[Left ventricular thrombosis after anterior ST-elevation myocardial infarction: surgical management with a...

A 66-year-old patient with an anterior ST-elevation myocardial infarction (STEMI), treated with primary angioplasty and stenting of the proximal left anterior descending artery, developed an extensive left ventricular thrombosis that was initially sessile but later, after the introduction of anticoagulant therapy, became pedunculated and mobile. Given the high cardioembolic risk, the case was extensively discussed by the Heart Team, which recommended surgical thrombectomy through a transmitral approach. The procedure, performed with fibroscopic assistance, allowed complete removal of the thrombus using an unprotected aspirator. The postoperative course was complicated by hemopericardium, which required surgical resolution, followed by favorable clinical evolution. Left ventricular thrombosis is a not uncommon complication of acute myocardial infarction, particularly in anterior infarctions, and is associated with a high risk of systemic embolization. Optimal management remains controversial: anticoagulant therapy is the first-line treatment, but in cases of large and mobile thrombi, surgical removal may be necessary - an option rarely reported in the literature. Our case highlights the importance of early echocardiographic monitoring in patients with anterior STEMI and of multidisciplinary evaluation for the management of high-risk thrombotic complications.