Author + information
- Received January 28, 2014
- Accepted February 13, 2014
- Published online October 1, 2014.
- Francisco Javier Lacunza-Ruiz, MD∗ (, )
- Carmen Muñoz-Esparza, MD and
- Juan García-de-Lara, MD
- ↵∗Reprint requests and correspondence:
Dr. Francisco Javier Lacunza-Ruiz, Cardiology Department, University Hospital Virgen de la Arrixaca. Ctra. Madrid-Cartagena s/n El Palmar 30120, Murcia, Spain.
A 66-year-old woman was admitted to our hospital with chest pain. Three months earlier, she underwent implantation of a mechanical mitral prosthesis with normal findings on preoperative angiography. The electrocardiogram obtained in the emergency department showed negative T waves in leads V2 to V4, not present on previous electrocardiograms. The patient was taken emergently to the catheterization laboratory. Angiography revealed an image suggestive of a thrombus in the middle segment of the left anterior descending artery straddling the bifurcation with a septal branch. Aspiration of thrombotic material was performed, and intracoronary ultrasound showed no damage to the vessel wall. The international normalized ratio at admission was 1.7, and echocardiography showed an echodense mass attached to the mitral prosthesis. Finally, the histopathological analysis of the extracted material was compatible with a fibrin thrombus (Figure 1).
The most frequent cause of acute coronary syndrome is the thrombotic complication of a coronary plaque. However, we cannot dismiss other possibilities such as a coronary embolism (1,2) when determining the diagnostic strategy and treatment. We must always keep in mind this clinical suspicion in patients with a cardiac prosthesis or atrial fibrillation, especially in cases of subtherapeutic anticoagulation. In this particular case, intravascular ultrasound and transesophageal echocardiography were essential for the correct diagnosis and subsequent treatment.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 28, 2014.
- Accepted February 13, 2014.
- American College of Cardiology Foundation
- Kushiyama S.,
- Ikura Y.,
- Iwai Y.