The effectiveness of extracorporeal membrane oxygenation in a patient with post myocardial infarct ventricular septal defect

Jintae Kwon,Donghyup Lee

doi:10.1186/s13019-016-0537-5

Abstract

BackgroundPost infarction ventricular septal defect (VSD) is an uncommon but life threatening complication of acute myocardial infarction.Case presentationA 62-year-old woman was admitted with acute myocardial infarction (AMI). However, the day after angioplasty and stenting, Transthoracic echocardiography (TTE) showed post infarction VSD. We decided to insert an extracorporeal membrane oxygenation (ECMO) device for stabilization purposes before surgical repair. After 4 days from the implantation, we performed surgical repair successfully.ConclusionsWhen optimal medical treatment fails to stabilize a patient in cardiogenic shock, peripheral ECMO could be used as a bridge to definitive surgical therapy.

Highlights

Post infarction ventricular septal defect (VSD) is an uncommon but life threatening complication of acute myocardial infarction
To defer surgery in patients with cardiogenic shock, peripheral extracorporeal membrane oxygenation (ECMO) could be used as a temporary bridge to definitive surgical repair after post acute myocardial infarction (AMI) VSD
In patients presenting with cardiogenic shock following AMI, the use of a percutaneously placed LVAD is more feasible, safe, and provides superior hemodynamic support than the standard treatment using IABP [3]

Summary

Background

Rupture of the ventricular septum after acute myocardial infarction (AMI) is a serious complication. Case presentation A 62-year-old woman with a history of hypertension was admitted with complaints of chest pain and shortness of breath of 3 days duration Her heart rate was 89 bpm, blood pressure 105/70 mmHg, and temperature 36.5 °C. The day after angioplasty and stenting, the patient suddenly experienced fatigue, dyspnea, and tachycardia At this time, her blood pressure was 70/50 mmHg and heart rate 120 bpm. Symptoms of congestive heart failure progressed due to low cardiac output, and the patient was transferred to the intensive care unit to treat the heart failure and to prevent progression of cardiogenic shock. The TTE prior to discharge showed a residual 6 mm VSD in the mid anterior ventricular septum, and at this time, the total pulmonary to total systemic blood flow ratio (Qp/Qs) of the residual VSD was 1.1.

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