Bellone P, Domenicucci S, Chiarella F, Bellotti P, Lupi G, Vecchio C
Cardiology Division, Ente Ospedaliero Ospedali Galliera, Genoa, Italy.
Int J Cardiol. 1996 Oct 11;56(2):201-4. doi: 10.1016/0167-5273(96)02727-1.
Left ventricular thrombosis is relatively common after acute myocardial infarction, especially in the anterior site, and represents a possible cause of potentially lethal peripheral embolization 1. Therefore, several studies have been performed in order to assess the efficacy of different antithrombotic drugs in resolving the detected thrombi or reducing their embolic potential. Fibrinolytic agents appear effective in this regard: in the majority of cases, they produce complete lysis and resolution of the thrombi. However, this treatment may itself cause embolic complications by producing a rapid fragmentation of thrombus and the subsequent emission of disrupted portions of the intracardiac mass into the systemic vascular bed [2]. This dramatic effect of thrombolysis has suggested the possibility that even the standard treatment of acute myocardial infarction with fibrinolysis implies a danger of embolization in those patients in whom a left ventricular thrombus may be present either from a previous myocardial infarction or from a very early thrombus development. However, this hypothesis has not yet been confirmed by direct observation. We report the case of a patient with a first acute anterior myocardial infarction, in whom the thrombolytic treatment induced lysis and embolization from a left ventricular thrombus present in an aneurysmatic dilatation of the infero-posterior wall due to a previous inferior myocardial infarction.
左心室血栓形成在急性心肌梗死后相对常见，尤其是在前壁部位，并且是潜在致命性外周栓塞的一个可能原因1。因此，已经进行了多项研究，以评估不同抗血栓药物在溶解已检测到的血栓或降低其栓塞可能性方面的疗效。纤维蛋白溶解剂在这方面似乎有效：在大多数情况下，它们能使血栓完全溶解和消退。然而，这种治疗本身可能会导致栓塞并发症，因为它会使血栓迅速破碎，并随后将心内血栓的破碎部分释放到体循环血管床中[2]。溶栓的这种显著效果提示，即使是急性心肌梗死的标准溶栓治疗，对于那些可能因既往心肌梗死或血栓形成非常早而存在左心室血栓的患者，也意味着有栓塞的危险。然而，这一假设尚未得到直接观察的证实。我们报告了一例首次发生急性前壁心肌梗死的患者，其溶栓治疗导致了因既往下壁心肌梗死而在左心室下后壁动脉瘤样扩张处存在的左心室血栓发生溶解和栓塞。
