axis, and apical two-chamber views with a standard transducer and also with the 5-short. Out of this group, 16 apical thrombi were identified, six with the 5-short only, three with standard transducers only, and seven by both techniques. The areas of the seven thrombi detected by both transducers were consistently larger when measured on 5-short images compared with standard transducer images (4.6 +/- 2.3 vs 3.7 +/- 2.3 cm2, p = 0.02). In the three studies positive only with the standard transducers, the 5-short demonstrated only prominent trabeculae but no thrombus. The studies positive only with the 5-short had significantly smaller calculated thrombi areas than those visualized by the standard transducers (1.6 +/- 1.2 vs 4.2 +/- 2.1 cm2, p = 0.02). No thrombus was detected by either technique in a normally contracting left ventricular apex. There were significantly fewer studies having near-field artifact when performed by the 5-short compared with those performed with standard transducers (14/101 vs 40/101, p = 0.00004).(ABSTRACT TRUNCATED AT 250 WORDS)