Left‐to‐right shunt reduction with intra‐aortic balloon pump in postmyocardial infarction ventricular septal defect

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.