Published online Jun 16, 2018. doi: 10.12998/wjcc.v6.i6.127
Peer-review started: February 14, 2018
First decision: March 8, 2018
Revised: March 24, 2018
Accepted: April 11, 2018
Article in press: April 12, 2018
Published online: June 16, 2018
Processing time: 126 Days and 11.4 Hours
A 64-year-old female with type II diabetes and hypertension presented with worsening dyspnea on exertion that had rapidly progressed from her baseline with orthopnea and paroxysmal nocturnal dyspnea.
Pulmonary rales, jugular venous distension, and a loud holosystolic murmur radiating to axilla.
New-onset heart failure due to mitral regurgitation vs cardiomyopathy.
Elevated troponin and brain natriuretic peptide.
Transthoracic echocardiogram with ultrasound enhancing agent showed severe functional secondary mitral regurgitation and reduced left ventricle ejection fraction of 30% with inferior wall aneurysm, while delayed enhancement cardiac magnetic resonance imaging (CMR) illustrated a large mural thrombus measuring 3.0 cm x 1.3 cm adherence to the basal inferior wall aneurysm as well as two apical thrombi.
Coronary artery bypass grafting, mitral valve replacement, removal of mural thrombus, and resection and plication of ventricular aneurysm.
Cardiac magnetic resonance is a well suited imaging modality in detecting left ventricular thrombus due to its high resolution images and is more reproducible than transthoracic echocardiogram.
Delayed-enhancement CMR provides the greatest sensitivity for detection of left ventricular thrombus, superior to standard transthoracic and contrast-enhanced transthoracic echocardiography.