title: Vent-induced prosthetic leaflet thrombosis treated by open-heart valve-in-valve implantation.
abstract: A patient required emergency mitral valve replacement and extracorporeal membrane oxygenation (ECMO) support for acute biventricular failure. The left ventricular (LV) vent inserted via the left upper pulmonary vein induced thrombotic immobilization of a prosthetic valve leaflet, with significant intra-prosthesis regurgitation after ECMO explantation. Therefore, the left atrium was opened on the beating heart during conventional extracorporeal circulation, all prosthesis leaflets were excised and a 29-mm expandable Edwards Sapien prosthesis was inserted within the scaffold of the original prosthesis under direct vision. This case illustrates the benefits and potential problems of LV venting on ECMO support, and a rapid and safe way of replacing the prosthesis leaflets in a critical situation.
authors.affiliation: Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany stamm@dhzb.de.
authors.forename: Christof
authors.initials: C
authors.lastname: Stamm
authors.affiliation: Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Miralem
authors.initials: M
authors.lastname: Pasic
authors.affiliation: Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Semih
authors.initials: S
authors.lastname: Buz
authors.affiliation: Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery; D017548:Echocardiography, Transesophageal; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*
keywords: Extracorporeal membrane oxygenation; Mitral valve; Valve-in-valve procedure