Floating ascending aortic thrombus with antiphospholipid syndrome: a case report

Area of Science:

• Cardiovascular Surgery
• Vascular Medicine
• Thrombosis Research

Background:

• Ascending aortic thrombus is a rare condition with poorly defined treatment guidelines.
• Antiphospholipid syndrome (APS) typically presents with venous or peripheral arterial thrombosis, rarely involving the aorta.
• Aortic thrombosis can lead to severe and fatal thromboembolic complications.

Purpose of the Study:

• To report a rare case of floating ascending aortic thrombus in a patient with APS.
• To highlight the diagnostic findings and surgical management of this condition.
• To emphasize the importance of surgical intervention for aortic thrombi with embolic potential.

Main Methods:

• A 74-year-old male with a 3-month history of left leg claudication was evaluated.
• Computed tomography angiography (CTA) and transthoracic echocardiography identified a pedunculated mass in the ascending aorta and left superficial femoral artery embolism.
• Surgical resection of the aortic mass was performed under deep hypothermic circulatory arrest without graft replacement.

Main Results:

• A floating, pedunculated mass was identified in the ascending aorta, consistent with thrombus.
• An embolism was present in the left superficial femoral artery.
• Postoperative CTA at 1 year showed no recurrence of the aortic thrombus.

Conclusions:

• Floating ascending aortic thrombi are rare but pose a significant embolic risk.
• Surgical intervention is considered the appropriate treatment for floating ascending aortic thrombi presenting with embolic events.
• This case underscores the efficacy of surgical resection in managing such rare cardiovascular emergencies.