Initial report of percutaneous right ventricular assist for right ventricular shock secondary to right ventricular infarction.
A 57-year-old female suffered an acute inferior ST segment elevation myocardial infarction. The patient failed thrombolysis and was urgently transferred for rescue percutaneous coronary intervention of the right coronary artery. She decompensated after reperfusion of the occluded RCA and developed cardiogenic shock from severe right heart failure refractory to IABP support and maximal pressors. A percutaneous right ventricular assist device was successfully implanted, which improved mean arterial pressure to a viable range and allowed withdrawal of inotropic medications. Right ventricular failure after infarction remains difficult to manage and has a high mortality. Intraaortic balloon pump and LVAD support have not proven beneficial in cardiogenic shock secondary to RV infarction. This is a report of the first insertion of a percutaneous right ventricular assist device for right ventricular support in a human. Further evaluation is warranted to evaluate the potential benefits of such a device as well as optimal timing of initiation of RV support.
Giesler
Gregory M
GM
Division of Cardiovascular Medicine, University of Texas Health Science Center and Memorial Herman Heart and Vascular Institute, Houston, Texas, USA.
Gomez
Jaime S
JS
Letsou
George
G
Vooletich
Mary
M
Smalling
Richard W
RW
D001794:Blood Pressure; D017809:Fatal Outcome; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D017211:Treatment Failure