| Thoracic Aortic Mobile Thrombus: Is There a Role for Early Surgical Intervention? | |
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MedLine Citation:
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PMID: 21529769 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: The diagnosis of thoracic aortic mobile thrombus (TAMT) is rare and is usually made after debilitating embolic events. The optimal treatment strategy is unknown. We report 14 patients with TAMT and aim to better define the role of early (less than 2 weeks) surgical thrombectomy. METHODS: Between February 1996 and February 2010, we treated 14 patients (9 women; aged 32 to 84 years, mean age 51 years) with TAMT. Hypercoagulable disorders or a strong family history of vascular thrombosis, or both, occurred in 9 patients. Diagnosis was made by transesophageal echocardiogram in 6, computed tomography angiography in 7, and digital subtraction angiography in 1. Embolic locations were extremities (n = 9), cerebral (n = 6), and abdominal (n = 6). Aortic thrombi (n = 17) locations were ascending/arch (n = 7), descending (n = 8), and thoracoabdominal (n = 2). RESULTS: All patients were initially treated with heparin and aspirin. Thoracic aortic thrombectomies were performed in 8 patients within 2 weeks of diagnosis: left thoracotomy (n = 5), thoracoabdominal (n = 1), and median sternotomy (n = 2). Left atrial-femoral bypass was used in 5 patients, cardiopulmonary bypass in 2, and no support in 1. Additional procedures were celiac artery (n = 1) and left subclavian artery (n = 2) thrombectomies. Procedures for embolic complications were performed in 7 patients before aortic thrombectomy. Operative mortality was 0%, with no recurrent embolic events after 24 ± 16 months. One patient had thrombectomy of the ascending aorta and medical therapy with warfarin and aspirin for a second concurrent small thrombus in the descending aorta. One patient presented with multiorgan failure and died shortly after admission. Six patients treated medically were discharged on a regimen of oral warfarin and aspirin (14 ± 11 months follow-up), with 2 fatal recurrent embolic events within 6 weeks (p = 0.09). CONCLUSIONS: Thoracic aortic mobile thrombus is rare and is commonly associated with morbid thromboembolic events. In our experience, early surgical aortic thrombectomy had a low operative risk and may prevent fatal recurrent embolic events. |
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Authors:
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Sebastian Pagni; Jaimin Trivedi; Brian L Ganzel; Matthew Williams; Nick Kapoor; Charles Ross; A David Slater |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-4-27 |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: - ISSN: 1552-6259 ISO Abbreviation: - Publication Date: 2011 Apr |
Date Detail:
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Created Date: 2011-5-2 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Divisions of Thoracic and Cardiovascular Surgery, Vascular Surgery and Cardiology, Departments of Surgery and Medicine, University of Louisville, Louisville, Kentucky. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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