Zhujiang Hospital Transitions from ECMO + IABP to MoyoAssist® in the Management of Cardiogenic Shock

Ultrasonic Findings:

1. Bedside ultrasound in the intensive care unit reveals pericardial effusion (depth approximately 7 - 10 mm). The aortic wall shows enhanced echo, with a flattened main wave and dicrotic wave. The diameter of the main pulmonary artery is normal, and the positional relationship of the great arteries is normal.

2. The left heart is significantly enlarged, while the size of the right heart chamber is normal.

3.The myocardial contractile motion of all walls of the left ventricle is generally and significantly reduced, especially in the extensive anterior wall and the apex; the myocardial contractile motion of the free wall of the right ventricle is basically normal.

4. The atrial and ventricular septa are continuous, and no abnormal channels are found between the great vessels. CDFI shows no shunt signals at the atrial, ventricular, and great vessel levels.

5. The echo quality of the mitral valve is fair, and a regurgitation gap can be seen during systole; the echo of the tricuspid valve is normal, and its opening and closing are normal. The aortic valve shows enhanced echo, and its opening and closing are normal. CW and CDFI show 5 ml of mitral regurgitation, 0.5 ml of tricuspid regurgitation (Vmax = 2.5 m/s, PGmax = 25 mmHg), and 0.5 ml of aortic valve regurgitation.

6. Left ventricular systolic function: (M - mode detection): EF = 23%, (by Simpson's method): EF = 24% (normal value 54% - 80%), FS = 12% (normal value 27% - 48%). The estimated effective stroke volume of the left ventricle is approximately 35 - 40 ml, indicating significantly reduced left ventricular systolic function.

7. A strong echo of the catheter (ECMO cannula) can be seen in the inferior vena cava; the diameter of the inferior vena cava is approximately 20 - 23 mm. Evaluation of right ventricular systolic function: FAC = 40% (normal value >35%); the tricuspid annular plane systolic excursion (TAPSE) is approximately 16 mm, and the tissue velocity of the free - wall of the tricuspid annulus s'= 10 cm/s. Although the original standard indicates TAPSE < 16 mm and Vs'< 9.5 cm/s suggesting reduced right ventricular systolic function, the measured TAPSE here is approximately 16 mm, which requires further clinical judgment.

Ultrasonic Suggestions:

The sonogram suggests widespread myocardial ischemia in the left ventricle; degenerative changes of the aortic valve; mitral valve insufficiency (moderate, considered to be caused by papillary muscle dysfunction). The left ventricular systolic function is significantly reduced; the right ventricular systolic function is normal. There is a small amount of pericardial effusion; CDFI shows moderate mitral regurgitation; and trace tricuspid and aortic valve regurgitation.