[Floating thrombus of the left ventricle after recent myocardial infarction, treated by surgery]

The case of a 55 year old man admitted with an uncomplicated anteroseptal myocardial infarction is reported. At the third week this young patient underwent complete assessment. On coronary angiography severe double vessel disease was demonstrated and ventriculography showed a "floating" pediculated thrombus attached to the akinetic anterior wall. The ejection fraction was calculated at 40%. Subacute ischaemia of the right lower limb developed in the hours following catheterisation. In the face of all these findings surgery was proposed; ablation of the "fresh" thrombus was associated with a ventricular resection and an aorto-coronary bypass graft on the left marginal branch, together with disobliteration of the distal ilio-femoral artery of the right leg. The following points are emphasised with respect to this report: - the rarity of such cases in the litterature despite the high incidence of mural thrombi after infarction; - the value of diagnosing this complication by systematic investigation of patients under 60 years of age in full socio-professional activity; - the indications of rational surgery comprising ablation of the thrombus and any necessary prophylactic coronary revascularisation.