Transesophageal echocardiographic diagnosis of cardiac rupture during ECMO assisted percutaneous intervention: Rapid Diagnosis of Cardiac Rupture with TEE

Abstract Left ventricular free wall rupture is a feared complication of myocardial infarction and revascularization therapies. Transesophageal echocardiography (TEE) has an established role in cardiac surgery and a growing role in percutaneous intracardiac procedures, complex PCI and Extra-Corporeal Membrane Oxygenation (ECMO). This report concerns a 91-year old patient who underwent complex Extra-Corporeal Membrane Oxygenation (ECMO) assisted PCI. Despite successful angiography, the procedure was complicated by left ventricular free wall rupture. Transesophageal echocardiography (TEE) allowed for rapid diagnosis of the complication and associated pericardial effusion and facilitated surgical management of the effusion as well as the ultimate decision to palliate. The report highlights the ever-present risk of cardiac rupture post revascularization as well as the value of TEE in the rapid diagnosis of this complication and as a guide to anesthetic and procedural management in complex percutaneous cases