Morphological Assessment of Left Ventricular Thrombus by Live Three‐Dimensional Transthoracic Echocardiography

Abstract

We report the usefulness of live three-dimensional transthoracic echocardiography (3DTTE) in the morphological assessment of a left ventricular thrombus. Using live 3DTTE, the thrombus could be easily viewed end-on and from the sides. In addition, by cropping the 3D images sequentially in transverse (horizontal or short axis), longitudinal (vertical or long axis), frontal, and oblique planes, the degree and extent of lysis within the thrombus, which represents an integral part of the clot-resolution process, could be comprehensively assessed. The site of attachment of the thrombus in the left ventricular apex and its morphology could also be fully evaluated in three dimensions by live 3DTTE.

A Silent and Late Embolization of Atrial Septal Defect Occluder Device Into the Right Pulmonary Artery: A Case Report

“…Percutaneous transcatheter closure of ASD is an established alternative treatment to surgical closure as it has lesser morbidity, shorter hospital stay, lack of a scar, and comparable rates of complications 4-6). However, percutaneous device closure is associated with rare early and late complications such as migration or embolization of the device, pericardial effusion, arrhythmias, thrombus formation on the device, and mitral regurgitation and vascular injury 4)7)8). The most frequent complication of percutaneous transcatheter closure of ASD is device embolization with incidence ranging from 4% to 21% 9).…”

“…Embolization usually occurs within 24 hours and after that, it is rarely seen. Factors relating to device embolization are associated with the type of device used, larger size of defect, thin rim of atrial tissue, mobility of device postimplantation, use of undersized device and deficiency or absence of aortic rim 2)4)7)8). The aortic rim is very important and a margin <5 mm may predispose to both early and late device embolization 2).…”

Cardiac tumors and sources of embolism

“…11.3). The success of thrombolytics and anticoagulants can be monitored by 3D sizing of masses based on RT3DE datasets which was demonstrated in a study by Sinha et al [12], where the reduction of left ventricular thrombus size was assessed in serial RT3D TTE examinations under heparin administration.…”

Live Three‐Dimensional Transthoracic Echocardiographic Assessment of Right Atrial Thrombus

“…In addition, en face viewing of the cropped segments of the thrombus showed no evidence of echolucencies within the thrombus, suggesting absence of clot lysis (Figure). 3 At surgery, a large, free thrombus was noted in the right atrium, as well as multiple thrombi in both left and right pulmonary arteries with a saddle embolus at the bifurcation of the main pulmonary artery. The patient underwent pulmonary artery thrombectomy and removal of thrombus in the right atrium using cardiopulmonary bypass and insertion of an inferior vena caval Greenfield filter.…”

“…Large echolucencies within the thrombus, suggestive of clot lysis, indicate that the thrombus is gradually being absorbed while their absence in a chronic clot would raise the possibility that the natural lytic mechanisms in the coagulation cascade process are ineffective despite anticoagulant therapy, if that has been administered. 3 It is possible that live 3DTTE of intracardiac clots may also provide useful information regarding the time course of clot lysis and effectiveness of various thrombolytic agents. This finding could have important prognostic and therapeutic implications in patient management.…”