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Published on: October 16, 2021
Ultra-Early Transcatheter Edge-to-Edge Repair Intervention With Mechanical Circulatory Support for Post-Infarction
Xindi Yue1, Jing Zhang1, Zhenjie Hu1
1Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, People's Republic of China.
Background:
Papillary muscle rupture is a rare but highly lethal mechanical complication of acute myocardial infarction. Transcatheter edge-to-edge repair (TEER) combined with mechanical circulatory support offers a new therapeutic option for high-risk patients.
Case Summary:
A 57-year-old man with acute inferior myocardial infarction developed cardiogenic shock due to posteromedial papillary muscle rupture. Under venoarterial extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pump support, successful TEER was performed within 8 hours of diagnosis, reducing mitral regurgitation from severe to trace with immediate hemodynamic improvement, and the patient survived to discharge.
Discussion:
The highlight of this case is the ultra-early TEER intervention performed under dual mechanical circulatory support. These findings suggest that ultra-early TEER may represent a feasible salvage strategy in highly selected patients with ECMO-dependent cardiogenic shock, although its generalizability requires further investigation.
Take-Home Messages:
Ultra-early TEER can be considered a potential bridging strategy in selected patients with papillary muscle rupture and refractory cardiogenic shock. Dual mechanical circulatory support can provide hemodynamic stabilization to facilitate TEER in critically ill patients.
