A Case of Surgical Removal of Left Ventricular Thrombus and Biventricular Pacing with Alcoholic Cardiomyopathy

(Division of Cardiovascular Surgery, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan)

Shigeru Sakamoto Daisuke Sakamoto
A 62-year-old man had suffered from massive pedal edema, dyspnea and sinus bradycardia for 10 days. He had been heavy drinker for over 20 years. He was transferred to our hospital with severe heart failure. Echocardiography showed severe diffuse hypokinesis of left ventricular wall motion(EF20%)with dyssynchrony, and thrombus in the left ventricular apex. Under a diagnosis of LV thrombus due to severe heart failure, we made a plan for an emergency open heart surgery, but it could not be performed because of initial cardiogenic embolic stroke. Therefore, we waited for 2 weeks while performing anticoagulation therapy. The removal of LV thrombus and atrio-biventricular pacing for heart failure due to dyssynchrony were performed 2 weeks later. The pathological specimen of myocardium showed marked fibrous and hypertrophic change, which were similar to idiopathic dilated cardiomyopathy. Alcoholic cardiomyopathy due to alcohol intake for many years is similar to a clinical image of dilated cardiomyopathy, but its clinical prognosis by abstinence is not bad. In this case we performed an urgent open heart surgery due to cardiogenic embolic stroke, but must be essentially performed as an emergency operation. Postoperative course was uneventful and he was discharged 21 days after open heart surgery without any complications.
  Jpn. J. Cardiovasc. Surg. 42:324-328(2013)

Keywords:alcoholic cardiomyopathy, left ventricular thrombus, open heart surgery, cardiogenic embolic stroke, atrio-biventricular pacing