Coronary Artery Disease and Left Ventricular Mural Thrombi: Clinical, Hemodynamic and Angiocardiographic Aspects

¹ Department of Medicine, Cardiology Division and Department of Surgery, Cardiovascular Division, Long Island Jewish-Hillside Medical Center, New Hyde Park, Queens Hospital Center Affiliation, Jamaica; School of Medicine, Health Sciences Center, State University of New York at Stony Brook

Twenty-two patients were found, during cardiac catheterization, to have mural thrombi in the left ventricle. Their ages varied from 40 to 72; the majority were referred for evaluation because of angina pectoris. A history of multiple infarctions was noted in 13 patients. Only eight, however, had electrocardiographic evidence of two previous myocardial infarctions. The clinical and hemodynamic features included cardiomegaly in 12, electrocardiographic evidence of previous anterior wall (anterior or anteroseptal) myocardial infarction in 21 and the uniform finding of left ventricular dysfunction as well as severe stenosis \l=g\ 95 percent) or complete obstruction of the left anterior descending artery in all 22. The frequency of mural thrombus in the total group of 458 patients with arteriosclerotic heart disease evaluated during the period of time of this study was 4.8 percent. If, however, one only considers patients with evidence of previous anterior wall myocardial infarction, the frequency varies from 19.7 to 29.6 percent. The left ventricular angiogram demonstrated a ventricular aneurysm in one patient, while the remaining 21 patients with mural thrombi of the left ventricle had apical akinesia with or without akinesia of the adjacent walls. The left ventricular angiogram revealed distortion of the normal apical contour by a filling defect which varied in size and appeared smooth or ragged, with the appearance of a mass projecting into the left ventricular cavity. Six patients underwent infarctectomy combined with aortocoronary bypass surgery and one patient had an aneurysmectomy. A mural thrombus was found in all these patients at the time of surgery. Another patient died and postmortem examination confirmed the presence of a mural thrombus. Systemic emboli presumably occurred in three patients and contributed to death in a fourth.