Left ventricular thrombosis following coronary artery bypass grafting in a patient with nephrotic syndrome: Report of a case

Kioka, Yukio; Irié, Hiroyuki; Okada, Masahiro; Yamada, Nobuyuki; Togawa, Junichiro; Ueeda, Masayuki

doi:10.1007/bf00311828

Cited by 3 publications

(3 citation statements)

References 2 publications

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“…Tarry et al 9 reported recurrent thrombosis of the brachial artery on postoperative day 1. Kioka et al 10 reported a patient who experienced three episodes of arterial thrombosis. Anticoagulation therapy is essential to prevent thrombosis, to improve the outcome, and to prevent progressive glomerular mesangial fibrosis.…”

Section: Discussionmentioning

confidence: 98%

Acute arterial thrombosis with antithrombin III deficiency in nephrotic syndrome: Report of a case

et al. 2000

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Nephrotic syndrome frequently causes venous thromboembolic complications. Arterial thrombosis has rarely been reported and is mainly observed in children. Only six cases of lower extremity arterial thrombosis in adults have been reported in the literature. The outcome in these cases was unsatisfactory because of the high rates of limb loss and recurrence of thrombosis. We report successful treatment of a 39-year-old man who suffered from right lower extremity arterial thrombosis associated with decreased levels of serum antithrombin III. He was admitted to our hospital with severe pain in his right foot. No pulse was palpable in his right dorsalis pedis or posterior tibial arteries. His right foot was cold and mottled, with a reduced sensation and motor activity. The laboratory data revealed a serum total protein concentration of 3.9g/dl and an albumin concentration of 1.5 g/dl. The coagulation profile showed a fibrinogen level of 879 mg/dl and antithrombin III value of 9.5%. Right lower extremity arteriography showed a complete occlusion of the right deep femoral artery and popliteal artery, and a filling defect in the common femoral artery. An emergency thrombectomy was performed under general anesthesia. The patient was treated successfully, and surgical treatment was followed by anticoagulant therapy with 1,000 units of antithrombin III. A renal biopsy revealed histologic evidence of minimal change of glomerulonephritis. He was discharged 3 months later, and no recurrence of thrombosis has yet been observed.

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Section: Discussionmentioning

confidence: 98%

Acute arterial thrombosis with antithrombin III deficiency in nephrotic syndrome: Report of a case

et al. 2000

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“…While a higher prevalence of chordal rupture (5.4%) has been reported in a small surgical series (12), a larger cohort of HCM patients showed that chordal rupture is a rare event in HCM (1%) (11). From a literature search, we found 26 cases of HCM with ruptured chordae tendineae (Table 1) (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27).…”

Section: Etiopathogenesismentioning

confidence: 85%

“…The thickened septum causes the flow drag to push MV anteriorly, resulting in SAM and LVOT obstruction. The rupture of chordae tendineae shifts posteriorly to the coaptation point by causing a lack of support to the AML with the resolution of SAM and LVOT obstruction (16). So it is not unusual to find that a worse, centrally directed, MR is accompanied by a wider LVOT, reduced LVOT gradient, and SAM disappearance in a patient previously known for an obstructive form of HCM (21).…”

Section: Echocardiographic and Doppler Featuresmentioning

confidence: 99%

Different mechanisms of mitral regurgitation in hypertrophic cardiomyopathy: A clinical case and literature review

Molisana¹,

Selimi²,

Gizzi³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundAbnormalities of the mitral valve (MV) apparatus are typical features of hypertrophic cardiomyopathy (HCM). These abnormalities include leaflet elongation, thick leaflets, displacement of papillary muscle, and systolic anterior motion (SAM) of the MV anterior leaflet. Mitral valve chordal rupture associated with HCM is a rare but serious issue capable of change the clinical apparence and the prognosis of the patient.Case summaryA 57-year-old lady with a history of diabetes, dyslipidemia, and a previous single episode of atrial fibrillation (treated with pharmacological cardioversion), presented to the Emergency Department for worsening dyspnea (New York Heart Association Classification class IV). A trans-thoracic echocardiogram (TTE) showed a significant, septal, and asymmetric left ventricular hypertrophy (basal anteroseptal wall diastolic thickness of 19 mm) with normal left ventricle systolic function. A SAM of AML was evident together with a left ventricular outflow tract gradient of 56 mmHg at rest, rising to 136 mmHg during the Valsalva maneuver. In addition, there was evidence of moderate to severe mitral regurgitation (MR) with an anteriorly directed jet, not very typical of MR related to SAM. A 2D-3D trans-esophageal echocardiogram (2D-3D TEE) revealed a combined MR mechanism based on PML degenerative prolapse with P2-flail from ruptured chordae with related eccentric anteriorly directed regurgitant jet, together with a second regurgitant posteriorly directed jet, related to SAM of AML. The patient underwent MV repair together with septal myectomy, with a good final outcome.ConclusionPre-operative echocardiography (both TTE and 2D-3D TEE) is an essential tool in order to detect different MV abnormalities in patients with HCM. These types of patients should never be treated by septal reduction alone. Surgical MV repair or replacement, together with septal myectomy, may be the preferred approach.

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Right ventricular thrombus in a patient with nephrotic syndrome

Fukui

Mitsuno

Yamamura

et al. 2013

Gen Thorac Cardiovasc Surg

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We treated a 21-year-old man with right ventricular thrombus caused by nephrotic syndrome. The right ventricular thrombus was safely removed and his postoperative course was uneventful. Peri- and postoperative management after surgery for the worsened nephrotic syndrome was relatively unique and difficult, and critical care was essential for saving the patient's life and protecting renal function.

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Left ventricular thrombosis following coronary artery bypass grafting in a patient with nephrotic syndrome: Report of a case

Cited by 3 publications

References 2 publications

Acute arterial thrombosis with antithrombin III deficiency in nephrotic syndrome: Report of a case

Acute arterial thrombosis with antithrombin III deficiency in nephrotic syndrome: Report of a case

Different mechanisms of mitral regurgitation in hypertrophic cardiomyopathy: A clinical case and literature review

Right ventricular thrombus in a patient with nephrotic syndrome

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