Anterolateral papillary muscle suction causing low flow in a COVID-19 patient without medical history: a case report of central extracorporeal life support with left ventricular apex decompression
Abstract Background Left ventricular (LV) decompression is an essential strategy for improving early survival in patients with refractory cardiogenic shock. Low pump flow in patients on extracorporeal life support (ECLS) with LV apex decompression is a life-threatening issue. However, identifying th...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2024-04-01
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| Series: | JA Clinical Reports |
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| Online Access: | https://doi.org/10.1186/s40981-024-00701-8 |
| _version_ | 1827284432926539776 |
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| author | Tomoaki Miyake Kimito Minami Masahiro Kazawa Naoki Tadokoro Kohei Tonai Satsuki Fukushima |
| author_facet | Tomoaki Miyake Kimito Minami Masahiro Kazawa Naoki Tadokoro Kohei Tonai Satsuki Fukushima |
| author_sort | Tomoaki Miyake |
| collection | DOAJ |
| description | Abstract Background Left ventricular (LV) decompression is an essential strategy for improving early survival in patients with refractory cardiogenic shock. Low pump flow in patients on extracorporeal life support (ECLS) with LV apex decompression is a life-threatening issue. However, identifying the underlying causes of low flow can be challenging. Case presentation A 38-year-old woman with COVID-19-related fulminant myocarditis was treated with central ECLS with LV apex decompression. The pump flow in the intensive care unit (ICU) was intermittently low, and low flow alerts were frequent. The initial evaluation based on pressure monitor waveforms and transthoracic echocardiography failed to identify the underlying cause. Prompt bedside transesophageal echocardiography (TEE) revealed that the anterolateral papillary muscle was suctioned into the vent cannula of the LV apex during systole. The patient underwent a repeat sternal midline incision in the operating room, and the cannula at the LV apex was repositioned. There were no further suction events after the repositioning, and the patient was weaned from ECLS 12 days after admission to the ICU. The patient was discharged in a stable condition and without neurological deficits. Conclusions TEE is an important diagnostic tool to identify the underlying cause of low flow flow in patients undergoing ECLS with LV apex decompression. |
| first_indexed | 2024-04-24T09:55:03Z |
| format | Article |
| id | doaj.art-19ab11724ce84a5ea43e3de00d988f23 |
| institution | Directory Open Access Journal |
| issn | 2363-9024 |
| language | English |
| last_indexed | 2024-04-24T09:55:03Z |
| publishDate | 2024-04-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | JA Clinical Reports |
| spelling | doaj.art-19ab11724ce84a5ea43e3de00d988f232024-04-14T11:09:48ZengSpringerOpenJA Clinical Reports2363-90242024-04-011011510.1186/s40981-024-00701-8Anterolateral papillary muscle suction causing low flow in a COVID-19 patient without medical history: a case report of central extracorporeal life support with left ventricular apex decompressionTomoaki Miyake0Kimito Minami1Masahiro Kazawa2Naoki Tadokoro3Kohei Tonai4Satsuki Fukushima5Department of Critical Care Medicine, National Cerebral and Cardiovascular CenterDepartment of Critical Care Medicine, National Cerebral and Cardiovascular CenterDepartment of Critical Care Medicine, National Cerebral and Cardiovascular CenterDepartment of Cardiac Surgery, National Cerebral and Cardiovascular CenterDepartment of Cardiac Surgery, National Cerebral and Cardiovascular CenterDepartment of Cardiac Surgery, National Cerebral and Cardiovascular CenterAbstract Background Left ventricular (LV) decompression is an essential strategy for improving early survival in patients with refractory cardiogenic shock. Low pump flow in patients on extracorporeal life support (ECLS) with LV apex decompression is a life-threatening issue. However, identifying the underlying causes of low flow can be challenging. Case presentation A 38-year-old woman with COVID-19-related fulminant myocarditis was treated with central ECLS with LV apex decompression. The pump flow in the intensive care unit (ICU) was intermittently low, and low flow alerts were frequent. The initial evaluation based on pressure monitor waveforms and transthoracic echocardiography failed to identify the underlying cause. Prompt bedside transesophageal echocardiography (TEE) revealed that the anterolateral papillary muscle was suctioned into the vent cannula of the LV apex during systole. The patient underwent a repeat sternal midline incision in the operating room, and the cannula at the LV apex was repositioned. There were no further suction events after the repositioning, and the patient was weaned from ECLS 12 days after admission to the ICU. The patient was discharged in a stable condition and without neurological deficits. Conclusions TEE is an important diagnostic tool to identify the underlying cause of low flow flow in patients undergoing ECLS with LV apex decompression.https://doi.org/10.1186/s40981-024-00701-8Left ventricular decompressionLow flowCardiogenic shockExtracorporeal life supportTransesophageal echocardiographyPapillary muscle suction |
| spellingShingle | Tomoaki Miyake Kimito Minami Masahiro Kazawa Naoki Tadokoro Kohei Tonai Satsuki Fukushima Anterolateral papillary muscle suction causing low flow in a COVID-19 patient without medical history: a case report of central extracorporeal life support with left ventricular apex decompression JA Clinical Reports Left ventricular decompression Low flow Cardiogenic shock Extracorporeal life support Transesophageal echocardiography Papillary muscle suction |
| title | Anterolateral papillary muscle suction causing low flow in a COVID-19 patient without medical history: a case report of central extracorporeal life support with left ventricular apex decompression |
| title_full | Anterolateral papillary muscle suction causing low flow in a COVID-19 patient without medical history: a case report of central extracorporeal life support with left ventricular apex decompression |
| title_fullStr | Anterolateral papillary muscle suction causing low flow in a COVID-19 patient without medical history: a case report of central extracorporeal life support with left ventricular apex decompression |
| title_full_unstemmed | Anterolateral papillary muscle suction causing low flow in a COVID-19 patient without medical history: a case report of central extracorporeal life support with left ventricular apex decompression |
| title_short | Anterolateral papillary muscle suction causing low flow in a COVID-19 patient without medical history: a case report of central extracorporeal life support with left ventricular apex decompression |
| title_sort | anterolateral papillary muscle suction causing low flow in a covid 19 patient without medical history a case report of central extracorporeal life support with left ventricular apex decompression |
| topic | Left ventricular decompression Low flow Cardiogenic shock Extracorporeal life support Transesophageal echocardiography Papillary muscle suction |
| url | https://doi.org/10.1186/s40981-024-00701-8 |
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