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Left atrial venting through atrial septotomy in patients with decreased left ventricular (LV) contractility after venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a simple and effective method for treating LV decompression. We report a case of prosthetic mitral valve thrombosis after left atrial venting in a patient with VA-ECMO. In patients undergoing mitral valve replacement, left atrial venting reduces the flow through the mitral valve and forms a prosthetic thrombosis. Therefore, excessive left atrial venting should be