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Wang YD, Lin JF, Huang XY, Han XD. Successful treatment of veno-arterial extracorporeal membrane oxygenation complicated with left ventricular thrombus by intravenous thrombolysis: A case report. World J Clin Cases 2023; 11:3323-3329. [PMID: 37274033 PMCID: PMC10237126 DOI: 10.12998/wjcc.v11.i14.3323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/22/2023] [Accepted: 04/04/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Left ventricular thrombus is a rare condition, for which appropriate treatments are not extensively studied. Although it can be treated by thrombectomy, such surgery can be difficult and risky, and not every patient can tolerate the surgery.
CASE SUMMARY We report a case of a middle-aged man receiving veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for acute myocardial infarction who developed left ventricular thrombus despite systemic anticoagulation. After systemic thrombolysis with urokinase, the left ventricular thrombus disappeared, ECMO was successfully withdrawn 9 days later, and the patient recovered and was discharged from hospital.
CONCLUSION Systemic thrombolysis is a treatment option for left ventricular thrombus in addition to anticoagulation and thrombectomy.
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Affiliation(s)
- Ya-Dong Wang
- Intensive Care Medicine, Nantong Third People's Hospital, Nantong 226000, Jiangsu Province, China
| | - Jin-Feng Lin
- Critical Care Medicine, Nantong Third People’s Hospital, Nantong 226000, Jiangsu Province, China
| | - Xiao-Ying Huang
- Critical Care Medicine, Nantong Third People’s Hospital, Nantong 226000, Jiangsu Province, China
| | - Xu-Dong Han
- Critical Care Medicine, Nantong Third People’s Hospital, Nantong 226000, Jiangsu Province, China
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Kiuchi N, Seino Y, Yamamoto M, Katagiri S, Takagi S, Nomura T, Suzuki T. Postoperative prosthetic mitral valve occlusion due to left atrial thrombus during veno-arterial extracorporeal membrane oxygenation: a case report. JA Clin Rep 2022; 8:93. [PMID: 36471130 PMCID: PMC9723070 DOI: 10.1186/s40981-022-00586-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Anticoagulation using heparin is generally used to prevent thrombus formation during mechanical circulatory support, such as veno-arterial extracorporeal membrane oxygenation (VA-ECMO). However, during the early period following cardiac surgery, anticoagulation becomes more difficult due to the greater risk of critical bleeding complications. CASE PRESENTATION A 71-year-old man presented with acute prosthetic valve occlusion caused by left atrial thrombus formation and bioprosthetic valve thrombosis during peripheral VA-ECMO following mitral valve replacement (MVR) despite continuous heparin administration and loading of antiplatelet agents. The VA-ECMO flow rate decreased 10 h after the intensive care unit (ICU) admission after MVR. Exploratory transesophageal echocardiography (TEE) examination revealed a left atrial thrombus, prosthetic valve obstruction by the thrombus, and an intrapericardial hematoma. CONCLUSIONS Intracardiac thrombus formation might occur during VA-ECMO despite appropriate anticoagulation and loading of antiplatelet agents. Exploratory TEE examination was helpful in the detection of intra-atrial thrombus formation after cardiac surgery and surgical decision-making.
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Affiliation(s)
- Naoto Kiuchi
- grid.260969.20000 0001 2149 8846Department of Anesthesiology, Nihon University School of Medicine, 30-1 Kamicho Oyaguchi, Itabashi-ku, Tokyo, Japan
| | - Yusuke Seino
- grid.410818.40000 0001 0720 6587Department of Intensive Care Medicine, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan ,grid.412764.20000 0004 0372 3116Department of Anesthesiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Japan
| | - Mai Yamamoto
- grid.260969.20000 0001 2149 8846Department of Anesthesiology, Nihon University School of Medicine, 30-1 Kamicho Oyaguchi, Itabashi-ku, Tokyo, Japan
| | - Seidai Katagiri
- grid.260969.20000 0001 2149 8846Department of Anesthesiology, Nihon University School of Medicine, 30-1 Kamicho Oyaguchi, Itabashi-ku, Tokyo, Japan
| | - Shunichi Takagi
- grid.260969.20000 0001 2149 8846Department of Anesthesiology, Nihon University School of Medicine, 30-1 Kamicho Oyaguchi, Itabashi-ku, Tokyo, Japan
| | - Takeshi Nomura
- grid.410818.40000 0001 0720 6587Department of Intensive Care Medicine, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Takahiro Suzuki
- grid.260969.20000 0001 2149 8846Department of Anesthesiology, Nihon University School of Medicine, 30-1 Kamicho Oyaguchi, Itabashi-ku, Tokyo, Japan
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Challa A, Latona J, Fraser J, Spanevello M, Scalia G, Burstow D, Platts D. Mitral valve bio-prosthesis and annuloplasty thrombosis during extracorporeal membrane oxygenation: case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-6. [PMID: 32617486 PMCID: PMC7319831 DOI: 10.1093/ehjcr/ytaa085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 08/29/2019] [Accepted: 03/23/2020] [Indexed: 11/14/2022]
Abstract
Background Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a well-recognized form of haemodynamic support for patients with refractory cardiogenic shock, who are unable to be weaned off cardiopulmonary bypass. Thrombosis or bleeding from cannula sites or surgical wounds are the leading cause of morbidity and mortality in these patients, and presents a delicate balance of anticoagulation during management of patients undergoing circulatory support. Case summary In this case series, we discuss three cases of patients undergoing mitral valve replacements or repair with thrombosis of their new bio-prosthesis in the immediate post-operative setting. All three patients were supported with VA-ECMO post-operatively, and thrombosis occurred despite anticoagulation. Discussion During extracorporeal membrane oxygenation, the reduced flow throughout the heart increases the risk of intra-cardiac thrombosis. This is of particular importance in the context of mitral valve replacements and repairs, where the bio-prosthesis is an additional risk factor for thrombosis. Our cases demonstrate the morbidity and mortality of such complications, with the likely aetiology being low transvalvular flow in a newly inserted valve combined with the pro-thrombotic state created by the VA-ECMO circuit.
