Temporary left ventricular assist device may be safer than veno-arterial extracorporeal membrane oxygenation for treating shock in the presence of a mitral prosthesis

Figures

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  Atrial view of mitral prosthesis (black arrow) and associated thrombus (white arrow).

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  Figure 1. Thrombus partially occluding a recently implanted mitral prosthesis that developed during veno-arterial extracorporeal membrane oxygenation support. (A) Thrombus (white arrow) layering the left atrial wall. Color flow Doppler reveals accelerated blood flow due to partial occlusion of the prosthesis. (B) Elevated mean gradient (14 mm Hg) across the mitral orifice due to partial occlusion of the prosthesis. (C) Three-dimensional en-face atrial view of prosthesis (black arrow) and thrombus (white arrow). LA, Left atrium; RV, right ventricle; LV, left ventricle; PG, pressure gradient; VTI, velocity time integral.

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  Figure 2. Improved flow across mitral prosthesis after thrombus evacuation and conversion from veno-arterial extracorporeal membrane oxygenation to a temporary extracorporeal left ventricular assist device with apical cannulation. (A) Improved flow across the mitral prosthesis demonstrated by color flow Doppler. (B) Improved mean gradient (6 mm Hg) across the prosthesis after thrombus evacuation. (C) Three-dimensional en-face views of prosthesis (black arrow) after thrombus evacuation. LA, Left atrium; RV, right ventricle; LV, left ventricle; PG, pressure gradient; VTI, velocity time integral.