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Surgical removal of a mobile, pedunculated left ventricular thrombus: report of 4 cases
1Department of Cardiothoracic Surgery, Beilinson Medical Center, Petach Tikva, Israel.
Insights
Surgical removal of mobile left ventricular thrombi after myocardial infarction proved effective in 4 patients, preventing emboli without mortality. Further research is needed to compare surgical versus medical treatment for these cardiac thrombi.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Surgery
Background:
- Left ventricular thrombus (LVT) formation is a known complication following myocardial infarction (MI).
- Mobile, pedunculated LVTs pose a significant risk of systemic embolization.
- Surgical intervention for LVT is considered in specific clinical scenarios.
Observation:
- Four patients with mobile, pedunculated left ventricular thrombi underwent surgical thrombectomy over an 11-month period.
- All patients had a history of myocardial infarction; two presented with systemic emboli, while two underwent prophylactic removal.
- Thrombus removal occurred during acute MI in two patients and 1-2 years post-MI in the other two. Three patients also underwent coronary artery bypass grafting.
Findings:
- No early or late deaths occurred in the study cohort.
- Follow-up (3-15 months) revealed no clinical or echocardiographic evidence of recurrent thrombi or emboli.
- Left ventricular thrombectomy demonstrated a potentially effective treatment outcome for mobile, pedunculated LVTs.
Implications:
- Surgical left ventricular thrombectomy may be a viable option for select patients with mobile, pedunculated LVTs.
- This study highlights the safety and efficacy of surgical LVT removal in the short term.
- Additional studies are warranted to establish optimal treatment strategies, comparing surgical thrombectomy with medical management for LVTs.
Abstract:
During an 11-month period, 4 patients underwent surgical removal of a mobile, pedunculated left ventricular thrombus. All 4 patients had a history of myocardial infarction. Two of the 4 patients had systemic emboli, and in the 2 others, the ventricular thrombi were removed to prevent emboli. The thrombus was removed during the acute phase of myocardial infarction in 2 patients and one and two years, respectively, following the infarct in the remaining 2 patients. Concomitant coronary artery bypass grafting was performed in 3 patients. There were no early or late deaths, and none of the patients had clinical or echocardiographic evidence of recurrent thrombi or emboli at follow-up 3 to 15 months later. These results indicate that left ventricular thrombectomy might be an effective treatment for patients with mobile, pedunculated, left ventricular thrombi. However, additional experience is required to compare surgical and medical treatment.