Fatal Pulmonary Hemorrhagic Infarction Caused by Pulmonary Vein Thrombotic Occlusion During Venoarterial Extracorporeal Membrane Oxygenation.

Abstract

A 20-year-old man with arrhythmogenic right ventricular cardiomyopathy (ARVC) was resuscitated from ventricular fibrillation. He was transferred to our hospital because of progressive multiorgan dysfunction despite mechanical circulatory support with peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pump (IABP). At admission to our hospital, chest X-ray showed bilateral complete lung opacification, and echocardiography revealed a massive thrombus occupying the left atrium (LA) and left ventricle (LV). Conversion to central ECMO with transapical LV venting and thrombectomy were performed. The huge LA thrombus occluded all pulmonary veins (PVs). Despite the surgery and intensive care, complete lung opacity remained, and he died of multiorgan failure associated with sepsis. Autopsy demonstrated bilateral pulmonary multiple red infarctions, and histopathology showed alveolar wall necrosis with extensive hemorrhage, confirming a diagnosis of pulmonary hemorrhagic infarction. Extensive pulmonary infarction was attributable to PV occlusion due to massive LA thrombus. PV thrombosis should be considered when refractory lung opacities are encountered during VA-ECMO and necessitates early intervention.

• Authors: Kohei Masaki, Toru Hashimoto, Masato Katsuki, Kisho Ohtani, Taiki Higo, Tomoki Ushijima, Yoshihisa Tanoue, Akira Shiose, Hiroyuki Tsutsui
• Journal: International heart journal (Int Heart J) Vol. 62 Issue 5 Pg. 1182-1185 (Sep 30 2021) ISSN: 1349-3299 [Electronic] Japan
• PMID: 34544989 (Publication Type: Case Reports, Journal Article)

Topics

• Arrhythmogenic Right Ventricular Dysplasia (complications)
• Autopsy (methods)
• Echocardiography (methods)
• Extracorporeal Membrane Oxygenation (methods)
• Fatal Outcome
• Heart Atria (diagnostic imaging, pathology)
• Heart Ventricles (diagnostic imaging, pathology)
• Hemorrhage (complications, diagnosis)
• Humans
• Intra-Aortic Balloon Pumping (methods)
• Male
• Multiple Organ Failure (complications)
• Pulmonary Infarction (diagnosis)
• Pulmonary Veins (diagnostic imaging, pathology)
• Pulmonary Veno-Occlusive Disease (complications, diagnosis)
• Resuscitation (methods)
• Sepsis (complications)
• Thrombectomy (methods)
• Thrombosis (diagnosis, pathology, surgery)
• Ventricular Fibrillation (etiology, therapy)
• Young Adult