Surgical removal of a left ventricular thrombus associated with cardiac sarcoidosis

Abstract

We report successful surgical management of a 31-year-old man with a left ventricular thrombus following heart failure due to cardiac sarcoidosis. Preoperative echocardiography showed diffuse hypokinesis and a mobile ball-like thrombus in the left ventricle. Computed tomography revealed a left ventricular tumor and bilateral hilar lymphadenopathy, while MRI of the brain showed small infarctions in the occipital lobe. Postoperative pathologic examination of a specimen from the left ventricular free wall and a mediastinal lymph node revealed non-caseating granulomas consistent with cardiac sarcoidosis. The patient was referred to a cardiologist for further treatment with prednisolone. This is a rare case of surgical removal of a left ventricular ball-like thrombus in a patient with cardiac sarcoidosis.

Cardiac Sarcoidosis

“…All these conditions may have led to refractory cardiogenic shock with an unfortunate outcome. In spite of this, a few cases of cardiac sarcoidosis treated surgically with an uneventful course were reported including left ventricular aneurysmectomy due to resistant ventricular tachycardia, open mitral commissurotomy combined with left ventricular aneurysmectomy, left ventricular aneurysmectomy with mitral and tricuspid valve repairs, removal of a left ventricular thrombus associated with cardiac sarcoidosis, aortic valve replacement for regurgitation caused by sarcoidotic aortic root involvement, and a case of a large left atrial sarcoidotic mass presumed to be a myxoma …”

Mobile pedunculated left ventricular masses in a man with recurrent emboli

“…In addition, an incision in the ventricular wall may increase the risk of bleeding, and ventriculotomy may potentially induce ventricular arrhythmia and poor function. [89] The surgical approach to LV masses can be made through the left atrium, aorta, or left ventricle. [10] Our surgical approach to the LV mass was through the left atrium.…”

Left ventricular thrombosis can still complicate acute myocardial infarction

“…34 Currently, it can be done under very special circumstances, such as before placement of a left ventricular assist device or if the thrombus is large, to prevent embolism. 35,36 ■ BLEEDING COMPLICATIONS WITH TRIPLE ANTITHROMBOTIC THERAPY…”