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Case Reports
. 2023 Aug 16;7(8):ytad393.
doi: 10.1093/ehjcr/ytad393. eCollection 2023 Aug.

Left atrial veno-arterial extracorporeal membrane oxygenation in post-myocardial infarction ventricular septal defect with cardiogenic shock: a case report

Gian Manuel Jiménez-Rodríguez  1 , Gustavo Rojas-Velasco  2 , Eduardo A Arias-Sánchez  1 , Daniel Manzur-Sandoval  2 , Norman Said Vega-Servin  1 , Ricardo-Eduardo Quirazco-Cordova  3 , Guering Eid-Lidt  1
Affiliations
Case Reports

Left atrial veno-arterial extracorporeal membrane oxygenation in post-myocardial infarction ventricular septal defect with cardiogenic shock: a case report

Gian Manuel Jiménez-Rodríguez et al. Eur Heart J Case Rep. .

Abstract

Background: Ventricular septal defect (VSD) complicating acute myocardial infarction (MI) represents a life-threatening condition and has a mortality of >90% if left untreated.

Case summary: A 53-year-old man with a prior medical history of diabetes and hypertension presented with cardiogenic shock secondary to VSD as a mechanical complication of non-reperfused inferior MI.

Discussion: The choice of mechanical support can be difficult in this type of patient. Given the risk of an increased shunt because of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and the increase in left ventricle (LV) afterload, several measures were taken to plan the best ECMO configuration. Given the absence of any real improvement in the LV and an elevated residual ratio between pulmonary and systemic flow (Qp/Qs), the final decision was to switch to left atrial VA-ECMO (LAVA-ECMO). The use of LAVA-ECMO improved the patient's haemodynamics and allowed his condition to stabilize; LAVA-ECMO is feasible and may be effective as a mechanical circulatory support (MCS) strategy for patients in cardiogenic shock due to VSD as a mechanical complication of acute MI.

Keywords: Acute heart failure; Case report; Mechanical complication; Myocardial infarction; Ventricular septal defect.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Transoesophageal echocardiogram. Deep transgastric two-dimensional view of the complex post-infarction posterobasal ventricular septal defect.
Figure 2
Figure 2
Computed tomography showing a complex posterobasal ventricular septal defect.
Figure 3
Figure 3
Coronary angiography. (A) Left coronary system without significant stenosis. (B) Right coronary artery with thrombotic occlusion in the middle segment.
Figure 4
Figure 4
Chest X-ray of the left atrial veno-arterial extracorporeal membrane oxygenation cannula at the end of the procedure.
See this image and copyright information in PMC

References

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