PMID- 31438988
OWN - NLM
STAT- MEDLINE
DCOM- 20191126
LR  - 20200225
IS  - 1749-8090 (Electronic)
IS  - 1749-8090 (Linking)
VI  - 14
IP  - 1
DP  - 2019 Aug 22
TI  - Left ventricular decompression on Veno-arterial extracorporeal membrane 
      oxygenation with intra-aortic balloon Counterpulsation.
PG  - 153
LID - 10.1186/s13019-019-0970-3 [doi]
LID - 153
AB  - BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been 
      used increasingly to support patients with cardiogenic shock (CS). There has been 
      growing recognition of the favorable and unfavorable hemodynamic effects of this 
      therapy and recent interest in the use of other percutaneous circulatory support 
      devices to offset some of the potentially harmful hemodynamic effects. Herein, we 
      provide visual evidence of the effects of intra-aortic balloon pump (IABP) 
      counterpulsation for a patient with peripheral VA-ECMO cannulation. CASE 
      PRESENTATION: A 68 year old man who had undergone orthotopic heart 
      transplantation presented with 2 days of fatigue, orthopnea, and paroxysmal 
      nocturnal dyspnea. On examination, he was tachycardic, hypotensive and hypoxic 
      with cool extremities, consistent with CS. Transthoracic echocardiogram (TTE) 
      showed new severe biventricular dysfunction with a left ventricular ejection 
      fraction of 15%, right heart catheterization demonstrated elevated filling 
      pressures and low output. An IABP was inserted via the left femoral artery with 
      minimal improvement in hemodynamics. He was escalated to VA-ECMO. Repeat TTE 
      demonstrated aortic valve (AV) opening with each cardiac cycle and mild MR. With 
      placement of the IABP on standby Additional file 1: Video 1 (video 0:03), the AV 
      no longer opened. Re-initiation of balloon counterpulsation resulted in resumed 
      AV opening with each beat Additional file 1: Video 1 (video 0:17). He was treated 
      for presumed acute allograft rejection with methylprednisolone, thymoglobulin, 
      intravenous immunoglobulin and plasmapheresis with improvement in allograft 
      function. However, he developed an Enterobacter aerogenes pneumonia and rapidly 
      fatal septic shock. CONCLUSIONS: This case visually demonstrates effective LV 
      decompression by IABP counterpulsation in VA-ECMO support. While the overall 
      effects of LV decompression in patients on VA-ECMO with IABP are still unclear, 
      this report demonstrates one potential mechanism of benefit in the prevention of 
      stagnation of blood flow that may lead to intra-cardiac or aortic root thrombus 
      formation.
FAU - Griffin, Jan M
AU  - Griffin JM
AUID- ORCID: 0000-0003-1729-7464
AD  - Columbia University Irving Medical Center, 173 Fort Washington Avenue, Room 4617, 
      630 West 168th St, New York, NY, 10032, USA. janmgriffinmd@gmail.com.
FAU - Restaino, Susan
AU  - Restaino S
AD  - Columbia University Irving Medical Center, 173 Fort Washington Avenue, Room 4617, 
      630 West 168th St, New York, NY, 10032, USA.
FAU - Takeda, Koji
AU  - Takeda K
AD  - Columbia University Irving Medical Center, 173 Fort Washington Avenue, Room 4617, 
      630 West 168th St, New York, NY, 10032, USA.
FAU - Garan, Arthur R
AU  - Garan AR
AD  - Columbia University Irving Medical Center, 173 Fort Washington Avenue, Room 4617, 
      630 West 168th St, New York, NY, 10032, USA.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Video-Audio Media
DEP - 20190822
PL  - England
TA  - J Cardiothorac Surg
JT  - Journal of cardiothoracic surgery
JID - 101265113
SB  - IM
MH  - Aged
MH  - Decompression, Surgical
MH  - Extracorporeal Membrane Oxygenation/*adverse effects/*methods
MH  - Fatal Outcome
MH  - Heart Transplantation/adverse effects
MH  - Heart Ventricles/surgery
MH  - Hemodynamics
MH  - Humans
MH  - *Intra-Aortic Balloon Pumping
MH  - Male
MH  - Shock, Cardiogenic/etiology/*therapy
MH  - Ventricular Function, Left/physiology
PMC - PMC6704520
OTO - NOTNLM
OT  - Acute heart failure
OT  - Extracorporeal circulation
OT  - Intra-aortic balloon pump
OT  - Rejection
OT  - Transplant
COIS- The authors declare that they have no competing interests.
EDAT- 2019/08/24 06:00
MHDA- 2019/11/27 06:00
PMCR- 2019/08/22
CRDT- 2019/08/24 06:00
PHST- 2019/03/16 00:00 [received]
PHST- 2019/07/29 00:00 [accepted]
PHST- 2019/08/24 06:00 [entrez]
PHST- 2019/08/24 06:00 [pubmed]
PHST- 2019/11/27 06:00 [medline]
PHST- 2019/08/22 00:00 [pmc-release]
AID - 10.1186/s13019-019-0970-3 [pii]
AID - 970 [pii]
AID - 10.1186/s13019-019-0970-3 [doi]
PST - epublish
SO  - J Cardiothorac Surg. 2019 Aug 22;14(1):153. doi: 10.1186/s13019-019-0970-3.