Successful emergent transcatheter aortic valve implantation and left ventricular unloading by Impella in a patient with severe aortic stenosis who experienced cardiogenic shock after primary percutaneous coronary intervention for ST-elevation myocardial infarction: a case report. Issue 2 (18th February 2021)

• Record Type: Journal Article
• Authors: Konami, Yutaka; Sakamoto, Tomohiro; Suzuyama, Hiroto; Unoki, Takashi
• Editors: Deharo, Pierre; Galyavich, Albert; Anwar, Shehab; Parma, Radoslaw; Mukherjee, Rahul; Jakstaite, Aiste Monika
• Is Part Of: European heart journal. Volume 5:Issue 2(2021)
• Publication Date: 2021-02-18
• Subjects: Impella CP -- Transcatheter aortic valve implantation -- ST-elevation myocardial infarction -- Aortic stenosis -- Cardiogenic shock -- Case report; Cardiology -- Periodicals; Cardiology -- Case studies -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Case studies -- Periodicals; 616.12
• DOI: 10.1093/ehjcr/ytab033
• Languages: English
• ISSNs: 2514-2119

Abstract

Abstract: Background: Determining the treatment strategy for cardiogenic shock following ST-elevation myocardial infarction in a patient with severe aortic stenosis remains challenging and is a matter of debate. Case summary: An 84-year-old man with chest pain was transferred to our institute and subsequently diagnosed with ST-elevation myocardial infarction and Killip class III heart failure. The patient was intubated, and urgent coronary angiography revealed severe tandem stenosis from the proximal to mid-left anterior descending coronary artery. We performed a primary percutaneous coronary intervention (PCI) and deployed drug-eluting stents from the left main trunk to mid-left anterior descending coronary artery. Although the procedure was successful, the patient went into cardiogenic shock a few hours later. Transthoracic echocardiography revealed low cardiac function and severe aortic stenosis. We decided to perform transcatheter aortic valve implantation using a self-expandable valve, followed by the insertion of a left ventricular assist device. The combination of procedures achieved haemodynamic stability. Discussion: It is difficult to treat cardiogenic shock that develops in patients with severe aortic stenosis and ST-elevation myocardial infarction. This case report demonstrates that combined transcatheter aortic valve replacement using a self-expanding valve and left ventricular assist device placement can be safe and effective after a primary PCI.