Successful Surgical Treatment of Left Ventricular Aneurysm with a Mobile Thrombus Concomitant with Essential Thrombocythemia

Yuko Kubota＊	Hidekazu Hirai＊	Takanobu Aoyama＊
Hiroyuki Seo＊	Yasuo Suehiro＊	Shigefumi Suehiro＊

（Department of Cardiovascular Surgery, Osaka Saiseikai Noe Hospital＊, Osaka, Japan）

Essential thrombocythemia is considered one of the chronic myeloproliferative disorders resulting in arterial thromboembolism, venous thrombosis, and bleeding tendency. We report a case of left ventricular aneurysm with successful treatment of the complications of this disease. A 66-year-old man who suddenly experienced right upper limb paralysis was carried to a nearby hospital. Computed tomography revealed multiple cerebral infarctions. An electrocardiogram confirmed findings of old myocardial infarctions in the anteroseptal wall. Echocardiography indicated a left ventricular aneurysm with mobile thrombus. The blood tests showed an abnormally high platelet count of 120×104/μl. His left ventricular thrombus showed an increasing tendency regardless of heparin administration;thus, he was transferred to our hospital. The resection of the aneurysm and left ventricular restoration was performed emergently to avoid re-embolism. There was a soft thrombus inside the aneurysm at its apex. During cardiopulmonary bypass, the activated clotting time was not prolonged easily. We gave additional heparin and antithrombin III. The patient had no problem with hemostasis or postoperative bleeding. We started low-molecular-weight heparin from the second postoperative day and he was diagnosed with essential thrombocythemia by bone marrow biopsy. We started warfarin and aspirin on the fifth day after surgery. The number of platelets increased to 183×104/μl on the 8th day;thus, oral administration of hydroxycarbamide was started. His platelet count fell to less than 100×104/μl around 3 weeks after surgery and he was discharged on the 34th day without new embolisms.

 

Jpn. J. Cardiovasc. Surg. 49:339-343（2020）

Keywords：essential thrombocythemia;cardiac surgery;left ventricular aneurysm;perioperative care