Anesthetic Management of Patient with Left Ventricular Thrombus Posted for Emergency Laparotomy

ischemia followed by infarction of the small bowel.The more proximal the obstruction, the more severe and widespread the intestinal infarction becomes.Early detection and management are crucial.There is a 50% chance of survival if diagnosed within 24 hours, and survival drops to 30% if diagnosed beyond 24 hours.5 Definitive treatment is essential upon diagnosis, with treatment options of minimally invasive catheter-directed thrombolytic infusion to mesenteric bypass.However, if signs of peritonitis are present, then, on IntroductIonLeft ventricular thrombus (LVT) is a morbid complication following acute coronary syndrome as well as nonischemic cardiac issues, such as dilated cardiomyopathy.The incidence of LVT varies from 4 to 39%, 1 in different studies, depending on the timing and frequency of screening.In the prepercutaneous coronary intervention (PCI) era, the incidence was around 28-46% which has reduced to 5-15% after PCI introduction.2 LVT is predominantly seen in anterior wall myocardial infarction (MI) with reduced ejection fraction (EF), involvement of left anterior descending artery with large infarct, or ST-elevation myocardial infarction (STEMI).There are reported cases of LVT in patients with nonischemic cardiomyopathy due to severe left ventricular (LV) dysfunction.The incidence of LVT following cardiomyopathy is anywhere between 2 and 36%. 3 According to studies by Li et al. and McCarthy et al., LVT causes cerebral and peripheral arterial embolism and subsequent mortality, and has higher chances of major adverse cardiac events (MACE).Mortality associated with LVT is somewhere between 24 and 34%, with more deaths in the geriatric age-group.Treatment with antiplatelets and anticoagulation has shown benefits in reducing embolization incidence.4 Superior mesenteric artery (SMA) thrombosis is one of the complications of LVT.It is due to thromboembolic obstruction of the SMA, providing arterial supply to the small intestine and ascending colon, irrespective of underlying atherosclerotic diseases of the SMA.The thrombosis leads to 1,