Download Boon Lim JK, Lee JH, Mok YH, Chan YH. Successful Use of

Submission Template for Case Reports

You must have signed informed consent from patients (or relatives/guardians) before
submitting. Please anonymise the patient’s details as much as possible, eg, specific
ages, occupations.
TITLE OF CASE
Right anterior thoracothomy for venous drainage – an unusual approach for ECMO
initiation.
SUMMARY Up to 150 words summarizing the case presentation and outcome
End staged heart failure can develop into a life-threatening disorder that requires
heart
transplantation
and/or
mechanical
cardiac
support
(MCS).
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is indicated in
reversible life-threatening circulatory failure or bridge to heart transplantation.
Challenges in ECMO support include defining appropriate patient selection criteria
and prognostic factors. We present a seven months old male patient, diagnosed
dilated myocardiopathy with cardiogenic shock and needed of MCS. He was
admitted in INTERMACS class 1 in our Institution and was bridged to a 10cc Berlin
Heart Excor using a VA ECMO. Because the presentation of superior vena cava
thrombosis, and small femoral vessel, a right anterior thoracotomy approach was
preferred to access the right atrium for venous drainage. This unusual approach
allowed us to implant a Berlin Heart Excor 9 days after the VA-EMCO initiation. No
complication related to this cannulation approach was reported.
BACKGROUND Why you think this case is important – why did you write it up?
In specific situations, unusual approaches can be successfully used. In this case,
the patient presented a right jugular vein thrombosis, which prevented cannulation
of this vessel. The femoral vessels were small in this patient as usual. The right
anterior thoracothomy proved to be a simple and safe approach to access the right
atrium during the bedside approach and in an emergency situation.
CASE PRESENTATION Presenting features, medical/social/family history
Seven months old male patient, diagnosed dilated myocardiopathy and poor
ventricular function, which was listed for cardiac transplantation. During hospital
admission, he evaluated to a cardiogenic shock (INTERMACS 1) and need a MCS
support. Because the presentation of right jugular thrombosis, a right anterior
thoracotomy approach was the only viable option for venous drainage. After nine
days the patient received a Berlin Heart Excor® and eleven months after a
orthotopic heart transplantation was performed.
INVESTIGATIONS If relevant
DIFFERENTIAL DIAGNOSIS If relevant
TREATMENT If relevant
OUTCOME AND FOLLOW-UP
Successful venous drainage and no complications was reported during the period
of ECMO.
DISCUSSION Include a very brief review of similar published cases
There are any similar published cases in the literature. Almost all cases reviewed
used central or peripheral canulation.
LEARNING POINTS/TAKE HOME MESSAGES 3 to 5 bullet points – this is a required
field
Novels
approaches
ameliorates
several of
the
current
limitations
to
peripheral/central VA-ECMO therapy
Potential for improving outcomes in VA-ECMO patients
Page 1 of 2
Effective and relatively safe approach for ECMO
REFERENCES
-Boon Lim JK, Lee JH, Mok YH, Chan YH. Successful Use of Extracorporeal
Membrane Oxygenation in a Neonate With Arterial pH Less Than 6.6. World J
Pediatr Congenit Heart Surg. 2015 Jul;6(3):466-9.
-Kyo M, Ohshimo S, Kida Y, Shimatani T, Torikoshi Y, Suzuki K et al. Pediatric
cardiorespiratory
failure
successfully
managed
with
venoarterialvenous extracorporeal membrane oxygenation: a case report. BMC Pulm Med. 2016
Aug 12;16(1):119.
-Botha P, Deshpande SR, Wolf M, Heard M, Alsoufi B, Kogon B et al.
Extracorporeal membrane oxygenator support in infants with systemic-pulmonary
shunts. J Thorac Cardiovasc Surg. 2016 Sep;152(3):912-8.
-Thiagarajan RR. Extracorporeal Membrane Oxygenation for Cardiac Indications in
Children. Pediatr Crit Care Med. 2016 Aug;17(8 Suppl 1):S155-9.
FIGURE/VIDEO CAPTIONS figures should NOT be embedded in this document
Date: 08/30/2016
Author: Guilherme Viotto Rodrigues da Silva, Luiz Fernando Caneo, Maria Aparecida
Batistão Gonçalves, Vanessa Alves Guimaraes, Filomena Regina Barbosa Gomes
Galas, Marcelo Biscegli Jatene
Page 2 of 2