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(Circulation. 2006;113:e38.)
© 2006 American Heart Association, Inc.

Images in Cardiovascular Medicine

Not So Mural Thrombus

Stefano Coli, MD; Marco Magnoni, MD; Carlo Meloni, MD; Domenico Cianflone, MD; Attilio Maseri, MD

From the Department of Cardiothoracic and Vascular Diseases, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy.

Correspondence to Stefano Coli, MD, Department of Cardiothoracic and Vascular Diseases, Via Olgettina 58, 2132 Milan, Italy.

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 64-year-old man with type 2 diabetes mellitus was admitted to our emergency department for a 12-hour history of waxing and waning chest pain. During the first hour of observation, he complained about a new episode of chest pain accompanied by ST elevation in leads V₂ and V₃. The patient underwent emergency coronary angiography that showed 80% stenosis of the proximal left anterior descending artery with subocclusive thrombotic lesion of its middle segment and TIMI-1 distal flow. Contrast ventriculography revealed left ventricular apical hypokinesia; primary angioplasty and stent implantation on the left anterior descending artery were performed. The patient was admitted to the coronary care unit and treated with ß-blockers, captopril, unfractionated heparin, tirofiban, aspirin, and clopidogrel. Clinical, ECG, and biochemical signs of reperfusion were observed. Peak creatine phosphokinase was 696 U/L, with 35 µg/L of the MB isoform. At the sixth day after admission, before the planned discharge, a standard second harmonic echocardiographic study (Sonos 5500 with S3 probe) revealed a hypokinetic apex with preserved wall thickness and a large mural thrombus (Movie I). Contrast echocardiography, performed to improve the definition of thrombus morphology (Figure 1 and Movie II), showed that the left ventricular thrombus was mobile and largely detached. This finding significantly increased the risk of embolism; therefore, the patient was not discharged, and full anticoagulation therapy with unfractionated heparin was started.

View larger version (20K): [in this window] [in a new window]   Figure 1. A second-generation contrast agent injection (perflutren protein type A microspheres, Optison), administered as an intravenous bolus (1.0 cm3), showed that the . . . [Full Text of this Article]

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Circulation 2006 113: 329. [Extract] [Full Text]