Aortic Root Thrombosis on ECMO-A Novel Management Strategy.

Area of Science:

• Pediatric Cardiology
• Critical Care Medicine
• Cardiovascular Research

Background:

• Viral myocarditis can lead to severe cardiogenic shock in adolescents.
• Extracorporeal membrane oxygenation (ECMO) is a critical support for pediatric patients with refractory cardiogenic shock.
• Thrombus formation in the left ventricle and aortic root is a serious complication during ECMO support.

Observation:

• A 15-year-old male presented with cardiogenic shock due to viral myocarditis, necessitating venoarterial ECMO.
• Large thrombi developed in the left ventricle and aortic root despite therapeutic anticoagulation.
• Interventions included increased anticoagulation, medications to prevent aortic valve opening, balloon atrial septostomy, left atrial vent, and direct aortic heparin infusion.

Findings:

• Serial echocardiograms demonstrated progressive resolution of the left ventricular and aortic root thrombi.
• The patient was successfully weaned from ECMO support.
• The patient was discharged home with no neurological deficits.

Implications:

• This case highlights a successful management strategy for complex thrombus formation in adolescents on ECMO for viral myocarditis.
• Multidisciplinary interventions can overcome life-threatening complications during mechanical circulatory support.
• Early recognition and aggressive management are crucial for favorable outcomes in pediatric cardiogenic shock with ECMO-related complications.