The authors thank Gonzalo J. López for the high-quality cardiac magnetic resonance examinations. Tamara Córdoba, Oscar Sanz, Nuria Valladares, Eugenio Fernández and the rest of the staff working in the animal facilities and CNIC ś farm were outstanding in animal care and unconditional collaboration. Laura García, Alberto Barroso and Xavier Navarro provided us with the ablation clamps and catheters and assisted us during the denervation procedures. Paula Garcia-Lunar provided valuable support with tissue sampling when it was most needed. SOURCES OF FUNDING:This work has been partially funded by the grant "Translational research project from the Sociedad Española de Cardiología" (to Dr. García-Álvarez) and by an unrestricted grant from Medtronic. The CNIC is supported by the Ministerio de Ciencia, Innovación y Universidades and the Pro CNIC Foundation, and is a Severo Ochoa Center of Excellence (SEV-2015-0505).IDIBAPS belongs to the CERCA Programme and receives partial funding from the Generalitat de Catalunya.

No abstract

Video clip is available online.Extracorporeal membrane oxygenation (ECMO) can provide immediate support to a rapidly declining patient. In the presence of a mechanical heart prosthesis, however, ECMO increases the risk of thrombotic complications, necessitating an early and customized reconfiguration of support.

Heparin-induced thrombocytopenia is not uncommon in cardiac surgery. Thrombosis is the most frequent complication. A 77-year-old man suffered cardiac arrest due to right coronary emboli. Transesophageal echocardiography revealed tissue valve thrombosis. He required support with an extracorporeal membrane oxygenator that also thrombosed. Heparin-induced thrombocytopenia was diagnosed, and anticoagulation was switched to argatroban. Heparin- induced thrombocytopenia normally presents as vascular thrombosis. In this case, the first symptom was tissue valve thrombosis causing an acute coronary syndrome. It is not an uncommon complication and should be considered if unexpected thrombosis and a sudden drop in platelet count develops after heparin exposure.