Successful treatment of veno-arterial extracorporeal membrane oxygenation complicated with left ventricular thrombus by intravenous thrombolysis: A case report

doi:10.12998/wjcc.v11.i14.3323

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World Journal of Clinical Cases

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Case Report

World J Clin Cases. May 16, 2023; 11(14): 3323-3329
Published online May 16, 2023. doi: 10.12998/wjcc.v11.i14.3323

Successful treatment of veno-arterial extracorporeal membrane oxygenation complicated with left ventricular thrombus by intravenous thrombolysis: A case report

Ya-Dong Wang, Jin-Feng Lin, Xiao-Ying Huang, Xu-Dong Han

Ya-Dong Wang, Intensive Care Medicine, Nantong Third People's Hospital, Nantong 226000, Jiangsu Province, China

Jin-Feng Lin, Xiao-Ying Huang, Xu-Dong Han, Critical Care Medicine, Nantong Third People’s Hospital, Nantong 226000, Jiangsu Province, China

Author contributions: Wang YD wrote the article, Lin JF reviewed the medical records, Huang XY conducted the literature review and Han XD revised the article; all authors have read and approved the final version to be submitted.

Informed consent statement: Informed written consent was obtained from the patient to publish this case report and accompanying images.

Conflict-of-interest statement: All the authors declare that they have no conflict of interest.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Xu-Dong Han, MD, Chief Physician, Critical Care Medicine, Nantong Third People’s Hospital, No. 60 Qingnian Road, Nantong 226000, Jiangsu Province, China. hanxudong9610@163.com

Received: February 13, 2023
Peer-review started: February 13, 2023
First decision: March 14, 2023
Revised: March 22, 2023
Accepted: April 4, 2023
Article in press: April 4, 2023
Published online: May 16, 2023
Processing time: 92 Days and 2.8 Hours

Abstract

BACKGROUND

Left ventricular thrombus is a rare condition, for which appropriate treatments are not extensively studied. Although it can be treated by thrombectomy, such surgery can be difficult and risky, and not every patient can tolerate the surgery.

CASE SUMMARY

We report a case of a middle-aged man receiving veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for acute myocardial infarction who developed left ventricular thrombus despite systemic anticoagulation. After systemic thrombolysis with urokinase, the left ventricular thrombus disappeared, ECMO was successfully withdrawn 9 days later, and the patient recovered and was discharged from hospital.

CONCLUSION

Systemic thrombolysis is a treatment option for left ventricular thrombus in addition to anticoagulation and thrombectomy.

Keywords: Extracorporeal membrane oxygenation; Left ventricular thrombus; Thrombolysis; Case report

Core Tip: Urokinase is a useful medicine for thrombolysis. This is the first case report of urokinase administration for left ventricular thrombus occurring during veno-arterial extracorporeal membrane oxygenation therapy. Systemic thrombolytic therapy with urokinase can be considered when the effect of anticoagulant therapy is poor or the risk of surgical treatment is high after left ventricular thrombus formation.