ArticleFrontiers in cardiovascular medicine2026
Case Report: Extracorporeal membrane oxygenation in acute coronary syndrome: a rare case of massive left ventricular thrombus.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Left ventricular (LV) thrombus is a catastrophic complication during veno arterial-extracorporeal membrane oxygenation (VA-ECMO) support for cardiogenic shock, arising from a confluence of hemodynamic stasis, a prothrombotic state, and potential limitations of conventional anticoagulation monitoring. Case presentation: A 42-year-old man with acute inferior-wall ST-elevation myocardial infarction developed refractory cardiogenic shock during percutaneous coronary intervention, necessitating VA-ECMO initiation. Dual antiplatelet therapy and systemic heparinization (targeting an activated partial thromboplastin time of 50-80 s) were maintained. Results: Despite therapeutic anticoagulation, serial echocardiography documented the formation of a massive LV thrombus occupying >90% of the cavity within a 14 h interval on the fourth day of ECMO support. The patient subsequently deteriorated into refractory multi-organ failure, leading to withdrawal of care. Conclusion: This case underscores the rapidity and severity of LV thrombus formation in VA-ECMO patients with severe ventricular dysfunction. It highlights the critical need for proactive management, including multimodal anticoagulation monitoring and aggressive, individualized LV unloading strategies that may require escalation beyond intra-aortic balloon pump support to more direct decompression methods.
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