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Migration of left ventricular thrombus causing abdominal aortic embolism during cardiac surgery in a child with severe left ventricular dysfunction

^a Department of Surgery, Ehime University School of Medicine, Stroke and Cardiovascular Center, 791-0295 Shitsukawa, Toon City, Ehime Prefecture, Japan
^b Department of Cardiovascular Surgery, Ehime Prefectural Niihama Hospital, Japan
^c Department of Pediatrics, Ehime University of Medicine, Japan

*Corresponding author. Tel.: +81-89-955-9835; fax: +81-89-960-5335.

E-mail address: mitsugi{at}aqua.plala.or.jp, mitsugi{at}m.ehime-u.ac.jp (M. Nagashima).

A 1-year-old girl with severe left ventricular dysfunction presented with large floating thrombi in the left ventricle. Surgical thrombectomy was urgently required. During cannulation, transesophageal echocardiogram detected that the thrombus had vanished from the left ventricle. Whole body angiogram under very low-flow cardiopulmonary bypass successfully obtained the exact site of embolization with reducing total amount of contrast media in the operating room. Consequently, under deep hypothermic circulatory arrest, the obstructive thrombi at the abdominal aorta were successfully removed using Fogarty catheters from ascending aortotomy. Although delayed sternal closure was postoperatively required, no complication including thromboembolic events were observed for a 1.5-year follow-up period.

Key Words: Thrombosis; Cardiomyopathy; Intraoperative angiography