Left ventricular thrombectomy in myocarditis: the epicardial scan & video-assisted transaortic approach

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Rheumatology

Background:

• Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis.
• Myocarditis can be a cardiac manifestation of EGPA.
• Left ventricular apical thrombus formation is a potential complication of myocarditis.

Observation:

• A 23-year-old male patient presented with myocarditis in the context of EGPA.
• Transthoracic echocardiography revealed a mobile left ventricular apical thrombus.
• The thrombus did not significantly reduce in size despite effective anticoagulation therapy.

Findings:

• Surgical removal of the left ventricular apical thrombus was performed via median sternotomy and cardiopulmonary bypass.
• Epicardial ultrasonography identified the thrombus's endocardial implantation site.
• A trans-aortic approach was utilized to prevent ventricular dysfunction and arrhythmias.

Implications:

• This case highlights a rare presentation of EGPA with cardiac thrombus formation.
• Surgical intervention may be necessary for left ventricular apical thrombi unresponsive to anticoagulation.
• The trans-aortic approach offers a viable surgical strategy for apical thrombus removal, minimizing cardiac damage.