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Cardiac Chambers and Myocardial Disease
Published in Paul Schoenhagen, Frank Dong, Cardiac CT Made Easy, 2023
Left ventricular thrombus is often associated with post-infarct aneurysms. Identification is most reliable with MRI and echocardiography, which show thrombus, associated wall motion abnormalities, and in the case of MRI, underlying myocardial scar. CT also reliably demonstrates thrombus (Figure 4.29).61
Complications of Mechanical Ventricular Assistance
Published in Wayne E. Richenbacher, Mechanical Circulatory Support, 2020
Patients who suffer a perioperative neurologic event usually do so as a result of intraoperative low systemic flow or perfusion pressure, dislodgement of a left ventricular thrombus or inadequate LVAD deairing. Patients who have suffered a transmural myocardial infarction or who have a very low ejection fraction secondary to a cardiomyopathy are prone to left ventricular thrombus formation. The degree to which this thrombus is organized and adherent to the trabeculae carneae within the left ventricle is variable. At the time of VAD insertion it is wise to avoid manipulation of the left ventricle until after CPB is initiated and the aortic crossclamp applied. If the left atrium is cannulated it may not be necessary to disturb the left ventricle at all. For left ventricular apex cannulation the endocardial surface of the left ventricle is carefully inspected to ensure that all thrombus is removed (Fig. 10.1).
Cardiac Chambers and Myocardial Disease *
Published in Paul Schoenhagen, Carl J. Schultz, Sandra S. Halliburton, Cardiac CT Made Easy, 2014
Paul Schoenhagen, Carl J. Schultz, Sandra S. Halliburton
Left ventricular thrombus is often associated with post-infarct aneurysms. Identification is most reliable with MRI and echocardiography, which show thrombus, associated wall motion abnormalities, and in the case of MRI, also underlying myocardial scar.133,134 CT also reliably demonstrates thrombus (Figure 4.34).
Mechanical circulatory support device selection for bridging to cardiac transplantation: a clinical guide
Published in Expert Review of Medical Devices, 2023
Tamari Miller, Veli K. Topkara
Percutaneous VADs have evolved as a contemporary alternative to the IABP with the potential to provide a higher level of support. The Impella® (Abiomed, Danvers, MA) series are endovascular transvalvular micro-axial flow pumps that are placed across the aortic valve into the left ventricle expelling blood from the left ventricle through a proximal inlet into the ascending aorta to provide up to 6.2 L/min of ventricular unloading [25]. These devices range from oldest with less augmentation of cardiac output with Impella 2.5®, Impella CP®, Impella 5.0® to newest and most robust hemodynamic support in the Impella 5.5®. More recently Impella CP® inserted through the femoral artery and impella 5.5® inserted surgically through a cutdown of the axillary artery have become the most commonly used devices. Impella 5.5® is particularly preferred for bridging to transplant given its axillary configuration that promotes mobility and rehabilitation and lower rates of complications such as hemolysis compared to Impella CP®. There is a paucity of robust prospective data for the use of each device as bridge to transplant but existing data suggest they provide effective hemodynamic support without a significant difference in long-term outcomes and are generally safe and effective for bridge to transplant [26–30]. Significant limitations of these devices are the potential for hemolysis and subsequent renal failure and contraindication to its use in patients with left ventricular thrombus due to risk of peripheral embolization and stroke.
A journey through anticoagulant therapies in the treatment of left ventricular thrombus in post-COVID-19 heparin-induced thrombocytopenia: a case report
Published in Hematology, 2022
Alberto Lázaro-García, Inés Martínez-Alfonzo, Rosa Vidal-Laso, Diego Velasco-Rodríguez, Marta Tomás-Mallebrera, Marta González-Rodríguez, Pilar Llamas-Sillero
After 1 h in the ICU, the patient had an inferior and posterior ST-elevation AMI. A transthoracic echocardiogram detected recurrence of the left ventricular thrombus (18 × 15 mm) with akinetic inferior and posterior areas (LVEF 35%–40%). Urgent coronariography was required. Bivalirudin (load of 0.75 mg/kg) was then administered; this was followed by a maintenance infusion during the procedure (1.75 mg/kg/h) [1]. Coronariography did not show new coronary lesions. Afterwards, a reduced maintenance infusion of bivalirudin was continued (0.25 mg/kg/h). A few hours later, bivalirudin was discontinued, and argatroban (0.5 µg/kg/min) was started. Blood tests showed a progressive increase in the levels of cardiac biomarkers, achieving the troponin I peak 24 h later (32.4 ng/mL). No haemorrhagic complications were observed; therefore, argatroban infusion speed was increased.
Acute myocardial infarction in a young man with large left ventricular thrombus and the antiphospholipid syndrome
Published in Baylor University Medical Center Proceedings, 2019
Mohamed Ayan, Yazeid Alshebani, Hamza Tantoush, Mohsin Salih, Waiel Abusnina, Mansour Khaddr, Aiman Smer
The optimal intensity of anticoagulation for the prevention of recurrent thrombosis in patients with APS is uncertain. Studies found that high-intensity anticoagulation (international normalized ratio >3) was associated with a higher bleeding risk and was not superior to moderate-intensity anticoagulation (international normalized ratio = 2–3).10,11 Lifelong use of anticoagulation is reasonable due to the high recurrence rate of thrombotic events.12 At the present time, the data on the efficacy and safety of novel oral anticoagulants in patients with APS are insufficient, and further studies are needed before these agents can be widely recommended.13,14 Modification of concomitant risk factors for thrombosis, such as hypertension, dyslipidemia, and smoking cessation, must also be addressed. The patient was treated with warfarin therapy and remained asymptomatic at his 2-year follow-up visit. Repeat echocardiogram revealed resolution of left ventricular thrombus.