Left Ventricular and Left Atrial Thrombi in Sinus Rhythm Patients with Dilated Ischemic Cardiomyopathy

Bakalli, Aurora; Georgievska-Ismail, Ljubica; Koçinaj, Dardan; Musliu, Nebi; Zahiti, Bedri; Krasniqi, Agim; Bekteshi, Tefik; Sejdiu, Basri

doi:10.5455/medarh.2012.66.155-158

Cited by 14 publications

(14 citation statements)

References 13 publications

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“…As the disease progresses, symptoms of decreased cardiac output such as fatigue, dyspnea and exercise intolerance appear. Thromboembolic events can occur in patients with dilated atria when thrombi form in the atrial appendage [42,57,69]. …”

Section: Rcm In Childhoodmentioning

confidence: 99%

Pediatric Cardiomyopathies: causes, epidemiology, Clinical course, Preventive Strategies and Therapies

et al. 2013

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Pediatric cardiomyopathies, which are rare but serious disorders of the muscles of the heart, affect at least one in every 100,000 children in the USA. Approximately 40% of children with symptomatic cardiomyopathy undergo heart transplantation or die from cardiac complications within 2 years. However, a significant number of children suffering from cardiomyopathy are surviving into adulthood, making it an important chronic illness for both pediatric and adult clinicians to understand. The natural history, risk factors, prevalence and incidence of this pediatric condition were not fully understood before the 1990s. Questions regarding optimal diagnostic, prognostic and treatment methods remain. Children require long-term follow-up into adulthood in order to identify the factors associated with best clinical practice including diagnostic approaches, as well as optimal treatment approaches. In this article, we comprehensively review current research on various presentations of this disease, along with current knowledge about their causes, treatments and clinical outcomes.

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Section: Rcm In Childhoodmentioning

confidence: 99%

Pediatric Cardiomyopathies: causes, epidemiology, Clinical course, Preventive Strategies and Therapies

et al. 2013

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“…The prevalence of LV thrombus in patients with dilated cardiomyopathy with reduced ejection fraction and sinus rhythm, is as high as 13%, with increasing LV size being independently associated with LV thrombus. 16 , 17 Since complete coagulation parameters were not initially obtained, it is difficult to quantify his level of hypercoagulability. Nonetheless, it is likely that this hypercoaguable state, in conjunction with acute myocarditis and worsening LV dilation, predisposed the patient to LV thrombus formation and cardioembolic stroke.…”

Section: Discussionmentioning

confidence: 99%

Cardioembolic Stroke in a Patient with Coronavirus Disease of 2019 (COVID-19) Myocarditis: A Case Report

Ford

Holmes

Jones

2020

Clinical Practice and Cases in Emergency Medicine

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Introduction: There is a growing body of literature detailing coronavirus 2019 (COVID-19) cardiovascular complications and hypercoagulability, although little has been published on venous or arterial thrombosis risk. Case Report: In this report, we present a single case of cardioembolic stroke in the setting of COVID-19 related myocarditis, diagnosed via cardiac magnetic resonance imaging and echocardiography. COVID-19 infection was confirmed via a ribonucleic acid polymerase chain reaction assay. Conclusion: Further research is needed to evaluate the hypercoagulable state of patients with COVID-19 to determine whether prophylactic anticoagulation may be warranted to prevent intracardiac thrombi and cardioembolic disease in patients with COVID-19 related myocarditis.

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“…The risk of thromboembolism in cardiomyopathy is increased both with larger LV size and lower ejection fraction, both of which affect the fluid dynamics. In patients with severe cardiac dysfunction, the dilated LV geometry and depressed function create shorter, rounder vortex structures that have lower strength and persistence, which are associated with greater energy dissipation and higher residence time (>2 s) than in the normal heart . These abnormal intraventricular flow dynamics may contribute to the progression of heart failure (HF)…”

Section: Discussionmentioning

confidence: 99%

“…In patients with severe cardiac dysfunction, the dilated LV geometry and depressed function create shorter, rounder vortex structures that have lower strength and persistence, which are associated with greater energy dissipation and higher residence time (>2 s) than in the normal heart. 29,[42][43][44][45][46][47][48] These abnormal intraventricular flow dynamics may contribute to the progression of heart failure (HF). 49 When LVAD support is added to the failing heart, the boost to cardiac output provides restoration of end-organ perfusion, but the incidence of serious thromboembolic complications increases several-fold.…”

Section: Discussionmentioning

confidence: 99%

Reducing regional flow stasis and improving intraventricular hemodynamics with a tipless inflow cannula design: An in vitro flow visualization study using the EVAHEART LVAD

et al. 2019

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Due to the high stroke rate of left ventricular assist device (LVAD) patients, reduction of thrombus has emerged as an important target for LVAD support. Left ventricular blood flow patterns with areas of flow stasis and recirculation are associated with platelet aggregation, which is worsened by exposure to high shear stress. Previous reports of intraventricular thrombus in LVAD patients have identified the outside of the LVAD inflow cannula as a nidus for LV thrombus formation. Previous studies of LVAD inflow cannula design have shown a region of low blood velocity and pulsatility at the apex, adjacent to the cannula. One unresolved question is whether the standard practice of inserting the LVAD inflow cannula several mm into the LV could be revised to reduce thrombus formation. To address this, a “tipless” inflow cannula was designed for the EVAHEART LVAS, and assessed in a mock circulatory loop of the LVAD‐supported heart. Customized transparent silicone models of a dilated LV were connected to the EVAHEART LVAS at the apex with a clear polycarbonate inflow cannula for flow visualization using particle image velocimetry (PIV). The “tipless” cannula was inserted flush with the endocardial border and did not protrude into the LV. This condition was compared to the standard cannula position with a 1‐cm insertion into the LV. The Pre‐LVAD condition corresponded to a severe heart failure patient (ejection fraction of 24%) with a dilated LV (180 mL). LVAD support was provided at speeds of 1.8 and 2.3 krpm. At the lower LVAD speed, 63% of the flow passed through the LVAD, with the remainder ejecting through the aortic valve. When LVAD speed was increased, nearly all flow (98%) left the LV through the LVAD. Both LVAD speed conditions produced a vortex ring similar to the Pre‐LVAD condition in diastole. However, the protruding inflow cannula interrupted the growth and restricted the movement of the vortex, and produced areas of low velocity and pulsatility adjacent to the cannula. The tipless cannula exhibited an uninterrupted pattern of the mitral jet toward the LV apex, which allowed the diastolic vortex to grow and aid in the washout of this region. In addition, the tipless cannula increased aortic valve flow, which reduces stasis in the left ventricular outflow tract. The EVAHEART LVAS tipless inflow cannula design improved regional velocity, pulsatility, and vortex formation compared to the standard protruding design, which all reduce the risk of thrombus formation. The clinical significance of the differences observed in the flow field will be dependent on other factors such as the cannula material and surface characteristics, as well as the patients' coagulation status.

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Left Ventricular and Left Atrial Thrombi in Sinus Rhythm Patients with Dilated Ischemic Cardiomyopathy

Cited by 14 publications

References 13 publications

Pediatric Cardiomyopathies: causes, epidemiology, Clinical course, Preventive Strategies and Therapies

Pediatric Cardiomyopathies: causes, epidemiology, Clinical course, Preventive Strategies and Therapies

Cardioembolic Stroke in a Patient with Coronavirus Disease of 2019 (COVID-19) Myocarditis: A Case Report

Reducing regional flow stasis and improving intraventricular hemodynamics with a tipless inflow cannula design: An in vitro flow visualization study using the EVAHEART LVAD

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