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ECMO as bridge to recovery in ventricular septal defect after anterior acute myocardial infarction

Session Poster Session 3 - ST Elevation Acute Coronary Sydrome

Speaker Alfredo Chauca Tapia

Event : Acute Cardiovascular Care 2018

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : ST-Elevation Myocardial Infarction (STEMI)
  • Session type : Poster Session

Authors : I Noval Morillas (Cadiz,ES), A Chauca Tapia (Cadiz,ES), W Delgado Nava (Cadiz,ES), L Gutierrez Alonso (Cadiz,ES), P Cabeza Lainez (Cadiz,ES), R Fernandez Rivero (Cadiz,ES)

Authors:
I Noval Morillas1 , A Chauca Tapia1 , W Delgado Nava1 , L Gutierrez Alonso1 , P Cabeza Lainez1 , R Fernandez Rivero1 , 1University Hospital Puerta del Mar, Cardiology - Cadiz - Spain ,

Citation:
European Heart Journal Supplement ( 2018 ) 7 ( Supplement ), S185

We present the case of a 72 year old man, with no previous medical history, who presented an episode of chest pain 1 week ago, self-limited, assessed in emergency department, being discharged.
He returns complaining for rapidly progressive dyspnea at the emergency department (NYHA class III-IV). In ECG, there is an extensive ST elevation (V2-V6).
An urgent transthoracic echocardiogram showed severe systolic dysfunction, extensive anterior dyskinesia and mid-distal interventricular communication (gradient VI-VD of 90mmHg).
Is admitted to the intensive care unit, IABP was implanted and urgent coronary angiography was performed in which a thrombotic occlusion of ostial DA was observed, performing balloon angioplasty.
Delaying surgery of VSD (> 14 days after AMI) was decided jointly with the Cardiac Surgery Service. Initially it presented clinical improvement, reason why it was possible to withdraw the IABP but then started with respiratory insufficiency and multiorganic failure, requiring reimplantation of the IABP, with improvement in the later days.
The VSD closure was performed by a pericardial patch, resecting the infarcted myocardium. During the postoperative period, the patient persist with cardiogenic shock despite supportive therapies requiring the implantation of VA ECMO, as well as vasoactive drugs at high doses.
24 hours after surgery, TEE showed clots in lateral and posterior left ventricle that were surgical drained with with minimal posterior hemodynamic improvement
5 days after surgery, despite supportive therapies, including IABP and ECMO, the patient patient died from progressive heart failure.
Conclusion: Although ECMO is a good option to maintain patients’ hemodynamic stability as a bridge to recovery, the mechanical complications of acute myocardial infarction have a fatal prognosis.

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