Abstract
BackgroundObstruction of the left ventricular outflow tract (LVOT) as seen in hypertrophic cardiomyopathy is a dynamic condition with a wide range of clinical presentations and symptoms.Case summaryWe report the use of veno-arterial extracorporeal membrane oxygenation in a female patient who was resuscitated after out-of-hospital cardiac arrest. Soon after admission the patient developed critical haemodynamic compromise due to severe obstruction of the left ventricle outflow tract and systolic anterior motion (SAM) of the mitral valve. Veno-arterial extracorporeal membrane oxygenation restored haemodynamics and was weaned after 4 days without any haemodynamic compromise due to SAM. The patient was discharged from the intensive care unit at Day 13, and after 3 days at the coronary care unit, she was discharged to ambulatory follow-up with no sequelae.DiscussionVeno-arterial extracorporeal membrane oxygenation restored haemodynamic stability in this patient with dynamic severe LVOT obstruction following cardiac arrest.
Highlights
Obstruction of the left ventricular outflow tract (LVOTO) is most frequently seen as a consequence of septal myocardial hypertrophy in hypertrophic obstructive cardiomyopathy and in hypertensive heart disease
Systolic anterior motion (SAM) often accompanies LVOTO and is the result of high velocity blood flow in mid-systole, displacing the anterior mitral leaflet to the hypertrophied septum causing a dynamic obstruction throughout systole accompanied by mitral regurgitation (MR).[1]
Left ventricular outflow tract obstruction is associated with increased risk of sudden cardiac death, exercise intolerance, angina, and syncope
Summary
Veno-arterial extracorporeal membrane oxygenation restored haemodynamic stability in this patient with dynamic severe LVOT obstruction following cardiac arrest. Veno-arterial extracorporeal membrane oxygenation can restore haemodynamic stability in patients with transient severe left ventricular outflow tract obstruction following cardiac arrest and cardiogenic shock. Veno-arterial extracorporeal membrane oxygenation improves systemic circulation and oxygenation
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