Mitral valve bio-prosthesis and annuloplasty thrombosis during extracorporeal membrane oxygenation: case series.

Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a well-recognized form of haemodynamic support for patients with refractory cardiogenic shock, who are unable to be weaned off cardiopulmonary bypass. Thrombosis or bleeding from cannula sites or surgical wounds are the leading cause of morbidity and mortality in these patients, and presents a delicate balance of anticoagulation during management of patients undergoing circulatory support.

Case Summary: In this case series, we discuss three cases of patients undergoing mitral valve replacements or repair with thrombosis of their new bio-prosthesis in the immediate post-operative setting.

Improving the echocardiographic assessment of pulmonary pressure using the tricuspid regurgitant signal-The "chin" vs the "beard".

Aim: Transthoracic echocardiography (TTE) is a fundamental investigation for the noninvasive assessment of pulmonary hemodynamics and right heart function. The aim of this study was to assess the correlation and agreement of Doppler calculation of right ventricular systolic pressure (RVSP) and pulmonary vascular resistance (PVR) using "chin" and "beard" measurements of tricuspid regurgitant velocity (TRV ), with invasive pulmonary artery systolic pressure (PASP) and PVR.

Methods: One hundred patients undergoing right heart catheterisation (RHC) and near simultaneous transthoracic echocardiography were studied.

Management of oral anticoagulation in the surgical patient.

New oral anticoagulants (NOACs) have recently emerged as an alternative for vitamin K antagonists and are now widely available. Although there is good evidence for their roles in the appropriate clinical settings, so far no reversal agent is currently available. Likewise, there is no readily available laboratory test to quantify drug levels but coagulation assays may provide qualitative information about the presence of some NOACs.

New oral anticoagulants and perioperative management of anticoagulant/antiplatelet agents.

Background: The strategy of whether to continue anticoagulation and antiplatelet agents during surgery depends on an evaluation of the thromboembolic risk and haemorrhagic risk of the individual patients. Procedures that carry a significant risk of bleeding may require temporary cessation of the medication.

Objective: We briefly review the use of common oral anticoagulant and antiplatelet agents, including clinical indications and limitations associated with those agents.