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Review
. 2020 Dec 22;14(2):123-128.
doi: 10.17925/HI.2020.14.2.123. eCollection 2020.

Spontaneously Recanalised Coronary Thrombus in the Left Anterior Descending Artery Presenting as Ventricular Tachycardia

Jie Man Low  1 , Noah Kimit  1 , Rizwan Rashid  2 , Magdi El-Omar  1   2
Affiliations
Review

Spontaneously Recanalised Coronary Thrombus in the Left Anterior Descending Artery Presenting as Ventricular Tachycardia

Jie Man Low et al. Heart Int. .

Abstract

Spontaneously recanalized coronary thrombus (SRCT), also known as honeycomb, lotus root or Swiss-cheese lesion, is an increasingly recognised finding in patients undergoing coronary angiography. It is thought to arise from partial resorption of an initially occlusive thrombus. Most patients present with angina or exertional breathlessness. We describe a case of a 69-year-old patient who presented with ventricular tachycardia and was found to have SRCT in the left anterior descending artery on coronary angiography. Echocardiography and left ventricular (LV) angiography showed an akinetic, aneurysmal, thin-walled LV apex, diagnostic of an old anterior infarct. We highlight the role of optical coherence tomography in making the diagnosis and discuss the available management options of this condition.

Keywords: Spontaneously recanalized coronary thrombus; honeycomb lesion; lotus root lesion; optical coherence tomography; ventricular tachycardia.

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Conflict of interest statement

Disclosure: Jie Man Low, Noah Kimit, Rizwan Rashid and Magdi El-Omar have no financial or non-financial relationships or activities to declare in relation to this article.

Figures

Figure 1:
Figure 1:. Electrocardiogram on admission showing ventricular tachycardia at a rate of 170 bpm
Figure 2:
Figure 2:. Electrocardiogram following pharmacological cardioversion showing sinus rhythm, loss of R waves in V1–V3 and T-wave inversion in the anterolateral and inferior leads
Figure 3:
Figure 3:. Apical 4 chamber (A) and apical 2 chamber (B) echocardiographic views showing a thin-walled, aneurysmal left ventricular apex (arrows)
Figure 4:
Figure 4:. Left ventricular angiography (end-systolic frame) showing an aneurysmal apex (arrows) with good basal contraction
Figure 5:
Figure 5:. Selective coronary angiography of the right (A) and left (B–D) coronary arteries
Figure 6:
Figure 6:. Serial cross-sectional optical coherence tomography images of the hazy segment in the mid-left anterior descending artery
Figure 7:
Figure 7:. Longitudinal mode optical coherence tomography image of the hazy mid-left anterior descending segment
Figure 8:
Figure 8:. Structures that have a similar appearance to a spontaneously recanalised coronary thrombus as seen on optical coherence tomography
See this image and copyright information in PMC

References

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