title: From swirling to a mobile, pedunculated mass--the evolution of left ventricular thrombus despite full anticoagulation. Echocardiographic demonstration.
abstract: We describe the unusual evolution of a left ventricular thrombus following acute anterior myocardial infarction despite adequate anticoagulation. Serial echocardiographic examinations demonstrated the evolution from swirling in the left ventricle through a solid apical mass gradually dislodging into a mobile, pedunculated mass that was removed surgically to prevent embolization. This report emphasizes the need to follow echocardiographically left ventricular thrombi during treatment with anticoagulants, and to identify morphologic changes that may predict embolization. This case suggests that left ventricular thrombectomy should be considered in selected patients in whom a very high-risk thrombus morphology is detected.
authors.affiliation: Heart Institute, Tel Aviv University, Tel Hashomer, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Glikson
authors.forename: O
authors.initials: O
authors.lastname: Agranat
authors.forename: Z
authors.initials: Z
authors.lastname: Ziskind
authors.forename: E
authors.initials: E
authors.lastname: Kaplinski
authors.forename: Z
authors.initials: Z
authors.lastname: Vered
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D004452:Echocardiography; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*; D006352:Heart Ventricles; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy; D013300:Streptokinase / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin; D013300:Streptokinase