A case of perioperative IABP use in a patient with AMI complicated with VSR.

Abstract

Ventricular septal rupture (VSR) following myocardial infarction may lead to rapid clinical deterioration with pulmonary edema, hypotension, and a high early mortality. Inotropic agents can increase systemic output but at the possible cost of increased myocardial ischemia. In contrast, intra-aortic balloon pump (IABP) can decrease ischemia by raising coronary perfusion pressure and will reduce afterload. We are presenting the case of a 67-year-old male presented in the emergency department with strong chest pain, diagnosed as inferior acute myocardial infarction (AMI), in TTE visualised VSR with left-to-right shunt. After a few hours, the hemodynamic parameters deteriorated, with hemodynamic instability. The patient is placed on regime with IABP on 1: 1 ratio and on high-dose inotropic drug regime. Once hemodynamic stability is ensured, the patient prepares to perform the intervention. The intervention performed was closure of the VSR with patch Dacron via ventriculotomy of the inferior wall of the left ventricle. At all times, the patient remained associated with IABP, except for extracorporeal circulation time. After the intervention, the patient remained for several days bound to IABP, until hemodynamic stability was achieved, and the dose of inotropic drugs was reduced.

Keywords

• VSR
• AMI
• IABP
• Cardiac surgery