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Mural thrombus in left ventricular aneurysm: incidence, role of angiography, and relation between anticoagulation and
Insights
Mural thrombus affects nearly half of patients after left ventricular aneurysmectomy, often missed by angiography. Anticoagulant therapy may reduce thrombus formation, but embolism remains a risk.
Area of Science:
- Cardiovascular Surgery
- Diagnostic Imaging
- Thrombosis Research
Background:
- Left ventricular aneurysmectomy is a surgical procedure to treat heart conditions.
- Mural thrombus formation is a potential complication following cardiac surgery.
- Accurate detection of mural thrombus is crucial for patient management.
Purpose of the Study:
- To determine the incidence of mural thrombus in patients undergoing left ventricular aneurysmectomy.
- To evaluate the accuracy of angiography in detecting mural thrombus.
- To assess the impact of anticoagulant therapy on thrombus and embolism.
Main Methods:
- Retrospective review of 100 consecutive patients undergoing left ventricular aneurysmectomy.
- Analysis of angiographic findings for mural thrombus detection.
- Correlation of anticoagulant therapy duration with thrombus and embolism incidence.
Main Results:
- Mural thrombus was present in 48% of patients, predominantly in antero-apical aneurysms.
- Angiography showed low sensitivity (31%) and predictive accuracy (54%) for thrombus detection.
- Thrombus incidence inversely correlated with anticoagulant therapy duration.
- Embolism occurred in 5% of patients.
Conclusions:
- Left ventricular aneurysmectomy patients have a high incidence of mural thrombus.
- Angiography is unreliable for diagnosing mural thrombus in this population.
- Anticoagulant therapy may mitigate thrombus risk, but vigilance for embolism is necessary.
Abstract:
One hundred consecutive patients undergoing left ventricular aneurysmectomy were reviewed to determine the incidence of associated mural thrombus, the accuracy of angiography in detecting thrombus, and any effect of anticoagulant therapy on the incidence of thrombus and embolism. Thrombus was present in 48% of cases and was located in antero-apical aneurysms in all but two cases. Angiography resulted in correct diagnosis of thrombus with a sensitivity of only 31% and a predictive accuracy of 54%. Presence of mural thrombus correlated inversely with duration of anticoagulant therapy. Embolism occurred in 5% of patients with left ventricular aneurysm.