Clinical SpotlightA Rare Cause of Takotsubo Cardiomyopathy Related Left Ventricular Apical Thrombus Requiring Surgery
Introduction
Here we describe a case of a 48 year-old male presenting with massive haemoptysis on a background of cystic fibrosis who was later found to have Takotsubo cardiomyopathy with an associated left ventricular thrombus. The thrombus was successfully removed by an apical left ventriculotomy and the patient subsequently made a full recovery. To our knowledge, this is the first case described in the literature where a ventricular thrombus secondary to Takotsubo cardiomyopathy has been successfully treated surgically.
Section snippets
Case
A 48 year-old male non-smoker with a history of cystic fibrosis was brought to a suburban hospital by ambulance with massive haemoptysis, dyspnoea, and respiratory arrest at home.
On arrival to the suburban hospital he was hypotensive, hypoxic and had a decreased level of consciousness – he required intubation and a noradrenaline infusion. He was transferred to a tertiary hospital for further management. A presumptive diagnosis of bronchial arterio-alvelolar fistula was made due to CF-related
Discussion
Thrombus formation in the LV is common following acute myocardial infarction and other events, such as cardiomyopathy or heart failure [1], [2]. Takotsubo cardiomyopathy or stress induced cardiomyopathy is a rare condition in which the apical segments of the LV are depressed, which results in compensatory hyperkinesis of the basal segments and ballooning of the apex during systole. The exact mechanism is still unknown; however, most authors suggest a catecholamine-mediated mechanism via cardiac
Acknowledgements
There were no grants or financial support received by the authors in preparing this paper.
References (5)
- et al.
Simplified method of left ventricular thrombectomy
Ann Thorac Surg
(2001) - et al.
Surgical removal of a mobile, pedunculated left ventricular thrombus: report of 4 cases
Ann Thorac Surg
(1988)
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2016, Heart Failure ClinicsCitation Excerpt :Patients suffering from cerebral ischemia or stroke were treated with thrombolysis or platelet inhibitors according to the time of symptom onset.21,25,44 In very rare cases, surgical treatment was recommended for patients with unstable LV thrombus and for those with presence of thrombus despite therapeutic anticoagulation.45,46 Patients developing peripheral embolization were treated with balloon angioplasty, platelet inhibitors, and anticoagulation drugs such as warfarin and/or heparin.
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