Rescue Balloon Aortic Valvuloplasty for Malignant Ventricular Arrhythmias and Cardiogenic Shock

Abstract

Introduction: Severe Calcific Aortic Stenosis (AS) remains a major cause of morbidity and mortality in aged population. Asymptomatic with reduced LVEF has high risk of sudden death. Aim: To study the complexity of clinical course of Severe Calcific AS with LV Dysfunction. Case Report: A Seventy-Six-year-old male was admitted with ACS, NSTEMI, LVEF 35% and Severe Calcific AS. With plan of AVR, CAG was done and showed Mild CAD. Post-procedure he had sequence of catastrophic clinical events that includes, A systolic Cardiac Arrest (reverted after CPR) and Protracted Pulmonary edema (Connected to Mechanical Ventilation). Later had Malignant Ventricular Arrhythmias, treated with 34 times DC Shocks. He was not suitable for Surgical AVR or TAVI. After high-risk consent, he successfully underwent emergency Aortic Balloon Valvuloplasty (ABV) with significant drop in AV gradients. Post ABV, also had Paroxysmal AF. Arrhythmias were also treated with Beta blocker, Antiarrhythmics, Digoxin and Potassium supplementation. Gradually stabilized, discharged and followed up. Discussion: Aortic stenosis, a disease of elderly age group. Symptomatology varies widely. It has limited management options. In our case, Post CAG critical illness was probably due to “Pre -CAG” LV dysfunction with subclinical symptoms. ABV used as bail out the procedure in high-risk patients. Conclusion: ABV is considered as a viable palliative option, with the introduction of smaller profile balloons, rapid pacing and vascular closure devices. ABV can safely used as bridging procedure before Surgical AVR or TAVI in high-risk patients