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Updated: Dec 15, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
A staged surgical strategy for cardiogenic shock and iatrogenic ventricular septal perforation due to a malpositioned
Takuya Nishijima1, Yoshihisa Tanoue1, Tomoki Ushijima1
1Department of Cardiovascular Surgery, Kyushu University Hospital, 3-1-1 Maidashi, Higashiku, Fukuoka, 812-8582, Japan.
Insights
A patient with heart attack experienced cardiac arrest and required extracorporeal membrane oxygenation (ECMO). A misplaced catheter caused complications, but staged repair and ECMO management led to recovery.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Acute myocardial infarction can lead to cardiogenic shock and cardiopulmonary arrest, necessitating advanced mechanical circulatory support.
- Extracorporeal membrane oxygenation (ECMO) is a critical intervention for patients with severe cardiac dysfunction.
- Complications can arise from invasive procedures, impacting patient outcomes.
Observation:
- A 59-year-old woman developed cardiogenic shock post-myocardial infarction, requiring ECMO.
- Computed tomography revealed a drainage catheter malpositioning through the right ventricle and septum into the left ventricle.
- The malpositioning resulted in insufficient ECMO flow, leading to multiple organ failure and disseminated intravascular coagulation.
Findings:
- Conversion to central ECMO after catheter removal improved the patient's general condition.
- A persistent ventricular septal shunt was noted post-catheter removal.
- Staged surgical repair of the ventricular septal perforation 15 days after the initial operation was successfully performed.
Implications:
- Optimal mechanical circulatory support, including ECMO, is vital in managing acute cardiac events.
- Careful monitoring and prompt management of complications, such as catheter malpositioning, are crucial for ECMO success.
- A staged surgical approach can effectively address complex cardiac defects arising during critical care, leading to favorable outcomes.
Abstract:
A 59-year-old woman fell into cardiogenic shock due to acute myocardial infarction with total occlusion of the left anterior descending artery. Although intra-aortic balloon pump was inserted and a coronary stent was placed, she went into cardiopulmonary arrest and percutaneous veno-arterial extracorporeal membrane oxygenation (ECMO) was initiated. She was transferred to our hospital after drainage for pericardial effusion. Computed tomography revealed the drainage catheter lying through the right ventricular free wall and the ventricular septum, and leading into the left ventricle. She showed multiple organ failure and disseminated intravascular coagulation syndrome due to insufficient ECMO flow. Conversion to central ECMO after catheter removal was performed and her general condition improved; however, ventricular septal shunt remained. Repair of the perforation and ECMO removal was performed 15 days after the first operation. The combination of optimal mechanical circulatory support and the staged surgical repair contributed to her dramatic recovery.
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