Document Detail

Intractable cardiogenic shock in stress cardiomyopathy with left ventricular outflow tract obstruction: is extra-corporeal life support the best treatment?
MedLine Citation:
PMID:  19468019     Owner:  NLM     Status:  MEDLINE    
We report the use of extra-corporeal cardiopulmonary support (ECLS), in a case of complicating refractory severe cardiogenic shock, in a patient with Tako-tsubo cardiomyopathy (TC). Tako-tsubo cardiomyopathy syndrome is characterized by left ventricular (LV) wall motion abnormalities, usually without coronary artery disease, mimicking the diagnosis of acute coronary syndrome. This ventricular dysfunction is typically reversible in the acute phase, though it can progress into refractory cardiogenic shock with limited therapeutic options available. Here, we report for the first time in a Tako-tsubo patient with refractory cardiogenic shock, the use of ECLS treatment in order to unload the heart, sustain circulation and end-organ perfusion, and promote potential ventricular recovery. Extra-corporeal life support allowed inotropic drug weaning while maintaining end-organ function and supported the patient until myocardial recovery. The patient recovered completely, and a normal LV ejection fraction was documented by 2D echocardiography on day 7. From our experience, ECLS can be an appropriate treatment for severe refractory cardiogenic shock in patients with TC. Extra-corporeal life support was an effective ultimate solution.
Massimo Bonacchi; Massimo Maiani; Guy Harmelin; Guido Sani
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2009-05-24
Journal Detail:
Title:  European journal of heart failure     Volume:  11     ISSN:  1388-9842     ISO Abbreviation:  Eur. J. Heart Fail.     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-06-25     Completed Date:  2010-09-21     Revised Date:  2011-06-08    
Medline Journal Info:
Nlm Unique ID:  100887595     Medline TA:  Eur J Heart Fail     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  721-7     Citation Subset:  IM    
Cardiac Surgery, Medical and Surgical Critical Care Department, University of Florence, 50134 Firenze, Italy.
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MeSH Terms
Extracorporeal Membrane Oxygenation*
Recovery of Function
Shock, Cardiogenic / diagnosis,  etiology,  therapy*
Stroke Volume
Takotsubo Cardiomyopathy / complications,  therapy*
Ventricular Dysfunction, Left / therapy
Ventricular Function, Left
Ventricular Outflow Obstruction / complications,  therapy*

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