Bai YB, Zhao F, Wu ZH, Shi GN, Jiang N. Left ventricular thrombosis caused cerebral embolism during venoarterial extracorporeal membrane oxygenation support: A case report. World J Clin Cases 2024; 12(5): 973-979 [PMID: 38414596 DOI: 10.12998/wjcc.v12.i5.973]
Corresponding Author of This Article
Zhen-Hua Wu, MD, Chief Doctor, Intensive Care Unit, Department of Cardiac Surgery, Tianjin Chest Hospital, No. 261 Taierzhuang South Road, Jinnan District, Tianjin, Tianjin 300222, China. wzh8306@sina.cn
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Feb 16, 2024; 12(5): 973-979 Published online Feb 16, 2024. doi: 10.12998/wjcc.v12.i5.973
Left ventricular thrombosis caused cerebral embolism during venoarterial extracorporeal membrane oxygenation support: A case report
Yao-Bang Bai, Feng Zhao, Zhen-Hua Wu, Guo-Ning Shi, Nan Jiang
Yao-Bang Bai, Zhen-Hua Wu, Guo-Ning Shi, Intensive Care Unit, Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin 300222, China
Feng Zhao, Nan Jiang, Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin 300222, China
Author contributions: Zhao F, Shi GN and Jiang N contributed to acquisition, analysis and interpretation of the data; all authors participated in drafting the manuscript; Jiang N and Zhao F critically revised the manuscript; all authors read and approved the final version of the manuscript. Bai YN and Zhao F give substantial contributions to the conception or the design of the manuscript.
Supported byTianjin Health Science and Technology Project, No. ZC20147.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhen-Hua Wu, MD, Chief Doctor, Intensive Care Unit, Department of Cardiac Surgery, Tianjin Chest Hospital, No. 261 Taierzhuang South Road, Jinnan District, Tianjin, Tianjin 300222, China. wzh8306@sina.cn
Received: October 27, 2023 Peer-review started: October 27, 2023 First decision: December 7, 2023 Revised: December 13, 2023 Accepted: January 18, 2024 Article in press: January 18, 2024 Published online: February 16, 2024 Processing time: 95 Days and 16.9 Hours
Abstract
BACKGROUND
Venoarterial (VA) extracorporeal membrane oxygenation (ECMO), an effective short-term circulatory support method for refractory cardiogenic shock, is widely applied. However, retrospective analyses have shown that VA-ECMO-assisted cases were associated with a relatively high mortality rate of approximately 60%. Embolization in important organs caused by complications of left ventricular thrombosis (LVT) during VA-ECMO is also an important reason. Although the incidence of LVT during VA-ECMO is not high, the consequences of embolization are disastrous.
CASE SUMMARY
A 37-year-old female patient was admitted to hospital because of fever for 4 d and palpitations for 3 d. After excluding the diagnosis of coronary heart disease, we established a diagnosis of “clinically explosive myocarditis”. The patient still had unstable hemodynamics after drug treatment supported by VA-ECMO, with heparin for anticoagulation. On day 4 of ECMO support, a left ventricular thrombus attached to the papillary muscle root of the mitral valve was found by transthoracic echocardiography. Left ventricular decompression was performed and ECMO was successfully removed, but the patient eventually died of multiple cerebral embolism.
CONCLUSION
LVT with high mobility during VA-ECMO may cause embolism in important organs. Therefore, a "wait and see" strategy should be avoided.
Core Tip: Embolism in vital organs (brain, mesenteric artery, etc.) caused by detachment of a left ventricular thrombosis (LVT) can lead to catastrophic consequences. We report a case of explosive myocarditis in which a LVT was attached to the papillary muscle root of the mitral valve, which resulted in massive cerebral emboli. Although a "wait and see" strategy can be adopted considering the autolytic rate of LVT and the fatal complications associated with thrombolysis and surgical thrombectomy, more aggressive treatment methods should be adopted for left ventricular thrombi with high mobility, such as transcatheter left ventricular thrombolysis or surgical thrombectomy.
