A Case of Acute Mechanical Mitral Valve Thrombosis Management With Venoarterial Extracorporeal Membrane Oxygenation

TL;DR

This paper describes a case where VA ECMO was used to manage a rare and life-threatening condition involving a mechanical mitral valve thrombosis, allowing for successful treatment and recovery.

Contribution

The paper presents a novel case of using VA ECMO to manage mitral PVT and discusses its potential as a perioperative support strategy.

Findings

VA ECMO successfully managed cardiogenic shock in a patient with mitral PVT.

VA ECMO allowed for reversal of multiple organ failure and deferred surgery in a high-risk patient.

The use of VA ECMO shows promise as a supportive strategy for PVT-related cardiorespiratory collapse.

Abstract

Mechanical prosthetic valve thrombosis (PVT) and obstruction are rare and dangerous events often related to inappropriate anticoagulant therapy. High mortality rates occur because of delayed diagnosis, hemodynamic instability, multiple organ failure (MOF), and high perioperative risk. Surgical repair is a first-line treatment for obstructive PVT with hemodynamic instability but is often not readily available or safely performed. Venoarterial extracorporeal membrane oxygenation (VA ECMO) support has been increasingly used in patients with PVT and cardiorespiratory collapse, allowing MOF reversal and safer deferred surgery. The authors present a case of a young female with refractory cardiogenic shock secondary to mitral PVT successfully managed with VA ECMO. Furthermore, the promising role of perioperative VA ECMO support for PVT-related cardiogenic shock is also discussed.

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