Share this page on LinkedIn
Share This Page on Google+
Share This Page on Twitter
tell someone about this page print this page
You are here: Contents > 2016 > Volume 25 Number 5 September 2016 > CASE REPORTS > Atrial Septostomy as a Bridge to Replace a Thrombosed Mechanical Aortic Valve Requiring Extracorporeal Membrane Oxygenation

Atrial Septostomy as a Bridge to Replace a Thrombosed Mechanical Aortic Valve Requiring Extracorporeal Membrane Oxygenation

Adarsh Katamreddy1, David F. Snipelisky1, Mackram F. Eleid1,2

1Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
2Electronic correspondence: Eleid.mackram@mayo.edu

Atrial septostomy is an infrequently used percutaneous technique to decompress either side of the heart. Here, a case is reported of atrial septostomy performed as an emergency ‘bridge’ procedure in a hemodynamically unstable 62-year-old man with acute mechanical prosthetic aortic valve thrombosis requiring peripheral venoarterial (VA) extracorporeal membrane oxygenation (ECMO). ECMO was placed emergently as the patient suffered cardiac arrest during anesthesia induction for surgical replacement of the thrombosed prosthetic aortic valve. The increased afterload as a result of ECMO, in the setting of severe prosthetic valve dysfunction, led to a marked elevation of the left heart pressures, pulmonary edema and multiorgan dysfunction. A percutaneous atrial septostomy led to a rapid

decompression of the left heart by shunting blood to the right atrium, allowing for a marked improvement in the patient’s clinical condition. This facilitated the performance of re-do surgery to replace the dysfunctional thrombosed aortic prosthetic valve. Postoperatively, the pulmonary edema resolved completely and the patient achieved full recovery with no residual cardiac symptoms at three months.

Video: Gated cardiac CT angiography demonstrating a large thrombus present between the St. Jude Medical mechanical aortic prosthetic leaflets, resulting in severe restriction of leaflet motion.

The Journal of Heart Valve Disease 2016;25:644-647


Atrial Septostomy as a Bridge to Replace a Thrombosed Mechanical Aortic Valve Requiring Extracorporeal Membrane Oxygenation

Click the above hyperlink to view the article, right click (Ctrl click on a Mac) to open in a new browser window or tab.

Purchase this Article

Please click the button below to purchase this article. Single article purchases are provided at $50.00 per article. Upon clicking the button below, single article user account subscription details are requested and, upon successful payment, a single article user account is created. Single articles are availble in your account for seven days after purchase.