Biventricular thrombus formation in association with acute myocardial infarction: Diagnosis by two‐dimensional echocardiography

Abstract

Left ventricular thrombus formation is a well-described complication of acute myocardial infarction, and two-dimensional echocardiography is a reliable method for its detection.'.2 The echocardiographic detection of biventricular thrombi in this setting, however, has not previously been rep o d . CASE REPORT Clinical FeaturesA previously healthy 33-year-old man developed crushing substernal chest pain. An acute anterior myocardial infarction was diagnosed on the basis of clinical symptoms and pathologic Q waves, ST-T wave changes, and a transient right bundle branch block on the electrocardiogram. Cardiac catheterization 5 h after the onset of pain revealed total proximal left anterior descending coronary artery occlusion and a 30% stenosis of the proximal circumflex artery. Left ventriculography showed globally depressed function, apical and septal dyskinesis, and severe anterolateral wall hypokinesis. Reperfusion of the occluded artery was achieved with balloon angioplasty, and a residual 80% stenosis and 18 mm Hg translesional gradient remained. Intravenous nitroglycerin, lidocaine, and heparin, as well as oral dipyridamole 75 mg TID; aspirin 324 mg TID; and nifedipine 30 mg TID were prescribed.The early hospital course was complicated by hypotension necessitating the use of an intraaor- Report tic balloon pump and temporary inotropic support. Repeat catheterization was performed on the third hospital day because of recurrent chest pain that was confirmed to be secondary to partial reocclusion of the left anterior descending artery. The stenosis was again reduced by angioplasty to 60%, and the translesional gradient to less than 10 mm Hg. There was no further chest pain. Hemodynamic recovery was complete, and intravenous heparin was stopped on the sixth hospital day. On the 10th day a radionuclide ventriculogram showed anterior, apical, and septal wall motion abnormalities and a left ventricular ejection fraction of 37%. EchocardiographyA two-dimensional echocardiogram was performed 18 days after infarction and demonstrated the previously noted wall motion defects as well as right and left ventricular masses. Both masses were highly echogenic, acoustically distinct from underlying myocardium, exhibited free intracavitary motion in systole and diastole, and were attached to the septum. Both of the masses were prominent in the parasternal long-and short-axis views (Fig. 1). Bilateral ventricular thrombi were diagnosed, and coumadin was prescribed. Eight weeks after infarction a repeat M-mode and twodimensional echocardiogram showed a thin akinetic septum and persistance of the biventricular thrombi despite therapeutic anticoagulation.Catheterization at 2 months because of exertional chest pain revealed no change in the coronary anatomy. Moreover, a right atrial contrast injection with levophase ventriculography confirmed the presence of bilateral intraventricular thrombi. After 6 months, there was echocardiographic resolution of the left ventricular throm- bus but not of the right ventricular thrombus, and couma...

Biventricular Thrombi

“…2 Since their original description, biventricular thrombi have been reported to occur in association with idiopathic dilated cardiomyopathy, ischemic cardiomyopathy, and hypercoagulable state secondary to nephrotic syndrome. In 1986, Friedman et al presented the rst case report in association with acute myocardial infarction.…”

“…In 1986, Friedman et al presented the rst case report in association with acute myocardial infarction. 2 Since their original description, biventricular thrombi have been reported to occur in association with idiopathic dilated cardiomyopathy, ischemic cardiomyopathy, and hypercoagulable state secondary to nephrotic syndrome. 3,4 Reprinted with permission from ECHOCARDIOGRAPHY, Volume 18, No.…”

Acute renal infarction, transient ischemic attack, and biventricular thrombi secondary to substance use disorder: A case report

“…Isolated left or right ventricle thrombus has been well documented; however, biventricular thrombi are rare . Cases of biventricular thrombi are often reported in patients with prothrombic conditions such as, antiphospholipid antibody syndrome (APS) and heparin‐induced thrombocytopenia, and in patients with Libman‐Sacks endocarditis …”

Three-dimensional echocardiography findings of biventricular thrombi complicated by cerebral embolism

“…Biventricular thrombi have been reported in patients with pump failure, eosinophilic endomyocarditis and hypercoagulability states such as nephrotic syndrome [1][2][3][4]. Despite the high incidence of mural thrombi reported in autopsy series, biventricular thrombi detected by imaging studies are very rare.…”