Left Ventricular Thrombi: Intraoperative Detection by Transesophageal Echocardiography and Recognition of a Source of Post CABG Embolic Stroke

Maslow, Andrew; Lowenstein, Edward; Steriti, John; Leckie, Robert S.; Cohn, William E.; Haering, Michael

doi:10.1097/00000542-199811000-00030

Cited by 9 publications

(3 citation statements)

References 14 publications

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“…A free-floating thrombus in a beating left-heart during the CPB is a potential source of systemic embolization[ 3 ] that warrants surgical extraction. However, reopening the heart for the surgical retrieval of a thrombus increases the morbidity by prolonging CPB and adding the risk of cardiotomy.…”

Section: Discussionmentioning

confidence: 99%

“…For echocardiographic identification of a thrombus, a clear thrombus-blood interface, and a distinct border from endocardium should be visualized in at least 2 planes adjacent to the akinetic or dyskinetic myocardium. [ 3 6 7 ] If the echogenicity of a thrombus is different from that of the underlying myocardium, it can be detected easily by echocardiography. However, many thrombi have the echogenicity similar to that of the myocardium and are difficult to visualize.…”

Section: Discussionmentioning

confidence: 99%

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Echocardiographic detection of free-floating thrombus in left ventricle during coronary artery bypass grafting

et al. 2015

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We report an incident of detection of a free-floating thrombus in the left ventricle (LV) using intraoperative two-dimensional (2D) and three-dimensional (3D) transesophageal echocardiography (TEE) during proximal coronary artery bypass graft anastomosis. A 58-year-old man presented to us with a 6-month history of chest pain without any history suggestive of myocardial infarction or transient ischemic attacks. His preoperative echocardiography revealed the systolic dysfunction of LV, mild hypokinesia of basal and mid-anterior wall, and the absence of an aneurysm. He was scheduled for on-pump coronary artery bypass surgery. On intraoperative TEE before establishing cardiopulmonary bypass (CPB), a small immobile mass was found attached to LV apical area. After completion of distal coronary artery grafting, when the aortic cross-clamp was removed, the heart was filled partially and beating spontaneously. TEE examination using 2D mode revealed a free-floating mass in the LV, which was suspected to be a thrombus. Additional navigation using biplane and 3D modes confirmed the presence of the thrombus and distinguished it from papillary muscles and artifact. The surgeon opened the left atrium after re-establishing electromechanical quiescence and removed a thrombus measuring 1.5 cm × 1 cm from the LV. The LV mass in the apical region was no longer seen after discontinuation of CPB. Accurate TEE-detection and timely removal of the thrombus averted disastrous embolic complications. Intraoperative 2D and recent biplane and 3D echocardiography modes are useful monitoring tools during the conduct of CPB.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Echocardiographic detection of free-floating thrombus in left ventricle during coronary artery bypass grafting

et al. 2015

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“…Надо сказать, что двухмерная эхокардиография является основным неинвазивным методом диагностики объемных образований в ЛЖ с чувствительностью 92-95 % и специфичностью 86-88 % [21]. Разрешающая способность, пространственная ориентация и качество визуализации чреспищеводной эхокардиографии позволяет диагностировать даже небольшие массы в ЛЖ, а идентификация объемных образований ЛЖ больших размеров достигает почти 100 % [22][23][24]. В связи с этим чреспищеводное сканирование является лучшим диагностическим инструментом детекции тромбов в левом желудочке.…”

Section: клинический случайunclassified

Geometric reconstruction of the left ventricle in lateral wall thrombosis

Алшибая¹,

Slivneva²,

Амирбеков³

et al. 2020

PKiK

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One variant of postinfarction ischaemic cardiomyopathy is a dyskinetic or akinetic left ventricular aneurysm. Lateral localisation of the postinfarction aneurysms in the interpapillary space is an extremely rare pathology. As a rule, in postinfarction aneurysms of this localization, intracavitary thrombosis develops with large aneurysm sizes or the formation of a false aneurysm. However, thrombus formation in the area of small aneurysms or postinfarction scar of the sidewall, as observed in our case, is extremely rare. This report describes an extremely rare case of the surgical treatment of thrombosis of the posterior-lateral wall of the left ventricle involving the base of the posteromedial papillary muscle. A 59-year-old man was admitted to the hospital with complaints of weakness and shortness of breath under minimal load. He had experienced a heart attack 5 y previously, as per his coronary angiography and had a multi-vessel lesion of the coronary arteries. According to the results of electrocardiography-scarring changes along the posterior wall of the left ventricle, transthoracic echocardiography-dilation of the left heart, a decrease in the ejection fraction of the left ventricle, akinesia of the posterior and posterolateral walls with floating thrombosis of this zone. Surgical intervention was performed under conditions of cardiopulmonary bypass and pharmaco-cryocardioplegia. The heart cavity was opened with left-sided ventriculotomy along the posterior wall, along the interventricular septum. A blood clot was removed with the excision of the lining area along the posterior-lateral wall. Plastic surgery was performed to isolate the scarred myocardium with a Dacron patch; thereafter, reconstruction of the posterior left ventricular wall was performed with a second patch. Plastic surgery of the posterior wall of the left ventricle was performed. The last stage was performed via coronary bypass surgery of the anterior interventricular artery. The duration of stay in the intensive care unit was 20 h, and the duration of hospitalisation was 9 d. He was discharged in the state corresponding to the Class I–II (New York Heart Association Functional Classification, NYHA). Patients with thrombosed left ventricular aneurysms need surgical treatment, irrespective of the localization of the process for de-escalation of the thrombogenic zone and restoration of the ventricle geometry. However, the choice of surgery is clinically challenging and depends on a deep understanding of the anatomical relationships in the left ventricle as well as the prediction of a positive transformation after left ventricular reconstruction. Despite our extensive experience in the treatment of postinfarction aneurysms, this was the first time we treated a patient with an unusual location of a blood clot.Received 17 April 2020. Revised 28 May 2020. Accepted 3 June 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributions Participation in the operation: M.D. Alshibaya, M.M. Amirbekov, Z.M. Cheishvili, O.S. Lagutina, I.V. Slivneva Conception and design: M.D. Alshibaya, I.V. Slivneva Drafting the article: M.D. Alshibaya, I.V. Slivneva, M.M. Amirbekov, Z.M. Cheishvili, O.S. Lagutina Critical revision of the article: M.D. Alshibaya, I.V. Slivneva, M.M. Amirbekov Final approval of the version to be published: M.D. Alshibaya, I.V. Slivneva, M.M. Amirbekov, Z.M. Cheishvili, O.S. Lagutina

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High mortality associated with intracardiac and intrapulmonary thromboses after cardiopulmonary bypass

et al. 2011

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Left Ventricular Thrombi: Intraoperative Detection by Transesophageal Echocardiography and Recognition of a Source of Post CABG Embolic Stroke

Cited by 9 publications

References 14 publications

Echocardiographic detection of free-floating thrombus in left ventricle during coronary artery bypass grafting

Echocardiographic detection of free-floating thrombus in left ventricle during coronary artery bypass grafting

Geometric reconstruction of the left ventricle in lateral wall thrombosis

High mortality associated with intracardiac and intrapulmonary thromboses after cardiopulmonary bypass

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