Related Experiment Video

Updated: Oct 26, 2025

Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
07:39

Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock

Published on: August 16, 2021

3.8K

Cardiogenic Shock in Obstructive Hypertrophic Cardiomyopathy Plus Apical Ballooning: Management With VA-ECMO and

Flavia Caniato1, Valentina Andrei1, Pasquale Bernardo1

  • 1Cardiac Intensive Care Unit, Careggi University Hospital, Florence, Italy.

JACC. Case Reports
|July 28, 2021
PubMed

Insights

Obstructive hypertrophic cardiomyopathy treatment is complex due to worsening left ventricular outflow tract obstruction and mitral regurgitation. Surgical myectomy provided a definitive solution for a patient in cardiogenic shock.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery

Background:

  • Obstructive hypertrophic cardiomyopathy (oHCM) can lead to severe left ventricular outflow tract obstruction (LVOTO).
  • Patients may develop complex hemodynamic instability involving mitral regurgitation and apical ballooning.

Observation:

  • A patient with oHCM presented with worsening LVOTO, severe mitral regurgitation, and apical ballooning.
  • This combination precipitated cardiogenic shock, posing a therapeutic challenge where interventions for one condition could exacerbate others.

Findings:

  • Initial management with veno-arterial extracorporeal membrane oxygenation (VA-ECMO), levosimendan, and noradrenaline provided transient hemodynamic and gas exchange support.
  • Surgical septal myectomy was ultimately required for definitive treatment of the obstructive cardiomyopathy.

Implications:

  • This case highlights the intricate management of decompensated oHCM with multiple concurrent complications.
  • Surgical myectomy remains a crucial option for severe, refractory cases unresponsive to medical or mechanical support.

Keywords:
AF, atrial fibrillationCS, cardiogenic shockEF, ejection fractionHCM, hypertrophic cardiomyopathyHF, heart failureLVOTO, left ventricular outflow tract obstructionMR, mitral regurgitationSAM, systolic anterior movementTTE, transthoracic echocardiographyVA-ECMO, veno-arterial extracorporeal membrane oxygenationacute heart failurecardiac assist devicescardiomyopathyinotropes

More Related Videos

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock06:10

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Published on: June 12, 2021

3.4K
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery09:12

Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery

Published on: March 27, 2018

9.6K

Related Concept Videos

Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
73
Cardiomyopathy III: Hypertrophic Cardiomyopathy01:29

Cardiomyopathy III: Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
101
Cardiomyopathy VII: Pre and Post Operative Nursing Management01:28

Cardiomyopathy VII: Pre and Post Operative Nursing Management

Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
73
Cardiomyopathy II: Dilated Cardiomyopathy01:30

Cardiomyopathy II: Dilated Cardiomyopathy

Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
87
Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
87
Mitral Stenosis III: Medical Management01:26

Mitral Stenosis III: Medical Management

Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
58