[Ventricular thrombi in the chronic infarct stage].

Left ventricular thrombi were detected in 98 (11%) of 864 consecutive patients examined by 2-D-echocardiography in the chronic phase of myocardial infarction. Using unequivocal criteria in identifying intracavitary masses as thrombus, the sensitivity and specificity of the echocardiographic diagnosis reached 90% compared to intraoperative findings (n = 23). To avoid false positive diagnoses, normal apical structures like muscular trabeculae must be ruled out, preferably by applying high-frequency transducers. All thrombi were located on akinetic or dyskinetic segments near the ventricular apex. Accordingly they were best visualised in the apical 4-chamber (92%) and 2-chamber (96%) views as well as in apical short-axis cross-sections (49%). Thrombus size ranged from 0.5 to 32 cm2. Two-thirds of the thrombi appeared as flat, one-third as protruding masses. Thrombi were found mainly with anterior wall infarctions (14.5%) and with aneurysms (28.5%), but rarely with posterior wall infarctions (.6%). 95% of the thrombus patients had suffered large infarctions. The rate of embolic events prior to the thrombus diagnosis was 7% in patients with thrombi but only 0.6% in patients without thrombi.