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European Journal of Echocardiography Advance Access published online on March 23, 2009
European Journal of Echocardiography, doi:10.1093/ejechocard/jep022
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Left atrial thrombus after biventricular pacemaker implantation

Ignatios Ikonomidis, Costas Papadopoulos*, Panayota Flevari, Ioannis Paraskevaidis, John Lekakis and Dimitrios T. Kremastinos

Second Department of Cardiology, Attikon Hospital, School of Medicine, University of Athens, 1 Rimini Street, Athens 12462, Greece

Received 14 November 2008; accepted after revision 1 March 2009.

* Corresponding author. Tel: +30 210 8679705. E-mail address: papcost{at}gmail.com


  Abstract

We report the case of a patient with ischaemic cardiomyopathy who was admitted to our hospital for an echocardiographic follow-up a few days after the implantation of a biventricular pacemaker/defibrillator. Transthoracic echocardiographic examination revealed an immobile echogenic mass attached to the left atrial side of the fossa ovalis which was not present a month before the biventricular pacemaker implantation. Because the images of the pre-operative echocardiogram were not available at the time of the examination, the differential diagnosis included a tumour or a thrombus formed on the left side of intra-atrial septum. The use of low myocardial infarction contrast echocardiography and power Doppler clarified the lack of microcirculation and blood flow within the mass, respectively, and confirmed the diagnosis of thrombus. After an episode acute renal failure, the thrombus was absent at a follow-up echocardiogram presumably because of peripheral embolization.

Keywords: Biventricular pacemaker; Echogenic mass; Left atrial thrombus; Contrast agent


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