Totally Endoscopic Transmitral Thrombectomy for a Mobile Left Ventricular Thrombus Associated with Loeffler Endomyocarditis

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Mobile left ventricular apical thrombus associated with Loeffler endomyocarditis and multiple cerebral infarctions (n=1). Intervention: Totally endoscopic trans-left atrial transmitral thrombectomy, warfarin, and oral prednisolone. Primary outcome: Complete thrombus removal and preservation of left ventricular function.

Takeshi Inoue; Yoshihisa Morimoto; R. Kawai; Chihiro Okubo; Akitoshi Yamada; Ryo Tohma; Hidekazu Nakai; Kunio Gan; Tatsuro ASADA

doi:10.4326/jjcvs.55.210

September 15, 2026Japanese Journal of Cardiovascular SurgeryOpen Access

Totally Endoscopic Transmitral Thrombectomy for a Mobile Left Ventricular Thrombus Associated with Loeffler Endomyocarditis

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Key result

Totally endoscopic transmitral thrombectomy completely clears large LV thrombus in Loeffler endomyocarditis, preserving LVEF.

n=1

Why the study?

A totally endoscopic trans-left atrial, transmitral approach was selected to remove a high-risk mobile left ventricular apical thrombus associated with Loeffler endomyocarditis under direct vision while avoiding ventricular dysfunction from a left ventriculotomy.

Key Points

To report the successful surgical removal of a high-risk mobile left ventricular apical thrombus associated with Loeffler endomyocarditis using a minimally invasive, ventriculotomy-sparing endoscopic technique.
Evaluated a man in his 50s presenting with multiple cerebral infarctions, marked eosinophilia (31.7%), and a mobile left ventricular apical mass (18×27×20 mm on echocardiography; 21×25 mm on CT).
Performed totally endoscopic, trans-left atrial, transmitral thrombectomy under cardiopulmonary bypass (operative time 148 min, aortic clamp time 48 min), followed by postoperative anticoagulation and oral prednisolone 50 mg/day.
Pathological examination of the resected mass confirmed an organized thrombus with superficial fresh thrombi and no neoplastic cells.
Postoperative echocardiography on day 7 demonstrated complete disappearance of the apical thrombus with preserved left ventricular function (ejection fraction 65%), and the patient remained recurrence-free at 1 year.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 male patient in his 50s with Loeffler endomyocarditis, marked eosinophilia (31.7%), multiple cerebral infarctions, and a mobile left ventricular apical thrombus, followed for 1 year.

I

Intervention

Totally endoscopic, trans-left atrial, transmitral surgical thrombectomy under cardiopulmonary bypass (operative time 148 min, cardiopulmonary bypass time 92 min, aortic cross-clamp time 48 min), followed by early heparin transitioning to lifelong oral warfarin (target PT-INR 2.0-3.0, specifically 2.0-2.5) started at 24 hours postoperatively, and oral prednisolone 50 mg/day initiated on postoperative day 5.

O

Outcome

Complete disappearance of the left ventricular apical thrombus and preservation of left ventricular function (EF 65%) on echocardiography at postoperative day 7, and recurrence-free survival with independent activities of daily living (ADL) at 1 year.hard clinical

Limitations

Single patient case report
Pathological examination of the resected thrombus showed no obvious eosinophilic infiltration or degranulation
Need for continued long-term follow-up of eosinophil counts, cardiac function, and imaging due to the risk of recurrence or progression to restrictive cardiomyopathy

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Implication

Totally endoscopic trans-left atrial, transmitral thrombectomy is a viable surgical option that avoids left ventriculotomy and preserves left ventricular function when removing a high-risk mobile apical thrombus in Loeffler endomyocarditis.

Abstract

症例は50代男性．4カ月前より手足のしびれが出現し進行した．頭部MRIで多発脳梗塞を認め，血液検査で好酸球31.7%と著明な増加を認めた．好酸球性多発血管炎性肉芽腫症疑いで精査中に経胸壁心エコーを施行し，左室心尖部に可動性腫瘤を認めた．造影CTでは左室内腔に造影効果の乏しい腫瘤構造と左室壁肥厚を認めた．好酸球増多，左室壁肥厚を伴う心内膜障害所見，および可動性腫瘤の性状からLoeffler心内膜心筋炎に伴う左室内血栓を第一に疑い，すでに多発脳梗塞を来していることから塞栓症高リスクと判断した．左室切開による機能低下を回避しつつ心尖部血栓を直視下に摘除する目的で，完全内視鏡下経左房・経僧帽弁的アプローチによる血栓摘除を行った．腫瘤は新鮮血栓付着を伴う陳旧性血栓であり，迅速病理でも血栓と診断された．術後は早期抜管し，ヘパリン開始後ワーファリンに移行し，生涯投与方針とした．術後5日よりステロイドを開始し，術後7日目心エコーで血栓消失と心機能温存を確認した．術後1年でADLは自立し，再発なく経過している．

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Cite This Study

Inoue et al. (2026) conducted a case report in Mobile left ventricular apical thrombus associated with Loeffler endomyocarditis and multiple cerebral infarctions (n=1). Totally endoscopic trans-left atrial transmitral thrombectomy, warfarin, and oral prednisolone was evaluated on Complete thrombus removal and preservation of left ventricular function. Totally endoscopic transmitral thrombectomy completely removed a 27-mm left ventricular thrombus in Loeffler endomyocarditis, preserving ejection fraction at 65% with no recurrence at 1 year.

synapsesocial.com/papers/6af0e999de503f3774140a4b https://doi.org/10.4326/jjcvs.55.210

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Totally Endoscopic Transmitral Thrombectomy for a Mobile Left Ventricular Thrombus Associated with Loeffler Endomyocarditis

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Totally Endoscopic Transmitral Thrombectomy for a Mobile Left Ventricular Thrombus Associated with Loeffler Endomyocarditis

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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