Refractory cardiogenic shock complicating hemolytic uremic syndrome treated by extracorporeal life support and balloon atrial septosomy. A case report.

Abstract

Hemolytic uremic syndrome (HUS) is known to cause kidney damage and bicytopenia can affect many other organs including the cardiovascular system. Although rare, it can be rapidly fatal. HUS causes myocardial vascular damage responsible for acute heart failure, which can progress to a state of refractory cardiogenic shock. The literature on this cardiac complication is sparse and there is no specific treatment. Management of patients with HUS therefore remains a challenge to the clinician. Extracorporeal life support (ECLS) can be used during the acute phase of HUS to help patients recover myocardial integrity. ECLS, which is widely used post-operatively after cardiac surgery, could also be used as rescue therapy to ensure circulatory support during myocardial recovery. We report a case of cardiac arrest secondary to severe heart failure returning to normal cardiac function after ECLS assistance in association with balloon atrial sep- tostomy (BAS). BAS was carried out by an endovascular procedure to decompress the left heart and optimize my- ocardial vascularization. To our knowledge, no previous case using BAS combined with ECLS in the recovery of cardiac function secondary to HUS has been reported.

Keywords

• hemolytic uremic syndrome; extracorporeal membrane oxygenation; extracorporeal life support; balloon atrial septostomy; cardiac failure