title: Mobile left ventricular thrombus in left ventricular dysfunction: case report and review of literature.
abstract: BACKGROUND
  Left ventricular (LV) thrombi carry a high risk of embolization. Therapeutic recommendations like treatment with low molecular heparin and intravenous unfractionated heparin (UFH), thrombolysis or surgical thrombectomy have failed to reach a consensus.
  
  
  METHODS
  A 56-year-old female patient presented in cardiogenic shock to the emergency department. Echocardiography demonstrated a dilated LV with a severely depressed global systolic function and a large LV apical thrombus. Treatment with UFH was initiated as well as a treatment with catecholamines for stabilizing the patient's hemodynamic situation. On the follow-up echocardiographic examination, extensive free-floating parts of the thrombus could be documented. Given the high risk of embolization in a now hemodynamically stable situation, emergency surgical embolectomy was performed.
  
  
  CONCLUSIONS
  A conservative procedure might be useful for bridging till surgical treatment is available and/or the risk due to surgery is acceptable.
  
  
  CONCLUSIONS
  In absence of evidence-based guidelines for the treatment of LV thrombi, individualized management options concerning surgical, embolization and bleeding risk must be taken into account.
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Leick
authors.forename: Sebastian
authors.initials: S
authors.lastname: Szardien
authors.forename: Christoph
authors.initials: C
authors.lastname: Liebetrau
authors.forename: Matthias
authors.initials: M
authors.lastname: Willmer
authors.forename: Ulrich
authors.initials: U
authors.lastname: Fischer-Rasokat
authors.forename: Jörg
authors.initials: J
authors.lastname: Kempfert
authors.forename: Holger
authors.initials: H
authors.lastname: Nef
authors.forename: Andreas
authors.initials: A
authors.lastname: Rolf
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.forename: Christian
authors.initials: C
authors.lastname: Hamm
authors.forename: Helge
authors.initials: H
authors.lastname: Möllmann
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D002395:Catecholamines / Q000627:therapeutic use; D004452:Echocardiography; D017128:Embolectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000473:pathology; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000503:physiopathology; D013927:Thrombosis / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000601:surgery
chemical_list: D000925:Anticoagulants; D002395:Catecholamines; D006493:Heparin