Thrombi in left ventricular hypertrabeculation/noncompaction--review of the literature

Abstract

Objective: Left ventricular hypertrabeculation/noncompaction (LVHT) is diagnosed when numerous, excessively prominent trabeculations and deep interventricular recesses are found in the left ventricle. Although it is assumed that the intertrabecular recesses are a location prone to thrombus formation, the prevalence of thrombi in LVHT hearts is unknown.

Methods: A Medline research was carried out looking for reports of pathoanatomical investigations of LVHT hearts. Excluded were reports in which a connection between the coronary arteries with the intertrabecular recesses were described.

Results: In 22 articles pathoanatomical findings of 37 hearts were described (9 women, 27 men, 1 not indicated). The age ranged from 26 gestational weeks to 80 years. Twenty-four hearts were investigated by autopsy, 13 as explanted hearts. The left ventricle was dilated in 29 patients. In 9 patients, a previous embolic event had occurred. All 9 patients had additional risk factors for embolism such as atrial fibrillation (n = 1), left ventricular dysfunction (n = 5) or atrial fibrillation and left ventricular dysfunction (n = 3). In only 2 patients, a thrombus was detected pathoanatomically.

Conclusions: Thrombus-formation is a rare event in patients with LVHT. From these data we infer that LVHT in itself is no indication for oral anticoagulation. However, if additional cardiac abnormalities, known to increase the risk of embolism, like atrial fibrillation or left ventricular systolic dysfunction, accompany LVHT, they have to be treated as usual.