Abstract 17034: Acute Ventricular Septal Rupture Management By The Cardiac Intensivist

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Khoa Nguyen ◽  
Clint Kolseth ◽  
Srini V Mukundan
Keyword(s):  
Surgical Repair ◽  
Systolic Function ◽  
Kidney Injury ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Drug Eluting Stent ◽  
Optimal Timing ◽  
Arterial Line ◽  
Ventricular Septal Rupture

Case Presentation: A 59-year-old male presented with chest pain and electrocardiogram showed convex ST elevations in the inferior leads. He underwent emergent coronary angiography revealing a 99% mid-distal right coronary artery thrombotic occlusion followed by placement of a drug-eluting stent. Transthoracic echocardiogram (TTE) revealed a 2.5 cm muscular ventricular septal rupture (VSR) with a calculated pulmonary-systemic flow ratio (Qp/Qs) of 2.4 in the setting of normal right and left ventricular systolic function. In the intensive care unit, he still had nausea and chest discomfort, along with acute kidney injury and elevated lactate levels. A trial of aggressive medical management was pursued to avoid emergent cardiac surgery. We placed an arterial line and initiated afterload reduction with sodium nitroprusside, utilizing serial bedside TTEs to monitor his Qp/Qs, which trended down to 1.8 over the subsequent 12 hours followed by normalization of lactate and kidney function. His symptoms resolved and he remained stable while transitioning to oral vasodilators. After four weeks of medical therapy, he underwent timely surgical repair of his VSR and discharged home. Discussion: Ventricular septal rupture is a serious complication of inferior myocardial infarctions (MI). From a cardiac intensivist perspective, we maintained the patient at a euvolemic state while using systemic vasodilators to divert the left-to-right shunt flow and augment his systemic flow. We want to highlight the utility of serial bedside TTEs to guide therapy for VSR (Figure 1). Fortunately, our patient did not require mechanical circulatory support to maintain his hemodynamics. We also discussed with our cardiothoracic surgeons about the optimal timing for surgical repair. The guidelines suggest urgent VSR repair following an MI; however, the exact timing is debatable given the fragility of the inflamed post-MI myocardium and better surgical outcomes with maturation of the VSR.

scholarly journals Giant Cell Myocarditis: Not Always a Presentation of Cardiogenic Shock

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Rose Tompkins ◽  
William J. Cole ◽  
Barry P. Rosenzweig ◽  
Leon Axel ◽  
Sripal Bangalore ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Giant Cell ◽  
Systolic Function ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Rapid Decline ◽  
Giant Cell Myocarditis ◽  
Hemodynamic Compromise ◽  
Hemodynamic Deterioration

Giant cell myocarditis is a rare and often fatal disease. The most obvious presentation often described in the literature is one of rapid hemodynamic deterioration due to cardiogenic shock necessitating urgent consideration of mechanical circulatory support and heart transplantation. We present the case of a 60-year-old man whose initial presentation was consistent with myopericarditis but who went on to develop a rapid decline in left ventricular systolic function without overt hemodynamic compromise or dramatic symptomatology. Giant cell myocarditis was confirmed via endomyocardial biopsy. Combined immunosuppression with corticosteroids and calcineurin inhibitor resulted in resolution of symptoms and sustained recovery of left ventricular function one year later. Our case highlights that giant cell myocarditis does not always present with cardiogenic shock and should be considered in the evaluation of new onset cardiomyopathy of uncertain etiology as a timely diagnosis has distinct clinical implications on management and prognosis.

scholarly journals Comparison of Left Ventricular Systolic Function by 2D Echocardiography between Diabetic and Non-Diabetic Patients undergoing Percutaneous Coronary Intervention in Non-ST elevated Myocardial Infarction

2019 ◽  
Vol 14 (2) ◽  
pp. 47-52
Author(s):  
MSI Tipu Chowdhury ◽  
Harisul Hoque ◽  
Manzoor Mahmood ◽  
Khurshed Ahmed ◽  
Md Mukhlesur Rahman ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Systolic Function ◽  
Left Ventricular Systolic Function ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Diabetic Group ◽  
Drug Eluting Stent ◽  
Diabetic Patients ◽  
Percutaneous Coronary ◽  
Drug Eluting

