TY - JOUR
AU1 - Scherman, Jacques
AU2 - da Silva, Natercia
AU3 - Myburgh, Adriaan
AU4 - Pennel, Timothy
AB - Clinical message A 52-year-old male patient, with a background of IgA nephropathy and hypertension presented with left-sided weakness, right-sided hemianopia, headaches, and a pre-syncopal attack. Electrocardiogram findings were consistent with an inferior ST-elevation myocardial infarction (STEMI) and cardiac enzymes elevated (TropT-level 3796 ng/L). Contrast tomography (CT)-brain demonstrated features consistent with a left posterior cerebral artery infarction, without haemorrhagic transformation. The source of the embolism was identified with transoesophageal echocardiography (TOE), (Supplementary material online, Video) revealing a 1.3 × 1.3 cm pedunculated inhomogeneous mass originating from within the aortic root adjacent to the right coronary artery (RCA) ostium (Panels A–C), with features suggestive of proximal RCA occlusion (Panel B, arrow) and concomitant inferoseptal hypokinesia. Urgent surgery was conducted via median sternotomy using cardiopulmonary bypass on an arrested heart for removal of the mass (Panel D) and embolectomy of the proximal RCA. Following this, intra-operative TOE confirmed good flow in the proximal RCA (Panel E, arrow). Dual antiplatelet therapy was commenced post-operatively, and the patient recovered uneventfully from surgery. The left-sided weakness almost completely resolved, as did the hemianopia. Histology revealed features consistent with an organizing thrombus. In view of the underlying renal dysfunction, a follow-up cardiac magnetic resonance imaging study was done which demonstrated an unobstructed proximal RCA (Panel Fi–iii) without any residual intracardiac- or coronary thrombus or mass. Primary aortic thrombi are rare in the absence of underlying atherosclerotic disease, and its aetiology relatively enigmatic. Amongst others, hypercoagulable states have been implicated as a risk factor. This rare case in a patient with IgA-nephropathy demonstrates the value of TOE to diagnose and delineate extent of involvement. Supplementary material is available at European Heart Journal online. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)
TI - Pedunculated aortic thrombus propagating from the right coronary artery in a patient with IgA nephropathy
JF - European Heart Journal
DO - 10.1093/eurheartj/ehy282
DA - 2018-05-16
UR - https://www.deepdyve.com/lp/oxford-university-press/pedunculated-aortic-thrombus-propagating-from-the-right-coronary-a7JUjeVuaV
SP - 3000
EP - 3000
VL - 39
IS - 32
DP - DeepDyve
ER -