Education  |   June 2019
Fibrin Sheath Formation during Mechanical Circulatory Support: Another Reason for Transesophageal Echocardiographic Monitoring
Author Notes
  • From the Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio.
  • Address correspondence to Dr. Essandoh: michael.essandoh@osumc.edu
Article Information
Education / Images in Anesthesiology / Cardiovascular Anesthesia / Radiological and Other Imaging
Education   |   June 2019
Fibrin Sheath Formation during Mechanical Circulatory Support: Another Reason for Transesophageal Echocardiographic Monitoring
Anesthesiology 6 2019, Vol.130, 1036. doi:10.1097/ALN.0000000000002616
Anesthesiology 6 2019, Vol.130, 1036. doi:10.1097/ALN.0000000000002616
Discontinuing mechanical circulatory support is often guided by transesophageal echocardiography (TEE).1,2  TEE was used to guide removal of an bicaval dual-lumen catheter (Avalon Elite, Maquet, Rastatt, Germany) after recovery of lung function in a patient supported with venovenous extracorporeal membrane oxygenation. TEE assessment of the right atrium showed a large fibrin sheath after removal of the catheter (arrow on panel A; LA, left atrium; RA, right atrium). Because of the large size and mobile nature of the retained fibrin sheath, it was percutaneously removed (panel B; LA, left atrium; RA, right atrium; SVC, superior vena cava; AngioVac system, AngioDynamics, USA) to avoid pulmonary embolization.