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Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
03:40

Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting

Published on: January 17, 2025

Huge intracardiac thrombosis in a patient on veno-arterial extracorporeal membrane oxygenation support

Florian Weis1, Andres Beiras-Fernandez, Dirk Bruegger

  • 1Department of Anesthesiology, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany. Florian.Weis@med.uni-muenchen.de

Interactive Cardiovascular and Thoracic Surgery
|November 15, 2008
PubMed

Insights

Congenital hypertrophic obstructive cardiomyopathy (HOCM) patients undergoing TASH and AICD implantation may face acute heart failure and severe cardiac thrombosis, even with anticoagulation.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Critical Care Medicine

Background:

  • Congenital hypertrophic obstructive cardiomyopathy (HOCM) presents significant challenges in heart failure management.
  • Transcoronary ablation of the septal hypertrophy (TASH) and automated cardioverter/defibrillator (AICD) implantation are therapeutic options for symptomatic HOCM.

Observation:

  • A young woman with HOCM experienced acute heart failure post-TASH and AICD implantation.
  • The patient required veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support.
  • Near-complete thrombosis of cardiac chambers developed despite therapeutic anticoagulation.

Findings:

  • Perioperative acute heart failure is a potential complication following TASH and AICD procedures in HOCM.
  • Severe intra-cardiac thrombosis can occur in the context of VA-ECMO and anticoagulation therapy.
  • The interplay between HOCM, surgical interventions, and anticoagulation requires further investigation.

Implications:

  • This case highlights the critical need for vigilant monitoring for thrombosis in HOCM patients post-intervention.
  • Optimal anticoagulation strategies in patients with HOCM on VA-ECMO warrant further research.
  • Understanding and mitigating perioperative complications are crucial for improving outcomes in HOCM management.

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