The presence of small or moderate size thrombosis is not uncommon in left ventricle (LV) as results of basic co-moribund disease, but huge LV thrombosis that protrudes to aortic valve in the LV outflow tract (LVOT) tract is an exceptionally rare phenomenon. We report a 34-year-old bodybuilder athlete with cardiomyopathy and massive LV thrombosis. The thrombosis extended to LVOT and protruded through the aortic valve in systole and posed a high risk of systemic emboli. The patient underwent open heart surgery, and the clot was removed. The operation was complicated by low cardiac output syndrome that managed by intra-aortic balloon pump and high dose of inotropic drugs and hemodialysis. The patient died on the 15 th day after surgery with multiorgan failures.
Keren A, Goldberg S, Gottlieb S, Klein J, Schuger C, Medina A, et al. Natural history of left ventricular thrombi: Their appearance and resolution in the posthospitalization period of acute myocardial infarction. J Am Coll Cardiol 1990;15:790-800.
Asinger RW, Mikell FL, Elsperger J, Hodges M. Incidence of left-ventricular thrombosis after acute transmural myocardial infarction. Serial evaluation by two-dimensional echocardiography. N Engl J Med 1981;305:297-302.
Visser CA, Kan G, Lie KI, Durrer D. Left ventricular thrombus following acute myocardial infarction: A prospective serial echocardiographic study of 96 patients. Eur Heart J 1983;4:333-7.
Jugdutt BI, Sivaram CA. Prospective two-dimensional echocardiographic evaluation of left ventricular thrombus and embolism after acute myocardial infarction. J Am Coll Cardiol 1989;13:554-64.
Chiarella F, Santoro E, Domenicucci S, Maggioni A, Vecchio C. Predischarge two-dimensional echocardiographic evaluation of left ventricular thrombosis after acute myocardial infarction in the GISSI-3 study. Am J Cardiol 1998;81:822-7.
Solheim S, Seljeflot I, Lunde K, Bjørnerheim R, Aakhus S, Forfang K, et al. Frequency of left ventricular thrombus in patients with anterior wall acute myocardial infarction treated with percutaneous coronary intervention and dual antiplatelet therapy. Am J Cardiol 2010;106:1197-200.
Mollet NR, Dymarkowski S, Volders W, Wathiong J, Herbots L, Rademakers FE, et al. Visualization of ventricular thrombi with contrast-enhanced magnetic resonance imaging in patients with ischemic heart disease. Circulation 2002;106:2873-6.
Weinsaft JW, Kim HW, Crowley AL, Klem I, Shenoy C, van Assche L, et al. LV thrombus detection by routine echocardiography: Insights into performance characteristics using delayed enhancement CMR. JACC Cardiovasc Imaging 2011;4:702-12.
Turpie AG, Robinson JG, Doyle DJ, Mulji AS, Mishkel GJ, Sealey BJ, et al. Comparison of high-dose with low-dose subcutaneous heparin to prevent left ventricular mural thrombosis in patients with acute transmural anterior myocardial infarction. N Engl J Med 1989;320:352-7.
Vecchio C, Chiarella F, Lupi G, Bellotti P, Domenicucci S. Left ventricular thrombus in anterior acute myocardial infarction after thrombolysis. A GISSI-2 connected study. Circulation 1991;84:512-9.
Delemarre BJ, Visser CA, Bot H, Dunning AJ. Prediction of apical thrombus formation in acute myocardial infarction based on left ventricular spatial flow pattern. J Am Coll Cardiol 1990;15:355-60.
Srichai MB, Junor C, Rodriguez LL, Stillman AE, Grimm RA, Lieber ML, et al. Clinical, imaging, and pathological characteristics of left ventricular thrombus: A comparison of contrast-enhanced magnetic resonance imaging, transthoracic echocardiography, and transesophageal echocardiography with surgical or pathological validation. Am Heart J 2006;152:75-84.
van Dantzig JM, Delemarre BJ, Bot H, Visser CA. Left ventricular thrombus in acute myocardial infarction. Eur Heart J 1996;17:1640-5.
Weinsaft JW, Kim RJ, Ross M, Krauser D, Manoushagian S, LaBounty TM, et al. Contrast-enhanced anatomic imaging as compared to contrast-enhanced tissue characterization for detection of left ventricular thrombus. JACC Cardiovasc Imaging 2009;2:969-79.
Meltzer RS, Visser CA, Fuster V. Intracardiac thrombi and systemic embolization. Ann Intern Med 1986;104:689-98.
Johannessen KA, Nordrehaug JE, von der Lippe G, Vollset SE. Risk factors for embolisation in patients with left ventricular thrombi and acute myocardial infarction. Br Heart J 1988;60:104-10.
Haugland JM, Asinger RW, Mikell FL, Elsperger J, Hodges M. Embolic potential of left ventricular thrombi detected by two-dimensional echocardiography. Circulation 1984;70:588-98.
Domenicucci S, Bellotti P, Chiarella F, Lupi G, Vecchio C. Spontaneous morphologic changes in left ventricular thrombi: A prospective two-dimensional echocardiographic study. Circulation 1987;75:737-43.
Vaitkus PT, Barnathan ES. Embolic potential, prevention and management of mural thrombus complicating anterior myocardial infarction: A meta-analysis. J Am Coll Cardiol 1993;22:1004-9.
Sabzi F, Mirzaei S, Faraji R. Right Ventricular Thrombus and Cerebral Artery Aneurysm in a Patient with Behçet′s Disease. Sultan Qaboos Univ Med J 2016;16:e250-3.