Objective: Preoperative management of post-infarction left ventricular free wall rupture (LVFWR) is not clearly standardized. Surgical repair is the only therapeutic option. Crucial is to choose which mechanical device should be used in case of a very unstable haemodynamic status of the patient. In this case, before proceeding with any surgical repair rescue act becomes an essential step. We report a case of LVFWR with tamponade and cardiogenic shock in which cardiopulmonary support with portable ECMO was used to rescue the patient before the operation. Methods: A 67 old man with a recent history of myocardial infarction was admitted in emergency department by collapse. Diagnosis of LVFWR was done by 2D- echocardiogram which showed pericardial effusion around the heart. Emergent pericardiocentesis was done. Due to a very critical status an ECMO was installed percutaneously via femoral vein and artery. Centrifugal pump (Jostra-Rota Floww) was used. The pump flow was maintained at 2.5 l/min/m2 obtaining a mean systemic pressure of 50-60 mmHg. In this way diastolic perfusion was improved and cardiac workload reduced. So, we could obtain a better haemodynamic stabilization and reduced pericardial effusion. At the moment of the operation, after conversion of ECMO in standard cardiopulmonary bypass, surgical repair consisted in visualization of the site of rupture, infartectomy of inferior wall and closure of the area with large Teflon strips sutures. ECMO was then maintained for two days in order to reduce the workload of the heart and to avoid re-rupture and it was weaned off uneventfully. Results: The patient was estubated at 5th postoperative day. The course was complicated by lung infection treated with antibiotic therapy. He was discharged at the 12th postoperative day Conclusions: Free wall rupture occurs in 4% to 25% of patient with AMI between 1-7 days after infarction. The rupture is usually a gradual process that begins with a small endocardial tears which soon dissects resulting in sudden pericardial tamponade often fatal. Use of aortic counter pulsation is described but it is not always useful to avoid further complications in very critical ill patients and in those situations in which the death of patient is imminent. In this latter case, the role of portable ECMO implanted in emergency department, could stabilize the haemodynamic status and improve the postoperative course, reducing the mortality rate of this pathology.

ECMO SUPPORT TO TREAT CARDIOGENIC SHOCK DUE TO LEFT VENTRICULAR FREE WALL RUPTURE: A CASE REPORT / Formica, F; Ferro, O; Corti, F; Avalli, L; Paolini, G. - In: INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY. - ISSN 1569-9293. - (2004), pp. s48-s48. (Intervento presentato al convegno 53rd International Congress of European Society for Cardiovascular and Endovascular Surgery (ESCVS) tenutosi a Ljiubljana (Slovenia) nel 2-5 Giugno 2004).

ECMO SUPPORT TO TREAT CARDIOGENIC SHOCK DUE TO LEFT VENTRICULAR FREE WALL RUPTURE: A CASE REPORT

Formica F;
2004-01-01

Abstract

Objective: Preoperative management of post-infarction left ventricular free wall rupture (LVFWR) is not clearly standardized. Surgical repair is the only therapeutic option. Crucial is to choose which mechanical device should be used in case of a very unstable haemodynamic status of the patient. In this case, before proceeding with any surgical repair rescue act becomes an essential step. We report a case of LVFWR with tamponade and cardiogenic shock in which cardiopulmonary support with portable ECMO was used to rescue the patient before the operation. Methods: A 67 old man with a recent history of myocardial infarction was admitted in emergency department by collapse. Diagnosis of LVFWR was done by 2D- echocardiogram which showed pericardial effusion around the heart. Emergent pericardiocentesis was done. Due to a very critical status an ECMO was installed percutaneously via femoral vein and artery. Centrifugal pump (Jostra-Rota Floww) was used. The pump flow was maintained at 2.5 l/min/m2 obtaining a mean systemic pressure of 50-60 mmHg. In this way diastolic perfusion was improved and cardiac workload reduced. So, we could obtain a better haemodynamic stabilization and reduced pericardial effusion. At the moment of the operation, after conversion of ECMO in standard cardiopulmonary bypass, surgical repair consisted in visualization of the site of rupture, infartectomy of inferior wall and closure of the area with large Teflon strips sutures. ECMO was then maintained for two days in order to reduce the workload of the heart and to avoid re-rupture and it was weaned off uneventfully. Results: The patient was estubated at 5th postoperative day. The course was complicated by lung infection treated with antibiotic therapy. He was discharged at the 12th postoperative day Conclusions: Free wall rupture occurs in 4% to 25% of patient with AMI between 1-7 days after infarction. The rupture is usually a gradual process that begins with a small endocardial tears which soon dissects resulting in sudden pericardial tamponade often fatal. Use of aortic counter pulsation is described but it is not always useful to avoid further complications in very critical ill patients and in those situations in which the death of patient is imminent. In this latter case, the role of portable ECMO implanted in emergency department, could stabilize the haemodynamic status and improve the postoperative course, reducing the mortality rate of this pathology.
2004
ECMO SUPPORT TO TREAT CARDIOGENIC SHOCK DUE TO LEFT VENTRICULAR FREE WALL RUPTURE: A CASE REPORT / Formica, F; Ferro, O; Corti, F; Avalli, L; Paolini, G. - In: INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY. - ISSN 1569-9293. - (2004), pp. s48-s48. (Intervento presentato al convegno 53rd International Congress of European Society for Cardiovascular and Endovascular Surgery (ESCVS) tenutosi a Ljiubljana (Slovenia) nel 2-5 Giugno 2004).
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11381/2875648
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