VA ECMO For Management Of Contained Rupture Of Thoracic Aortic Aneurysm

Proposal Number:

MCC-7151 

Proposal Type:

Medically Challenging Case Report Poster 

Author:

Madiha Yazdani  
University of Colorado Hospital, Department of Anesthesiology and Critical

Co-Author(s):

Martin Krause  
University of Colorado, Department of Anesthesiology and Critical Care
T. Brett Reece  
University of Colorado, Department of Cardiothoracic Surgery

Abstract:

Recent advancements in mechanical circulation have resulted in improvements in both survival and quality of life for an increasing number of patients. Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is an established strategy for cardiopulmonary support in patients with iminent cardiovascular collapse. The use of VA ECMO in aortic aneurysm repair has been reported in a handful of cases, mostly in endovascular repair. We present a case in which VA ECMO was used to reduce right heart strain secondary to a large aortic aneurysm compressing the pulmonary artery.

The patient is a 71 year old male with a pertinent medical history of a thoracic aortic aneurysm status post repair in 2016 who presented to our facility with dyspnea. A bedside transthoracic echocardiogram was performed, demonstrating septal flattening with an enlarged, hypertrophied right ventricle.

The patient was admitted to the cardiology ICU and a left heart catheterization revealed a contained rupture at distal end of the graft, proximal to the innominate artery, with compression of the pulmonary artery. Computed tomography angiography demonstrated contained rupture of the distal anastomosis, right ventricle dysfunction, severe tricuspid regurgitation, and a right-to-left shunt through a patent foramen ovale. His INR was greater than four with some evidence of renal and liver malperfusion. Cardiothoracic surgery was consulted and decided to place the patient on Veno-arterial Extracorporeal Membrane Exchange (VA ECMO) to rest his right ventricle and alleviate the malperfusion.

The patient was transported to the operating room for ECMO initiation. He was successfully peripherally cannulated. Four days later, the patient was taken to the OR for an aortic bioroot, ascending hemiarch replacement, tricuspid repair, PFO closure. He was decannulated fifteen days after initiating VA ECMO.

Professional Category:

Resident/Trainee

Keywords:

Cardiothoracic
Critical Care

Supporting Image: ScreenShot2019-08-04at104429PM.png
   ·Large ascending aortic pseudoaneurysm measures 7.5 x 11.2 x 12.9 cm. There is mild surrounding edema with mild mass effect on the right main pulmonary artery.
Supporting Image: ScreenShot2019-08-04at95114PM.png
 

Enter up to two references.

  Reference
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2. Veno-arterial-ECMO in the intensive care unit: From technical aspects to clinical practice. Le Gall A, Anaesth Crit Care Pain Med. 2018 Jun;37(3):259-268. doi: 10.1016/j.accpm.2017.08.007. Epub 2017 Oct 13.