Utility of transesophageal echocardiography to assess real time left atrial pressure changes and dynamic mitral regurgitation following placement of transseptal multistage venous cannula for systemic venous drainage and indirect left ventricular venting in venoarterial extracorporeal membrane oxygenation

Abstract

A 29-year-old man with biventricular heart failure (HF) secondary to nonischemic cardiomyopathy presented in transfer to our institution following placement of peripheral venoarterial extracorporeal membrane oxygenation (VA ECMO) for cardiogenic shock. To provide adequate drainage of both atria, the decision was made to place a single multistage venous cannula across the inter-atrial septum (IAS) using

Anterolateral papillary muscle suction causing low flow in a COVID-19 patient without medical history: a case report of central extracorporeal life support with left ventricular apex decompression

“…TEE is a vital tool in diagnosing and managing unstable circulatory states within the ICU [ 4 ]. Its ability to detect anatomical and hemodynamic changes has led to its expanded use in the ICU management of various MCS systems, including LVAD [ 5 ] and V-A ECMO [ 6 ]. While TTE is the preferred initial approach due to its ease of use, availability, and non-invasiveness, it often encounters limitations in postoperative patients affected by factors such as swelling, fluid retention, pulmonary edema, drainage tubes, and MCS devices.…”

Echocardiography for extracorporeal membrane oxygenation

“…55 Several instances of direct percutaneous cannulation of the LA (left atrial veno-arterial [LAVA] ECMO) with a venous cannula as a method of indirect left ventricular venting are now reported in the literature. [56][57][58] As opposed to balloon septostomy, the addition of a drainage cannula allows for adjustment of flow to facilitate more or less unloading of the chamber.…”

“…Upon initiation of LAVA-ECMO, flows can be adjusted with TEE assistance with a goal of AV opening with each cardiac cycle (Video 26) 56. In the case of severe MR, initiation of LAVA-ECMO has been shown to improve pulmonary vein flow reversal as visualized by PWD to at least blunted systolic pulmonary vein flow 58. Ventricular function is evaluated by TEE in the context of direct measurement of biventricular filling pressures to provide a more comprehensive picture of cardiac function after LAVA ECMO initiation.…”