Key result
Emergent thrombus evacuation and revised cannulation with a 36 French angled cannula in the left ventricular apex successfully bridged a patient with pan-LV thrombosis to a durable LVAD without neurological injury.
Case Report (n=1)
Apical left ventricular cannulation can effectively decompress the ventricle and prevent embolization in patients with pan-LV thrombosis on ECMO, serving as a successful bridge to durable LVAD.
We present the case of a 57 year old woman who developed pan-left ventricular thrombus while being supported with central extracorporeal membrane oxygenation support for cardiogenic shock. The left heart thrombus was evacuated emergently through the aortic valve, left atriotomy, and left ventriculotomy. The cannulation was then revised with the addition of a 36 French angled cannula in the apex of the left ventricle to decompress the ventricle, minimize stasis, and allow for any residual microthrombus to be trapped in the oxygenator membrane, not causing embolization. Once her neurological status was confirmed intact, a durable device was implanted. She recovered well without any neurological injury.
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Ogawa et al. (2016) conducted a case report in Pan-left ventricular thrombus during central ECMO for cardiogenic shock (n=1). Thrombus evacuation and revised cannulation with a 36 French angled cannula in the LV apex was evaluated on Neurological status and recovery. Emergent thrombus evacuation and revised cannulation with a 36 French angled cannula in the left ventricular apex successfully bridged a patient with pan-LV thrombosis to a durable LVAD without neurological injury.
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