Ventricular Thrombosis Post-Venoarterial Extracorporeal Membrane Oxygenation
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The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for the support of critically ill patients with cardiogenic shock is rapidly increasing. Intracardiac thrombus formation is a well-recognized complication. We present 3 cases of dramatic intracardiac thrombosis after the initiation of VA-ECMO.
A 64-year-old man presented to a community hospital 3 days after the onset of chest pain with ECG evidence of anterior ST-elevation–myocardial infarction and clinical findings of cardiogenic shock. Physical examination was notable for a pansystolic murmur suggestive of a ventricular septal defect. Coronary angiography showed an occluded left anterior descending artery. Echocardiography confirmed an ischemic ventricular septal defect. He was taken urgently to the operating room for aortocoronary bypass and ventricular septal defect patch repair. Attempts to wean off cardiopulmonary bypass were unsuccessful, and the patient was placed on central VA-ECMO as a bridge to decision, with the chest left open. Forty-eight hours after the initiation of ECMO, the circuit was converted to a peripheral set-up to facilitate chest closure. Transesophageal echocardiogram performed 24 hours after chest closure showed complete thrombosis of the right ventricle despite full anticoagulation (Figure [A]; Movie I in the Data Supplement). He was taken back …