Case report
Double intracardiac thrombosis in a patient assisted by a venoarterial extracorporeal membrane oxygenation
Trombosis intracardíaca doble en paciente asistido mediante membrana de oxigenación extracorpórea venoarterial
A. Martínez Salgadoa,
, M. Taboada Muñiza, J.M. Martínez Cereijob, P. Otero Castroa, J. Álvarez Escuderoa,c
Corresponding author
a Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
b Servicio de Cirugía Cardíaca, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
c Departamento de Cirugía y Especialidades Médico-Quirúrgicas, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
Read
2
Timeswas read the article
0
Total PDF
2
Total HTML
Share statistics
array:24 [ "pii" => "S2341192919300848" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.12.011" "estado" => "S300" "fechaPublicacion" => "2019-06-01" "aid" => "1000" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "copyrightAnyo" => "2019" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2019;66:335-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "HTML" => 1 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0034935619300167" "issn" => "00349356" "doi" => "10.1016/j.redar.2018.12.010" "estado" => "S300" "fechaPublicacion" => "2019-06-01" "aid" => "1000" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Esp Anestesiol Reanim. 2019;66:335-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 75 "formatos" => array:2 [ "HTML" => 44 "PDF" => 31 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso clínico</span>" "titulo" => "Trombosis intracardíaca doble en paciente asistido mediante membrana de oxigenación extracorpórea venoarterial" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "335" "paginaFinal" => "337" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Double intracardiac thrombosis in a patient assisted by a venoarterial extracorporeal membrane oxygenation" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1163 "Ancho" => 1500 "Tamanyo" => 71905 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Plano ecográfico de ETE centrado en la prótesis mitral, en donde se demuestra el bloqueo de uno de los hemidiscos de la prótesis mitral mecánica (flecha azul), al día siguiente de la colocación de la ECMO-VA.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">AI: aurícula izquierda; ECMO-VA: membrana de oxigenación extracorpórea venoarterial; ETE: ecocardiograma transesofágico; VI: ventrículo izquierdo.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Martínez Salgado, M. Taboada Muñiz, J.M. Martínez Cereijo, P. Otero Castro, J. Álvarez Escudero" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Martínez Salgado" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Taboada Muñiz" ] 2 => array:2 [ "nombre" => "J.M." "apellidos" => "Martínez Cereijo" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Otero Castro" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Álvarez Escudero" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341192919300848" "doi" => "10.1016/j.redare.2018.12.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192919300848?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935619300167?idApp=UINPBA00004N" "url" => "/00349356/0000006600000006/v1_201905250733/S0034935619300167/v1_201905250733/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341192919300824" "issn" => "23411929" "doi" => "10.1016/j.redare.2019.05.001" "estado" => "S300" "fechaPublicacion" => "2019-06-01" "aid" => "1006" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2019;66:338-41" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "PDF" => 2 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Anaesthetic management of C-section in Brugada syndrome: When less is more" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "338" "paginaFinal" => "341" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Manejo anestésico del síndrome de Brugada para cesárea: cuando menos es más" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Marques da Costa, M. Luís, F. Lança" "autores" => array:3 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Marques da Costa" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Luís" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Lança" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935619300258" "doi" => "10.1016/j.redar.2019.01.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935619300258?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192919300824?idApp=UINPBA00004N" "url" => "/23411929/0000006600000006/v1_201905290656/S2341192919300824/v1_201905290656/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341192919300903" "issn" => "23411929" "doi" => "10.1016/j.redare.2019.02.004" "estado" => "S300" "fechaPublicacion" => "2019-06-01" "aid" => "1016" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2019;66:324-34" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "HTML" => 2 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Continuing education</span>" "titulo" => "Emerging therapies in clinical development and new contributions for neuropathic pain" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "324" "paginaFinal" => "334" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Terapias emergentes en desarrollo clínico y nuevas aportaciones en dolor neuropático" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2462 "Ancho" => 2917 "Tamanyo" => 492690 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Mechanisms of action of EMA401 fulranumab. <span class="elsevierStyleBold">ASIC</span>: <span class="elsevierStyleItalic">Acid-sensing ion channel</span>; <span class="elsevierStyleBold">AT2R</span>: <span class="elsevierStyleItalic">Angiotensin II type 2 receptor</span><span class="elsevierStyleBold">NGF</span>: <span class="elsevierStyleItalic">Nerve growth factor</span>; <span class="elsevierStyleBold">PX/PY</span>: <span class="elsevierStyleItalic">Purinergic receptors</span>; <span class="elsevierStyleBold">ROS</span>: <span class="elsevierStyleItalic">Reactive oxygen species</span>; <span class="elsevierStyleBold">TrkA</span>: <span class="elsevierStyleItalic">Tropomyosin receptor kinase A</span>; <span class="elsevierStyleBold">TRPA1</span>: <span class="elsevierStyleItalic">Transient receptor potential ankyrin 1</span>; <span class="elsevierStyleBold">TRPV1</span>: <span class="elsevierStyleItalic">Transient receptor potential vanilloid 1.