Multiple left ventricular thrombi in a patient with left ventricular noncompaction

Abstract

The major clinical features of myocardial noncompaction are heart failure, arrhythmias, and thromboembolic events. Prominent myocardial trabeculae and deep recesses characteristic of myocardial noncompaction can cause stagnant blood flow and the formation of left ventricular clots. We describe the case of a 62-year-old woman who presented with symptoms of heart failure secondary to left ventricular noncompaction. Transthoracic and transesophageal echocardiography revealed multiple left ventricular thrombi, which had formed despite the patient's long-term therapy with aspirin. Anticoagulative therapy should be considered for patients with myocardial noncompaction who also have risk factors for thromboembolism, such as atrial fibrillation, a history of systemic embolism, or severe left ventricular systolic dysfunction. However, chronic antiplatelet therapy may not sufficiently prevent clot formation in patients who have myocardial noncompaction and severe left ventricular systolic dysfunction.

Keywords: Cardiomy-opathies/complications/diagnosis/drug therapy; echocardiography; heart ventricles/abnormalities; myocardium/pathology; ventricular dysfunction, left/ultrasonography.

Fig. 1 Two-dimensional transthoracic echocardiograms show a hypertrabeculated, sponge-like appearance of the left ventricle in A) apical 3-chamber view and B) zoomed apical 3-chamber view.

Fig. 2 Two-dimensional transthoracic echocardiogram (apical long-axis view) shows a hypertrabeculated left ventricular myocardium. Real-time motion image is available at www.texasheart.org/journal.

Fig. 3 Transesophageal echocardiogram shows a hypertrabeculated, sponge-like appearance of the left ventricle.

Fig. 4 Color-flow Doppler echocardiogram shows blood flow between the hypertrabeculated segments.

Fig. 5 Transthoracic echocardiograms of the left ventricle show mobile, homogeneous echodense structures (arrows), possibly thrombi, in the A) basal septum and B) apicolateral noncom-pacted segment. Real-time motion image of Figure 5A is available at www.texasheart.org/journal.

Fig. 6 Transesophageal echocardiograms show multiple echodense structures (arrows) in the left ventricle between the deep myocardial recesses in A) short-axis view at 0° and B) transgastric view at 106°. Real-time motion images are available at www.texasheart.org/journal.