Cardiogenic Shock in Obstructive Hypertrophic Cardiomyopathy Plus Apical Ballooning: Management With VA-ECMO and Myectomy

Flavia Caniato; Valentina Andrei; Pasquale Bernardo; Cecilia Agostini; Francesco Cappelli; Pier Luigi Stefano; Iacopo Olivotto; Maurizio Pieroni; Leonardo Bolognese; Carlo Di Mario

doi:10.1016/j.jaccas.2020.11.029

Cardiogenic Shock in Obstructive Hypertrophic Cardiomyopathy Plus Apical Ballooning: Management With VA-ECMO and Myectomy

JACC Case Rep. 2021 Mar 17;3(3):433-437. doi: 10.1016/j.jaccas.2020.11.029. eCollection 2021 Mar.

Affiliations

¹ Cardiac Intensive Care Unit, Careggi University Hospital, Florence, Italy.
² Cardiac Surgery Unit, Careggi University Hospital, Florence, Italy.
³ Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy.
⁴ Cardiology Department, San Donato Hospital, Arezzo, Italy.

Abstract

A patient with known obstructive hypertrophic cardiomyopathy developed worsening left ventricular outflow tract obstruction, severe mitral regurgitation, and apical ballooning leading to cardiogenic shock, a combination in which treatment of each component could worsen the others. Emergency veno-arterial extracorporeal membrane oxygenation, levosimendan, and noradrenaline transiently restored adequate systemic perfusion and gas exchange. Surgical myectomy offered a more definitive solution. (Level of Difficulty: Intermediate.).

Keywords: AF, atrial fibrillation; CS, cardiogenic shock; EF, ejection fraction; HCM, hypertrophic cardiomyopathy; HF, heart failure; LVOTO, left ventricular outflow tract obstruction; MR, mitral regurgitation; SAM, systolic anterior movement; TTE, transthoracic echocardiography; VA-ECMO, veno-arterial extracorporeal membrane oxygenation; acute heart failure; cardiac assist devices; cardiomyopathy; inotropes.

Publication types

Case Reports