Live Echocardiographic Visualization of the Migration of a Voluminous Left Ventricular Thrombus Complicating an Acute Myocarditis
2009; Lippincott Williams & Wilkins; Volume: 120; Issue: 2 Linguagem: Inglês
10.1161/circulationaha.109.863456
ISSN1524-4539
AutoresF. Aboukhoudir, S. Rekik, Jean Lou Hirsch,
Tópico(s)Cardiovascular Effects of Exercise
ResumoHomeCirculationVol. 120, No. 2Live Echocardiographic Visualization of the Migration of a Voluminous Left Ventricular Thrombus Complicating an Acute Myocarditis Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessReview ArticlePDF/EPUBLive Echocardiographic Visualization of the Migration of a Voluminous Left Ventricular Thrombus Complicating an Acute Myocarditis Falah Aboukhoudir, MD, Sofiene Rekik, MD and Jean Lou Hirsch, MD Falah AboukhoudirFalah Aboukhoudir From the Cardiology Department, Avignon Hospital Center, Avignon, France (F.A., S.R., J.L.H.), and Cardiology Department, University Hospital Hedi Chaker, Sfax, Tunisia (S.R.). , Sofiene RekikSofiene Rekik From the Cardiology Department, Avignon Hospital Center, Avignon, France (F.A., S.R., J.L.H.), and Cardiology Department, University Hospital Hedi Chaker, Sfax, Tunisia (S.R.). and Jean Lou HirschJean Lou Hirsch From the Cardiology Department, Avignon Hospital Center, Avignon, France (F.A., S.R., J.L.H.), and Cardiology Department, University Hospital Hedi Chaker, Sfax, Tunisia (S.R.). Originally published14 Jul 2009https://doi.org/10.1161/CIRCULATIONAHA.109.863456Circulation. 2009;120:e8–e10A 52-year-old man was referred to our intensive care unit by the emergency department for chest pain and severe recent-onset dyspnea. The patient had no particular medical history and no cardiovascular risk factors. His complaints started 3 weeks previously after what he described as a severe flu with cough and fever.At clinical examination, the patient was breathless with a respiratory rate of 28 cycles per minute and a fever of 38.3°C. His heart rate was 88 bpm and blood pressure was 112/68 mm Hg. Pulmonary auscultation revealed bilateral wet rales in the lower lung fields. An ECG showed no particularities. Biology found a frank inflammatory syndrome with an erythrocyte sedimentation rate of 90, a C-reactive protein of 180 mg/L, and a white blood cell count of 14 500. His troponin I level was 6.4 mg/L and BNP level was 6788 pg/mL.Transthoracic echocardiography performed at admission (Figure 1 and Movie I of the online-only Data Supplement) showed a severely depressed left ventricular function with an ejection fraction of ≈30%, along with a massive apical adherent thrombus. Another spherical, highly mobile, pedunculated thrombus was observed, as well as a circumferential pericardial effusion and an important pleural effusion. Download figureDownload PowerPointFigure 1. Two-dimensional transthoracic echocardiogram in the apical 4-chamber view demonstrating a highly mobile and pedunculated thrombus located in the apex of the left ventricle.Given the potentially high risk of distal embolization, an urgent surgery was discussed; meanwhile, the patient was treated with unfractionated heparin. A second echocardiographic control was performed just 1 hour later, which showed an impressive live preprocedural migration of the mobile thrombus from the left ventricular apex toward the outlet chamber and through the aortic orifice to the systemic circulation (Figure 2 and Movie II of the online-only Data Supplement). Extraordinarily and fortunately, no symptomatic embolic event was noted. A whole-body computed tomography scan showed no signs of infarction or embolization; Doppler echocardiography of the lower limbs and renal arteries also proved normal, as did the coronary angiogram. The final presumptive diagnosis of acute myocarditis complicated by an asymptomatic embolization was made. Anticoagulation with unfractionated heparin was continued, but surgery was canceled. The evolution was favorable, with rapid clinical improvement and partial recovery of ventricular function with a notable reduction in thrombus size. U.S. was discharged home on day 10 with angiotensin-converting enzyme inhibitors, β-blockers, diuretics, and Coumadin. On the control performed 1 month later, he was completely symptom free, and echocardiography revealed no abnormalities (Figure 3 and Movie III of the online-only Data Supplement). Download figureDownload PowerPointFigure 2. Two-dimensional transthoracic echocardiogram in the long-axis view showing the migration of a spherical, highly mobile thrombus from the left ventricular apex toward the aortic orifice. Also shown are pericardial and pleural effusions.Download figureDownload PowerPointFigure 3. Control 2-dimensional transthoracic echocardiogram in the long-axis view performed 1 month later showing no abnormalities.The online-only Data Supplement is available at http://circ.ahajournals.org/cgi/content/full/120/2/e8/DC1.DisclosuresNone.FootnotesCorrespondence to Sofiene Rekik, MD, Service de Cardiologie, Centre Hospitalier d'Avignon, 305, rue Raoul Follereau, Avignon, France. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Uchida Y (2018) Recent Advances in Percutaneous Cardioscopy for Heart Disease, Angioscopy, 10.15791/angioscopy.re.18.0022, 4:1, (12-22), . Uchida Y (2018) Advances in percutaneous cardioscopy for heart disease, Journal of Indian College of Cardiology, 10.1016/j.jicc.2018.11.002, 8:4, (200-208), Online publication date: 1-Dec-2018. Suzuki N, Suzuki K, Mizuno T, Kato Y, Suga N, Yoshino M, Miura N, Banno S and Imai H (2016) Hypertensive Crisis and Left Ventricular Thrombi after an Upper Respiratory Infection during the Long-term Use of Oral Contraceptives, Internal Medicine, 10.2169/internalmedicine.55.5500, 55:1, (83-88), . Caivano D, Birettoni F, Giorgi M and Porciello F (2014) What Is Your Diagnosis?, Journal of the American Veterinary Medical Association, 10.2460/javma.245.9.1003, 245:9, (1003-1005), Online publication date: 1-Nov-2014. Nagamoto Y, Shiomi T, Matsuura T, Okahara A, Takegami K, Mine D, Shirahama T, Koga Y, Yoshida K, Sadamatsu K and Hayashida K (2013) Resolution of a left ventricular thrombus by the thrombolytic action of dabigatran, Heart and Vessels, 10.1007/s00380-013-0403-5, 29:4, (560-562), Online publication date: 1-Jul-2014. Rizzello V, Mureddu G and Boccanelli A (2012) A vanishing left ventricular thrombus: Live imaging by trans-thoracic 2D-echocardiography, International Journal of Cardiology, 10.1016/j.ijcard.2011.07.102, 156:1, (e11-e12), Online publication date: 1-Apr-2012. Uchida Y, Uchida Y, Sakurai T, Kanai M, Shirai S and Nakagawa O (2011) Cardioscopic Detection of Left Ventricular Thrombi - With Special Reference to a Comparison With Left Ventriculography and Echocardiography -, Circulation Journal, 10.1253/circj.CJ-11-0248, 75:8, (1920-1926), . Uchida Y (2011) Recent Advances in Percutaneous Cardioscopy, Current Cardiovascular Imaging Reports, 10.1007/s12410-011-9092-6, 4:4, (317-327), Online publication date: 1-Aug-2011. July 14, 2009Vol 120, Issue 2 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.109.863456PMID: 19597060 Originally publishedJuly 14, 2009 PDF download Advertisement SubjectsCardiomyopathyEchocardiographyThrombosis
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