Treatment options for patients with mobile left ventricular thrombus and ventricular dysfunction: a case series

Little is known about the optimal management of large, mobile, pedunculated left ventricular clots. The management is particularly challenging in patients with advanced heart failure considered for left ventricular assist device implantation, because the clot may cause pump thrombosis.

We retrospectively reviewed the records of patients with left ventricular thrombi identified by echocardiography, and found three cases with large protruding mobile clots.

In this paper, we are presenting three challenging cases where the clots were successfully treated surgically. In two cases, the removal of clot was performed simultaneously with the implantation of ventricular assist devices. In the third case, the patient underwent only thrombectomy. Overall, the early outcomes were good in all three patients, but one subsequently died from unrelated causes.

These clinical cases give evidence for surgical treatment of large mobile clots without systemic embolism, even if ventricular assist device is implanted during the same operation.