Transient Left Ventricular Apical Ballooning in a Patient With Bicuspid Aortic Valve Created a Left Ventricular Thrombus Leading to Acute Renal Infarction

Norihito Sasaki; Toru Kinugawa; Masahiro Yamawaki; Yoshiyuki Furuse; Masaki Shimoyama; Kazuhide Ogino; Osamu Igawa; Ichiro Hisatome; Chiaki Shigemasa

doi:10.1253/circj.68.1081

Case Report

Transient Left Ventricular Apical Ballooning in a Patient With Bicuspid Aortic Valve Created a Left Ventricular Thrombus Leading to Acute Renal Infarction

Norihito Sasaki, Toru Kinugawa, Masahiro Yamawaki, Yoshiyuki Furuse, Masaki Shimoyama, Kazuhide Ogino, Osamu Igawa, Ichiro Hisatome, Chiaki Shigemasa

Author information

Norihito Sasaki
Division of Regenerative Medicine and Therapeutics, Department of Genetic Medicine and Regenerative Therapeutics, Institute of Regenerative Medicine and Biofunction, Graduate School of Medical Science
Toru Kinugawa
Department of Cardiovascular Medicine, Faculty of Medicine, Tottori University
Masahiro Yamawaki
Department of Cardiovascular Medicine, Faculty of Medicine, Tottori University
Yoshiyuki Furuse
Department of Cardiovascular Medicine, Faculty of Medicine, Tottori University
Masaki Shimoyama
Department of Cardiovascular Medicine, Faculty of Medicine, Tottori University
Kazuhide Ogino
Department of Cardiovascular Medicine, Faculty of Medicine, Tottori University
Osamu Igawa
Department of Cardiovascular Medicine, Faculty of Medicine, Tottori University
Ichiro Hisatome
Division of Regenerative Medicine and Therapeutics, Department of Genetic Medicine and Regenerative Therapeutics, Institute of Regenerative Medicine and Biofunction, Graduate School of Medical Science
Chiaki Shigemasa
Department of Cardiovascular Medicine, Faculty of Medicine, Tottori University

Keywords: Bicuspid aortic valve, Left ventricular thrombus, Renal infarction, Tako-tsubo-like ventricular dysfunction

JOURNAL FREE ACCESS

2004 Volume 68 Issue 11 Pages 1081-1083

DOI https://doi.org/10.1253/circj.68.1081

Details

Abstract

A 44-year-old woman had tako-tsubo-like ventricular dysfunction with chest pain and ST segment elevation on the ECG. Echocardiography revealed a bicuspid aortic valve with moderate to severe aortic regurgitation. She developed mild heart failure during the clinical course, but the medication (furosemide, enalapril, and asprin) had to be stopped because of skin eruptions. Four weeks after ceasing the antiplatelet agent, she was re-admitted with acute renal infarction. Enhanced chest computed tomography revealed a filling defect in the left ventricle and echocardiography showed a high echogenic mass in the left ventricular apical wall. These findings strongly suggested that the renal infarction was caused by an embolism derived from a left ventricular thrombus that formed during the clinical course of the transient left ventricular apical ballooning. Anticoagulation therapy with urokinase and warfarin successfully lysed the thrombus. Left ventricular thrombus should be considered a complication of transient left ventricular apical ballooning, especially in patients with organic heart disease. (Circ J 2004; 68: 1081 - 1083)

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