PMC6942779_01
Intraoperative TEE before veno-arterial-ECMO cannulation. (A) Bicaval view-large thrombus visualized in the right atrium (RA) from static blood flow and coagulopathy. (B) Trans-gastric SAX-Right ventricle (RV) thrombus occluding the right ventricular outflow tract (RVOT). Left ventricle (LV) is hyperdynamic and underfilled. (C) Four chamber view-septal bowing into the LV, D-shaped septum suggesting RV pressure overload.
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fig1
The right ventricle appeared dilated and dyskinetic while the left ventricle was underfilled and hyperdynamic (Figure 1).
Intraoperative TEE before veno-arterial ECMO decannulation. (A) Right atrial view-RA shows resolution of thrombus load. (B) Four chamber view-normalization of RV/LV ratio. Resolution of septal bowing. (C) Four chamber view-RA dilation persisted despite overall clinical improvement and resolution of thrombus load.
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fig2
TEE exams showed decreased thrombus load, resolution of RV dilatation, and progressive improvement in contractility (Figure 2). Thus, the patient was decannulated from veno-arterial ECMO 26 hours after initiation.