46: Successful use of Veno-Arterial ECMO as a bridge to recovery in a patient with stuck Mitral valve prosthesis: A case report

Background: Acute prosthetic mitral valve obstruction is a life-threatening emergency causing rapid hemodynamic deterioration. Early recognition and circulatory support are critical while definitive therapy is planned. Veno-arterial extracorporeal membrane oxygenation (VA ECMO) provides temporary mechanical support, allowing time for stabilization and therapeutic intervention. Case Presentation: A 52-year-old male, known case of rheumatic heart disease status post mitral valve replacement and left atrial appendage ligation (2015), presented with sudden-onset palpitations and dyspnea. Echocardiography revealed a stuck mitral prosthesis with markedly elevated transmitral gradients. Despite escalating inotropes, he developed refractory cardiogenic shock. VA ECMO was initiated for circulatory stabilization. After multidisciplinary discussion, systemic thrombolysis with streptokinase was administered. Repeat transesophageal echocardiography demonstrated a reduction in mean transmitral gradient to 7 mm Hg and peak 16 mm Hg, indicating partial resolution. The patient was transitioned to heparin infusion for anticoagulation. Hemodynamics improved rapidly, enabling decannulation on day 2. He was discharged home in stable condition after one week. Discussion: This case highlights the pivotal role of VA ECMO as a bridge to recovery in acute prosthetic valve thrombosis presenting with cardiogenic shock. ECMO provided essential circulatory support, permitting safe administration of thrombolytic therapy and recovery of valve function. Conclusion: VA ECMO can serve as a lifesaving bridge to decision or recovery in patients with prosthetic mitral valve obstruction and shock, particularly when prompt thrombolysis is planned. Keywords: VA ECMO, prosthetic mitral valve thrombosis, cardiogenic shock, thrombolysis, bridge to recovery