Left ventricular thrombosis caused cerebral embolism during venoarterial extracorporeal membrane oxygenation support: A case report

Abstract

BACKGROUND

Venoarterial (VA) extracorporeal membrane oxygenation (ECMO), an effective short-term circulatory support method for refractory cardiogenic shock, is widely applied. However, retrospective analyses have shown that VA-ECMO-assisted cases were associated with a relatively high mortality rate of approximately 60%. Embolization in important organs caused by complications of left ventricular thrombosis (LVT) during VA-ECMO is also an important reason. Although the incidence of LVT during VA-ECMO is not high, the consequences of embolization are disastrous.

CASE SUMMARY

A 37-year-old female patient was admitted to hospital because of fever for 4 d and palpitations for 3 d. After excluding the diagnosis of coronary heart disease, we established a diagnosis of “clinically explosive myocarditis”. The patient still had unstable hemodynamics after drug treatment supported by VA-ECMO, with heparin for anticoagulation. On day 4 of ECMO support, a left ventricular thrombus attached to the papillary muscle root of the mitral valve was found by transthoracic echocardiography. Left ventricular decompression was performed and ECMO was successfully removed, but the patient eventually died of multiple cerebral embolism.

CONCLUSION

LVT with high mobility during VA-ECMO may cause embolism in important organs. Therefore, a "wait and see" strategy should be avoided.

Keywords: Venoarterial extracorporeal membrane oxygenation; Left ventricular thrombosis; Cerebral embolism; Magnetic Resonance Imaging; Therapy; Case report

Core Tip: Embolism in vital organs (brain, mesenteric artery, etc.) caused by detachment of a left ventricular thrombosis (LVT) can lead to catastrophic consequences. We report a case of explosive myocarditis in which a LVT was attached to the papillary muscle root of the mitral valve, which resulted in massive cerebral emboli. Although a "wait and see" strategy can be adopted considering the autolytic rate of LVT and the fatal complications associated with thrombolysis and surgical thrombectomy, more aggressive treatment methods should be adopted for left ventricular thrombi with high mobility, such as transcatheter left ventricular thrombolysis or surgical thrombectomy.