Percutaneous coronary intervention under temporary peripheral veno-arterial extracorporeal membrane oxygenation.

We describe the case of a 68-year old female presenting with subacute ST-elevation myocardial infarction and severe depressed left ventricular ejection fraction (15%) in the presence of severe three-vessel coronary artery disease. The patient was haemodynamically stable. After heart team discussion, a percutaneous coronary intervention was performed under peripheral veno-arterial extracorporeal membrane oxygenation without complications.

[Post-myocardial infarction ventricular septal defect]. / Communication interventriculaire postinfarctus du myocarde : mise au point.

Post-myocardial infarction ventricular septal defect corresponds to the rupture of the ventricular septum between the healthy and infarcted parts. It is a rare complication still associated with a high mortality rate. Its diagnostic should be evoked in case of pathologic cardiac auscultation and confirmed by emergent transthoracic echocardiography. Hemodynamic stabilisation, mainly with the insertion of an intra-aortic balloon pump is the first step in the management. The subsequent modality of closure, either surgical or transcatheter, as well as the ideal timing should be discussed in the Heart team. Successful closure decreases the 30-day mortality rate to 30-40 %.

La communication interventriculaire postinfarctus du myocarde correspond à la rupture du septum interventriculaire au niveau de la transition entre les tissus sain et infarci. C'est une complication rare mais mortelle après un infarctus du myocarde. Le diagnostic est avant tout clinique et doit être évoqué en cas d'auscultation cardiaque pathologique et confirmé par une échocardiographie transthoracique réalisée en urgence. La stabilisation hémodynamique, dans la majorité des cas à l'aide d'un ballon de contre-pulsion intra-aortique, est la première étape de la prise en charge. Ensuite, la décision d'une fermeture chirurgicale ou percutanée et son timing doivent être évalués au sein du Heart team. La fermeture chirurgicale ou percutanée permet de diminuer la mortalité à 30-40 % à 30 jours.

Pre-hospital alarm activation for STEMI patients undergoing primary percutaneous coronary intervention in the era of transradial procedures.

BACKGROUND: Transradial access (TRA) improves outcome compared with trans-femoral access for the management of patients with acute coronary syndromes. In this setting, it is unknown whether the activation of a pre-hospital alarm system (PHAS) confers additional benefit for the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS: We retrospectively analyzed a cohort of patients with a first STEMI who underwent a primary percutaneous coronary intervention (PPCI) at a single center within a prospective cohort of acute coronary syndrome patients (SPUM-ACS). TRA was used in 85% of patients. We assessed how PHAS (n=165) vs. no-PHAS (n=166) activation was associated with the composite outcome of all-cause mortality and recurrence of myocardial infarction (MI) at 1-year follow-up. As secondary outcomes, the individual clinical endpoints were separately assessed for association. RESULTS: Compared with no-PHAS patients, patients in the PHAS group were predominantly women, and presented more frequently with dyslipidemia and cardiac arrest. A significant reduction in the composite outcome of all-cause mortality and recurrent MI at 1-year was observed in the PHAS group, compared with no-PHAS (3.6% vs. 8.5%, p=0.027). When adjusted for age, sex and resuscitation status, PHAS activation remained associated with decreased all-cause mortality and recurrent MI (HR: 0.36 [95% CI: 0.13-0.95]; p=0.040). CONCLUSIONS: This study suggests that the benefit of PHAS activation in STEMI patients undergoing PPCI persists also in the era of TRA.

Percutaneous Aortic Balloon Valvuloplasty and Intracardiac Adrenaline in Electromechanical Dissociation as Bridge to Transcatheter Aortic Valve Implantation.

This report describes an emergent balloon aortic valvuloplasty (BAV) procedure performed under cardiopulmonary resuscitation in a 79-year-old man with severe symptomatic aortic stenosis (mean gradient 78 mm Hg, valve area 0.71 cm, and left ventricular ejection fraction 40%) awaiting surgery and who was admitted for heart failure rapidly evolving to cardiogenic shock and multiorgan failure. Decision was made to perform emergent BAV. After crossing the valve with a 6 French catheter, the patient developed an electromechanical dissociation confirmed at transesophageal echocardiography and cardiac arrest. Manual chest compressions were initiated along with the application of high doses of intravenous adrenaline, and BAV was performed under ongoing resuscitation. Despite BAV, transoesophageal echocardiography demonstrated no cardiac activity. At this point, it was decided to advance a pigtail catheter over the wire already in place in the left ventricle and to inject intracardiac adrenaline (1 mg, followed by 5 mg). Left ventricular contraction progressively resumed and, in the absence of aortic regurgitation, an intraaortic balloon pump was inserted. The patient could be weaned from intraaortic balloon pump and vasopressors on day 1, extubated on day 6, and recovered from multiorgan failure. In the absence of neurologic deficits, he underwent uneventful transcatheter aortic valve implantation on day 12 and was discharged to a cardiac rehabilitation program on day 30. At 3-month follow-up, he reported dyspnea NYHA class II as the only symptom.This case shows that severe aortic stenosis leading to electromechanical dissociation may be treated by emergent BAV and intracardiac administration of high-dose adrenaline. Intracardiac adrenaline may be considered in case of refractory electromechanical dissociation occurring in the cardiac catheterization laboratory.