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Lysis of a Left Ventricular Thrombus With Recombinant Tissue Plasminogen Activator*

Benjamin T. Rester, MD; James L. Warnock, MD; Praful B. Patel, MD; Michael R. McMullan, MD; Thomas N. Skelton, MD; Nancy A. Collop, MD, FCCP
Author and Funding Information

*From the Department of Internal Medicine, Divisions of Cardiology and Pulmonology/Critical Care, University of Mississippi Medical Center, Jackson, MS.

Correspondence to: Nancy A. Collop, MD, FCCP, Professor of Medicine, Pulmonary and Critical Care Medicine, University of Mississippi Medical Center, 2500 North State St, Jackson, MS 39216-4505; e-mail: ncollop@aol.com



Chest. 2001;120(2):681-683. doi:10.1378/chest.120.2.681
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A 23-year-old woman with peripartum cardiomyopathy presented with a 2.1 × 2.5-cm pedunculated, mobile, left ventricular thrombus and evidence of systemic embolization. Due to the patient’s poor left ventricular function, thrombectomy was not a viable option. Treatment with high-dose IV heparin was initially utilized but was unsuccessful as the thrombus appeared to enlarge on echocardiography. An accelerated weight-adjusted dose of recombinant tissue plasminogen activator (rt-PA) successfully lysed the thrombus without evidence of embolization. Although rt-PA has been used for primary lysis of high-risk ventricular thrombi, this is the first documentation of successful lysis of a left ventricular thrombus in a patient with peripartum cardiomyopathy.

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