Aortic Thrombus Formation in the Mixing Zone of a Patient With Acute Myocarditis

A 66-year-old man presented with chills, exertional dyspnea, and palpitations; he later developed a fever. Because of his elevated cardiac enzymes and electrocardiography and coronary angiography findings, he was diagnosed with acute myocarditis. Given his unstable hemodynamics, an intra-aortic balloon pump was inserted; however, he experienced a hemodynamic collapse due to refractory ventricular fibrillation. He was then cannulated with venoarterial extracorporeal membrane oxygenation and microaxial flow pump and underwent steroid pulse therapy. His lactate levels were elevated, and computed tomography imaging revealed an aortic thrombus possibly formed in the mixing zone of the venoarterial extracorporeal membrane oxygenation and microaxial flow pump. Based on the antibody test results, he was diagnosed with heparin-induced thrombocytopenia; thus, heparin was replaced with argatroban. Surgical intervention restored the arterial flow. The patient was stabilized and discharged on day 47.