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Mobile left ventricular thrombus in left ventricular dysfunction: case report and review of literature

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Abstract

Introduction

Left ventricular (LV) thrombi carry a high risk of embolization. Therapeutic recommendations like treatment with low molecular heparin and intravenous unfractionated heparin (UFH), thrombolysis or surgical thrombectomy have failed to reach a consensus.

Case description

A 56-year-old female patient presented in cardiogenic shock to the emergency department. Echocardiography demonstrated a dilated LV with a severely depressed global systolic function and a large LV apical thrombus. Treatment with UFH was initiated as well as a treatment with catecholamines for stabilizing the patient’s hemodynamic situation. On the follow-up echocardiographic examination, extensive free-floating parts of the thrombus could be documented. Given the high risk of embolization in a now hemodynamically stable situation, emergency surgical embolectomy was performed.

Discussion

A conservative procedure might be useful for bridging till surgical treatment is available and/or the risk due to surgery is acceptable.

Conclusion

In absence of evidence-based guidelines for the treatment of LV thrombi, individualized management options concerning surgical, embolization and bleeding risk must be taken into account.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2–8, 61231, Bad Nauheim, Germany

    Jürgen Leick, Sebastian Szardien, Christoph Liebetrau, Matthias Willmer, Ulrich Fischer-Rasokat, Jörg Kempfert, Holger Nef, Andreas Rolf, Thomas Walther, Christian Hamm & Helge Möllmann

  2. Department of Cardiology, University of Giessen, Medizinische Klinik I, Giessen, Germany

    Christoph Liebetrau, Holger Nef, Andreas Rolf, Christian Hamm & Helge Möllmann

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  1. Jürgen Leick
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Correspondence to Helge Möllmann.

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J. Leick and S. Szardien contributed equally to this work.

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Leick, J., Szardien, S., Liebetrau, C. et al. Mobile left ventricular thrombus in left ventricular dysfunction: case report and review of literature. Clin Res Cardiol 102, 479–484 (2013). https://doi.org/10.1007/s00392-013-0565-2

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