The Emergency Resection of a Mobile Left Ventricular Thrombus in Dilated Cardiomyopathy: A Case of Multiorgan Embolism and Postoperative Ventricular Tachycardia

Dilated cardiomyopathy (DCM) is characterized by marked left ventricular (LV) dilation and systolic dysfunction, which predispose patients with DCM to LV thrombus (LVT) formation and potentially fatal multiorgan embolism. We report the case of a 52-year-old male with severe DCM (ejection fraction (EF), 14%; LV diameter, 89 mm) who developed a large, mobile LVT (40 × 30 mm) that caused embolic events in the lungs, kidneys, spleen, superior mesenteric artery, and posterior cerebral cortex. Since anticoagulation therapy was deemed insufficient to control the embolic source, emergency surgical thrombectomy was performed via an apical LV incision. Although the patient's condition initially stabilized, he developed ventricular tachycardia and torsades de pointes on postoperative day (POD) nine, which led to cardiac arrest. He was successfully resuscitated but required intensive antiarrhythmic therapy and circulatory support. The patient was discharged on POD 41 with an implantable cardioverter-defibrillator. This report illustrates that surgical removal of a large, mobile LVT is effective in controlling embolic events; however, an LV incision may induce postoperative life-threatening ventricular arrhythmias due to myocardial scarring and electrical heterogeneity. Rigorous perioperative monitoring and comprehensive arrhythmia management are essential when surgical thrombectomy is considered for LVT related to DCM.