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Trans-aortic left ventricular thrombo-embolectomy following COVID-19 infection
Michael Janula1, Andre Navarro1, John Bonello2
1Department of Cardiothoracic Surgery, Mater Dei Hospital, Msida, Malta.
Insights
A COVID-19 infection complicated a myocardial infarction, leading to a large left ventricular thrombus. Surgical removal was necessary due to the thrombus size and patient
Area of Science:
- Cardiology
- Infectious Diseases
- Thrombosis
Background:
- Left ventricular thrombosis is a recognized complication following myocardial infarction.
- COVID-19 is associated with a procoagulant state, increasing the risk of venous and arterial thrombosis.
Observation:
- A patient with COVID-19 presented with non-ST elevation myocardial infarction (NSTEMI).
- This NSTEMI led to a large, pedunculated apical thrombus within the left ventricle.
Findings:
- Conservative management of the left ventricular thrombus was initially attempted.
- Surgical thromboembolectomy became necessary for complete thrombus resection.
- Transaortic access was utilized to avoid ventriculotomy in a patient with reduced left ventricular systolic function.
Implications:
- This case highlights the potential for COVID-19 to exacerbate cardiac complications like left ventricular thrombosis after myocardial infarction.
- The transaortic approach offers a viable surgical option for managing left ventricular thrombi, particularly in patients with compromised cardiac function.
- Prompt diagnosis and intervention are crucial for managing complex thrombotic events in the context of COVID-19 and myocardial infarction.
Abstract:
Left ventricular thrombosis is a known complication of myocardial infarction. COVID 19 has been shown to produce a procoagulant state resulting in venous and less commonly arterial thrombosis. Here, we describe a patient who presented with a non-ST elevation myocardial infarction (NSTEMI), in the context of a COVID 19 infection. This NSTEMI resulted in the formation of a large pedunculated apical thrombus, which was initially managed conservatively, however ultimately required surgical thromboembolectomy. Access to the left ventricle was gained via the transaortic route in order to avoid ventriculotomy in a patient with a reduced LV systolic function. Post-operative imaging confirmed complete resection of thrombus.
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