Transitioning from VA to VV ECMO following mitral valve replacement successfully supported a patient with acute severe mitral regurgitation and persistent severe ARDS until weaning on day 20.
Case Report (n=1)
Sequential ECMO therapy, transitioning from VA to VV mode, is an effective strategy for managing patients with acute severe mitral regurgitation who evolve from circulatory collapse to isolated respiratory failure post-surgery.
Background: Acute severe mitral regurgitation (MR) due to chordae tendineae rupture is a life-threatening condition that can lead to rapid hemodynamic collapse and refractory respiratory failure, necessitating urgent surgical intervention and advanced mechanical circulatory support. Clinical Course: A 51-year-old male presented with fever, progressive dyspnea, and profound hypoxemia (SpO2 70–80%, P/F ratio < 100). Imaging and echocardiography confirmed diffuse pulmonary infiltrates and acute severe MR caused by chordae tendineae rupture. As the patient deteriorated into cardiogenic shock, peripheral veno-arterial (VA) ECMO was initiated as a bridge to emergency mitral valve replacement (MVR). Postoperatively, while cardiac function recovered, severe ARDS and hypoxemia persisted. To facilitate lung-protective ventilation and avoid the complications of arterial cannulation, the circuit was converted to veno-venous (VV) ECMO. The patient’s pulmonary status gradually improved, and he was successfully weaned from VV-ECMO on postoperative day 20. Discussion: In acute MR, VA-ECMO provides essential circulatory support but increases left ventricular (LV) afterload, which can exacerbate pulmonary edema. Following surgical correction, the primary challenge often shifts from cardiac failure to persistent lung injury (e.g., ARDS or pneumonia). Transitioning to VV-ECMO at this stage mitigates risks associated with prolonged VA-ECMO, such as differential hypoxia (Harlequin syndrome) and systemic thromboembolism, while optimizing respiratory recovery. Conclusion: Sequential ECMO therapy, transitioning from VA to VV mode, is an effective strategy to address the evolving physiological needs of patients with acute MR, transitioning from a state of circulatory collapse to one of isolated respiratory failure.
Wu et al. (Mon,) conducted a case report in Acute severe mitral regurgitation and severe ARDS (n=1). Transition from VA to VV ECMO was evaluated on Clinical recovery and weaning from ECMO. Transitioning from VA to VV ECMO following mitral valve replacement successfully supported a patient with acute severe mitral regurgitation and persistent severe ARDS until weaning on day 20.