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Biventricular thrombi in a patient with doxorubicin-induced cardiomyopathy
T Germans, AM Beek, AC van Rossum
T Germans
AM Beek
AC van Rossum
VU University Medical Centre, Amsterdam, the Netherlands
Correspondence to: T. Germans
VU University Medical Centre, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
E-mail: t.germans@vumc.nl
A 51-year-old female patient was evaluated for biventricular pacemaker implantation.
Her functional capacity was classified as NYHA class III, despite optimal medical treatment. She was referred for magnetic resonance imaging (MRI) to evaluate left ventricular function and infarct size. Four years ago, she received neoadjuvant chemotherapy with doxorubicin for stage III breast cancer. In addition, she had been admitted twice with a diagnosis of myocardial infarction of limited size.
However, a coronary angiogram showed no significant stenosis. Cine MRI showed a global, severely depressed systolic function of both ventricles; ejection fraction of the left ventricle and right ventricle were 12 and 11% respectively. Delayed contrast enhancement showed a small subendocardial region of hyperenhancement in the mid and distal inferoseptal wall, which was attributed to infarctions, and also a small region of subepicardial hyperenhancement in the lateral wall, presumably caused by regional fibrosis. Moreover, thrombi were seen in the apex of both ventricles (figures 1 and 2).
Figure 1. Four-chamber view of the heart.
LV=left ventricle, LA=left atrium, RV=right ventricle, RA=right atrium.
Asterisks indicate thrombi. Arrows indicate subepicardial fibrosis in the lateral wall and subendocardial fibrosis in the inferoseptum. |
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Figure 2. Short-axis view of left and right ventricle.
RV=right ventricle, LV=left ventricle.
Asterisks indicate thrombi. |
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The pacemaker implantation was cancelled, and warfarin treatment was started.
The finding of biventricular thrombi is rare and has been previously described in patients with dilated cardiomyopthy and peripartum cardiomyopathy.1
References
- Sanchez-Rubio Lezcano J, Galache Osuna JG, Marquina Barcos A, et al. Peripartum cardiomyopathy with biventricular thrombi. Ann Med Interne 2004;21:42-4.
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