Background: Long term mortality is higher in patients with Non-ST-segment elevated myocardial infarction (NSTEMI) than those with STEMI. In diabetic patients with NSTEMI are at high risk for subsequent cardiovascular events. But, the widespread use of drug eluting stents(DES) will further improve outcomes in patients with diabetes undergoing early percutaneous coronary intervention(PCI). Objective: The aim of the study was to determine the changes in left ventricular (LV) systolic function after successful PCI in NSTEMI diabetic patients compared with non-diabetic patients. Methods: From April 2017 to March 2018, this comparative clinical study was carried out in the Department of Cardiology, University Cardiac Center, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. 30 diabetic and 34 nondiabetic patients with NSTEMI undergoing Percutaneous coronary intervention were included in the study. Successful PCI with drug eluting stent was performed for all patients. 2-Dimensional echocardiography was done at baseline, at discharge following PCI and 3 months thereafter to measure the LV systolic functions and compare them between diabetics and non-diabetics at all levels of evaluation to assess the outcome of intervention. Results: At baseline LVEF was somewhat lower in diabetic group than that in non-diabetic group. Number of segments with abnormal wall motion (WMA) was higher in the diabetics compared to the non-diabetics. While the LVEDV, LVIDd and LVIDs were significantly greater in the former group than those in the latter group, the LVESV was no different between the groups. At discharge, no significant improvement was observed in either group following PCI in terms of LVEF, number of segments with WMA, LVIDd and LVIDs. However, both LVEDV and LVESV reduced effectively in both groups with decrease of LVESV being more marked in the nondiabetics compared to that in diabetics (p = 0.018). However, 3 months after PCI, LVEF improved 8.4±1.2% in diabetics and 7.9±1.2% in non diabetics but the difference of this improvement between two groups was not statistically significant(p = 0.631). Similarly baseline to 3 months after PCI LVIDs decreases in diabetics 5.7±1.9% and in non diabetics 4.8±1.1% but the difference between these two groups was not significant (p = 0.201). Diabetic patients more often required 2 stents (p = 0.30), although the diameter and length of the stents did not differ between the study groups. Conclusion: Our study demonstrated that improvement of the parameters of left ventricular systolic function after using of drug eluting stent in diabetic patients with NSTEMI was not inferior to the non diabetic group under same condition. So, indications of PCI with drug eluting stent may be extended in diabetic patient with NSTEMI. University Heart Journal Vol. 14, No. 2, Jul 2018; 47-52

End-systolic wall stress is a major determinant of postoperative left ventricular dysfunction in patients with congenital mitral regurgitation

2002 ◽  
Vol 12 (3) ◽  
pp. 236-239 ◽  
Author(s):  
Tomoaki Murakami ◽  
Makoto Nakazawa ◽  
Toshio Nakanishi ◽  
Kazuo Momma
Keyword(s):  
Mitral Regurgitation ◽  
Surgical Repair ◽  
Systolic Function ◽  
Wall Stress ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Strongly Correlated ◽  
Ventricular Systolic Function ◽  
Ventricular Performance ◽  
Congenital Mitral Regurgitation

To clarify the contribution of afterload to left ventricular performance after repair of mitral regurgitation, we evaluated echocardiographically 8 children who had undergone surgical repair for isolated congenital mitral regurgitation. We examined the relationship between left ventricular systolic function and preload, afterload, and contractility. The left ventricular systolic function was strongly correlated with the afterload after the surgical repair. In the postoperative state, reducing afterload by vasodilators could be a useful means of treating cardiac failure, in addition to using catecholamines to increase the contractility.

scholarly journals Successful Treatment of Occlusive Left Main Coronary Artery Dissection by Impella-Supported Stenting

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
James J. Glazier ◽  
Amir Kaki ◽  
Theodore L. Schreiber
Keyword(s):  
Coronary Artery ◽  
Successful Treatment ◽  
Left Main Coronary Artery ◽  
Systolic Function ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Artery Dissection ◽  
Left Main ◽  
Coronary Artery Dissection

We report successful treatment of a patient, who, during diagnostic angiography, developed an ostial left main coronary artery dissection with stump occlusion of the vessel. First, mechanical circulatory support with an Impella CP device was established. Then, patency of the left coronary system was achieved by placement of stents in the left anterior descending, left circumflex, and left main coronary arteries. On completion of the procedure, left ventricular systolic function, as assessed by echocardiography, was normal. At 24-month clinical follow-up, the patient remains angina-free and well. This is the first reported case of the use of an Impella device to support treatment of iatrogenic left main coronary artery dissection.

An Atypical Presentation of Acute Coronary Syndrome

2012 ◽  
Vol 8 (1) ◽  
pp. 67
Author(s):  
Syed Khurram Mushtaq Gardezi ◽  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Systolic Function ◽  
Artery Bypass ◽  
Left Ventricular Systolic Function ◽  
Regional Wall Motion ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Ventricular Systolic Function ◽  
Coronary Syndrome

A 61-year-old man was admitted to hospital with severe occipital headache and weakness and numbness of the left arm. His electrocardiograms showed changes hinting at acute coronary syndrome (ACS). However, in view of his clinical presentation, he underwent tests for likely subarachnoid haemorrhage, but this was ruled out. The next day, he was referred to cardiology. A transthoracic echocardiogram showed reduced left ventricular systolic function along with regional wall motion abnormalities involving inferoposterior walls. The patient was treated as per the protocol for ACS. A dobutamine stress echocardiogram confirmed inferior myocardial infarction with evidence of myocardial viability in the affected left ventricular segments. Subsequent investigations confirmed three-vessel coronary artery disease and reduced left ventricular systolic function. The patient underwent successful coronary artery bypass grafting.

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