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Left‐to‐right shunt reduction with intra‐aortic balloon pump in postmyocardial infarction ventricular septal defect
Author(s) -
Testuz Ariane,
Roffi Marco,
Bonvini Robert Francis
Publication year - 2013
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.24290
Subject(s) - medicine , cardiology , myocardial infarction , shunt (medical) , interventricular septum , hemodynamics , cardiac catheterization , ejection fraction , right coronary artery , perfusion , infarction , heart failure , coronary angiography , ventricle
This case aims to describe the hemodynamic effects of intra‐aortic balloon pump (IABP) in patients with ventricular septal defect (VSD) complicating myocardial infarction (MI). A 79‐year‐old man with no previous cardiovascular history presented to the emergency department with subacute inferior myocardial infarction associated with mild signs of systemic hypoperfusion. A transthoracic echocardiography revealed a large akinesia of the left ventricular inferior wall with preserved global left ventricular ejection fraction, as well as a large VSD in the midinferior portion of the interventricular septum. Coronary angiography showed an occlusion of the mid portion of a dominant circumflex coronary artery. The invasive hemodynamic evaluation showed a sizable left‐to‐right shunt ( Q p / Q s = 3.1). Activation of the IABP led to an immediate reduction of the shunt ( Q p / Q s = 2.4 = 22% reduction), an increase in systemic cardiac output (from 2.1 L/min to 2.4 L/min = +12%) and a decrease in the systemic vascular resistances (from 2240 to 1920 dyne‐sec/cm 5 = 15% reduction). In patients with post‐MI VSD, placement of IABP leads to an immediate reduction in left‐to‐right shunt and as a consequence to an increase in systemic cardiac output, which may allow hemodynamic stabilization of the patient prior to surgical VSD closure. © 2012 Wiley Periodicals, Inc.