title: Considerations in cardio-oncology: Multiple mobile left-sided cardiac thrombi in chemotherapy-induced cardiomyopathy.
abstract: With advances in cancer chemotherapy, the importance of the new clinical discipline of cardio-oncology, which is concerned with the cardiac effects of chemotherapy, is increasing. Herein we describe the case of a 48-year-old woman with a history of breast cancer who presented with symptoms of heart failure due to chemotherapy-induced cardiomyopathy. Treatment for the patient's breast cancer had included surgery and chemotherapy with anthracyclines and trastuzumab. Echocardiography revealed multiple mobile thrombi in the left ventricle and atrium. In addition, brain magnetic resonance imaging revealed small acute cerebral infarctions due to embolization. Given the high risk of re-embolization, surgical thrombectomy was performed. Thus far, there are no standardized therapeutic guidelines for left-sided cardiac thrombi and the optimal treatment remains contentious. Although this patient was managed successfully with surgical thrombectomy, patients should be managed individually, taking into consideration embolization, bleeding, and surgical risks. With further improvements in cancer chemotherapy, there may be an increase in the incidence of complications such as multiple cardiac thrombi. From the cardio-oncology standpoint, we propose close interactions between cardiologists and oncologists for the optimal care of cancer patients.
authors.affiliation: Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Toshinori
authors.initials: T
authors.lastname: Minamishima
authors.affiliation: Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan. Electronic address: kenichi-matsushita@umin.ac.jp.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Matsushita
authors.affiliation: Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Hiromu
authors.initials: H
authors.lastname: Morikubo
authors.affiliation: Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Aoi
authors.initials: A
authors.lastname: Isaka
authors.affiliation: Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Matsushita
authors.affiliation: Department of Cardiovascular Surgery, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Hidehito
authors.initials: H
authors.lastname: Endo
authors.affiliation: Department of Cardiovascular Surgery, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kubota
authors.affiliation: Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Konomi
authors.initials: K
authors.lastname: Sakata
authors.affiliation: Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Satoh
authors.affiliation: Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Yoshino
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy*; D009202:Cardiomyopathies / Q000139:chemically induced / Q000175:diagnosis; D003328:Coronary Thrombosis / Q000139:chemically induced / Q000175:diagnosis; D005260:Female; D006801:Humans; D008875:Middle Aged
chemical_list: D000970:Antineoplastic Agents
keywords: Cardio-oncology; Chemotherapy; Thrombectomy; Thrombus; Trastuzumab