PMC9270772_01
Chest X-ray showing the extraction (femoral) and return (jugular) cannulas.
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A 23 French extraction venous cannula (Medtronic plc., Minneapolis, MN, USA) was inserted through the right femoral vein (FV) directed toward the inferior vena cava (IVC), and a 21 French arterial return cannula (Medtronic plc., Minneapolis, MN, USA) was inserted through the right internal jugular vein (YV) into the right atrium directed toward the tricuspid valve (Fig. 1).
Transthoracic echocardiogram, apical 4-chamber view. A: RV dilatation, with a RV/LV ratio >1 and fractional shortening (FS) of 33.5% (normal >=35%), confirming RV dilatation and dysfunction. B: RV/LV ratio <1 and FS of 42.7%, confirming improving of the RV systolic function. RV: Right ventricle, LV: left ventricle.
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Moreover, the patient developed shock, with decreased blood pressure and central venous saturation as well as increased central venous pressure and lactate levels; Thus, a transthoracic echocardiogram was performed, documenting right ventricular dilatation and dysfunction (Fig. 2A). The diameter of the right ventricle was decreased, and his functional parameters improved (Fig. 2B), with no subsequent requirements for inotropes and maintenance of serum lactate levels below 2 mmol/L.
A: The hydrophilic metal wire guide (asterisk) was introduced through the return cannula (arrow). B: A multipurpose catheter was advanced over the hydrophilic guide toward the pulmonary artery. C: An extra-stiff wire guide was introduced through the catheter. D: A venous cannula was advanced to the right branch of the pulmonary artery over the guide (final position).
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A hydrophilic metal wire guide was introduced through the previous return cannula and advanced to the PA under fluoroscopic guidance (Fig. 3A). Then, over the guide, a 5 French multipurpose catheter was advanced (Fig. 3B), through which a Lunderquist extra-stiff wire guide (Cook Medical LLC., Bloomington, IN, USA) (Fig. 3C) was introduced. Then, a 19 French venous cannula (Medtronic plc., Minneapolis, MN, USA) was advanced to the right branch of the PA (Fig. 3D).