Regional thrombolysis with tenecteplase during extracorporeal membrane oxygenation: a new approach for left ventricular thrombosis.
We present the case of a woman assisted with veno-arterial extracorporeal membrane oxygenation (v-a ECMO) for postischemic cardiogenic shock, who developed left ventricular thrombosis despite systemic anticoagulation and left ventricular apical venting. We successfully achieved local thrombolysis with tenecteplase administered through the venting cannula to obtain local thrombolysis while reducing systemic effects to a minimum. The procedure was effective with mild systemic bleeding and the patient was successfully weaned off the extracorporeal support a few days thereafter.
Department of Anesthesia and Intensive Care, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
Fabio
F
Sangalli
Department of Anesthesia and Intensive Care, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
Gianluca
G
Greco
Department of Anesthesia and Intensive Care, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
Lucia
L
Galbiati
Department of Cardiac Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
Francesco
F
Formica
Department of Anesthesia and Intensive Care, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
Serena
S
Calcinati
Department of Anesthesia and Intensive Care, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
Leonello
L
Avalli
D057785:Catheters; D003328:Coronary Thrombosis / Q000188:drug therapy* / Q000209:etiology*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006352:Heart Ventricles; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D019990:Perioperative Care; D012770:Shock, Cardiogenic / Q000209:etiology / Q000628:therapy*; D000077785:Tenecteplase; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D000077785:Tenecteplase