Left ventricle unloading by percutaneous pigtail during extracorporeal membrane oxygenation

Abstract

Arterial-venous extracorporeal membrane oxygenation (ECMO) is more and more used as first line mechanical support in acute cardiopulmonary failure. Important pitfall of this technique is the inappropriate unloading of left ventricle (LV) in case of myocardial insufficiency, leading to pulmonary stasis and inadequate myocardial recovery. We report our experience of left side unloading by a 7-F pigtail, introduced in the LV through the aortic valve, connected to the venous drainage. Echographic guidance is sufficient to pigtail positioning and follow-up monitoring avoiding catheterization laboratory transport. With this approach we were able to support three different patients, resolving LV distension and preventing lung congestion, without major complication.

Percutaneous Decompression of the Left Ventricle in Cardiogenic Shock Patients on Venoarterial Extracorporeal Membrane Oxygenation

“…Surgical decompression of the LV is generally achieved via a large cannula placed into the LV or the right upper pulmonary vein via a sternotomy or minithoracotomy . Due to the significant morbidity associated with these surgical techniques, several percutaneous alternatives were developed . These methods include placing a simple ‘venting’ catheter with multiple side holes into the LV, incorporating a large bore cannula (placed in the LV or in the pulmonary artery) into the ECMO circuit, or combing ECMO support with percutaneous left ventricular assist devices (pLVAD) such as Impella and TandemHeart.…”

“…The placement of a 7Fr pigtail catheter into the LV during ECMO support is a simple and readily available method for LV decompression . However, the unloading ability of such small catheters is limited, and larger bore cannulas are needed to provide a higher degree of unloading in many patients.…”

Positionspapier der Österreichischen Kardiologischen Gesellschaft zum Einsatz der extrakorporalen Membranoxygenation (ECMO) bei Erwachsenen kardiologischen Patienten

“…unmöglich werden. In mehreren Fallberichten wurden unterschiedliche Techniken (atriale Septostomie, trans-aortal eingeführte Pigtaildrainage oder Impella LP2.5 Pumpe) zur Entlastung einer linksventrikulären Dilatation während ECMO Therapie beschrieben [39][40][41][42][43].…”

Relation Between Left Ventricular Unloading During Ecmo and Drainage Catheter Size Assessed by Mathematical Modeling

“…A number of sources mention that the drainage catheter is successfully used for the LV unloading during the ECMO therapy [3,[16][17][18][19][20], but there is very little knowledge of the catheter size for an adequate LV unloading. This study was focused on the withdrawn blood volumes from the LV for a one cardiac cycle.…”