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Surgical removal of multiple left ventricular thrombi with video-assisted cardioscopy: a case report

Atsuyuki Mitsuishi1, Yujiro Miura1, Atsuko Furukawa2

  • 1Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Okohcho, Nankoku-shi, Kochi Prefecture 783-8505, Japan.

European Heart Journal. Case Reports
|November 9, 2023
PubMed

Insights

Surgical excision of left ventricular (LV) thrombus is rarely reported in coronary artery disease patients. This case highlights LV thrombectomy during bypass grafting for multiple, mobile LV thrombi due to high embolism risk.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Interventional Cardiology

Background:

  • Left ventricular (LV) thrombus is a severe complication of coronary artery disease (CAD), increasing risks of embolization and sudden death.
  • Optimal treatment strategies for LV thrombi remain unclear, with limited evidence supporting surgical excision.
  • A scarcity of case series exists regarding surgical LV thrombus excision in CAD patients, hindering evidence-based recommendations.

Observation:

  • A 52-year-old male with prior percutaneous coronary intervention presented with two-vessel CAD and three mobile, protuberant LV thrombi.
  • The patient underwent simultaneous coronary artery bypass grafting and LV thrombectomy utilizing video-assisted cardioscopy.
  • The thrombi were noted to be fragile, necessitating urgent intervention due to high embolic potential.

Findings:

  • Mobile and protuberant LV thrombi are primary risk factors for embolization.
  • Simultaneous formation of three LV thrombi post-myocardial infarction is rare, with undefined embolic risk.
  • Surgical intervention, including LV thrombectomy, may be indicated in high-risk cases with fragile thrombi.

Implications:

  • This case underscores the potential role of surgical LV thrombectomy in select CAD patients with high embolic risk.
  • Further case series are needed to establish optimal timing and techniques for surgical LV thrombus management.
  • Video-assisted cardioscopy can facilitate LV thrombectomy during concurrent cardiac procedures.
Abstract

Keywords:
Case reportCoronary artery bypass graftingCoronary artery diseaseLeft ventricular thrombusMultiple thrombiMyocardial infarctionVideo-assisted cardioscopy

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