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Affiliation(s)
- Abhinay Challa
- Department of Cardiology, The Prince Charles Hospital, Chermside, 4032 Brisbane, Australia.,Bond University, Robina, 4226 Gold Coast, Australia
| | - Jilani Latona
- Department of Cardiology, The Prince Charles Hospital, Chermside, 4032 Brisbane, Australia
| | - John Fraser
- University of Queensland, St Lucia, 4072 Brisbane, Australia.,Critical Care Research Group, The Prince Charles Hospital, Chermside, 4032 Brisbane, Australia
| | - Michelle Spanevello
- University of Queensland, St Lucia, 4072 Brisbane, Australia.,Department of Haematology, Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, 4029 Brisbane, Australia
| | - Gregory Scalia
- Department of Cardiology, The Prince Charles Hospital, Chermside, 4032 Brisbane, Australia.,University of Queensland, St Lucia, 4072 Brisbane, Australia
| | - Darryl Burstow
- Department of Cardiology, The Prince Charles Hospital, Chermside, 4032 Brisbane, Australia.,University of Queensland, St Lucia, 4072 Brisbane, Australia
| | - David Platts
- Department of Cardiology, The Prince Charles Hospital, Chermside, 4032 Brisbane, Australia.,University of Queensland, St Lucia, 4072 Brisbane, Australia.,Critical Care Research Group, The Prince Charles Hospital, Chermside, 4032 Brisbane, Australia
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Martínez Salgado A, Taboada Muñiz M, Martínez Cereijo JM, Otero Castro P, Álvarez Escudero J. Double intracardiac thrombosis in a patient assisted by a venoarterial extracorporeal membrane oxygenation. ACTA ACUST UNITED AC 2019; 66:335-337. [PMID: 30718016 DOI: 10.1016/j.redar.2018.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/19/2018] [Accepted: 12/24/2018] [Indexed: 11/28/2022]
Abstract
Intracardiac thrombosis is a rare complication in patients receiving haemodynamic support with venous-arterial extracorporeal membrane oxygenation (VA-ECMO), but it has a high risk of mortality. This case report describes a patient who suffered cardiogenic shock after a ST-segment elevation myocardial infarction (STEMI) and who presented with intracardiac thrombosis during VA-ECMO support on two occasions after mitral valve replacement. The first one was after the insertion of a mechanical prosthesis, and the second, after replacing it with a biological valve.
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Affiliation(s)
- A Martínez Salgado
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España.
| | - M Taboada Muñiz
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - J M Martínez Cereijo
- Servicio de Cirugía Cardíaca, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - P Otero Castro
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - J Álvarez Escudero
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España; Departamento de Cirugía y Especialidades Médico-Quirúrgicas, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, España
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Sachdev S, Bardia N, Nguyen L, Omar B. Bioprosthetic Valve Thrombosis. Cardiol Res 2018; 9:335-342. [PMID: 30627283 PMCID: PMC6306127 DOI: 10.14740/cr789] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 10/25/2018] [Indexed: 11/14/2022] Open
Abstract
Degenerative valve disease is on the rise with greater than 100,000 valve operations performed in the US alone per year. The majority of those procedures employ tissue bioprostheses to avoid the attendant risk of anticoagulation, especially in the elderly. Though traditionally this approach has been considered a superior option to avoid anticoagulation, more recent analyses have demonstrated a significant incidence of previously unrecognized thrombosis associated with bioprosthetic valves, especially with the more recent advent of the transcatheter aortic valve replacement implantations. Bioprosthetic valve thrombosis is a major cause of either acute or indolent bioprosthetic valve degeneration, and often has an elusive presentation causing delayed recognition and treatment. The literature has extensively addressed the risks and benefits of anticoagulation following bioprosthetic valve replacement to prevent bioprosthetic valve thrombosis (BPVT), without conclusive evidence-based recommendations. The duration of anticoagulation following an episode of BPVT is unclear, and lifelong anticoagulation has been suggested. The increasing use of transcatheter aortic valve replacement as an alternative to surgical aortic valve replacement in various risk groups has introduced new challenges with regards to valve thrombosis, which have been poorly studied with regards to optimal treatment and prevention. The increasing use of valve-in-valve procedures is expected to bring on further uncharted challenges.
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Affiliation(s)
| | - Nikky Bardia
- University of South Alabama, Mobile, AL 36617, USA
| | | | - Bassam Omar
- University of South Alabama, Mobile, AL 36617, USA
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