A transesophageal echocardiography was performed for a patient supported with peripheral veno-arterial extracorporeal membrane oxygenation (VA ECMO) for his acute decompensated heart failure. One of the main aims of echocardiography was to assess whether the aortic valve could open despite increased afterload from the retrograde ECMO flow. The absence of forward blood flow across the aortic valve would lead to elevated left ventricular diastolic pressure and intra-ventricular clot formation.
