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Bai YB, Zhao F, Wu ZH, Shi GN, Jiang N. Left ventricular thrombosis caused cerebral embolism during venoarterial extracorporeal membrane oxygenation support: A case report. World J Clin Cases 2024; 12:973-979. [PMID: 38414596 PMCID: PMC10895634 DOI: 10.12998/wjcc.v12.i5.973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/13/2023] [Accepted: 01/18/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Venoarterial (VA) extracorporeal membrane oxygenation (ECMO), an effective short-term circulatory support method for refractory cardiogenic shock, is widely applied. However, retrospective analyses have shown that VA-ECMO-assisted cases were associated with a relatively high mortality rate of approximately 60%. Embolization in important organs caused by complications of left ventricular thrombosis (LVT) during VA-ECMO is also an important reason. Although the incidence of LVT during VA-ECMO is not high, the consequences of embolization are disastrous. CASE SUMMARY A 37-year-old female patient was admitted to hospital because of fever for 4 d and palpitations for 3 d. After excluding the diagnosis of coronary heart disease, we established a diagnosis of "clinically explosive myocarditis". The patient still had unstable hemodynamics after drug treatment supported by VA-ECMO, with heparin for anticoagulation. On day 4 of ECMO support, a left ventricular thrombus attached to the papillary muscle root of the mitral valve was found by transthoracic echocardiography. Left ventricular decompression was performed and ECMO was successfully removed, but the patient eventually died of multiple cerebral embolism. CONCLUSION LVT with high mobility during VA-ECMO may cause embolism in important organs. Therefore, a "wait and see" strategy should be avoided.
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Affiliation(s)
- Yao-Bang Bai
- Intensive Care Unit, Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin 300222, China
| | - Feng Zhao
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin 300222, China
| | - Zhen-Hua Wu
- Intensive Care Unit, Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin 300222, China
| | - Guo-Ning Shi
- Intensive Care Unit, Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin 300222, China
| | - Nan Jiang
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin 300222, China
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Fan Y, Liu L, Li F, Zhou H, Ye Y, Yuan C, Shan H, Zang W, Luo Y, Yan S. Construction of ultrasound-responsive urokinase precise controlled-release nanoliposome applied for thrombolysis. Front Bioeng Biotechnol 2022; 10:923365. [PMID: 36017353 PMCID: PMC9396409 DOI: 10.3389/fbioe.2022.923365] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
Urokinase is widely used in the dissolution of an acute pulmonary embolism due to its high biocatalytic effect. However, how to precisely regulate its dose, avoid the side effects of hemolysis or ineffective thrombolysis caused by too high or too low a dose, and seize the golden time of acute pulmonary embolism are the key factors for its clinical promotion. Therefore, based on the precise design of a molecular structure, an ultrasonic-responsive nanoliposome capsule was prepared in this paper. Singlet oxygen is continuously generated under the interaction of the ultrasonic cavitation effect and the sonosensitizer protoporphyrin, and the generated singlet oxygen will break the thiol acetone bond between the hydrophilic head and the hydrophobic tail of the liposome, and the lipid The body structure disintegrates rapidly, and the urokinase encapsulated inside is rapidly released, down-regulating the expression of fibrinogen in the body, and exerting a thrombolytic function. The in vitro and in vivo results show that the smart urokinase nanoliposomes prepared by us have sensitive and responsive cytocompatibility to ultrasound and good in vivo thrombolytic properties for acute pulmonary embolism, which provides a new strategy for clinical acute pulmonary embolism thrombolysis.
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Affiliation(s)
- Yongliang Fan
- Department of Cardio-Thoracic Surgery, Shanghai 10th People’s Hospital, School of Clinical Medicine of Nanjing Medical University, Shanghai, China
- Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Liu
- Department of Ultrasound Medicine, Chongqing University Cancer Hospital, Chongqing, China
| | - Fang Li
- Department of Ultrasound Medicine, Chongqing University Cancer Hospital, Chongqing, China
| | - Hang Zhou
- Department of Ultrasound Medicine, Chongqing University Cancer Hospital, Chongqing, China
| | - Yizhou Ye
- Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunping Yuan
- Shanghai Engineering Technology Research Center for Pharmaceutical Intelligent Equipment, Shanghai Frontiers Science Center for Druggability of Cardiovascular Non-coding RNA, Institute for Frontier Medical Technology, Shanghai University of Engineering Science, Shanghai, China
| | - Hongli Shan
- Shanghai Engineering Technology Research Center for Pharmaceutical Intelligent Equipment, Shanghai Frontiers Science Center for Druggability of Cardiovascular Non-coding RNA, Institute for Frontier Medical Technology, Shanghai University of Engineering Science, Shanghai, China
| | - Wangfu Zang
- Department of Cardio-Thoracic Surgery, Shanghai 10th People’s Hospital, School of Clinical Medicine of Nanjing Medical University, Shanghai, China
- *Correspondence: Sijing Yan, ; Wangfu Zang, ; Yu Luo,
| | - Yu Luo
- Shanghai Engineering Technology Research Center for Pharmaceutical Intelligent Equipment, Shanghai Frontiers Science Center for Druggability of Cardiovascular Non-coding RNA, Institute for Frontier Medical Technology, Shanghai University of Engineering Science, Shanghai, China
- *Correspondence: Sijing Yan, ; Wangfu Zang, ; Yu Luo,
| | - Sijing Yan
- Department of Ultrasound, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
- *Correspondence: Sijing Yan, ; Wangfu Zang, ; Yu Luo,
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Kadan M, Erol G, Kubat E, İnce ME, Akyol FB, Karabacak K, Doğancı S, Yıldırım V, Bolcal C, Demirkılıç U. Robotic repair of atrial septal defect with partial pulmonary venous return anomaly: Our 5 year experience. Int J Med Robot 2022; 18:e2395. [DOI: 10.1002/rcs.2395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Murat Kadan
- Department of Cardiovascular Surgery Gulhane Medical Faculty Ankara Turkey
| | - Gökhan Erol
- Department of Cardiovascular Surgery Gulhane Medical Faculty Ankara Turkey
| | - Emre Kubat
- Department of Cardiovascular Surgery Gulhane Medical Faculty Ankara Turkey
| | - Mehmet Emin İnce
- Department of Anesthesiology Gulhane Medical Faculty Ankara Turkey
| | - Furkan Burak Akyol
- Department of Cardiovascular Surgery Gulhane Medical Faculty Ankara Turkey
| | - Kubilay Karabacak
- Department of Cardiovascular Surgery Gulhane Medical Faculty Ankara Turkey
| | - Suat Doğancı
- Department of Cardiovascular Surgery Gulhane Medical Faculty Ankara Turkey
| | - Vedat Yıldırım
- Department of Anesthesiology Gulhane Medical Faculty Ankara Turkey
| | - Cengiz Bolcal
- Department of Cardiovascular Surgery Gulhane Medical Faculty Ankara Turkey
| | - Ufuk Demirkılıç
- Department of Cardiovascular Surgery Gulhane Medical Faculty Ankara Turkey
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Robotic redo mitral valve replacement combined with dysfunctional amplatzer plug resection on a beating heart. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:391-394. [PMID: 34589259 PMCID: PMC8462101 DOI: 10.5606/tgkdc.dergisi.2021.21326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 05/18/2021] [Indexed: 12/03/2022]
Abstract
Redo-cardiac surgery is associated with high morbidity and mortality rates. Although redo surgery are relative contraindications for robotic surgery, robotic redo mitral valve surgery has been performed with endo-aortic occlusion techniques and on fibrillated heart successfully. Beating heart mitral valve surgery is another well-known option for redo cardiac surgery practice. Robotic beating heart surgery is not well-studied before. As a new point of view to robotic reoperation surgery, herein, we aimed to present a case who underwent redo robotic mitral valve replacement combined with dysfunctioned amplatzer plug resection on a beating heart.
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Cruz Rodriguez JB, Okajima K, Greenberg BH. Management of left ventricular thrombus: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:520. [PMID: 33850917 PMCID: PMC8039643 DOI: 10.21037/atm-20-7839] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Left ventricular thrombus (LVT) is a serious complication of acute myocardial infarction (MI) and also non-ischemic cardiomyopathies. We performed a narrative literature review, manual-search of reference lists of included articles and relevant reviews. Our literature review indicates that the incidence of LVT following acute MI has decreased, probably due to improvement in patient care as a result of better and earlier reperfusion techniques. Predictors of LVT include anterior MI, involvement of left ventricular (LV) apex (regardless of the coronary territory affected), LV akinesis or dyskinesis, reduced LV ejection fraction (LVEF), severe diastolic dysfunction and large infarct size. LVT is associated with increased risk of systemic embolism, stroke, cardiovascular events and death, and there is evidence that anticoagulant therapy for at least 3 months can reduce the risk of these events. Cardiac magnetic resonance (CMR) has the highest diagnostic accuracy for LVT, followed by echocardiography with the use of echocardiographic contrast agents (ECAs). Although current guidelines suggest use of vitamin K antagonist (VKA) for a minimum of 3 to 6 months, there is growing evidence of the benefits of direct acting oral anticoagulants in treatment of LVT. Embolic events appear to occur even after resolution of LVT suggesting that anticoagulant therapy needs to be considered for a longer period in some cases. Recommendations for the use of triple therapy in the presence of the LVT are mostly based on extrapolation from outcome data in patients with atrial fibrillation (AF) and MI. We conclude that the presence of LVT is more likely in patients with anterior ST-segment elevation MI (STEMI) (involving the apex) and reduced ejection fraction (EF). LVT should be considered a marker of increased long-term thrombotic risk that may persist even after thrombus resolution. Ongoing clinical trials are expected to elucidate the best management strategies for patients with LVT.
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Affiliation(s)
- Jose B Cruz Rodriguez
- Division of Cardiovascular Diseases, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Kazue Okajima
- Division of Cardiovascular Diseases, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Barry H Greenberg
- Heart Failure/Cardiac Transplantation Program, University of California, San Diego, CA, USA
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Massussi M, Scotti A, Lip GYH, Proietti R. Left ventricular thrombosis: new perspectives on an old problem. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:158-167. [PMID: 32569361 DOI: 10.1093/ehjcvp/pvaa066] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/07/2020] [Accepted: 06/12/2020] [Indexed: 12/14/2022]
Abstract
Left ventricular thrombosis (LVT) is a major risk factor for systemic thromboembolism and might complicate both the acute and the chronic phase of ischaemic heart disease after myocardial infarction and, less frequently, non-ischaemic cardiomyopathies. The pathophysiology of thrombus formation is complex and involves the three aspects of Virchow's triad: blood stasis, prothrombotic state, and tissue injury. Advances in technology have improved the detection rate of intracardiac thrombi, but several uncertainties still remain regarding the optimal treatment strategy within daily clinical practice. Of note, anticoagulation therapy with heparin and vitamin K antagonists decreases the risk of embolic stroke though exposing patients to an undeniable risk of bleeding complications. Although limited data on the off-label use of direct oral anticoagulants have reported safety and efficacy for LVT resolution, yet more evidence is needed to justify their use in clinical practice.
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Affiliation(s)
- Mauro Massussi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Via Giustiniani 2, 35128 Padua, Italy
| | - Andrea Scotti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Via Giustiniani 2, 35128 Padua, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Chest and Heart Hospital, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK
| | - Riccardo Proietti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Via Giustiniani 2, 35128 Padua, Italy
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