Percutaneous Coronary Intervention Supported by Extracorporeal Membrane Oxygenation in a Patient With Cardiogenic Shock and Prior Coronary Artery Bypass Grafting

Li Chin Sung, Bee Song Chang, Ji Hung Wang

Research output: Contribution to journalArticle

Abstract

We report a diabetic man with prior coronary artery bypass grafting (CABG) who underwent coronary angiography (CAG) because of medically refractory unstable angina. CAG revealed severe stenosis of the left circumflex artery (LCX) and the right coronary artery (RCA), patent artery graft to the left anterior descending artery and total occlusion of saphe-nous venous grafts to the RCA and LCX. During percutaneous coronary intervention (PCI), the patient suffered from circulatory collapse. We postponed the procedure and placed an intra-aortic balloon pump (IABP); however, the patient remained hemodynamically unstable. He was rescued by PCI with extracorporeal membrane oxygenation (ECMO) support. No major cardiovascular event was reported during the 6-month follow-up period since treatment. We have learned that PCI in patients with prior CABG and severe left ventricular dysfunction has a high risk of inducing cardiogenic shock when an IABP is used. ECMO should be considered for these patients when PCI is performed on the vessels that supply only viable and contractile myocardium.

Original languageEnglish
Pages (from-to)232-236
Number of pages5
JournalTzu Chi Medical Journal
Volume22
Issue number4
DOIs
Publication statusPublished - Dec 2010

Fingerprint

Extracorporeal Membrane Oxygenation
Cardiogenic Shock
Percutaneous Coronary Intervention
Coronary Artery Bypass
Arteries
Coronary Angiography
Coronary Vessels
Transplants
Unstable Angina
Left Ventricular Dysfunction
Shock
Myocardium
Pathologic Constriction
Therapeutics

Keywords

  • Cardiogenic shock
  • Coronary artery bypass grafting
  • Extracorporeal membrane oxygenation
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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title = "Percutaneous Coronary Intervention Supported by Extracorporeal Membrane Oxygenation in a Patient With Cardiogenic Shock and Prior Coronary Artery Bypass Grafting",
abstract = "We report a diabetic man with prior coronary artery bypass grafting (CABG) who underwent coronary angiography (CAG) because of medically refractory unstable angina. CAG revealed severe stenosis of the left circumflex artery (LCX) and the right coronary artery (RCA), patent artery graft to the left anterior descending artery and total occlusion of saphe-nous venous grafts to the RCA and LCX. During percutaneous coronary intervention (PCI), the patient suffered from circulatory collapse. We postponed the procedure and placed an intra-aortic balloon pump (IABP); however, the patient remained hemodynamically unstable. He was rescued by PCI with extracorporeal membrane oxygenation (ECMO) support. No major cardiovascular event was reported during the 6-month follow-up period since treatment. We have learned that PCI in patients with prior CABG and severe left ventricular dysfunction has a high risk of inducing cardiogenic shock when an IABP is used. ECMO should be considered for these patients when PCI is performed on the vessels that supply only viable and contractile myocardium.",
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AU - Wang, Ji Hung

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N2 - We report a diabetic man with prior coronary artery bypass grafting (CABG) who underwent coronary angiography (CAG) because of medically refractory unstable angina. CAG revealed severe stenosis of the left circumflex artery (LCX) and the right coronary artery (RCA), patent artery graft to the left anterior descending artery and total occlusion of saphe-nous venous grafts to the RCA and LCX. During percutaneous coronary intervention (PCI), the patient suffered from circulatory collapse. We postponed the procedure and placed an intra-aortic balloon pump (IABP); however, the patient remained hemodynamically unstable. He was rescued by PCI with extracorporeal membrane oxygenation (ECMO) support. No major cardiovascular event was reported during the 6-month follow-up period since treatment. We have learned that PCI in patients with prior CABG and severe left ventricular dysfunction has a high risk of inducing cardiogenic shock when an IABP is used. ECMO should be considered for these patients when PCI is performed on the vessels that supply only viable and contractile myocardium.

AB - We report a diabetic man with prior coronary artery bypass grafting (CABG) who underwent coronary angiography (CAG) because of medically refractory unstable angina. CAG revealed severe stenosis of the left circumflex artery (LCX) and the right coronary artery (RCA), patent artery graft to the left anterior descending artery and total occlusion of saphe-nous venous grafts to the RCA and LCX. During percutaneous coronary intervention (PCI), the patient suffered from circulatory collapse. We postponed the procedure and placed an intra-aortic balloon pump (IABP); however, the patient remained hemodynamically unstable. He was rescued by PCI with extracorporeal membrane oxygenation (ECMO) support. No major cardiovascular event was reported during the 6-month follow-up period since treatment. We have learned that PCI in patients with prior CABG and severe left ventricular dysfunction has a high risk of inducing cardiogenic shock when an IABP is used. ECMO should be considered for these patients when PCI is performed on the vessels that supply only viable and contractile myocardium.

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