Successful Lysis of a Mobile Left Ventricular Thrombus by Slow Infusion of Low-Dose Tissue Plasminogen Activator

Abstract

There is no consensus on the management of intracardiac mural thrombi. A 59-year-old man underwent echocardiographic examination for right leg pain and pulse deficits in the right lower extremity, which showed severe left ventricular systolic dysfunction and a bellshaped protruding mobile thrombus in the left ventricular apex. Due to high risk of surgery, 50 mg recombinant tissue-type plasminogen activator (rt-PA) was slowly infused over eight hours. Serial echocardiographic examinations showed a progressive decrease in the size of the thrombus within the first hours of rt-PA infusion, resulting in complete lysis after 24 hours. Lowdose and slow-infusion thrombolytic therapy may be an alternative therapy for left ventricular thrombi when surgery is not feasible.