Image in cardiology
Thrombotic myocardial infarction with aspiration of large thrombi
Enfarte trombótico com aspiração de grandes trombos
Davide Moreira
, Anne Delgado, Bruno Marmelo, Luís Nunes, Oliveira Santos
Corresponding author
Serviço de Cardiologia, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
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Axial (A) and multiplanar (B, C and D) reconstructions showing atrioventricular and ventriculoarterial discordance, with anterior right aorta and posterior left pulmonary artery, infundibular septal defect with subarterial communication (asterisk), and anomalous origin of the right coronary artery in the left coronary sinus, coursing between the aorta and the pulmonary artery. 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Physical examination showed him to be hemodynamically stable, with no abnormalities on cardiac or pulmonary auscultation. ST-segment elevation was seen in leads II, III and aVF on the 12-lead ECG. Urgent coronary angiography by a right radial approach showed a dominant right coronary artery occluded by thrombi throughout its length; no lesions were observed in the other coronary arteries (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). Primary angioplasty of the occluded right coronary was performed and the thrombi were aspirated using a 6F Export<span class="elsevierStyleSup">©</span> AP<span class="elsevierStyleSup">©</span> aspiration catheter (Medtronic Vascular, Santa Rosa, California, USA) and placed in the receptacle. Since the thrombi had become trapped when the aspiration catheter was inserted, the catheter had to be completely withdrawn in order to extract them. Several thrombi, the largest over 30 mm in length, were removed (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Balloon angioplasty was successful, with no residual lesion and with final TIMI flow 3 (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">During the patient's hospital stay, oral anticoagulation with warfarin was begun, for a target INR of 2.0–3.0. There were no complications and he was discharged on the fourth day, and was asymptomatic five months after the event.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-03-16" "fechaAceptado" => "2013-04-25" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Moreira D, Delgado A, Marmelo B, et al. Enfarte trombótico com aspiração de grandes trombos. Rev Port Cardiol. 2013;32:835–836.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 725 "Ancho" => 850 "Tamanyo" => 87436 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Right coronary artery occluded by thrombi.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 702 "Ancho" => 850 "Tamanyo" => 87312 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Thrombi extracted after catheter aspiration.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 693 "Ancho" => 850 "Tamanyo" => 118264 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Right coronary artery after thrombus aspiration and balloon angioplasty.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003200000010/v1_201312121254/S2174204913001876/v1_201312121254/en/main.assets" "Apartado" => array:4 [ "identificador" => "9915" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003200000010/v1_201312121254/S2174204913001876/v1_201312121254/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204913001876?idApp=UINPBA00004E" ]
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