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Mitral valve replacement through mini sternotomy after long ECMO course: Case report
Tamer Abdalghafoor1, Hatem Sarhan1, Ali Kindawi1
1Department of Cardiothoracic Surgery, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
Introduction:
Mitral regurgitation (MR) is defined as an abnormal reversal of blood flow from the left ventricle to the left atrium (LA). It is caused by disruption in any part of the mitral valve apparatus. Surgical intervention remains the mainstay of management for severe cases.
Case Summary:
We are reporting a case of pneumonia with severe sepsis, that had a complicated hospital course. The patient developed multi-organ failure. Echocardiography on admission showed severe mitral regurgitation. He required early mechanical ventilation and then Veno-venous Extracorporeal Membrane Oxygenation (VV-ECMO) over 29 days. He might be the first case of Coronavirus Disease 2019 (COVID-19) in our hospital. Mitral valve replacement was done after stabilization of the patient and weaning from the ECMO.
Discussion:
Our report demonstrates that the use of a long term VV-ECMO as a bridge for stabilization, facilitates management of the critically ill respiratory failure patient with severe MR and patient outcomes. Still the long-term results and the optimal timing of intervention need more research to define.
Conclusion:
Our report demonstrates that the use of a long term VV ECMO facilitates management of patients with respiratory failure associated with severe MR. Future studies focusing on stabilizing such patients, might help to define the optimal timing for intervention in these patients and the long-term outcome.
Insights
Severe mitral regurgitation (MR) in a critically ill patient was managed with Veno-venous Extracorporeal Membrane Oxygenation (VV-ECMO) as a bridge to mitral valve replacement. This approach facilitated stabilization and improved outcomes.
Area of Science:
- Cardiology
- Critical Care Medicine
- Cardiovascular Surgery
Background:
- Severe mitral regurgitation (MR) often necessitates surgical intervention, but critically ill patients present management challenges.
- Respiratory failure, particularly in the context of severe sepsis and COVID-19, can complicate the care of patients with severe MR.
Observation:
- A patient with pneumonia, severe sepsis, and multi-organ failure presented with severe MR.
- The patient required mechanical ventilation and prolonged Veno-venous Extracorporeal Membrane Oxygenation (VV-ECMO) for 29 days due to respiratory failure.
- Mitral valve replacement was successfully performed after the patient was stabilized and weaned from VV-ECMO.
Findings:
- Long-term VV-ECMO served as a crucial bridge for stabilizing a critically ill patient with severe MR and respiratory failure.
- This strategy facilitated the eventual successful mitral valve replacement.
Implications:
- The use of long-term VV-ECMO can be a viable approach to manage critically ill patients with severe MR and respiratory failure.
- Further research is needed to determine the long-term outcomes and optimal timing for intervention in such complex cases.
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