Case Presentation
A 63-year-old male patient was admitted to the local hospital for acute
left heart failure after field operations. He suffered from severe
hypoxemia along with cardiogenic shock. He was intubated 12 hours after
treatment with diuresis, cardiotonic, vasodilator, and ventilation. When
our team arrived on day 2, his blood pressure was maintained at 80/50
mmHg with high-dose inotropic support (noradrenaline [100 ug/min],
pituitrin [2U/h], and dobutamine [20 ug/kg.min]), and his
PaO2/FiO2 (P/F) ratio was only 80 mmHg. It is worth noting that his
blood pressure considerably fluctuated with heart rate. A bed-side
echocardiography showed a giant anomalous vegetation bearing a strong
resemblance to
the
evil eye (Figure. 1). He was put on
veno-arteriovenous extracorporeal
membrane oxygenation (VAV-ECMO) for progressive cardiopulmonary failure
and was transferred to our
intensive care unit (ICU) 4 hours
later.
On day 3, surgery was performed
through the right atrium and atrial septum, and revealed a 75 × 30mm
mass attached by a narrow stalk (10 mm) originating from the atrial
septum (Figure. 2). ECMO was suspended for 60 minutes during
cardiopulmonary bypass and was removed 2 days later. On day 10, the
patient was discharged from the ICU in good condition and was doing well
on outpatient follow-up.