Glikson M, Agranat O, Ziskind Z, Kaplinski E, Vered Z
Heart Institute, Tel Aviv University, Tel Hashomer, Israel.
Chest. 1993 Jan;103(1):281-3. doi: 10.1378/chest.103.1.281.
We describe the unusual evolution of a left ventricular thrombus following acute anterior myocardial infarction despite adequate anticoagulation. Serial echocardiographic examinations demonstrated the evolution from swirling in the left ventricle through a solid apical mass gradually dislodging into a mobile, pedunculated mass that was removed surgically to prevent embolization. This report emphasizes the need to follow echocardiographically left ventricular thrombi during treatment with anticoagulants, and to identify morphologic changes that may predict embolization. This case suggests that left ventricular thrombectomy should be considered in selected patients in whom a very high-risk thrombus morphology is detected.
我们描述了一例急性前壁心肌梗死后尽管进行了充分抗凝治疗，但左心室血栓仍出现异常演变的病例。系列超声心动图检查显示，血栓从左心室内的漩涡状逐渐演变为坚实的心尖部团块，随后逐渐松动成为可移动的带蒂团块，最终通过手术切除以预防栓塞。本报告强调了在抗凝治疗期间通过超声心动图监测左心室血栓的必要性，以及识别可能预测栓塞的形态学变化。该病例提示，对于检测到具有极高风险血栓形态的特定患者，应考虑行左心室血栓切除术。
