A Rare Case Report of Saddle Embolism in the Abdominal Aorta Following Acute Myocardial Infarction

Systemic embolism can be one of the unfortunate side effects of left ventricular thrombus following acute heart infarction, and its timely diagnosis and treatment is very important. In this report, a patient with saddle embolism in the abdominal aorta due to the complete separation of the left ventricular thrombus following acute anterior infarction is presented.

Case Report: 

The patient is a 60-year-old man who referred to the emergency room complaining of severe retrosternal chest pain, nausea and cold sweats. In the ECG, he had ST segment elevation in leads V1-V5, and with the diagnosis of acute anterior infarction with ST segment elevation (acute anterior STEMI), he underwent primary angioplasty with stent placement (Primary PCI) on the left anterior descending artery. In transthoracic echocardiography three days later, a large thrombus was seen in the apex of the left ventricle. Seven days after stent implantation, the patient experienced severe pain and paraplegia of the lower limbs. In Doppler ultrasound, bilateral iliac artery occlusion was seen. Despite treatment with aspirin, clopidogrel, and anticoagulants, the left ventricular thrombus was embolized to the bifurcation of the abdominal aorta and caused bilateral acute ischemia of the lower limbs. The patient underwent emergency embolectomy and was discharged one week later with a stable condition and two antiplatelets and warfarin. Three months later, warfarin was discontinued.

According to this case report, abdominal aortic saddle embolism following acute myocardial infarction may rarely be seen. Paying attention to clinical symptoms, careful examination and quick diagnosis and treatment can improve the prognosis. In any patient with a left ventricular thrombus following an acute myocardial infarction, the possibility of systemic embolism should be considered.