Postoperative prosthetic mitral valve occlusion due to left atrial thrombus during veno-arterial extracorporeal membrane oxygenation: a case report

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...

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Bibliographic Details
Published in:JA clinical reports 2022-12, Vol.8 (1), p.93-93, Article 93
Main Authors: Kiuchi, Naoto, Seino, Yusuke, Yamamoto, Mai, Katagiri, Seidai, Takagi, Shunichi, Nomura, Takeshi, Suzuki, Takahiro
Format: Article
Language:English
Subjects:
Anesthesiology
Blood clots
Case Report
Case reports
Critical Care Medicine
Emergency Medicine
Extracorporeal membrane oxygenation
Heart surgery
Intensive
Left atrial thrombus
Medicine
Medicine & Public Health
Mitral valve occlusion
Pain Medicine
Prostheses
Prosthetic valve
Transesophageal echocardiography
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Summary: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.
ISSN:2363-9024
2363-9024
DOI:10.1186/s40981-022-00586-5