The effectiveness of extracorporeal membrane oxygenation in a patient with post myocardial infarct ventricular septal de
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CASE REPORT
Open Access
The effectiveness of extracorporeal membrane oxygenation in a patient with post myocardial infarct ventricular septal defect Jintae Kwon1 and Donghyup Lee2*
Abstract Background: Post infarction ventricular septal defect (VSD) is an uncommon but life threatening complication of acute myocardial infarction. Case presentation: A 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. Conclusions: When optimal medical treatment fails to stabilize a patient in cardiogenic shock, peripheral ECMO could be used as a bridge to definitive surgical therapy. Keywords: Post infarction ventricular septal defect, Extracorporeal membrane oxygenation, Cardiogenic shock
Background Rupture of the ventricular septum after acute myocardial infarction (AMI) is a serious complication. In the pre-thrombolytic era, its incidence was 1–2 % but the use of thrombolytic agents reduced it to 0.2 % [1, 2]. The mortality rate with only medical treatment reaches 90–95 %, but the rate varies from 19 to 60 % with surgical intervention [1]. Despite optimal medical treatment, when ventricular septal defect (VSD) related cardiogenic shock causes rapid deterioration, surgical repair is the only definitive treatment. However, early surgical repair is difficult and complicated due to the presence of friable, infarcted, necrotic tissue. To defer surgery in patients with cardiogenic shock, peripheral ECMO could be used as a temporary bridge to definitive surgical repair after post AMI VSD.
* Correspondence: [email protected] 2 Department of Thoracic and Cardiovascular Surgery, Yeungnam University Hospital, 317-1 Daemyung 5 dong, Namgu, Daegu, South Korea Full list of author information is available at the end of the article
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. Chest X-ray revealed cardiomegaly and pulmonary edema. On admission, blood tests revealed Hb 10.9 g/dl, troponin I 5.26, CK-MB 4 ng/ ml. Arterial blood gas revealed pH 7.32, pCO 2 21.6, pO 2 80.2 mmHg, bicarbonate 11 mmol/l and SaO 2 92.8 % on room air. Electrocardiography (ECG) showed ST-segment elevation and Q waves in leads V1-4 and coronary catheterization revealed total proximal occlusion of the anterior interventricular branch of the left coronary artery. Angioplasty and stent implantation were performed, and chest pain, shortness of breath, and general malaise disappeared after the procedure. However, the day after angioplasty and stenting, the patient suddenly experienced fatigue, dyspnea, and tachycardia. At this time, her blood pressure wa
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