Related Experiment Videos
Oozing-type of left ventricular rupture treated under percutaneous cardiopulmonary support without surgical repair
Nobuyuki Masaki1, Koh Arakawa, Tadashi Yamagishi
1First Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan.
Insights
A patient experiencing acute myocardial infarction and cardiogenic shock survived an oozing left ventricular rupture with percutaneous cardiopulmonary support (PCPS). PCPS aided recovery by reducing ventricular tension and systemic hypoperfusion.
Area of Science:
- Cardiology
- Cardiovascular Surgery
Background:
- Acute myocardial infarction (AMI) can lead to life-threatening complications such as cardiogenic shock and left ventricular rupture.
- Early diagnosis and intervention are critical for managing these severe conditions.
Observation:
- A 65-year-old male presented with AMI and cardiogenic shock, successfully treated with primary percutaneous transluminal coronary angioplasty (PTCA) and intra-aortic balloon pumping (IABP).
- The patient subsequently developed cardiac tamponade due to an oozing-type left ventricular rupture.
- Despite the risks of increased effusion with anticoagulation, percutaneous cardiopulmonary support (PCPS) was initiated for systemic hypoperfusion.
Findings:
- PCPS was successfully employed to manage persistent cardiogenic shock and systemic hypoperfusion.
- The patient recovered cardiac function and was weaned from both PCPS and IABP.
- The patient remained in satisfactory condition for over a year post-discharge.
Implications:
- Percutaneous cardiopulmonary support (PCPS) can be a life-saving intervention in patients with myocardial infarction complicated by ventricular rupture and cardiogenic shock.
- PCPS may mitigate effusion from oozing-type ruptures by decreasing ventricular wall tension.
- This case highlights the potential benefit of mechanical circulatory support in managing complex post-infarction complications.
Abstract:
A 65-year-old man was admitted to the National Defense Medical College Hospital for acute anterolateral myocardial infarction and cardiogenic shock. Emergency coronary angiography demonstrated occlusion of the proximal left anterior descending artery. Primary percutaneous transluminal coronary angioplasty (PTCA) was successfully performed with the support of intra-aortic balloon pumping (IABP) and medical treatment to stabilize the patient's blood pressure. On the second hospital day, the patient suffered cardiac tamponade. Pericardiocentesis showed bloody fluid and revealed that an oozing-type of left ventricular rupture had occurred after the myocardial infarction. Cardiogenic shock persisted after successful removal of the pericardial effusion. Although the heparinization required during percutaneous cardiopulmonary support (PCPS) can increase pericardial effusion, PCPS was initiated to correct the systemic hypoperfusion; a surgical team was on standby in case massive pericardial effusion resulted, but fortunately that did not occur, and cardiac function recovered. The patient was weaned successfully from PCPS and IABP and has remained in a satisfactory condition for over 1 year. PCPS contributed to the patient's recovery from cardiac shock and may have decreased the effusion from the oozing-type rupture by reducing ventricular wall tension.