RESUMEN
A 68-year old lady present with left ventricular free wall rupture and cardiac arrest post-myocardial infarction. This article illustrates a strategy combining pericardiocentesis with autologous transfusion together with VA-ECMO as a bridge to definitive surgical repair.
Asunto(s)
Oxigenación por Membrana Extracorpórea , Rotura Cardíaca Posinfarto , Rotura Cardíaca , Femenino , Humanos , Anciano , Pericardiocentesis , Rotura Cardíaca Posinfarto/cirugía , Transfusión de Sangre Autóloga , Rotura Cardíaca/cirugíaRESUMEN
A 70-years old man was referred to our department for acute heart failure due to post myocardial infarction papillary muscle rupture. We planned emergent surgery, but he refused blood transfusion because of religious reason( Jehovah's Witness). Therefore, we chose medical therapy using intra-aortic balloon pumping and catecholamine. He was also treated with subcutaneous erythropoietin and intravenous iron supplement to increase preoperative hemoglobin. One month later, we decided to undergo mitral valve repair because he was stabilized with medical treatment. The patient underwent mitral valve repair with artificial chordae through median sternotomy. The mitral valve A3 prolapse was caused by posterior papillary muscle rupture. No blood transfusion was given and postoperative course was uneventful. We experienced successful mitral repair for post infarction papillary muscle rupture in a Jehova's Witnessess patient.
Asunto(s)
Rotura Cardíaca Posinfarto , Testigos de Jehová , Insuficiencia de la Válvula Mitral , Anciano , Rotura Cardíaca Posinfarto/cirugía , Humanos , Masculino , Válvula Mitral , Insuficiencia de la Válvula Mitral/cirugía , Infarto del Miocardio , Músculos PapilaresRESUMEN
A 54-year-old man with a left ventricular free wall rupture following acute anterior myocardial infarction underwent a repair surgery with percutaneous cardiopulmonary support (PCPS). During surgery and postoperatively, PCPS provided sufficient support flow. The patient was successfully weaned from PCPS on the 15th postoperative day and discharged subsequently. In the management of cardiac rupture patients, PCPS has the merit of preventing rupture progression and the advantage of recovery of pulmonary function. However, there are several problems to solve. The support effectiveness and recovery of the patient's heart should be carefully evaluated. Effective left heart decompression also needs to be established. Heparin-coated circuits still need proper anticoagulation treatment to prevent thrombus formation especially while support flow is low. A circuit construction that allows easier maintenance and safer exchange of oxygenators and pump heads is suggested. Ischemia of the cannulated leg should be prevented by femoral artery perfusion.
Asunto(s)
Puente Cardiopulmonar/métodos , Rotura Cardíaca Posinfarto/terapia , Corazón Auxiliar , Infarto del Miocardio/complicaciones , Angioplastia Coronaria con Balón , Anticoagulantes/uso terapéutico , Benzamidinas , Transfusión de Sangre Autóloga , Circulación Coronaria/fisiología , Guanidinas/uso terapéutico , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/terapia , Rotura Cardíaca Posinfarto/cirugía , Hemodinámica/fisiología , Humanos , Inyecciones Intraarteriales , Contrapulsador Intraaórtico , Isquemia/prevención & control , Pierna/irrigación sanguínea , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Infarto del Miocardio/tratamiento farmacológico , Infarto del Miocardio/terapia , Oxigenadores de Membrana , Activadores Plasminogénicos/administración & dosificación , Activadores Plasminogénicos/farmacología , Activadores Plasminogénicos/uso terapéutico , Activador de Tejido Plasminógeno/administración & dosificación , Activador de Tejido Plasminógeno/farmacología , Activador de Tejido Plasminógeno/uso terapéutico , Resultado del TratamientoRESUMEN
Percutaneous cardiopulmonary support system (PCPS) was applied for a 85 years old man with circulatory collapse caused by left ventricular free wall blow out rupture following acute anterior myocardial infarction. PCPS was started after the cardiac massage for 7 minutes without thoracotomy or release of cardiac tamponade and flow of ranging from 2.3 to 2.7 L/min/m2 was achieved. The patient was transferred to operating room and closure of the ventricular rupture was performed under the usual cardiopulmonary bypass. Postoperative recovery of cardiac function and consciousness was satisfactory but he was died of multiple organ failure caused by sepsis at 36 postoperative day. PCPS and consecutive surgical therapy seemed useful method for the treatment of left ventricular free wall blow out rupture.