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. 2018 Nov 27;2(4):yty134.
doi: 10.1093/ehjcr/yty134. eCollection 2018 Dec.

A case report: haemodynamic instability due to true dynamic left ventricular outflow tract obstruction and systolic anterior motion following resuscitation: reversal of haemodynamics on supportive veno-arterial extracorporeal membrane oxygenation

Christina Stolzenburg Oxlund  1 , Mikael Kjær Poulsen  1 , Peter Blom Jensen  2 , Karsten Tange Veien  1 , Jacob Eifer Møller  1
Affiliations

A case report: haemodynamic instability due to true dynamic left ventricular outflow tract obstruction and systolic anterior motion following resuscitation: reversal of haemodynamics on supportive veno-arterial extracorporeal membrane oxygenation

Christina Stolzenburg Oxlund et al. Eur Heart J Case Rep. .

Abstract

Background: Obstruction of the left ventricular outflow tract (LVOT) as seen in hypertrophic cardiomyopathy is a dynamic condition with a wide range of clinical presentations and symptoms.

Case summary: We report the use of veno-arterial extracorporeal membrane oxygenation in a female patient who was resuscitated after out-of-hospital cardiac arrest. Soon after admission the patient developed critical haemodynamic compromise due to severe obstruction of the left ventricle outflow tract and systolic anterior motion (SAM) of the mitral valve. Veno-arterial extracorporeal membrane oxygenation restored haemodynamics and was weaned after 4 days without any haemodynamic compromise due to SAM. The patient was discharged from the intensive care unit at Day 13, and after 3 days at the coronary care unit, she was discharged to ambulatory follow-up with no sequelae.

Discussion: Veno-arterial extracorporeal membrane oxygenation restored haemodynamic stability in this patient with dynamic severe LVOT obstruction following cardiac arrest.

Keywords: Case report; Mitral regurgitation (MR); Obstruction of the left ventricle outflow tract; Systolic anterior motion (SAM); Veno-arterial extracorporeal membrane oxygenation.

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Figures

Figure 1
Figure 1
Transoesophageal echocardiographic systolic long-axis images. (A and B) Acquired before, and (C and D) Immediately after initiation of veno-arterial extracorporeal membrane oxygenation. (A) White arrow shows severe systolic anterior motion and (B) left ventricular outflow tract obstruction causing severe mitral regurgitation (red arrow). After initiation of veno-arterial extracorporeal membrane oxygenation systolic anterior motion, left ventricular outflow tract obstruction and mitral regurgitation disappeared.
See this image and copyright information in PMC

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