Impella percutaneous left ventricular assist device for severe acute ischaemic mitral regurgitation as a bridge to surgery

Jalil, Bilal; El‐Kersh, Karim; Frizzell, Jarrod D.; Ahmed, Shozab

doi:10.1136/bcr-2017-219749

Cited by 18 publications

(12 citation statements)

References 12 publications

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“…Sodium nitroprusside can reduce systemic vascular resistance, thereby alleviating MR; however, the use of vasodilators in patients with systemic hypotension is usually limited. Moreover, the short-term circulatory assistive devices, [ 11 ] such as the intra-aortic balloon counterpulsation, Impella percutaneous left ventricular assist device, and extracorporeal membrane oxygenation (ECMO), can be used as a temporary measure before emergency valve surgery to temporarily stabilize the patient's condition. After 3 days of medical treatment, our patient's condition had not improved.…”

Section: Discussionmentioning

confidence: 99%

Unilateral cardiogenic pulmonary edema caused by acute mitral valve prolapse

Jiang

Cheng²,

Zhang³

2021

Medicine

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Rationale: Unilateral cardiogenic pulmonary edema is a rare disease. A common cause is mitral valve and asymmetrical blood regurgitation that is primarily directed toward the upper right pulmonary vein, causing mean capillary pressure to increase on the right side and leading to right pulmonary edema. Patient concerns: A 41-year-old man was diagnosed with pneumonia after presenting with a 2-day history of cough and shortness of breath. Computed tomography indicated right pulmonary edema. He was managed with noninvasive ventilation; however, his condition continued to deteriorate, and he was transferred to the intensive care unit after tracheal intubation. Diagnosis: Acute posterior mitral valve prolapses; unilateral cardiogenic pulmonary edema. Intervention: Emergency mitral valve replacement was performed. During the operation, 2 ruptures of the chordae tendineae in the P2 scallop of the posterior mitral valve were found, and a No. 29 St. Jude mechanical mitral valve was implanted. Outcomes: Cardiotonic and diuretic drugs were administered postoperatively. Tracheal intubation was removed on day 7; the patient was transferred to the general ward on day 11 and discharged on day 23 postoperatively. Lessons: Unilateral cardiogenic pulmonary edema is easily misdiagnosed. Computed tomographic (CT) imaging presentation, brain natriuretic peptide, and cardiac color Doppler ultrasound can assist in determining a differential diagnosis. Early surgical treatment is recommended for patients with acute mitral valve prolapse.

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Section: Discussionmentioning

confidence: 99%

Unilateral cardiogenic pulmonary edema caused by acute mitral valve prolapse

Jiang

Cheng²,

Zhang³

2021

Medicine

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“…The Impella device offers more robust cardiac output augmentation and directly unloads the LV, which improves oxygenation and hemodynamics as it decreases retrograde flow across the mitral valve (29). ECMO use alone may increase afterload and potentially worsen the MR (30).…”

Section: Pre-operative Use Of Mcsmentioning

confidence: 99%

Pre- and post-operative mechanical circulatory support in surgical repair of post-acute myocardial infarction mechanical complications

Bhardwaj¹,

Kumar²,

Armas³

et al. 2022

Ann Cardiothorac Surg

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The outcomes of patients with acute myocardial infarctions (AMI) have significantly improved with advances in early reperfusion strategies; however, patients with massive infarcts or those who do not receive timely revascularization may develop mechanical complications of AMI. The most common mechanical complications are ventricular septal rupture (VSR), acute mitral regurgitation (MR) due to papillary muscle rupture, and free-wall rupture. Each complication is associated with a high risk of morbidity and mortality, and requires a multidisciplinary approach for prompt diagnosis and hemodynamic stabilization. Surgery is the mainstay of therapy but is associated with poor outcomes if performed too early during the treatment course for VSR or if performed too late with MR and free wall rupture. Optimal timing for surgery in combination with temporary circulatory support may be a feasible strategy for better results.

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“…The IABP is classically recommended for acute severe MR due to its unique ability to lower afterload without lowering blood pressure, and the Impella is also effective; both TandemHeart and peripheral ECMO can be used, the latter in particular carrying a risk of worsening pulmonary edema due to increased LV afterload. 63,64 Positive-pressure ventilation can potentially improve MR severity by reducing LV preload and LV afterload. 21…”

Section: Mitral Valve Emergenciesmentioning

confidence: 99%

Structural Heart Disease Emergencies

Jentzer

Ternus

Eleid

et al. 2020

J Intensive Care Med

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Structural heart disease (SHD) emergencies include acute deterioration of a stable lesion or development of a new critical lesion. Structural heart disease emergencies can produce heart failure and cardiogenic shock despite preserved systolic function that may not respond to standard medical therapy and typically necessitate surgical or percutaneous intervention. Comprehensive Doppler echocardiography is the initial diagnostic modality of choice to determine the cause and severity of the underlying SHD lesion. Patients with chronic SHD lesions which deteriorate due to intercurrent illness (eg, infection or arrhythmia) may not require urgent intervention, whereas patients with an acute SHD lesion often require definitive therapy. Medical stabilization prior to definitive intervention differs substantially between stenotic lesions (aortic stenosis, mitral stenosis, left ventricular outflow tract obstruction) and regurgitant lesions (aortic regurgitation, mitral regurgitation, ventricular septal defect). Patients with regurgitant lesions typically require aggressive afterload reduction and inotropic support, whereas patients with stenotic lesions may paradoxically require β-blockade and vasoconstrictors. Emergent cardiac surgery for patients with decompensated heart failure or cardiogenic shock carries a substantial mortality risk but may be necessary for patients who are not eligible for catheter-based percutaneous SHD intervention. This review explores initial medical stabilization and subsequent definitive therapy for patients with SHD emergencies.

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Impella percutaneous left ventricular assist device for severe acute ischaemic mitral regurgitation as a bridge to surgery

Cited by 18 publications

References 12 publications

Unilateral cardiogenic pulmonary edema caused by acute mitral valve prolapse

Unilateral cardiogenic pulmonary edema caused by acute mitral valve prolapse

Pre- and post-operative mechanical circulatory support in surgical repair of post-acute myocardial infarction mechanical complications

Structural Heart Disease Emergencies

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