Recurrent Ventricular Fibrillation Induced by a Mobile Thrombus in the Sinus of Valsalva in a Patient With Bipolar Disorder.

Mobile thrombi of the sinus of Valsalva are rare and may result in life-threatening complications. We report a surgical case of recurrent ventricular fibrillation caused by a mobile thrombus in the sinus of Valsalva in a patient with bipolar disorder. A 42-year-old man with bipolar disorder collapsed due to loss of consciousness. Ventricular fibrillation was documented, and return of spontaneous circulation was achieved after cardiopulmonary resuscitation. Recurrent ventricular fibrillation required eight defibrillations. Emergency coronary angiography revealed no significant stenosis, whereas left ventriculography disclosed a mobile intraluminal filling defect in the ascending aorta. Contrast-enhanced computed tomography and echocardiography suggested aortic dissection. Emergency surgery removed an 8×25-mm mobile mass attached 5 mm distal to the left coronary ostium. Histopathology examination confirmed thrombus. Transient obstruction of the left coronary ostium by the mobile thrombus was considered the cause of the recurrent ventricular fibrillation. Bipolar disorder-associated systemic inflammation might have been involved in thrombus formation. Although rare, this entity should be considered in patients with otherwise unexplained malignant ventricular arrhythmias. Early surgical removal followed by appropriate postoperative anticoagulation may help prevent recurrence and improve outcomes.