Transient Left Ventricular Apical Ballooning in a Patient With Bicuspid Aortic Valve Created a Left Ventricular Thrombus Leading to Acute Renal Infarction

We report a case of a 67-year-old man who presented to urgent care with a one-week history of left-sided abdominal pain and oliguria. Over the past month, he reported feeling fatigued as well as noticed decreased urine output. The patient does have a significant cardiac medical history that includes coronary artery disease with a previous myocardial infarction, reduced ejection fraction, and hypertension. Imaging studies were conducted which revealed the likely etiology of his current symptoms. A transthoracic echocardiogram (TTE) revealed the presence of a large non-mobile apical thrombus occupying most of the apex of the left ventricle. Computed Tomography (CT) confirmed an apical left ventricular thrombus and showed decreased perfusion to the spleen and ischemia/infarction of the left kidney. The patient was initially treated with heparin but subsequently given enoxaparin with bridging to warfarin. He began to feel better with less left flank pain. Although this presentation of an LV thrombus is a rare occurrence, it is important for physicians to consider abdominal pain as a presenting complaint.

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Huge Left Ventricular Thrombus and Apical Ballooning associated with Recurrent Massive Strokes in a Septic Shock Patient

Korean Journal of Critical Care Medicine ◽

10.4266/kjccm.2016.31.1.39 ◽

2016 ◽

Vol 31 (1) ◽

pp. 39 ◽

Cited By ~ 2

Author(s):

Hyun-Jung Lee ◽

Hack-Lyoung Kim ◽

Doyeon Hwang ◽

Chan-Soon Park ◽

Jae-Sung Lim ◽

...

Keyword(s):

Septic Shock ◽

Septic Shock Patient ◽

Apical Ballooning ◽

Left Ventricular ◽

Left Ventricular Thrombus ◽

Ventricular Thrombus

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Left ventricular thrombus associated with left ventricular apical ballooning

BMJ Case Reports ◽

10.1136/bcr.2006.095372 ◽

2009 ◽

Vol 2009 (feb16 1) ◽

pp. bcr2006095372-bcr2006095372

Author(s):

P. Robles ◽

J. J. Jimenez ◽

M. Alonso

Keyword(s):

Apical Ballooning ◽

Left Ventricular ◽

Left Ventricular Thrombus ◽

Ventricular Thrombus

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Transapical Aortic Valve Replacement Aided by Cardiopulmonary Bypass in a Patient with a Left Ventricular Thrombus

10.22541/au.162774699.92388947/v1 ◽

2021 ◽

Author(s):

Mingyu Qu ◽

Li Bao ◽

Sheng Jing

Keyword(s):

Cardiopulmonary Bypass ◽

High Risk ◽

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Left Ventricular ◽

Left Ventricular Thrombus ◽

Ventricular Thrombus ◽

Risk Patients

Aortic stenosis is one of the most common degenerative valvular diseases in the elderly. Transapical aortic valve implantation (TAVI) is an innovative technique for high-risk patients with severe, symptomatic aortic stenosis and multiple comorbidities. However, potential obstruction to the left ventricular outflow tract, from a left ventricular thrombus, poses significant patient risk and challenge for the anesthetist. An 82-year-old man with these conditions underwent TAVI and intracardiac thrombectomy under general anesthesia, combined with cardiopulmonary bypass. We abandoned traditional surgical aortic valve replacement and thrombectomy; a fast-track cardiac anesthesia strategy was adopted. No complications were observed during recovery. Cardiac function was normal upon follow-up 1 year, post-operatively. Transapical aortic valve replacement aided by cardiopulmonary bypass, implemented under Enhanced Recovery After Surgery (ERAS) strategy, is suitable for high-risk patients under similar conditions. Strategies and equipment should be maximized for analgesia, organ protection, and circulatory homeostasis for perioperative safety and enhanced prognosis.

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