Floating Clots in the Descending Aorta
A Rare Complication of Femoral Venoarterial Extracorporeal Membrane Oxygenation Combined With Microaxial Pump for Cardiogenic Shock
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- extracorporeal membrane oxygenation
- myocardial infarction
- shock, cardiogenic
Left ventricular (LV) distension during femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) support is an untoward complication, leading to pulmonary edema, insufficient myocardial recovery, and LV thrombosis.1 Impella (Abiomed, Danvers, MA) has been reported to effectively decompress such a distended LV with minimal invasion.2 However, we encountered a rare case who developed a huge thrombus in the descending aorta resulting from the stagnation of blood flow because of interaction between antegrade (Impella) and retrograde (VA-ECMO) flows despite adequate anticoagulation.
A 67-year-old man with history of hypertension, hyperlipidemia, diabetes mellitus, and chronic tobacco use presented to an outside hospital with chest pain and orthopnea. He was in a shock state, and his ECG showed ST elevations in the anterior leads. Emergent left heart catheter revealed total occlusion of proximal left anterior descending artery. He got intubated and was placed on an intra-aortic balloon pumping via right femoral artery. Thrombus extraction followed by coronary stenting was performed, but ultimately only thrombolysis in myocardial infarction grade 1 flow was …