Catastrophic Left Ventricular Thrombosis Complicating Extra-corporeal Membrane Oxygenation: A Case Report

Pořízka, Michal; Kopecký, P; Mikulenka, Vladimír; Kunstýř, Jan; Lipš, Michal; Borggrefe, Martin

doi:10.14712/23362936.2017.15

Cited by 1 publication

(3 citation statements)

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“…23 Interestingly, in this report, the LV thrombus was only identified on Day 4 post-operatively despite daily transthoracic echocardiograms. 23 A review incorporating 12 case reports describes intracardiac thrombus formation despite heparin anticoagulation, but the presence or absence of pulsatility was not defined. 24 There was marked heterogeneity in these cases with a minority being post-cardiotomy.…”

Section: Discussionmentioning

confidence: 52%

“…A further case report described LV thrombus in an akinetic LV supported with C-VA-ECMO following AV replacement. 23 This occurred despite heparin anticoagulation being commenced on post-operative Day 1. 23 Interestingly, in this report, the LV thrombus was only identified on Day 4 post-operatively despite daily transthoracic echocardiograms.…”

Section: Discussionmentioning

confidence: 99%

“…23 This occurred despite heparin anticoagulation being commenced on post-operative Day 1. 23 Interestingly, in this report, the LV thrombus was only identified on Day 4 post-operatively despite daily transthoracic echocardiograms. 23 A review incorporating 12 case reports describes intracardiac thrombus formation despite heparin anticoagulation, but the presence or absence of pulsatility was not defined.…”

Section: Discussionmentioning

confidence: 99%

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Thrombotic risk in central venoarterial extracorporeal membrane oxygenation post cardiac surgery

et al. 2020

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Introduction: Post-cardiotomy cardiogenic shock is an accepted indication for venoarterial extracorporeal membrane oxygenation. The true incidence and risk factors for the development of thrombosis in this setting remain unclear. Methods: Patients supported with central venoarterial extracorporeal membrane oxygenation due to ventricular dysfunction precluding weaning from cardiopulmonary bypass were retrospectively identified. Electronic records from a single institution spanning a 4-year period from January 2015 to December 2018 were interrogated to assess the incidence of thrombosis. The relationship to exposures including intracardiac stasis and procoagulant usage was explored. Results: Twenty-four patients met the inclusion criteria and six suffered major intracardiac thrombosis. All cases of thrombosis occurred early, and none survived to hospital discharge. The lack of left ventricular ejection conferred a 46% risk of developing thrombosis compared to 0% if ejection was maintained (p = 0.0093). Aprotinin use was also associated with thrombus formation (p = 0.035). There were no significant differences between numbers of patients receiving other procoagulants when grouped by thrombosis versus no thrombosis. Conclusion: Stasis is the predominant risk factor for intracardiac thrombosis. This occurs rapidly and the outcome is poor. As a result, we suggest early left ventricular decompression. Conventional management of post-bypass coagulopathy seems safe if the aortic valve is opening.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%