RIGHT-VENTRICULAR THROMBI IN PRIMARY ANTI PHOSPHOLIPID SYNDROME

Over a period of several months a 33-year-old man had recurrent pulmon ary emboli. No thromboses could be demonstrated in the peripheral veno us system. Transoesophageal echocardiography showed two spherical spac e-occupying structures in the right ventricle which were removed opera tively under the suspected diagnosis of multilobular myxomas. However, their histological examination revealed pure thrombi that had grown b y apposition. This unusual findings of right-ventricular thrombi could not be explained pre- and intraoperatively by any local thrombi-favou ring changes in the right heart. Tests of clotting mechanisms demonstr ated lupus anticoagulans (kaolin-clotting-time mixture test: LA index 21.7 [normal: <15]), as well as an increased IgG cardiolipin antibody concentration of 19.3 U/l). As no underlying disease was discovered, t he diagnosis was by definition primary antiphospholipid syndrome. No f urther thrombo-embolism has occurred during continuing oral anticoagul ation with phenprocoumon.