</span> (a) EMA401 is an AT2R antagonist. By blocking this receptor, immune system cells (such as macrophages) release less ROS that act on TRPA1 receptors, which are molecular integrators of many exogenous and endogenous noxious stimuli, including oxygen free radicals and other inflammatory agents released at the site of the injury, promoting the sensitisation of nociceptors. (b) Fulranumab is an anti-NGF antibody; it blocks TrkA, which is the NGF receptor. Under normal conditions, when the NGF bind to its receptor, it facilitates the transmission of the nociceptive signal. In addition, in peripheral sensitisation, stimulation of TrKA stimulates TRPV1, which is the target of multiple inflammatory mediators that trigger nociceptor sensitisation. Therefore, fulranumab can indirectly modulate the response of TRPV1, but has in itself a direct inhibitory effect on the nervous response through its own membrane receptor.</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Source</span>: Image courtesy of Carlos Goicoechea García.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Alcántara Montero, C.I. Sánchez Carnerero, C. Goicoechea García" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Alcántara Montero" ] 1 => array:2 [ "nombre" => "C.I." "apellidos" => "Sánchez Carnerero" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Goicoechea García" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935619300635" "doi" => "10.1016/j.redar.2019.02.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935619300635?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192919300903?idApp=UINPBA00004N" "url" => "/23411929/0000006600000006/v1_201905290656/S2341192919300903/v1_201905290656/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Double intracardiac thrombosis in a patient assisted by a venoarterial extracorporeal membrane oxygenation" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "335" "paginaFinal" => "337" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Martínez Salgado, M. Taboada Muñiz, J.M. Martínez Cereijo, P. Otero Castro, J. Álvarez Escudero" "autores" => array:5 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Martínez Salgado" "email" => array:1 [ 0 => "tinez_26@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Taboada Muñiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J.M." "apellidos" => "Martínez Cereijo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "P." "apellidos" => "Otero Castro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "J." "apellidos" => "Álvarez Escudero" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía Cardíaca, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Cirugía y Especialidades Médico-Quirúrgicas, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Trombosis intracardíaca doble en paciente asistido mediante membrana de oxigenación extracorpórea venoarterial" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1153 "Ancho" => 1500 "Tamanyo" => 100307 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">4-Chamber transoesophageal echocardiogram view, centred on the left cavities, showing a large intracardiac thrombus in the left atrium (red asterisk). Also note the absence of blood flow through the biological mitral prosthesis, shown on colour Doppler (red arrow).</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">AI: left atrium; lpm: beats per minute; VD: right ventricle; VI: left ventricle.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has become a vital tool in the treatment of patients with cardiogenic shock<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>; however, it is not without risks. The most frequent complications are bleeding and thrombus,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> which are associated with an in-hospital mortality rate of between 45% and 65%.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Intracardiac thrombosis (ICT) is a rare, potentially life-threatening complication.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Both its pathophysiology and therapeutic management are complex and multifactorial.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 66-year-old man with no personal history of interest, who was diagnosed with acute ST elevation myocardial infarction (STEMI), Killip III, with 3-vessel coronary artery disease and ventricular septal defect (VSD). An intra-aortic balloon pump (IABP) was placed and emergency on-pump surgery was performed.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Left internal mammary artery to left anterior descending artery bypass graft was performed, and the VSD was closed. Severe mitral regurgitation was observed during surgery, so an artificial mitral valve was placed.</p><p id="par0020" class="elsevierStylePara elsevierViewall">On postoperative day 1, in the postoperative care unit (PACU), the patient required high doses of catecholamines (up to 0.4<span class="elsevierStyleHsp" style=""></span>μg/kg/min norepinephrine and 7.8<span class="elsevierStyleHsp" style=""></span>μg/kg/min dobutamine) and IABP 1:1. A transoesophageal echocardiogram (TOE) showed severely depressed right ventricular function, absence of flow through the interventricular septum (IVS), and correct positioning and functioning of the mitral prosthesis. The patient made good progress over the following days, and he was extubated and the IABP was removed.