How should I treat a TAVI-eligible patient with a left ventricular thrombus and rapid clinical deterioration?
Consult your peers’ treatment and different viewpoints of the case «a TAVI-eligible patient with a left ventricular thrombus and rapid clinical deterioration», published in the EuroIntervention Journal by S. Deftereos, et al.
First, I would have checked for another reason for this worsening situation. Serial troponin measures and a coronary angiogram would have allowed the ruling out of silent acute coronary syndrome and potentially changed the antithrombotic regimen.
If there was no concomitant coronary artery disease, I would bridge VKA to parenteral heparin and perform TAVI immediately, given the rapid dissolution of the apical thrombus. This thrombus appears organised, flat and at low risk of embolisation.
Deftereos S, Giannopoulos G, Raisakis K, Vrettou AR, Kolokathis F, Zacharoulis A, Angouras D, Alexopoulos D, Lekakis J, Eggebrecht H, Lämmer J, Papadopoulos N, Collet JP