Left Main Coronary Artery Compression following Melody Pulmonary Valve Implantation: Use of Impella Support as Rescue Therapy and Perioperative Challenges with ECMO
The purpose of this case is to describe the complex perioperative management of a 30-year-old woman with congenital heart disease and multiple resternotomies presenting with pulmonary homograft dysfunction and evaluation for percutaneous pulmonary valve replacement. Transvenous, transcatheter Melody...
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| Format: | Article |
| Language: | English |
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Wiley
2014-01-01
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| Series: | Case Reports in Critical Care |
| Online Access: | http://dx.doi.org/10.1155/2014/959704 |
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| _version_ | 1832562735097839616 |
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| author | Erica D. Wittwer Juan N. Pulido Shane M. Gillespie Frank Cetta Joseph A. Dearani |
| author_facet | Erica D. Wittwer Juan N. Pulido Shane M. Gillespie Frank Cetta Joseph A. Dearani |
| author_sort | Erica D. Wittwer |
| collection | DOAJ |
| description | The purpose of this case is to describe the complex perioperative management of a 30-year-old woman with congenital heart disease and multiple resternotomies presenting with pulmonary homograft dysfunction and evaluation for percutaneous pulmonary valve replacement. Transvenous, transcatheter Melody valve placement caused left main coronary artery occlusion and cardiogenic shock. An Impella ventricular assist device (VAD) provided rescue therapy during operating room transport for valve removal and pulmonary homograft replacement. ECMO support was required following surgery. Several days later during an attempted ECMO wean, her hemodynamics deteriorated abruptly. Transesophageal and epicardial echocardiography identified pulmonary graft obstruction, requiring homograft revision due to large thrombosis. This case illustrates a role for Impella VAD as bridge to definitive procedure after left coronary occlusion and describes management of complex perioperative ECMO support challenges. |
| format | Article |
| id | doaj-art-4fc4ed3e4a1040cb925cd175decff821 |
| institution | Kabale University |
| issn | 2090-6420 2090-6439 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Critical Care |
| spelling | doaj-art-4fc4ed3e4a1040cb925cd175decff8212025-02-03T01:21:56ZengWileyCase Reports in Critical Care2090-64202090-64392014-01-01201410.1155/2014/959704959704Left Main Coronary Artery Compression following Melody Pulmonary Valve Implantation: Use of Impella Support as Rescue Therapy and Perioperative Challenges with ECMOErica D. Wittwer0Juan N. Pulido1Shane M. Gillespie2Frank Cetta3Joseph A. Dearani4Division of Critical Care Medicine and Cardiothoracic Anesthesia, Department of Anesthesiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USADivision of Critical Care Medicine and Cardiothoracic Anesthesia, Department of Anesthesiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USADivision of Critical Care Medicine and Cardiothoracic Anesthesia, Department of Anesthesiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USADivision of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, USADivision of Cardiovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, USAThe purpose of this case is to describe the complex perioperative management of a 30-year-old woman with congenital heart disease and multiple resternotomies presenting with pulmonary homograft dysfunction and evaluation for percutaneous pulmonary valve replacement. Transvenous, transcatheter Melody valve placement caused left main coronary artery occlusion and cardiogenic shock. An Impella ventricular assist device (VAD) provided rescue therapy during operating room transport for valve removal and pulmonary homograft replacement. ECMO support was required following surgery. Several days later during an attempted ECMO wean, her hemodynamics deteriorated abruptly. Transesophageal and epicardial echocardiography identified pulmonary graft obstruction, requiring homograft revision due to large thrombosis. This case illustrates a role for Impella VAD as bridge to definitive procedure after left coronary occlusion and describes management of complex perioperative ECMO support challenges.http://dx.doi.org/10.1155/2014/959704 |
| spellingShingle | Erica D. Wittwer Juan N. Pulido Shane M. Gillespie Frank Cetta Joseph A. Dearani Left Main Coronary Artery Compression following Melody Pulmonary Valve Implantation: Use of Impella Support as Rescue Therapy and Perioperative Challenges with ECMO Case Reports in Critical Care |
| title | Left Main Coronary Artery Compression following Melody Pulmonary Valve Implantation: Use of Impella Support as Rescue Therapy and Perioperative Challenges with ECMO |
| title_full | Left Main Coronary Artery Compression following Melody Pulmonary Valve Implantation: Use of Impella Support as Rescue Therapy and Perioperative Challenges with ECMO |
| title_fullStr | Left Main Coronary Artery Compression following Melody Pulmonary Valve Implantation: Use of Impella Support as Rescue Therapy and Perioperative Challenges with ECMO |
| title_full_unstemmed | Left Main Coronary Artery Compression following Melody Pulmonary Valve Implantation: Use of Impella Support as Rescue Therapy and Perioperative Challenges with ECMO |
| title_short | Left Main Coronary Artery Compression following Melody Pulmonary Valve Implantation: Use of Impella Support as Rescue Therapy and Perioperative Challenges with ECMO |
| title_sort | left main coronary artery compression following melody pulmonary valve implantation use of impella support as rescue therapy and perioperative challenges with ecmo |
| url | http://dx.doi.org/10.1155/2014/959704 |
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