Surgical removal of a left ventricular thrombus caused by acute myocarditis

Left ventricular thrombus is mainly caused by anterior myocardial infarction or severe cardiac wall dysfunction of the apex, and is rarely caused by a complication of acute myocarditis. A 12-year-old female who developed symptoms of motor dysphasia and incomplete hemiparesis of the right side was admitted to the hospital. The brain MRI taken on the day of her admission showed acute cerebral infarction in the left basal ganglia and the frontoparietal lobe. The echocardiogram showed a movable thrombus, which was 19×28 mm sized and located in the apex of the left ventricle. So in order to prevent further thromboembolic event we performed open cardiac surgery via the atrium and removed the thrombus of the left ventricle. After the removal of the thrombus her symptoms improved and she was discharged from the hospital. Thrombus formation in acute viral myocarditis are considered to be related with endocardial injury and blood flow stasis. Treatment with anticoagulants in left ventricular thrombosis may not be effective and may even cause a major thromboembolism. When the thrombus is laminar and fixed, one should consider anticoagulant therapy. But if the thrombus is pedunculated and movable, which means that there are higher possibilities of major embolism or there may be already one, one should consider surgical removal. We report a 12-year-old girl who required surgical removal of a left ventricular thrombus caused by acute viral myocarditis.