Abstract
We report a case of mechanical prosthetic mitral valve thrombosis in a 52-year-old
woman with previous diagnosis of dilated cardiomyopathy, who was supported with advanced
mechanical circulatory support after urgent mechanical mitral valve replacement (MVR)
and tricuspid annuloplasty. Difficult weaning from cardiopulmonary bypass needed support
with veno-arterial extracorporeal membranous oxygenation and Impella (Abiomed Inc,
Danvers, MA, USA), so-called ECPELLA. Temporary discontinuation of heparin and massive
blood transfusion were necessary due to four times of reoperation for bleeding during
ECPELLA support. Poor recovery of cardiac function needed escalation from ECPELLA
to extracorporeal biventricular assist device (ex-BiVAD) using two centrifugal pumps
on Day 12. After gradual decrease in the left ventricular assist device flow, transesophageal
echocardiography and fluoroscopic images revealed the stuck leaflets of the mitral
prosthesis. Therefore, the patient underwent re-MVR with a bioprosthesis on Day 18,
followed by continued assistance with ex-BiVAD. The patient was finally weaned from
ex-BiVAD on Day 28 and was transferred to the referral hospital for rehabilitation.
She was alive in good general condition at 2-year follow-up. It is important to balance
the effects of anticoagulation on advanced mechanical circulatory support with ECPELLA,
against the side effects of bleeding, especially in post-cardiotomy patients with
bleeding tendency.
<Learning objective: We should recognize the fatal risks of bleeding and thrombosis during advanced mechanical
support, including Impella, VA-ECMO, ECPELLA, and ex-BiVAD, especially in the post-cardiotomy
setting. We should also understand the choice of mechanical circulatory support, timely
escalation to ex-BiVAD to avoid multiorgan failure, the diagnosis of mechanical mitral
prosthetic thrombosed valve using echocardiography and fluoroscopy, and mitral valve
replacement in the patient supported with ex-BiVAD.>
Keywords
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Article info
Publication history
Published online: December 16, 2021
Accepted:
November 8,
2021
Received in revised form:
October 10,
2021
Received:
July 14,
2021
Identification
Copyright
© 2021 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
