J Cardiovasc Ultrasound.  2014 Sep;22(3):139-143. 10.4250/jcu.2014.22.3.139.

A Pedunculated Left Ventricular Thrombus in a Women with Peripartum Cardiomyopathy: Evaluation by Three Dimensional Echocardiography

• Kharwar RB
• Chandra S
• Dwivedi SK
• Saran RK

• KMID: 2045430
• DOI: http://doi.org/10.4250/jcu.2014.22.3.139

Abstract

Peripartum cardiomyopathy is a cardiac condition characterized by development of heart failure during the last month of pregnancy or during the first five months of post partum period without any other identifiable cause of heart failure. The hypercoagulable state in the pregnancy along with left ventricular (LV) systolic dysfunction predisposes the patient to thromboembolic complications like intraventricular thrombi. We report a case of a 30-year-old female with peripartum cardiomyopathy along with a highly mobile mass in the LV cavity on two dimensional echocardiography. Three dimensional transthoracic echocardiography clearly showed the pedicle of the mass attached to the interventricular septum along with internal echolucent areas within the mass. Due to denial of the patient to undergo surgery, she was started on oral anticoagulation, with complete dissolution of the mass within one month.

Keyword

Three dimensional echocardiography; Pedunculated; Left ventricular thrombus; Peripartum cardiomyopathy

MeSH Terms

Adult
Cardiomyopathies*
Denial (Psychology)
Echocardiography
Echocardiography, Three-Dimensional*
Female
Heart Failure
Humans
Peripartum Period*
Pregnancy
Thrombosis*

Figure

• 

  Fig. 1 Two dimensional transthoracic echocardiography. A large single pedunculated mass (indicated by *) can be seen in the LV cavity in apical four chamber (A), apical two chamber (C), and parasternal short axis (B) views. There is dilatation of all the four cardiac chambers with poor left ventricular ejection fraction of 32% (D). LA: left atrium, LV: left ventricle, RA: right atrium, RV: right ventricle.

• 

  Fig. 2 Three dimensional (3D) transthoracic echocardiography. The mass within the LV cavity (indicated by *) can be viewed from different imaging planes (A-D) with the help of cropping the basic 3D data set. The site of attachment of the mass to the IVS via a pedicle, the irregular surface characteristics as well as the internal echo lucent areas within the mass (arrow in D) can be clearly delineated. IVS: interventricular septum, LV: left ventricle, RV: right ventricle.

• 

  Fig. 3 Two dimensional transthoracic echocardiography. Follow-up echocardiography at 1 month after the onset of anticoagulation and heart failure therapy showed complete resolution of the intracardiac mass (A, B, and C) as well as improvement in the left ventricular ejection fraction (43%, D). LA: left atrium, LV: left ventricle, RA: right atrium, RV: right ventricle.

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