Surgical treatment of giant left ventricular apical thrombus diagnosed with contrast echocardiography in patient with previous anterior myocardial infarction

Introduction We report a case of a 66-year-old man with previous anterior ST-elevated myocardial infarction, treated with primary percutaneous coronary intervention and insertion of drug eluting stent on the left anterior descending coronary artery, and left ventricular (LV) apical aneurysm due to no-reflow. After 2 months follow-up contrast echocardiography allowed to detect giant apical LV thrombosis and to exclude impending LV wall rupture. Anticoagulant oral therapy failed to dissolve the thrombus. Aneurismectomy with left ventricular remodeling and excision of the thrombus was performed successfully and the patient was discharged in good condition. Conclusions Contrast echocardiography was fundamental in diagnosis of LV thrombus excluding an impending LV wall rupture and to guide treatment.