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European Journal of Cardio-Thoracic Surgery 45 (2014) 948 IMAGES IN CARDIO-THORACIC SURGERY doi:10.1093/ejcts/ezt441 Advance Access publication 1 September 2013 A rare indication for surgery in acute myocardial infarction: spontaneous aortic thrombus causing left main stem occlusion a b b c, Alexander Sirker , Narbeh Melikian , Cliona Kenny and Ranjit Deshpande * Department of Cardiology, The Heart Hospital, University College London Hospitals NHS Foundation Trust, London, UK Department of Cardiology, King’s College Hospital NHS Foundation Trust, London, UK Department of Cardiothoracic Surgery, King’s College Hospital NHS Foundation Trust, London, UK * Corresponding author. Department of Cardiothoracic Surgery, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS. Tel: +44 203 299 4365; Fax: +44 203 299 3433; e-mail: Ranjit.Deshpande@nhs.net. Received 6 June 2013; received in revised form 29 July 2013; accepted 31 July 2013 Keywords: Aortic � Thrombus � Left main stem � Myocardial infarction A 52-year old man presented with acute anterolateral ST elevation extending into the left coronary artery (Fig. 1B and C). The macro- myocardial infarction. At angiography, the left coronary artery was scopic appearance suggested a tumour (Fig. 1D); however, hist- not found. Aortic root injection revealed a large filling defect ology demonstrated only an organized thrombus, apparently (Fig. 1A). Emergency surgery identified an adherent aortic mass spontaneous. Figure 1: (A) Aortic root contrast angiogram (using a pigtail catheter). This was performed since the left coronary origin could not be located with selective catheters. A large filling defect (arrow) is seen in the aortic root, extending into the ascending aorta. (B) Transoesophaegeal echocardiogram performed at the time of emergency surgery. An aortic root-level short axis view is shown. An irregularly shaped mass is seen in the aortic root, extending into the left main stem origin and occluding flow into it. (C) Intraoperative photography demonstrates the location of the mass in the aortic root, where it was found to be adherent to the aortic wall. (D) Appearance of the mass immediately after its excision. Despite the gross appearance, this was later confirmed as a thrombus. The patient died 3 days post- operatively from multi-organ failure that developed as a consequence of a massive myocardial infarction sustained at the time of left main stem occlusion. Post-mortem findings demonstrated no evidence of local aortic injury, or of a thrombus or tumour elsewhere. No underlying prothrombotic condition was identified (but it is difficult to fully exclude this post mortem). Ao: ascending aorta; AoR: aortic root; AoV: aortic valve; LMS: left main stem. © The Author 2013. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
European Journal of Cardio-Thoracic Surgery – Oxford University Press
Published: May 1, 2014
Keywords: Aortic Thrombus Left main stem Myocardial infarction
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