Case Report
Copyright ©2014 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Clin Cases. Feb 16, 2014; 2(2): 32-35
Published online Feb 16, 2014. doi: 10.12998/wjcc.v2.i2.32
Surgical removal of a large mobile left ventricular thrombus via left atriotomy
Daizo Tanaka, Shinya Unai, James T Diehl, Hitoshi Hirose
Daizo Tanaka, Shinya Unai, James T Diehl, Hitoshi Hirose, Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, United States
Author contributions: Tanaka D, Unai S, Diehl JT and Hirose H were all contributed to the patient care, surgery and writing the manuscript.
Correspondence to: Hitoshi Hirose, MD, Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, 1025 Walnut Street Room 605, Philadelphia, PA 19107, United States.
Telephone: +1-215-955-5654 Fax: +1-215-955-6010
Received: November 12, 2013
Revised: December 14, 2013
Accepted: January 15, 2014
Published online: February 16, 2014

Left ventricular (LV) thrombus is a life-threatening complication of severe LV dysfunction. Ventriculotomy has been a commonly performed procedure for LV thrombus; however, it often further decrease LV function after surgery. We present an alternative approach to thrombectomy in order to minimize the postoperative LV dysfunction. A 37-year-old female with a postpartum cardiomyopathy found to have poor LV function and a large left ventricular apical thrombus (3 cm × 3 cm) attached to the apex by a narrow stalk. Given her severe LV dysfunction, the LV thrombus was approached via left atriotomy under cardiopulmonary bypass. The LV thrombus was easily extracted with gentle traction via the mitral valve. Postoperatively, the patient was discharged home without any embolization event or inotropic support. LV thrombectomy via left atriotomy through the mitral valve could be an alternative option for the patients with poor LV function with a mobile LV thrombus.

Keywords: Left ventricular thrombus, Atriotomy, Cardiomyopathy, Surgical thrombectomy, Pedunculated thrombus

Core tip: We successfully treated the patient of a large pedunculated left ventricular (LV) thrombus with poor LV function via left atriotomy. Compared to conventional ventriculotomy, left atrial approach would be more suitable for emergency LV thrombectomy for highly mobile thrombi because the left atriotomy may not further decrease the LV function and would preserve the LV apex for future ventricular assist device placement.