LAUSR

A 3-year-old male presented with a history of cyanosis and recurrent cyanotic spells. An echocardiogram demonstrated a large ventricular septal defect (VSD) and severe infundibular and pulmonary valvular stenosis consistent with tetrology of Fallot (TOF). In addition, there was a 2.4 × 1.1-cm left ventricular (LV) mass arising from the LV apex via a narrow stalk (Figure 1; Supplementary Video S1). A computed tomography angiogram confirmed the presence of the LV mass (Figures 2A and 2B). A preoperative thromboticworkup revealed a hemoglobin of 24 g/dl, a hematocrit of 72%, a white blood cell count of 5000, a platelet count of 88,000, a bleeding time of 80 seconds, a clotting time of 2 minutes 3 seconds, and an international normalized ratio of 1.4.We suspect that the hyperviscosity due to the elevated hematocrit and decreased platelet countwas responsible for the LVclot. Following a platelet transfusion, the patient underwent urgent repair of the TOF. A patent foramen of ovale (PFO) was enlarged and the LV mass was removed after retracting the FIGURE 1 Parasternal short axis view showing LV mass arising from LV apex. LV = left ventricular