Emergent Percutaneous Coronary Intervention under Extracorporeal Membrane Oxygenation Support for a Patient with Inferior ST Elevation Myocardial Infarction and Refractory Shock: A Case Report and Literature Review

Li-Chin Sung, Yu-Chih Chen, Bee Song Chang

Research output: Contribution to journalArticle

Abstract

Early emergency revascularization with intra-aortic balloon pump (IABP) support is mandatory for patients with acute myocardial infarction (AMI) and concomitant cardiogenic shock. We report our experience with a patient of cardiogenic shock caused by an AMI refractory to conventional therapies including IABP that impede subsequent revascularization procedures. We used extracorporeal membrane oxygenation (ECMO) to provide further hemodynamic support and performed successful revascularization. However, the patient failed to wean from ECMO and severe mitral regurgitation with suspected papillary muscle rupture was observed 5 days later. The patient later underwent mitral valve replacement, survived and was discharged from the hospital. The use of ECMO can support hemodynamics for revascularization and reverse shock-induced organ damage. The shock and heart failure caused by mitral regurgitation should be considered in patients with inferoposterior AMI after successful revascularization, who are still hemodynamically unstable. We also discuss the management regarding inferior AMI with mitral regurgitation and refractory shock.
Original languageEnglish
Pages (from-to)248-255
JournalTaiwan Crit. Care Med
Volume10
Issue number3
Publication statusPublished - 2009

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Inferior Wall Myocardial Infarction
Extracorporeal Membrane Oxygenation
Percutaneous Coronary Intervention
Shock
Mitral Valve Insufficiency
Cardiogenic Shock
Myocardial Infarction
Hemodynamics
Papillary Muscles
Mitral Valve
Rupture
Emergencies
Heart Failure
ST Elevation Myocardial Infarction

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title = "Emergent Percutaneous Coronary Intervention under Extracorporeal Membrane Oxygenation Support for a Patient with Inferior ST Elevation Myocardial Infarction and Refractory Shock: A Case Report and Literature Review",
abstract = "Early emergency revascularization with intra-aortic balloon pump (IABP) support is mandatory for patients with acute myocardial infarction (AMI) and concomitant cardiogenic shock. We report our experience with a patient of cardiogenic shock caused by an AMI refractory to conventional therapies including IABP that impede subsequent revascularization procedures. We used extracorporeal membrane oxygenation (ECMO) to provide further hemodynamic support and performed successful revascularization. However, the patient failed to wean from ECMO and severe mitral regurgitation with suspected papillary muscle rupture was observed 5 days later. The patient later underwent mitral valve replacement, survived and was discharged from the hospital. The use of ECMO can support hemodynamics for revascularization and reverse shock-induced organ damage. The shock and heart failure caused by mitral regurgitation should be considered in patients with inferoposterior AMI after successful revascularization, who are still hemodynamically unstable. We also discuss the management regarding inferior AMI with mitral regurgitation and refractory shock.",
author = "Li-Chin Sung and Yu-Chih Chen and Chang, {Bee Song}",
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AU - Chang, Bee Song

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AB - Early emergency revascularization with intra-aortic balloon pump (IABP) support is mandatory for patients with acute myocardial infarction (AMI) and concomitant cardiogenic shock. We report our experience with a patient of cardiogenic shock caused by an AMI refractory to conventional therapies including IABP that impede subsequent revascularization procedures. We used extracorporeal membrane oxygenation (ECMO) to provide further hemodynamic support and performed successful revascularization. However, the patient failed to wean from ECMO and severe mitral regurgitation with suspected papillary muscle rupture was observed 5 days later. The patient later underwent mitral valve replacement, survived and was discharged from the hospital. The use of ECMO can support hemodynamics for revascularization and reverse shock-induced organ damage. The shock and heart failure caused by mitral regurgitation should be considered in patients with inferoposterior AMI after successful revascularization, who are still hemodynamically unstable. We also discuss the management regarding inferior AMI with mitral regurgitation and refractory shock.

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