Figures’ legend
Figure 1. Typical example of left ventricular thrombosis assessment by
dedicated cardiac magnetic resonance after anterior myocardial
infarction.
Patient example. Panel A: Patients with transmural anterior infarction
with older mural thrombus (low signal intensity in T1 in cine cardiac).
Panel B, C: acute protruding thrombus in the left ventricular apex
(yellow arrow) showing high signal intensity on T1. Panel D: phase
sensitive contrast-enhanced magnetic resonance images. Panel E:
contrast-enhanced magnetic resonance images: note that thrombus appears
black on long inversion time (T1).
Figure 2. Different morphological left ventricular thrombi aspects
detected by transthoracic echocardiography.
Panel A: 4-chamber apical view showing a left ventricular mural thrombus
visible as a minus image (asterisk) because of contrast agent. Panel B:
a protruding left ventricular thrombus visualized before (arrow) and
after contrast injection (asterisk). Panel C: a large protruding and
free mobile left ventricular thrombus before (arrow) and after contrast
injection (asterisk).
Figure 3. Left ventricular apical thrombus detected by echocardiography
15 days after acute anterior myocardial infarction.
Panel A: 4-chamber and 2-chamber apical views showing a large protruding
LV apical thrombus (asterisk) in an akinetic LV apex. Note soft density
and irregular shape typical of recent thrombus Panel B: after contrast
injection, the thrombus is visible as a minus image (asterisk).
Panel C: full volume RT3D apical view oriented from the LV apex, shows
the spatial definition of LV thrombus.
Panel D: multislice multiplane view of LV apex with thrombus attached to
the apical septal and apical inferior segments.
Panel E: follow-up echocardiogram after 3 months of anticoagulant
therapy showing almost complete resolution of the apical thrombus but
residual shallow mural thrombus with smooth and hyperechogenic surface
visible in the apical 2 chamber view (arrow) in the akinetic LV apex.
Data on the embolic avoidance and subsequent antithrombotic management
in patients who did not achieve total LVT regression are limited or
lacking.
Figure 4. Transthoracic echocardiography-based flow chart for guiding
LVT management after anterior myocardial infarction. Note that for many
decision-making there is no scientific evidence. Therefore, the proposed
algorithm is inevitably, for the most part, based on the opinion and
clinical practice of the authors.
WMSI: wall motion score index; LVT: left ventricular thrombus; AC:
anticoagulation therapy; TTE: transthoracic echocardiography; LV: left
ventricle; SEC: spontaneous echo-contrast.