2026 FSA Podium and Poster Abstracts

Background: Transthoracic echocardiography (TTE) is a timely, noninvasive, and cost-effective method to evaluate cardiac structure and function. Anesthesiologists can perform focused TTE in the pre-operative setting to rapidly assess ventricular function, regional wall motion, volume status, and valvular function. These findings can prompt medical optimization, thereby improving postoperative outcomes.   

Clinical Vignette: A 59 year old male presented to the ED with a non-healing right foot wound, and was subsequently admitted to the medical floor. His RLE ABI was 0.71, suggesting moderate arterial disease, and was scheduled for RLE angiogram with possible intervention. His PMH included HTN, CAD s/p PCI to LAD in 2018 and CABG (LIMA to LAD and SVG to OM2) in 2020, chronic HFrEF (LVEF 25-30%) secondary to ICMP on GDMT, group 2 pulmonary hypertension, left ventricular thrombus (LVT) previously on apixaban, PAD s/p left BKA in December 2024 followed by AKA in February 2025, and schizoaffective disorder. In pre-op holding, a TTE was performed by the anesthesiology team to evaluate the patient’s cardiac structure and function.

Results: Pre-operative TTE revealed a sizable mobile thrombus in the left ventricle (Figure 1). Upon discussing this finding with the surgical team, we realized that the patient had not restarted anticoagulation since arriving in the hospital, despite his known prior diagnosis of LVT. This non-emergent case was deferred to allow for pre-operative anticoagulation due to the increased thromboembolic risk associated with proceeding. Formal TTE was obtained, which corroborated the finding of persistent LVT, along with other abnormalities consistent with the patient’s known cardiac history. The patient was started on a therapeutic heparin infusion, and subsequently underwent surgery four days later without complication.

Figure 1. Subcostal 4-chamber view illustrating a thrombus in the left ventricular apex.

Conclusion: In this scenario, pre-operative TTE allowed the anesthesiology team to uncover an unexpected finding, prompting further medical optimization. LVT is a known complication of acute MI (particularly those affecting the anterior wall) and non-ischemic cardiomyopathies, and can result in cerebral and peripheral arterial embolism. The reported risk of embolic events from a LVT post-MI ranges from 6.1% to 86%, and appears to be greatest in the first 3 months post MI. Anticoagulation should begin immediately and should continue for at least 3 months, after which the LVT should be reassessed via imaging. If no change in size of characteristics, anticoagulation and monitoring should continue on a regular basis.