Challa Abhinay, Latona Jilani, Fraser John, Spanevello Michelle, Scalia Gregory, Burstow Darryl, Platts David
Department of Cardiology, The Prince Charles Hospital, Chermside, 4032 Brisbane, Australia.
Bond University, Robina, 4226 Gold Coast, Australia.
Eur Heart J Case Rep. 2020 Apr 24;4(3):1-6. doi: 10.1093/ehjcr/ytaa085. eCollection 2020 Jun.
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a well-recognized form of haemodynamic support for patients with refractory cardiogenic shock, who are unable to be weaned off cardiopulmonary bypass. Thrombosis or bleeding from cannula sites or surgical wounds are the leading cause of morbidity and mortality in these patients, and presents a delicate balance of anticoagulation during management of patients undergoing circulatory support.
In this case series, we discuss three cases of patients undergoing mitral valve replacements or repair with thrombosis of their new bio-prosthesis in the immediate post-operative setting. All three patients were supported with VA-ECMO post-operatively, and thrombosis occurred despite anticoagulation.
During extracorporeal membrane oxygenation, the reduced flow throughout the heart increases the risk of intra-cardiac thrombosis. This is of particular importance in the context of mitral valve replacements and repairs, where the bio-prosthesis is an additional risk factor for thrombosis. Our cases demonstrate the morbidity and mortality of such complications, with the likely aetiology being low transvalvular flow in a newly inserted valve combined with the pro-thrombotic state created by the VA-ECMO circuit.
静脉-动脉体外膜肺氧合（VA-ECMO）是一种公认的对难治性心源性休克患者进行血流动力学支持的方式，这些患者无法脱离体外循环。插管部位或手术伤口的血栓形成或出血是这些患者发病和死亡的主要原因，并且在对接受循环支持的患者进行管理期间，抗凝需要谨慎权衡。
在本病例系列中，我们讨论了三例在二尖瓣置换或修复术后即刻出现新生物瓣膜血栓形成的患者。所有三名患者术后均接受VA-ECMO支持，尽管进行了抗凝治疗，但仍发生了血栓形成。
在体外膜肺氧合期间，流经心脏的血流减少会增加心内血栓形成的风险。在二尖瓣置换和修复的情况下，这一点尤为重要，因为生物瓣膜是血栓形成的另一个风险因素。我们的病例显示了此类并发症的发病率和死亡率，其可能的病因是新植入瓣膜的跨瓣血流低，以及VA-ECMO回路所导致的促血栓形成状态。
