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首页> 外文期刊>Cardiology Research >Peripheral Embolization of Left Ventricular Thrombus Leading to Acute Bilateral Critical Limb Ischemia: A Rare Phenomenon
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Peripheral Embolization of Left Ventricular Thrombus Leading to Acute Bilateral Critical Limb Ischemia: A Rare Phenomenon

机译：左心室血栓外周枢化导致急性双侧临界肢体缺血：一种罕见的现象

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Left ventricular thrombus (LVT) is a well-known complication of myocardial infarction (MI) leading to significant morbidity and mortality. LVT can also lead to systemic thromboembolic events causing threatening limb ischemia. We report a rare case of critical bilateral limb ischemia that resulted from peripheral embolization of LVT post MI, which was managed successfully by emergent surgical intervention and anticoagulation. A 74-year-old male with a medical history of hypertension, diabetes, hyperlipidemia and coronary artery disease status post stenting of the left anterior descending and left circumflex arteries presented to the emergency department with typical chest pain and progressive shortness of breath. Cardiac troponin levels on admission were 35 ng/mL of blood. The patient subsequently underwent emergent cardiac catheterization which revealed significant triple vessel disease, and was referred for coronary artery bypass grafting (CABG) surgery. Transthoracic and transesophageal echocardiograms revealed the presence of an apical aneurysm with chronic organized mobile thrombus at the apex. Post CABG, the patient complained of excruciating right leg pain. Computed tomography (CT) angiogram of the abdominal aorta and lower extremities revealed a large embolus at the aortic bifurcation occluding the right and nearly occluding the left common iliac arteries and thrombus in the right popliteal artery. He underwent emergent vascular surgery with resolution of his symptoms and remained without further complications. The incidence of LVT remains high in post-MI patients, and complications of LVT are known to include thromboembolic events. Peripheral embolization of acute or chronic LVT leading to bilateral distal embolization and critical limb ischemia remains a rare occurrence. This case report aims to aid clinicians to recognize and promptly manage LVT and related arterial thromboembolic events with anticoagulation and emergent surgical intervention if limb ischemia develops.Copyright 2020, Agarwal et al.
机译：左心室血栓（LVT）是心肌梗死（MI）的众所周知的并发症，导致显着的发病率和死亡率。 LVT还可以导致系统性血栓栓塞事件导致威胁肢体缺血。我们报告了一例罕见的双侧肢体缺血，由LVT后MI的外周栓塞引起，这是通过紧急手术干预和抗凝成功管理的。一个74岁的男性，具有高血压，糖尿病，高脂血症和冠状动脉疾病状态的病史，左前期下降和左侧颈动脉的支柱呈现给急诊部门，具有典型的胸痛和逐步的呼吸急促。入场时的心肌肌钙蛋白水平为35 ng / ml血液。患者随后接受了突出的心脏导管插入，显示出显着的三血管疾病，并且被称为冠状动脉旁路移植（CABG）手术。 Transthoracic和TranseSophagehacehocarcograms揭示了在顶点上具有慢性有组织的移动血栓的顶端动脉瘤的存在。发布后CABG，患者抱怨令人讨厌的右腿疼痛。腹部主动脉和下肢的计算机断层扫描（CT）血管造影显示出在主动脉分叉的大型栓塞中遮挡右侧，几乎闭塞在右吞咽动脉中的左常见的髂动脉和血栓。他接受了急诊血管手术，解决了他的症状，仍然没有进一步并发症。后MI患者的LVT发病率仍然高，并且已知LVT并发症包括血栓栓塞事件。急性或慢性LVT的外周栓塞导致双侧远端栓塞和临界肢体缺血仍然是罕见的。本案例报告旨在帮助临床医生识别和迅速管理患有抗凝和急诊手术干预的LVT和相关动脉血栓栓塞事件，如果肢体缺血发展，则为肺缺血。2020，Agarwal等人。

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