</p><p id="par0025" class="elsevierStylePara elsevierViewall">However, he developed a clotting disorder and severe thrombocytopaenia (with a platelet count of less than 50,000/mm<span class="elsevierStyleSup">3</span>), which prevented us from starting anticoagulation therapy with intravenous heparin infusion until the fifth postoperative day. Prothrombin time testing was used to monitor clotting time, obtaining serial INR ranges with the lowest value being 70.2<span class="elsevierStyleHsp" style=""></span>s.</p><p id="par0030" class="elsevierStylePara elsevierViewall">On postoperative day 7, the patient presented sudden clinical worsening, involving respiratory distress, tachypnoea, tachycardia, elevated central venous pressure and low central venous oxygen saturation. Transthoracic echocardiography (TTE) showed reopening of the VSD, so the patient underwent emergency reoperation to replace the IABP and close the new VSD.</p><p id="par0035" class="elsevierStylePara elsevierViewall">TTE performed after cardiopulmonary bypass (CPB) weaning showed a thrombus in the mitral prosthesis, so CPB was restarted and the thrombus was removed. Due to a serious biventricular dysfunction that prevented CPB weaning, the patient was connected to a VA-ECMO system (Cardiohelp, Maquet) by peripheral cannulation of the ipsilateral femoral vein and artery, maintaining a constant flow rate of between 4.5 and 5.5 l/min. A left ventricle (LV) drain was not placed for 2 reasons: TOE showed that the remaining left ventricular function was sufficient for the aortic valve to open on each beat, and no LV dilation was observed. In addition, the presence of an IABP was considered sufficient to reduce LV afterload.</p><p id="par0040" class="elsevierStylePara elsevierViewall">On admission to the PACU, anticoagulation therapy was restarted with continuous infusion of heparin, which maintained clotting within INR ranges. The next day, the TOE showed a new thrombus in one of the leaflets of the mitral valve prosthesis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), so another urgent reoperation was required,</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">In this third intervention, the artificial mitral valve was replaced with a biological prothesis. TOE confirmed correct operation and absence of VSD. A follow-up TOE at 24<span class="elsevierStyleHsp" style=""></span>h showed severe depression of biventricular function and a large thrombus in the left atrium (LA), blocking the mitral prosthesis and preventing flow to the left chambers (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Heparin was up-dosed, without success. Given the patient's conditions and the extremely high risk, it was agreed jointly not to increase therapeutic measures, so 48<span class="elsevierStyleHsp" style=""></span>h later, with the ICT unresolved, the VA-ECMO was disconnected and the IABP removed. The patient died.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">In the context of a VSD, VA-ECMO can be used to both stabilise the patient for septal repair surgery, and as a bridge to transplantation.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">ICT in patients on VA-ECMO is a rare complication, and few cases have been published. This case is interesting because the patient presented ICT on 2 separate occasions, and with a biological prosthesis. Many factors can favour a procoagulant state in these patients: exposure of blood to synthetic material, ventricular dysfunction, inadequate heart drainage, antithrombin III deficiency, and inadequate anticoagulation therapy, among others.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> The prevention of ICT includes early initiation of anticoagulation,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> a high ECMO flow rate, which prevents the formation of thrombi in the circuit but not ICT,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> and the use of an IABP or an Impella device to improve LV drainage.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Recent evidence has shown that the combination of ECMO and Impella could improve outcomes compared to ECMO alone.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Once ICT has been diagnosed, treatment includes up-dosing heparin, fibrinolysis, and surgical thrombectomy.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> However, further studies are needed to specifically analyse these cases.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0065" class="elsevierStylePara elsevierViewall">ICT is a rare complication in patients on ECMO; nevertheless, a high index of suspicion should be maintained due to its high rate of mortality. Most importantly, ICT formation should be prevented by using a high ECMO flow rate, anticoagulation in the therapeutic range, and good cardiac drainage, considering the use of an Impella. TOE is essential in the management of patients on ECMO, because it can be used to verify correct cannulation and can haemodynamic status by monitoring heart function, thus facilitating early diagnosis of complications such as ICT.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Funding</span><p id="par0070" class="elsevierStylePara elsevierViewall">No funding was received for this study.