2 . 2023

Restoration of cardiac function and prevention of multiorgan failure during the use of veno-arterial ECMO support and levosimendan therapy in a patient with refractory cardiogenic shock

Abstract

The presented clinical case describes the successful restoration of cardiac activity against the background of mechanical circulatory support and the administration of levosimendan after acute myocardial infarction complicated by cardiogenic shock and circulatory arrest, which occurred during catheter ablation of left ventricular extrasystole in a 46-year-old patient.

Clinical case. During radiofrequency ablation of left ventricular extrasystole, a 46-year-old patient developed cardiogenic shock, accompanied by circulatory arrest, due to acute myocardial infarction. Resuscitation required cardiopulmonary bypass, and then mechanical support using veno-arterial (VA) extracorporeal membrane oxygenation (ECMO). According to ECHO-CG,the ejection fraction of the left ventricle was 13% (according to Simpson). The patient underwent coronary angiography, which revealed hemodynamically significant stenosis of the mouth of the left coronary artery (LCA) trunk 80% and signs of tubular narrowing of the body of the LCA trunk up to 50% with a transition to the mouth of the circumflex artery. To restore coronary blood flow, angioplasty and stenting of LCA trunk were performed. In the postoperative period, against the background of circulatory shock and the use of anticoagulants, the patient developed massive bleeding, which required the use of large volumes of blood transfusion, combined pharmacological therapy, surgical hemostasis, and extraction of a thrombus from the left atrium. In the future, the severity of the postoperative period was due to the associated multiple organ dysfunction (SOFA scores 13): cardiovascular; respiratory failure due to bilateral polysegmental pneumonia caused by Klebsiella pneumonia ssp.; DIC syndrome; hepatic and renal insufficiency; encephalopathy.

Results. Restoration of heart function (ejection fraction up to 35%), discontinuation of mechanical support in 16 days, discharge from the hospital on the 73^rd day.

Conclusion. Acute coronary occlusion leading to myocardial infarction and cardiogenic shock is a very rare but severe reported complication of radiofrequency catheter ablation. The use of VA ECMO in refractory cardiogenic shock can buy time for effective therapy aimed to restore cardiac activity.

Keywords:cardiogenic shock; extracorporeal membrane oxygenation; levosimendan

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Eremenko A.A., Babaev M.A., Kolyvanova V.V., Zyulyaeva T.P., Podolyak D.G., Evseev E.P., Aidamirov Ya.A., Pshenichny T.A., Urbanov A. V., Komnov R.D., Polyakov R.S., Petrov A.S. Restoration of cardiac function and prevention of multiorgan failure during the use of veno-arterial ECMO support and levosimendan therapy in a patient with refractory cardiogenic shock. Clinical and Experimental Surgery. Petrovsky Journal. 2023; 11 (2): 111–8. DOI: https://doi.org/10.33029/2308-1198-2023-11-2-111-118 (in Russian)

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