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Case Reports
. 2020 Nov;37(11):1860-1863.
doi: 10.1111/echo.14879. Epub 2020 Oct 2.

Utility of three-dimensional transesophageal echocardiography to guide transseptal positioning of a single multistage venous cannula to provide both venous drainage and indirect left ventricular venting in veno-arterial extracorporeal membrane oxygenation

Dylan R Addis  1 , Bo Wang  2 , Shane P Prejean  3 , Thomas Evans Watts 3rd  3 , Navin C Nanda  3 , Mustafa I Ahmed  3
Affiliations
Case Reports

Utility of three-dimensional transesophageal echocardiography to guide transseptal positioning of a single multistage venous cannula to provide both venous drainage and indirect left ventricular venting in veno-arterial extracorporeal membrane oxygenation

Dylan R Addis et al. Echocardiography. 2020 Nov.

Abstract

A patient with heart failure due to dilated ischemic cardiomyopathy presented in cardiogenic shock for institution of veno-arterial extracorporeal membrane oxygenation as a bridge to cardiac transplantation. To provide adequate venous drainage and simultaneous decompression of the left atrium (indirect left ventricular venting), a single venous cannula was placed across the interatrial septum so that the distal orifice and side ports were located within the left atrium and the proximal set of side ports were positioned at the cavoatrial junction. Three-dimensional transesophageal echocardiography demonstrated utility in guiding cannula placement and appropriate positioning within the left atrium.

Keywords: ECMO; cannulation; decompression; three-dimensional echocardiography; three-dimensional transesophageal echocardiography; transseptal; venting.

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Conflict of interest statement

CONFLICT OF INTEREST

Drs. Addis, Wang, Watts, Nanda, and Prejean have no financial disclosures to declare. Dr Ahmed serves as a consultant and proctor for Abbott, Edwards, and Medtronic.

Figures

FIGURE 1
FIGURE 1
Modified mid-esophageal 4-chamber two-dimensional TEE view obtained prior to cannulation demonstrating severe left ventricular dilation and increased sphericity. LV = left ventricle; MV = mitral valve; RV = right ventricle; TEE = transesophageal echocardiography
FIGURE 2
FIGURE 2
Live three-dimensional (3D) TEE image obtained during positioning of the venous cannula across the interatrial septum (IAS) used for guidance and as the source image to perform multiplanar reconstruction to measure the distance the cannula tip extended across the IAS. AV = aortic valve; MV = mitral valve; TEE = transesophageal echocardiography; TV = tricuspid valve
FIGURE 3
FIGURE 3
Live 3D TEE image of the final cannula tip position within the left atrium (LA). The green line displays the measured distance of the cannula across the IAS (43 mm) projected onto three-dimensional space. This measurement was obtained using multiplanar reconstruction for optimal plane alignment just as performed on the ultrasound system in the catheterization laboratory at the time of cannulation (see Figure 5). IAS = interatrial septum; MV = mitral valve; TEE = transesophageal echocardiography
FIGURE 4
FIGURE 4
Live 3D TEE image projected to demonstrate a basal view of the heart aligned in anatomical position to demonstrate the course of the venous cannula across the IAS. AV = aortic valve; IAS = interatrial septum; MV = mitral valve; TEE = transesophageal echocardiography; TV = tricuspid valve
FIGURE 5
FIGURE 5
Multiplanar reconstruction of a 3D dataset (Figure 2 demonstrates original 3D capture) demonstrating plane alignment on the venous cannula used to accurately measure the distance the cannula tip projected into the left atrium
FIGURE 6
FIGURE 6
Nonstandard TEE window demonstrating final position of a 23F multistage venous cannula with color Doppler flow noted at the distal tip and side ports after initiation of left atrial veno-arterial (LAVA)-ECMO. IAS = interatrial septum; TEE = transesophageal echocardiography
See this image and copyright information in PMC

References

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