A staged surgical strategy for cardiogenic shock and iatrogenic ventricular septal perforation due to a malpositioned catheter

Abstract

A 59-year-old woman fell into cardiogenic shock due to acute myocardial infarction with total occlusion of the left anterior descending artery. Although intra-aortic balloon pump was inserted and a coronary stent was placed, she went into cardiopulmonary arrest and percutaneous veno-arterial extracorporeal membrane oxygenation (ECMO) was initiated. She was transferred to our hospital after drainage for pericardial effusion. Computed tomography revealed the drainage catheter lying through the right ventricular free wall and the ventricular septum, and leading into the left ventricle. She showed multiple organ failure and disseminated intravascular coagulation syndrome due to insufficient ECMO flow. Conversion to central ECMO after catheter removal was performed and her general condition improved; however, ventricular septal shunt remained. Repair of the perforation and ECMO removal was performed 15 days after the first operation. The combination of optimal mechanical circulatory support and the staged surgical repair contributed to her dramatic recovery.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Jones BM, Kapadia SR, Smedira NG, Robich M, Tuzcu EM, Menon V, et al. Ventricular septal rupture complicating acute myocardial infarction: a contemporary review. Eur Heart J. 2014;35:2060–8.

    Article  Google Scholar 

  2. 2.

    Isoda S, Imoto K, Uchida K, Hashiyama N, Yanagi H, Tamagawa H, et al. Sandwich Technique via right ventricle incision to repair postinfarction ventricular septal defect. J Card Surg. 2004;19:149–50.

    CAS  Article  Google Scholar 

  3. 3.

    Arnaoutakis GJ, Zhao Y, George TJ, Sciortino CM, McCarthy PM, Conte JV. Surgical repair of ventricular septal defect after myocardial infarction: outcomes from the Society of Thoracic Surgeons National Database. Ann Thorac Surg. 2012;294:436–44.

    Article  Google Scholar 

  4. 4.

    Yamazaki F. Current review of surgical repair of postinfarction ventricular septal defect. J Jpn Coron Assoc. 2016;22:119–25.

    Article  Google Scholar 

  5. 5.

    ItoT. Post infarction ventricular septal rupture. J Jpn Coron Assoc. 2016;22:116–8.

    Article  Google Scholar 

  6. 6.

    Matos D, Madeira M, Nolasco T, Neves JP. The role of extracorporeal membrane oxygenation in acute basal ventricular septal rupture. Eur J Cardiothorac Surg. 2019. https://doi.org/10.1093/ejcts/ezz235.

    Article  Google Scholar 

  7. 7.

    Iida M, Uchiyama M, Shimokawa T. A successful case of percutaneous left ventricular assist device “Impella” to postmyocardial infarction ventricular septal perforation in Japan. Artif Organs. 2019;43:806–7.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Akira Shiose.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest in association with the present study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Nishijima, T., Tanoue, Y., Ushijima, T. et al. A staged surgical strategy for cardiogenic shock and iatrogenic ventricular septal perforation due to a malpositioned catheter. Gen Thorac Cardiovasc Surg 69, 336–339 (2021). https://doi.org/10.1007/s11748-020-01425-z

Download citation

Keywords

  • Ventricular septal perforation
  • Iatrogenic heart injury