299 LEFT VENTRICULAR APICAL THROMBUS

Abstract LV thrombus is a complication of AMI. It estimated that 40-60% patients with large anterior wall MI will develop thrombus. The risk highest during the first 3 months following Accurate and timely detection important as it poses high for thromboembolic events. Advances in technology have improved rate intracardiac thrombi, but several uncertainties still remain regarding optimal treatment strategy within daily clinical practice. We report case 61-year-old male extensive MI. A man, hypertension, former smoker, subjected to epatic orthotopic transplant HCC treated immunosuppressive therapy (Everolimus), development lymphocytic leukemia fu. He underwent thoracic ct, wich showed hypodense imaging left ventricular apex referable thrombotic formation 2cm, endocardial rim hypointense like ischemic outcomes. ECG demonstrated Q waves leads biphasic T same leads. patient was absolutely asyntomatic. transthoracic echocardiography, apical mass (2×0,9cm) very mobile akinesia thinning ventricol middle-apical aneurysmatic evolution. CMR, confirmed presence defects at subendocardial layer interventricular septal also involvement all apex; burden late gadolinium enhancement (ischemic pattern) extended segment. Coronary angiography subocclusion involving second tract descending (99%) critical coronary stenosis third right (70%). completely removed surgically through atriotomy, prevention embolization due dimension, motility labile docking station. histological examination nature mass. International guidelines agree on recommending anticoagulation affected by thrombosis. OAC vitamin K antagonists should be started soon LVT identified, first-line parenteral discontinued when effective therapeutic range warfarin has been achieved (INR 2–3). European American stressing efficacy heparin; there are no randomized trials examined VKA compared therapy. DOACs attractive alternatives because their potential safety even though trial proves effect LVT. Oral resolution established. Surgical removal an option embolic risk, our patient. morbidity mortality this approach outweigh benefits performing surgery solely indication