Transaortic Extraction of Left Ventricular Thrombus
Joel Eyekpegha1, Paul D Williams2, Srinivasan V Krishnan3
1Cardiothoracic Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom.
Insights
Surgical thrombectomy for left ventricular thrombi can be beneficial in select acute myocardial infarction patients. A video-assisted transaortic approach offers excellent visualization and access, avoiding ventriculotomy complications.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Left ventricular thrombi (LVT) are a complication of acute myocardial infarction (AMI).
- Anticoagulation is the primary treatment for LVT.
- Surgical thrombectomy is considered for high-risk patients with concurrent indications for cardiac surgery.
Observation:
- A 43-year-old diabetic male presented with non-ST-segment elevation myocardial infarction and acute LVT.
- The patient underwent a transaortic thrombectomy and coronary artery bypass graft.
Findings:
- Traditional left ventriculotomy for thrombectomy can impair left ventricular function.
- A video-assisted transaortic left ventriculoscopy provides superior visualization.
- This technique avoids the need for ventriculotomy, mitigating functional decline.
Implications:
- Video-assisted transaortic thrombectomy is a viable option for select AMI patients with LVT.
- This approach enhances surgical safety and efficacy.
- It offers improved visualization and access compared to conventional methods.
Background:
Left ventricular thrombi may complicate acute myocardial infarction, and anticoagulation is the mainstay of management. Surgical thrombectomy may be considered in some patients with a perceived high risk for thromboembolism if there is another indication for urgent cardiac surgery.
Case Summary:
A 43-year-old diabetic man presented with a non-ST-segment elevation myocardial infarction and an acute left ventricular thrombus. He had a transaortic thrombectomy and coronary artery bypass graft.
Discussion:
The usual approach for surgical thrombectomy is left ventriculotomy. This however may cause deterioration of left ventricular function. A left atrial approach has also been described but access may be challenging. A video-assisted transaortic left ventriculoscopy combines excellent visualization provided by the endoscope and avoidance of a left ventriculotomy.
Take-Home Messages:
Surgical thrombectomy may be beneficial in a select group of patients with acute left ventricular thrombus. A video-assisted transaortic approach provides excellent access and visualization in these patients.
