Multiple left ventricular thrombi in a patient with left ventricular noncompaction

Area of Science:

• Cardiology
• Internal Medicine

Background:

• Myocardial noncompaction is a rare congenital heart defect characterized by prominent trabeculae and deep intertrabecular recesses.
• Clinical manifestations include heart failure, arrhythmias, and thromboembolic events due to stagnant blood flow.

Observation:

• A 62-year-old woman with symptoms of heart failure due to left ventricular noncompaction presented with multiple left ventricular thrombi.
• These thrombi formed despite long-term aspirin therapy, highlighting a potential limitation of antiplatelet agents in this condition.

Findings:

• Left ventricular noncompaction is associated with an increased risk of thrombus formation.
• Severe left ventricular systolic dysfunction in noncompaction may necessitate anticoagulation beyond antiplatelet therapy.

Implications:

• Patients with myocardial noncompaction and risk factors for thromboembolism (e.g., atrial fibrillation, systemic embolism history, severe LV dysfunction) should be considered for anticoagulative therapy.
• Chronic antiplatelet therapy alone may be insufficient for preventing clot formation in specific patient subgroups with myocardial noncompaction.