Transient left ventricular apical ballooning in a patient with bicuspid aortic valve created a left ventricular thrombus leading to acute renal infarction.
A 44-year-old woman had tako-tsubo-like ventricular dysfunction with chest pain and ST segment elevation on the ECG. Echocardiography revealed a bicuspid aortic valve with moderate to severe aortic regurgitation. She developed mild heart failure during the clinical course, but the medication (furosemide, enalapril, and asprin) had to be stopped because of skin eruptions. Four weeks after ceasing the antiplatelet agent, she was re-admitted with acute renal infarction. Enhanced chest computed tomography revealed a filling defect in the left ventricle and echocardiography showed a high echogenic mass in the left ventricular apical wall. These findings strongly suggested that the renal infarction was caused by an embolism derived from a left ventricular thrombus that formed during the clinical course of the transient left ventricular apical ballooning. Anticoagulation therapy with urokinase and warfarin successfully lysed the thrombus. Left ventricular thrombus should be considered a complication of transient left ventricular apical ballooning, especially in patients with organic heart disease.
Sasaki
Norihito
N
Division of Regenerative Medicine and Therapeutics, Department of Genetic Medicine and Regenerative Therapeutics, Institute of Regenerative Medicine and Biofunction, Graduate School of Medical Science, Yonago, Japan.
Kinugawa
Toru
T
Yamawaki
Masahiro
M
Furuse
Yoshiyuki
Y
Shimoyama
Masaki
M
Ogino
Kazuhide
K
Igawa
Osamu
O
Hisatome
Ichiro
I
Shigemasa
Chiaki
C
D000208:Acute Disease; D000328:Adult; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*; D017548:Echocardiography, Transesophageal; D005260:Female; D006352:Heart Ventricles; D006801:Humans; D007238:Infarction / Q000000981:diagnostic imaging / Q000209:etiology*; D007668:Kidney / Q000098:blood supply*; D014057:Tomography, X-Ray Computed; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging