ACUTE PROSTHETIC AORTIC VALVE OBSTRUCTION LEADING TO FREE AORTIC INSUFFICIENCY VENO-ARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION AS A BRIDGE TO SURGERY

Authors

  • Marisa Passos Silva Cardiology department, Vila Nova de Gaia/Espinho Hospital Center, Portugal
  • Daniel Caeiro Cardiology department, Vila Nova de Gaia/Espinho Hospital Center, Portugal
  • Fátima Neves Cardiac Surgery department, Vila Nova de Gaia/Espinho Hospital Center, Portugal
  • Pedro Braga Cardiology department, Vila Nova de Gaia/Espinho Hospital Center, Portugal

DOI:

https://doi.org/10.48729/pjctvs.129

Abstract

Introduction: Mechanical prosthetic valve thrombosis (PVT) and obstruction is a lifethreatening event. The significant morbidity and mortality associated with this condition warrants rapid diagnostic evaluation and treatment.

Case report: A 66-year-old female patient with a history of aortic valve replacement 13 years before, was admitted to our intensive cardiac care unit with symptoms and signs of prosthetic aortic valve dysfunction. During cardiac angiography, she collapsed and fluoroscopy showed an immobile disc, stopped in an open position and causing free aortic regurgitation. Cardio-pulmonary resuscitation (CPR) was initiated and a VA-ECMO was inserted as a bridge to emergent cardiac surgery. Surgery was then performed and the patient was successfully discharged with no neurological impairment.

Discussion: We present a case where Veno-Arterial Extracorporeal Membrane Oxygenation (VA- ECMO) was successfully used as a bridge to emergent surgery in a cardiac arrest patient due to prosthetic valve thrombosis.

Conclusions: This case illustrates how a relative contraindication (severe aortic insufficiency) to VA-ECMO may, in the end, be an indication in a very particular scenario.

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References

Roudaut R, Serri K, and Lafitte S. Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations. Heart, 2007; 93(1): p. 137-42.

Barbetseas J, Nagueh SF, Pistavos C et al. Differentiating thrombus from pannus formation in obstructed mechanical prosthetic valves: an evaluation of clinical, transthoracic and transesophageal echocardiographic parameters. J Am Coll Cardiol 1998; 1410–1417.10.1016/S0735-1097(98)00385-4.

Nishimura, R et al. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129(23): p. e521-643.

Huang G, Schaff HV, Sundt TM, et al. Treatment of obstructive thrombosed prosthetic heart valve. J Am Coll Cardiol 2013; 62:1731.

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Published

26-05-2021

How to Cite

1.
Passos Silva M, Caeiro D, Neves F, Braga P. ACUTE PROSTHETIC AORTIC VALVE OBSTRUCTION LEADING TO FREE AORTIC INSUFFICIENCY VENO-ARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION AS A BRIDGE TO SURGERY. Rev Port Cir Cardiotorac Vasc [Internet]. 2021 May 26 [cited 2023 Feb. 3];26(2):143-5. Available from: https://pjctvs.com/index.php/journal/article/view/129

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Section

Clinical Cases

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