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Sanjay Sharma
Afshin Ehsan
Gregory S. Couper
Stanton K. Shernan
Sary F. Aranki
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Ann Thorac Surg 2004;78:e79-e80
© 2004 The Society of Thoracic Surgeons

Case report

Unrecognized Left Ventricular Thrombus During Reoperative Coronary Artery Bypass Grafting

Sanjay Sharma, MDa, Afshin Ehsan, MDa, Gregory S. Couper, MDa, Stanton K. Shernan, MDb, Richard M. Wholey, MDc, Sary F. Aranki, MDa,*

a Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
b Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
c Department of Medicine, University of Massachusetts Memorial Hospital, Worcester, Massachusetts, USA

Accepted for publication October 16, 2003.

* Address reprint requests to Dr Aranki, Division of Cardiac Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
saranki{at}partners.org

Left ventricular thrombus after myocardial infarction is relatively common but rarely threatening enough to warrant surgical removal at the time of coronary revascularization. The rare cases of ventricular thrombectomy described in the literature involve a pedunculated thrombus. We describe an urgent coronary revascularization procedure in a patient who had unrecognized left ventricular thrombus. The large clot was detected by transesophageal echocardiography after decannulation in a hemodynamically unstable patient. The thrombus was removed after placing the patient back on cardiopulmonary bypass emergently. He recovered and was discharged with no neurologic sequelae. Aggressive removal of clot using cardiopulmonary bypass is warranted even for the critically ill patient.






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