Key result
Oral anticoagulation resolves a post-OPCAB LV thrombus after five months.
Why the study?
Reports of left ventricular thrombus in the early postoperative period after coronary artery bypass graft surgery were lacking.
Case Report (n=1)
No
This case demonstrates that left ventricular thrombus can develop early after off-pump coronary artery bypass grafting in patients with reduced ejection fraction and apical infarction, and can be successfully treated with oral anticoagulants.
Clinicians should monitor for early LV thrombus after off-pump CABG in reduced-EF patients; this case leaves optimal screening and therapy duration open.
Left ventricular (LV) thrombus is a serious complication of myocardial infarction (MI) that can lead to a fetal systemic embolism. Although coronary artery bypass graft surgery (CABG) after MI is widely performed, to our knowledge, there are no reports of LV thrombus in the early postoperative period. Here, we report a rare case of a 70-year-old man who underwent off-pump coronary artery bypass grafting (OPCAB) for unstable angina pectoris with reduced left ventricular ejection fraction (LVEF). An LV thrombus (13 mm × 12 mm) was incidentally discovered on an echocardiography 7 days after OPCAB. We administered an oral anticoagulant (OAC) and observed resolution of the thrombus five months post-surgery. In the present case, factors such as low LVEF, infarcted lesion at the apex, and hypercoagulable state due to systemic inflammation after CABG likely contributed to LV thrombus development. This case highlights that LV thrombus is a potential complication early after CABG; thus, careful follow-up is required during the early postoperative period. Prophylactic anticoagulant administration in the early postoperative period should be considered for patients at particularly high risk for LV thrombus.
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Machii et al. (2024) conducted a case report in Unstable angina pectoris with reduced left ventricular ejection fraction (n=1). Off-pump coronary artery bypass grafting (OPCAB) and oral anticoagulant was evaluated on Resolution of left ventricular thrombus. A 70-year-old man developed a left ventricular thrombus 7 days after off-pump coronary artery bypass grafting, which successfully resolved after five months of oral anticoagulant therapy.
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