Fatal Pulmonary Hemorrhagic Infarction Caused by Pulmonary Vein Thrombotic Occlusion During Venoarterial Extracorporeal Membrane Oxygenation.
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.
['Masaki|Kohei|K|', 'Hashimoto|Toru|T|', 'Katsuki|Masato|M|', 'Ohtani|Kisho|K|', 'Higo|Taiki|T|', 'Ushijima|Tomoki|T|', 'Tanoue|Yoshihisa|Y|', 'Shiose|Akira|A|', 'Tsutsui|Hiroyuki|H|']
D019571:Arrhythmogenic Right Ventricular Dysplasia D001344:Autopsy D004452:Echocardiography D015199:Extracorporeal Membrane Oxygenation D017809:Fatal Outcome D006325:Heart Atria D006352:Heart Ventricles D006470:Hemorrhage D006801:Humans D007423:Intra-Aortic Balloon Pumping D008297:Male D009102:Multiple Organ Failure D054060:Pulmonary Infarction D011667:Pulmonary Veins D011668:Pulmonary Veno-Occlusive Disease D012151:Resuscitation D018805:Sepsis D017131:Thrombectomy D013927:Thrombosis D014693:Ventricular Fibrillation D055815:Young Adult
Arrhythmogenic right ventricular cardiomyopathy Intracardiac thrombosis Left ventricular venting Pulmonary vein thrombosis