PMC9869361_01
Chest X-ray showing congestion of the vascular bed.
gr1.jpg
PMC9869361_01_gr1.jpg
fig1
Then, 12 hours later, the patient required a higher fraction of oxygen in the gas mixer, showed congestion of the vascular bed in the chest X-ray (Fig. 1), and developed LVD (despite management with inotropes and an IABP) with spontaneous echo contrast (Fig. 2A), an absence of opening of the aortic valve (Fig. 2B; Video 1,  view video online), and pulmonary edema.
(A) Transesophageal echocardiography (TEE) 4-chamber view. Dilated left ventricle with spontaneous echo contrast (white arrow). (B) Absence of opening of the aortic valve and spontaneous echo contrast in the aortic root (white arrow). (C) Through a 6-French sheath introducer in the left radial artery (black arrow), a 6-French pigtail catheter is introduced to the left ventricular (LV) cavity (white arrow). (D) Real-time TEE guidance showing the catheter passage through the aortic valve (white arrow) into the LV cavity (3-chamber view). (E) Chest X-ray showing the tip of the catheter at the LV cavity (white arrow). (F) The pigtail catheter is connected directly to the extraction cannula (black arrow). (G) Real-time TEE showing the opening of the aortic valve (white arrow) after the drainage is initiated (3-chamber view). (H) LV end-diastolic pressure of 7 mm Hg is registered.
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PMC9869361_01_gr2.jpg
fig2
Then, 12 hours later, the patient required a higher fraction of oxygen in the gas mixer, showed congestion of the vascular bed in the chest X-ray (Fig. 1), and developed LVD (despite management with inotropes and an IABP) with spontaneous echo contrast (Fig. 2A), an absence of opening of the aortic valve (Fig. 2B; Video 1,  view video online), and pulmonary edema. Because the patient could not be transferred to the catheterization laboratory, because of extreme hypotension, a 6-French pigtail catheter (Cordis US, Miami Lakes, FL) was introduced through the left radial artery with a 6-French sheath introducer (Fig. 2C). TEE (Fig. 2D). The correct position of the tip was confirmed with a portable chest X-ray (Fig. 2E). Then, the pigtail catheter was connected to the extraction cannula (Fig. 2F). TEE showed resolution of LVD as well as the spontaneous echo contrast and opening of the aortic valve (Fig. 2G; Video 2,  view video online). In addition, the LV end-diastolic pressure was measured, giving a value of 7 mm Hg (Fig. 2H).