Venovenous Extracorporeal Membrane Oxygenation for Alveolar Hemorrhage During Mitral Valve Repair via Right Minithoracotomy in a Patient With Myelodysplastic Syndrome

TL;DR

This paper describes the successful use of VV-ECMO to manage lung bleeding during heart surgery in a patient with MDS.

Contribution

The novel use of VV-ECMO for alveolar hemorrhage during minimally invasive mitral valve repair in MDS is presented.

Findings

VV-ECMO effectively provided oxygenation support during intraoperative lung hemorrhage.

Hemostasis was achieved without the need for mechanical circulatory support post-surgery.

The patient was successfully transitioned to the ICU after ECMO use.

Abstract

Cardiac surgery in patients with myelodysplastic syndrome (MDS) is difficult because extracorporeal circulation increases the risk of infection and hemorrhage. We discuss the efficacy of venovenous extracorporeal membrane oxygenation (VV-ECMO) in managing intraoperative alveolar hemorrhage in a patient with MDS undergoing minimally invasive cardiac surgery (MICS) for mitral valve repair. A 76-year-old man with MDS underwent mitral valve repair via right minithoracotomy with standard cardiopulmonary bypass. Left lung hemorrhage developed after declamping of the aorta, and oxygenation support was necessary when the cardiopulmonary bypass was finished, as a bridge until hemostasis. VV-ECMO was established, which involves withdrawing blood from the right femoral vein and returning it via the right internal jugular vein. Platelet transfusion and protamine were administered. Hemostasis was achieved, and the patient was admitted to the intensive care unit without mechanical circulatory support. VV-ECMO proved successful for MICS with hemorrhagic pulmonary complications.

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