Abrupt change in the shape of a left ventricular mural thrombus after intra-aortic balloon pump-supported percutaneous coronary intervention in recent myocardial infarction.

A 77-year-old woman was diagnosed with congestive heart failure and broad anterior acute myocardial infarction that had occurred 10 days prior to her presentation in our hospital. A flat and immobile thrombus was widely attached to the luminal surface of the left ventricular antero-apical wall with dyskinetic motion. For treatment-resistant heart failure, the patient underwent percutaneous coronary intervention (PCI), with intravenous heparin, supporting an intra-aortic balloon pump. Echocardiography obtained 3 h after the procedure revealed that the left ventricular mural thrombus had changed to a centrally hollow, ball-like shape of 4 cm in diameter. The thrombus was surgically removed and left ventriculo-plasty was simultaneously performed without any systemic embolic events. Physicians should be aware that a relatively fresh left ventricular mural thrombus, even with no protrusion or immobility, may peel away from the endocardium after introducing an intra-aortic balloon pump under an optimal anticoagulation for performing PCI. <Learning objective: When determining the therapeutic strategy for congestive heart failure following a recent myocardial infarction with a large, fresh mural thrombus in a left ventricular aneurysm, physicians should be aware that the thrombus, even with no protrusion or immobility, may peel away from the endocardium.>.