PMID- 30656612
OWN - NLM
STAT- MEDLINE
DCOM- 20200101
LR  - 20200101
IS  - 1868-4297 (Electronic)
IS  - 1868-4297 (Linking)
VI  - 34
IP  - 4
DP  - 2019 Oct
TI  - Acquired von Willebrand syndrome in patients treated with veno-arterial 
      extracorporeal membrane oxygenation.
PG  - 358-363
LID - 10.1007/s12928-019-00568-y [doi]
AB  - Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is a powerful device 
      for treatment of patients with life-threatening heart failure. Although bleeding 
      is often associated with VA ECMO and sometimes results in a fatal outcome, its 
      precise causes remain unknown. On the other hand, excessive high shear stress in 
      the cardiovascular system causes acquired von Willebrand syndrome (aVWS), 
      characterized by loss of von Willebrand factor (vWF) large multimers. vWF large 
      multimers of five consecutive patients treated with VA ECMO were quantitatively 
      evaluated using the vWF large multimer indices, defined as the ratio of the large 
      multimer ratio of a patient to that of a healthy subject analyzed simultaneously. 
      All 5 patients exhibited oozing type of bleeding at the skin insertion sites 
      under treatment with PCPS at flow rates of 2.5-3.0 l/min/m(2), including two 
      severe cases of bleeding; one patient had massive gastrointestinal bleeding and 
      another had hemothorax. Their vWF large multimer indices were 20.8, 28.8, 27.6, 
      51.0, and 31.0% (means 31.8 +/- 11.4%). Surprisingly, these values are much lower 
      than those observed in severe aortic stenosis reported previously by us (Tamura 
      et al. in J Atheroscler Thromb 22:1115-1123, 2015), where vWF multimer indices in 
      31 severe aortic stenosis patients with peak pressure gradient through the aortic 
      valves of 85.1 +/- 29.4 mmHg were 75.0 +/- 21.7% (p < 0.0001), indicating that much 
      higher grade of aVWS occurred in patients with VA ECMO than severe aortic 
      stenosis patients. All the 5 patients treated with VA ECMO developed aVWS that 
      was much more severe than in patients with severe aortic stenosis.
FAU - Tamura, Toshihiro
AU  - Tamura T
AUID- ORCID: 0000-0001-8655-0203
AD  - Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, 
      Japan. ttamu@tenriyorozu.jp.
FAU - Horiuchi, Hisanori
AU  - Horiuchi H
AD  - Department of Molecular and Cellular Biology, Institute of Development, Aging and 
      Cancer, Tohoku University, Sendai, Japan.
FAU - Obayashi, Yuki
AU  - Obayashi Y
AD  - Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, 
      Japan.
FAU - Fuki, Masayuki
AU  - Fuki M
AD  - Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, 
      Japan.
FAU - Imanaka, Miyako
AU  - Imanaka M
AD  - Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, 
      Japan.
FAU - Kuroda, Maiko
AU  - Kuroda M
AD  - Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, 
      Japan.
FAU - Nishimura, Shunsuke
AU  - Nishimura S
AD  - Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, 
      Japan.
FAU - Amano, Masashi
AU  - Amano M
AD  - Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, 
      Japan.
FAU - Sakamoto, Jiro
AU  - Sakamoto J
AD  - Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, 
      Japan.
FAU - Tamaki, Yodo
AU  - Tamaki Y
AD  - Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, 
      Japan.
FAU - Enomoto, Soichiro
AU  - Enomoto S
AD  - Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, 
      Japan.
FAU - Miyake, Makoto
AU  - Miyake M
AD  - Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, 
      Japan.
FAU - Kondo, Hirokazu
AU  - Kondo H
AD  - Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, 
      Japan.
FAU - Izumi, Chisato
AU  - Izumi C
AD  - Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, 
      Japan.
FAU - Nakagawa, Yoshihisa
AU  - Nakagawa Y
AD  - Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, 
      Japan.
LA  - eng
PT  - Journal Article
DEP - 20190117
PL  - Japan
TA  - Cardiovasc Interv Ther
JT  - Cardiovascular intervention and therapeutics
JID - 101522043
SB  - IM
MH  - Adult
MH  - Aged
MH  - Extracorporeal Membrane Oxygenation/*adverse effects
MH  - Female
MH  - Gastrointestinal Hemorrhage/etiology
MH  - Hemothorax/etiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/therapy
MH  - Myocarditis/therapy
MH  - Pulmonary Embolism/therapy
MH  - von Willebrand Diseases/*etiology
OTO - NOTNLM
OT  - Acquired von Willebrand syndrome
OT  - Aortic stenosis
OT  - Bleeding
OT  - Large VWF multimer index
OT  - VA ECMO
EDAT- 2019/01/19 06:00
MHDA- 2020/01/02 06:00
CRDT- 2019/01/19 06:00
PHST- 2018/11/08 00:00 [received]
PHST- 2018/12/31 00:00 [accepted]
PHST- 2019/01/19 06:00 [pubmed]
PHST- 2020/01/02 06:00 [medline]
PHST- 2019/01/19 06:00 [entrez]
AID - 10.1007/s12928-019-00568-y [pii]
AID - 10.1007/s12928-019-00568-y [doi]
PST - ppublish
SO  - Cardiovasc Interv Ther. 2019 Oct;34(4):358-363. doi: 10.1007/s12928-019-00568-y. 
      Epub 2019 Jan 17.