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LV LA LV LA RA RV E E Figure 1. Transthoracic echocardiography: Apical two left and four right chambers view revealed two gigant thrombus (arrows) in the apical and mid-anterior walls. LV = left ventricle, RV = Right ventricle, LA = left atrium, RA = Right atrium.A 57-year-old man was evaluated for progressive effort intolerance. Transthoracic echocardiography (TTE) revealed four-chamber dilation, and severe systolic dysfunction. Two gigant nonpedunculated thrombi were seen in the apical segment, which measured 3 cm and a prominent left ventricular (LV) thrombus in mid-anterior wall of the dilated left ventricle (Fig. 1). Depending on size, location, and mobility, left ventricular thrombi have the tendency to embolize, sometimes with direct consequences. Proper management of these thrombi is still controversial. 1The patient was commenced on warfarin. A second TTE was repeated after two months of warfarin therapy showed complete resolution of the thrombus (Fig. 2). Reference 1. Davutoglu V, Soydinc S, Sezen Y: Complete lysis of left ventricular giant thrombus with fibrinolytic therapy in clopidogrel resistant patient.

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A patient who had been previously diagnosed with congenital complete atrioventricular block (CCAVB) twenty years ago developed atrioventricular (AV) conduction through an accessory pathway (AP). With enhanced sympathetic tone (exercise, isoproterenol), 1:1 conduction down the AP occurred. An electrophysiologic study confirmed a suprahissian AV block and the presence of an AP. The AP was located on the left side and posterior. The absence of retrograde conduction through the AP and also a long conduction time were demonstrated.