Author + information
- Emmanuel Ekanem,
- Raghav Gattani,
- Hooman Bakhshi,
- Behnam Tehrani,
- Matthew William Sherwood,
- Kelly Epps,
- Abdulla Damluji,
- Carolyn Rosner,
- Alexander George Truesdell,
- Christopher R. DeFilippi,
- Shashank Sinha and
- Wayne B. Batchelor
Papillary muscle rupture (PMR) is a rare and catastrophic complication of acute myocardial infarction (AMI) associated with high operative mortality. We report a case series of three patients with AMI complicated by PMR managed with a VA-ECMO and Impella (ECPELLA) mechanical circulatory support (MCS) strategy as bridge to definitive surgery.
Patient 1:70 y/o female with 3 days of chest pain admitted with NSTEMI and holosystolic murmur noted on exam. Left heart catheterization (LHC) showed 95% circumflex and 80% RCA lesion with severe mitral regurgitation and flail posterior mitral leaflet on stat echocardiogram. Shock team was activated and she was initiated on MCS with ECPELLA. She stabilized hemodynamically with normal renal function and on day 7, underwent an uncomplicated CABG with mitral valve replacement (MVR) and was discharged home.
Patient 2: 79 y/o female admitted with NSTEMI. LHC demonstrated culprit 95% mid RCA lesion that was treated with 2 drug-eluting stents. On day 4, she developed cardiogenic shock, and echocardiogram showed severe mitral regurgitation with flail posterior mitral leaflet. She was immediately initiated on MCS with ECPELLA and stabilized hemodynamically. She underwent salvage MVR on day 5 and was discharged home.
Patient 3: 46 y/o male admitted with inferior STEMI. LHC showed totally occluded RCA requiring stent placement. He developed cardiogenic shock immediately after LHC and echocardiogram demonstrated severe MR with ruptured chord. MCS was provided with ECPELLA. Hospital course was complicated by stroke, and multi-organ failure. Family elected for comfort measures.
A temporizing strategy of ECPELLA for circulatory support with left ventricular venting helped to rapidly provide hemodynamic stabilization. 2/3 patients underwent surgical mitral valve replacement within 1 week of hospitalization with eventual discharge to home.
Post-MI cardiogenic shock complicated by PMR is a lethal syndrome associated with high operative mortality. Temporary MCS with ECPELLA may serve as a viable bridge to MVR by providing full circulatory support, left ventricular venting and preserving end organ function prior to MVR.
Posters Hall_Hall A
Sunday, March 29, 2020, 3:45 p.m.-4:30 p.m.
Session Title: FIT Clinical Decision Making: Heart Failure and Cardiomyopathies 6
Abstract Category: Heart Failure and Cardiomyopathies
Presentation Number: 1376-300
- 2020 American College of Cardiology Foundation