Andreka Judit, Zirngast Birgit, Toth Gabor G
Department of Cardiology, University Heart Center Graz, Graz, Austria.
Department of Cardiovascular Surgery, University Heart Center Graz, Graz, Austria.
JACC Case Rep. 2025 Aug 20;30(24):104683. doi: 10.1016/j.jaccas.2025.104683.
In hemodynamically unstable patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO), left ventricular unloading may be essential but technically challenging, especially after aortic valve replacement.
We report a case of a 64-year-old male patient with postcardiotomy cardiogenic shock after combined coronary and aortic valve surgery. VA-ECMO alone was insufficient, prompting the use of a microaxial flow pump via axillary access. Challenges included left ventricle wiring through the closed bioprosthetic aortic valve and navigating a severely stenotic subclavian artery. A combination of advanced imaging and vascular techniques enabled successful device placement.
TAKE-HOME MESSAGES: A transesophageal ultrasound-guided mother-and-child technique with steerable catheter allows precise control for atraumatic valve crossing in case of functionally closed aortic leaflets. Intravascular lithotripsy is a potent tool to facilitate large-bore access for mechanical circulatory support in patients with calcified peripheral artery disease.
在接受静脉-动脉体外膜肺氧合（VA-ECMO）治疗的血流动力学不稳定患者中，左心室减负可能至关重要，但技术上具有挑战性，尤其是在主动脉瓣置换术后。
我们报告了一例64岁男性患者，在冠状动脉和主动脉瓣联合手术后发生心脏切开术后心源性休克。仅使用VA-ECMO并不足够，因此通过腋窝入路使用了微型轴流泵。挑战包括通过关闭的生物人工主动脉瓣进行左心室布线以及穿过严重狭窄的锁骨下动脉。先进的成像技术和血管技术相结合，使得设备得以成功放置。
经食管超声引导的子母技术结合可操纵导管，在主动脉瓣叶功能关闭的情况下，可实现精确控制以无创穿过瓣膜。血管内碎石术是一种有效的工具，可促进患有钙化外周动脉疾病的患者获得大口径通路以进行机械循环支持。