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1196201" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1114599" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1196200" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1114598" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-09-11" "fechaAceptado" => "2018-12-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1114599" "palabras" => array:3 [ 0 => "Intracardiac thrombosis" 1 => "VA-ECMO" 2 => "Transoesophageal echocardiography" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1114598" "palabras" => array:3 [ 0 => "Trombosis intracardíaca" 1 => "ECMO-VA" 2 => "Ecocardiografía transesofágica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Intracardiac thrombosis is a rare complication in patients receiving haemodynamic support with venous-arterial extracorporeal membrane oxygenation (VA-ECMO), but it has a high risk of mortality. This case report describes a patient who suffered cardiogenic shock after a ST-segment elevation myocardial infarction (STEMI) and who presented with intracardiac thrombosis during VA-ECMO support on two occasions after mitral valve replacement. The first one was after the insertion of a mechanical prosthesis, and the second, after replacing it with a biological valve.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La trombosis intracardíaca es una complicación poco frecuente en los pacientes que reciben asistencia hemodinámica mediante una membrana de oxigenación extracorpórea venoarterial (ECMO-VA), pero conlleva una elevada mortalidad. Este caso clínico describe un paciente que tuvo un shock cardiogénico tras un infarto agudo de miocardio con elevación del ST (IAMCEST) y que presentó trombosis intracardíaca durante la asistencia con ECMO-VA en 2 ocasiones: la primera en relación con la colocación de una prótesis mitral mecánica y la segunda tras el recambio por una prótesis mitral biológica.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martínez Salgado A, Taboada Muñiz M, Martínez Cereijo JM, Otero Castro P, Álvarez Escudero J. Trombosis intracardíaca doble en paciente asistido mediante membrana de oxigenación extracorpórea venoarterial. Rev Esp Anestesiol Reanim. 2019;66:335–337.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1163 "Ancho" => 1500 "Tamanyo" => 74291 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Transoesophageal echocardiogram view of the mitral valve prosthesis 1 day after connection to venoarterial extracorporeal membrane oxygenation, showing a thrombus in one of the leaflets (blue arrow).</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">AI: left atrium: lpm: beats per minute; VI: left ventricle.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1153 "Ancho" => 1500 "Tamanyo" => 100307 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">4-Chamber transoesophageal echocardiogram view, centred on the left cavities, showing a large intracardiac thrombus in the left atrium (red asterisk). Also note the absence of blood flow through the biological mitral prosthesis, shown on colour Doppler (red arrow).</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">AI: left atrium; lpm: beats per minute; VD: right ventricle; VI: left ventricle.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Review of venoarterial extracorporeal membrane oxygenation and development of intracardiac thrombosis in adult cardiothoracic patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B. Williams" 1 => "W. Bernstein" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Extra Corpor Technol" "fecha" => "2016" "volumen" => "48" "paginaInicial" => "162" "paginaFinal" => "167" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27994255" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recurrent thrombosis after mechanical circulatory support" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Aissaoui" 1 => "K. Hakim-Meibodi" 2 => "M. Morshuis" 3 => "J. Gummert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/icvts/ivs025" "Revista" => array:6 [ "tituloSerie" => "Interact Cardiovasc Thorac Surg" "fecha" => "2012" "volumen" => "14" "paginaInicial" => "668" "paginaFinal" => "669" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22350773" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Asistencia circulatoria con oxigenador extracorpóreo de membrana como puente a trasplante cardiaco en rotura septal ventricular compleja" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I. Pascual" 1 => "F. López" 2 => "D. Hernández-Vaquero" 3 => "P. Avanzas" 4 => "J. Silva" 5 => "C. Morís" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rec.2016.02.015" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2016" "volumen" => "69" "paginaInicial" => "617" "paginaFinal" => "619" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27103450" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unexpected bioprosthetic mitral valve thrombus during left ventricular assist device implantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. Imada" 1 => "S.C. Shibata" 2 => "K. Okitsu" 3 => "Y. Fujino" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s40981-017-0086-5" "Revista" => array:5 [ "tituloSerie" => "JA Clin Rep" "fecha" => "2017" "volumen" => "3" "paginaInicial" => "15" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29457059" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Left ventricular thrombus associated with arteriovenous extra corporeal membrane oxygenation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Makdisi" 1 => "Z.A. Hashmi" 2 => "T.C. Wozniak" 3 => "I. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3978/j.issn.2072-1439.2015.11.18" "Revista" => array:5 [ "tituloSerie" => "J Thorc Dis" "fecha" => "2015" "volumen" => "7" "paginaInicial" => "E552" "paginaFinal" => "E554" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006600000006/v1_201905290656/S2341192919300848/v1_201905290656/en/main.assets" "Apartado" => array:4 [ "identificador" => "65601" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Report" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006600000006/v1_201905290656/S2341192919300848/v1_201905290656/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192919300848?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 0 | 1 |
| 2019 August | 1 | 0 | 1 |
