Microaxial-Flow Pump on Top of Atrial Septostomy for LV Decompression Strategy in ECMO-Supported MI-CS

Refractory cardiogenic shock (CS), despite successful reperfusion of myocardial infarction, carries a poor prognosis and high mortality. The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a treatment for refractory CS is widely adopted, but can cause catastrophic complications owing to unopposed retrograde blood flow.

A 78-year-old man diagnosed with subacute inferior myocardial infarction and multiple comorbidities experienced refractory CS even after successful reperfusion, necessitating VA-ECMO implantation. However, VA-ECMO resulted in left ventricle (LV) distention syndrome, which warranted LV decompression. A combined decompression strategy using a microaxial-flow pump (MAFP) on top of balloon atrial septostomy (BAS) was implemented, effectively improving the patient's clinical condition.

Combining BAS and MAFP enables direct left atrium monitoring, synergistically improving hemodynamics and oxygenation through simultaneous venting and unloading.

MAFP on top of BAS is an effective and safe decompression strategy to alleviate LV distention syndrome that can be applied in catastrophic clinical conditions.