The presence of a large mobile pedunculated left ventricular thrombus may require surgical intervention, as fatal embolization can occur despite adequate anticoagulation.
Embolization risk persists despite anticoagulation in mobile LV thrombi; leaves optimal management timing open to prospective study.
Two-dimensional echocardiography has permitted the noninvasive detection and determination of the course of the natural history of left ventricular thrombus. In this report we cite an illustrative case of the development of a large pedunculated mobile left ventricular thrombus in the setting of idiopathic congestive cardiomyopathy. A fatal cerebral embolization occurred despite full-dose intravenous anticoagulation before left ventricular thrombectomy could be performed. The presence of a large mobile pedunculated left ventricular thrombus in the setting of embolization and adequate anticoagulation may require surgical intervention.
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Chen et al. (1981) studied this question.
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