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Case Reports
. 2019 Feb 13;19(5):153-156.
doi: 10.1016/j.jccase.2018.12.015. eCollection 2019 May.

Simultaneous left and right ventricular apical thrombi after occlusion of the wrapped left anterior descending artery

Byung Gyu Kim  1 , Ki Hwan Kim  2 , Jong Chun Nah  1 , Sung Woo Cho  1
Affiliations
Case Reports

Simultaneous left and right ventricular apical thrombi after occlusion of the wrapped left anterior descending artery

Byung Gyu Kim et al. J Cardiol Cases. .

Abstract

Left ventricular (LV) thrombus formation is a well-known complication of acute myocardial infarction (AMI) and is reported to occur in 5-8% of patients who have anterior or apical myocardial infarction. However, right ventricular (RV) thrombus has not previously been reported after AMI. We describe a 54-year-old woman who presented with an ST-elevation myocardial infarction due to occlusion of the distal left anterior descending artery, which wrapped around the apex and led to simultaneous LV and RV apical thrombi. <Learning objective: This case emphasizes the following: (1) in patients who have a long left anterior descending artery (LAD) that wraps around the apex, even distal LAD occlusion can cause a large infarct area including the apex, inferior wall, and right ventricular apex, as well as serious complications such as cardiac arrest and left ventricular and right ventricular (RV) thrombus. (2) Cardiac magnetic resonance imaging is useful for detecting apical thrombus especially in the RV.>.

Keywords: Distal left anterior descending artery; Left ventricular apical thrombus; Percutaneous coronary intervention; Right ventricular thrombus; ST-elevation myocardial infarction.

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Figures

Fig. 1
Fig. 1
12-lead electrocardiography (ECG), initial coronary angiography (CAG), and primary percutaneous coronary intervention. (A) ECG showed ST-segment elevation of leads V3 to 5, II, III, and aVF. (B) Left CAG showed total occlusion of the distal left anterior descending artery (white arrow). (C) The right coronary artery was short, non-dominant, and tapers by supplying the right ventricular branches. (D) Predilatation using a 2.0 × 15-mm balloon was performed at the distal left anterior descending artery (LAD). (E) Coronary angiography after successful stent implantation revealed that the distal LAD was wrapped around the apex and long enough to supply the inferior wall of the apex.
Fig. 2
Fig. 2
Cardiac magnetic resonance imaging showing simultaneous left and right ventricular apical thrombi. (A) Delayed hyperenhancement of the apex and inferior wall (yellow arrows) and left ventricular (LV) apical thrombus (asterisk) were observed. (B) Delayed hyperenhancement was seen at the inferior septum and inferior wall of the apex (yellow arrows) and right ventricular (RV) apical thrombi (asterisks) were also detected. (C) A four-chamber view showed a delayed enhancement of the RV apex (yellow arrows) and simultaneous LV and RV apical thrombi (asterisks).
Fig. 3
Fig. 3
Schematic demonstration of the infarction area following occlusion of the distal wrapped LAD and electrocardiographic changes in our patient. LAD, left anterior descending artery; D1, the first diagonal branch; D2, the second diagonal branch.
See this image and copyright information in PMC

References

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