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Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Left ventricular (LV) thrombus is a catastrophic complication during veno arterial-extracorporeal membrane oxygenation (VA-ECMO) support for cardiogenic shock, arising from a confluence of hemodynamic stasis, a prothrombotic state, and potential limitations of conventional anticoagulation monitoring.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 42-year-old man with acute inferior-wall ST-elevation myocardial infarction developed refractory cardiogenic shock during percutaneous coronary intervention, necessitating VA-ECMO initiation. Dual antiplatelet therapy and systemic heparinization (targeting an activated partial thromboplastin time of 50\u201380\u2005s) were maintained.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Despite therapeutic anticoagulation, serial echocardiography documented the formation of a massive LV thrombus occupying &amp;gt;90% of the cavity within a 14\u2005h interval on the fourth day of ECMO support. The patient subsequently deteriorated into refractory multi-organ failure, leading to withdrawal of care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case underscores the rapidity and severity of LV thrombus formation in VA-ECMO patients with severe ventricular dysfunction. It highlights the critical need for proactive management, including multimodal anticoagulation monitoring and aggressive, individualized LV unloading strategies that may require escalation beyond intra-aortic balloon pump support to more direct decompression methods.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1778609","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T11:12:43Z","timestamp":1773659563000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Extracorporeal membrane oxygenation in acute coronary syndrome: a rare case of massive left ventricular thrombus"],"prefix":"10.3389","volume":"13","author":[{"given":"Jian","family":"Lan","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, Taizhou Municipal Hospital (Affiliated Taizhou University Hospital), School of Medicine, Taizhou University","place":["Taizhou, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yifeng","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Taizhou Municipal Hospital (Affiliated Taizhou University Hospital), School of Medicine, Taizhou University","place":["Taizhou, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chenyang","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Taizhou Municipal Hospital (Affiliated Taizhou University Hospital), School of Medicine, Taizhou University","place":["Taizhou, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Taizhou Municipal Hospital (Affiliated Taizhou University Hospital), School of Medicine, Taizhou University","place":["Taizhou, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiang","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Taizhou Municipal Hospital (Affiliated Taizhou University Hospital), School of Medicine, Taizhou University","place":["Taizhou, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingjing","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Urology, Taizhou Central Hospital (Affiliated Hospital of Taizhou University)","place":["Taizhou, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xijiang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Taizhou Municipal Hospital (Affiliated Taizhou University Hospital), School of Medicine, Taizhou University","place":["Taizhou, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheng","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Taizhou Municipal Hospital (Affiliated Taizhou University Hospital), School of Medicine, Taizhou University","place":["Taizhou, Zhejiang, China"]},{"name":"Taizhou Key Laboratory of Sepsis, Taizhou Municipal Hospital","place":["Taizhou, China"]},{"name":"Taizhou Key Laboratory of Infection and Tumor Immunology, Taizhou Municipal Hospital","place":["Taizhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1404","DOI":"10.1097\/CCM.0b013e31816f7cf7","article-title":"Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock","volume":"36","author":"Combes","year":"2008","journal-title":"Crit Care Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"S60","DOI":"10.1016\/S0003-4975(00)02626-6","article-title":"Postcardiotomy mechanical support: risk factors and outcomes","volume":"71","author":"Smedira","year":"2001","journal-title":"Ann Thorac Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2242","DOI":"10.1513\/AnnalsATS.201605-364SR","article-title":"Anticoagulation practices during venovenous extracorporeal membrane oxygenation for respiratory failure. 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