PERCUTANEOUS MITRAL PLICATION FOR WEANING BY VA–ECMO IN PATIENT WITH OBSTRUCTIVE SAM ASSOCIATED WITH PRECLINICAL PHENOTYPE OF HYPERTROPHIC CARDIOMYOPATHY AND STEMI COMPLICATED BY CARDIOGENIC SHOCK

Abstract

Abstract A 53–year–old man with a history of hypertrophic obstructive cardiomyopathy with a preclinical phenotype, classified at low risk of sudden cardiac death (HCM–SCD risk score 2.98%), and cardiac arrest (OHCA) in the absence of a shockable rhythm. The patient underwent cardiopulmonary resuscitation for more than 30 minutes before the diagnosis of complete atrioventricular block, masked by concomitant atrial stand–still, resolved after transcutaneous pacing. After temporary trans–venous cardiac pacing was obtained, the electrocardiogram revealed signs of an extensive anterolateral occlusive infarction (OMI), treated with primary angioplasty during percutaneous ventricular support (Impella CP). The ICU course was characterized by several ineffective attempts to wean from mechanical assistance to the circulation finally made possible by correction of outflow obstruction from mitral SAM, achieved by percutaneous mitral plication with MitraClip system. This case, in addition to suggesting an alternative strategy of weaning from mechanical assistance to the circulation in patients with a similar hemodynamic profile (SCAI D stage cardiogenic shock by dual mechanism: pump dysfunction and outflow obstruction), offers important insights into the management of OCHA in the absence of a shockable rhythm.