Successful treatment of cardiac dysfunction due to left main trunk obstruction and severe acute aortic regurgitation secondary to acute type A aortic dissection using Impella: a case report.

IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Ai Sakai, Kenji Iino, Hideyasu Ueda, Yoshitaka Yamamoto, Hirofumi Takemura
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引用次数: 0

Abstract

Background: Acute type A aortic dissection (A-AAD) with severe acute aortic regurgitation (AR) and coronary involvement is a potentially fatal condition that causes left ventricular volume overload and catastrophic acute myocardial infarction. We present the successful management of a patient using Impella 5.5 following cardiopulmonary arrest caused by A-AAD with severe acute AR and left main trunk (LMT) obstruction.

Case presentation: A 50-year-old man presented with acute anterior chest pain. The patient subsequently experienced a cardiac arrest, and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was administered accordingly. Contrast-enhanced computed tomography indicated type A aortic dissection extending from the sinotubular junction to the left common iliac artery. Transthoracic echocardiography revealed inversion of the aortic flap into the left ventricular outflow tract, resulting in acute severe AR and LMT obstruction. Based on these findings, the patient was diagnosed with A-AAD accompanied by severe acute AR and LMT obstruction. Emergent total arch replacement with a frozen elephant trunk (FET) was performed. However, the patient could not be weaned from cardiopulmonary bypass owing to cardiogenic shock, necessitating the introduction of VA-ECMO. Pulmonary capillary wedge pressure remained high at 22 mmHg. Subsequently, Impella 5.5 was introduced via a branch of the vascular graft to address the extensive myocardial damage due to preoperative LMT obstruction, acute AR-induced left ventricular volume overload, and increased afterload from VA-ECMO. The patient's cardiac function gradually improved. VA-ECMO and Impella 5.5 were weaned on postoperative day 8 and 20, respectively. However, three months postoperatively, a MitraClip was used to progress secondary mitral regurgitation associated with left ventricular remodeling after myocardial infarction. The patient gradually recovered from the neurological deficit and was transferred for physical rehabilitation five months postoperatively.

Conclusions: The patient exhibited severe cardiac dysfunction due to extensive myocardial infarction and acute AR from A-AAD. Retrograde perfusion via VA-ECMO was required for systemic organ perfusion but was expected to hinder cardiac recovery. This report demonstrates that Impella effectively aids the restoration of cardiac function in such desperate conditions.

使用 Impella 成功治疗急性 A 型主动脉夹层继发的左主干阻塞和严重急性主动脉瓣反流导致的心功能不全:病例报告。
背景:急性A型主动脉夹层(A- aad)合并严重急性主动脉反流(AR)和冠状动脉累及是一种潜在的致命疾病,可导致左心室容量过载和灾难性急性心肌梗死。我们报告了一例由a - aad引起的伴有严重急性AR和左主干梗阻的心肺骤停患者使用Impella 5.5的成功治疗。病例介绍:一名50岁男性,表现为急性胸痛。患者随后出现心脏骤停,并相应给予静脉-动脉体外膜氧合(VA-ECMO)。增强计算机断层扫描显示A型主动脉夹层从窦小管交界处延伸至左髂总动脉。经胸超声心动图显示主动脉瓣倒置进入左心室流出道,导致急性严重AR和LMT阻塞。基于这些发现,患者被诊断为A-AAD并伴有严重急性AR和LMT阻塞。采用冷冻象鼻(FET)进行紧急全弓置换术。然而,由于心源性休克,患者无法脱离体外循环,需要引入VA-ECMO。肺毛细血管楔压维持在22 mmHg的高位。随后,通过血管移植分支引入Impella 5.5,以解决术前LMT阻塞、急性ar诱导的左室容量过载以及VA-ECMO后负荷增加导致的广泛心肌损伤。病人的心功能逐渐好转。VA-ECMO和Impella 5.5分别于术后第8天和第20天断奶。然而,术后3个月,使用MitraClip治疗心肌梗死后与左心室重构相关的继发性二尖瓣返流。术后5个月,患者逐渐从神经功能障碍中恢复,并转入物理康复治疗。结论:A-AAD患者表现出严重的心功能障碍,由于广泛的心肌梗死和急性AR。通过VA-ECMO逆行灌注是全身器官灌注所必需的,但预计会阻碍心脏恢复。本报告表明,在这种绝望的情况下,Impella有效地帮助心脏功能恢复。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Cardiothoracic Surgery
Journal of Cardiothoracic Surgery 医学-心血管系统
CiteScore
2.50
自引率
6.20%
发文量
286
审稿时长
4-8 weeks
期刊介绍: Journal of Cardiothoracic Surgery is an open access journal that encompasses all aspects of research in the field of Cardiology, and Cardiothoracic and Vascular Surgery. The journal publishes original scientific research documenting clinical and experimental advances in cardiac, vascular and thoracic surgery, and related fields. Topics of interest include surgical techniques, survival rates, surgical complications and their outcomes; along with basic sciences, pediatric conditions, transplantations and clinical trials. Journal of Cardiothoracic Surgery is of interest to cardiothoracic and vascular surgeons, cardiothoracic anaesthesiologists, cardiologists, chest physicians, and allied health professionals.
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