A Visual Depiction of Left Ventricular Unloading in Veno-Arterial ExtraCorporeal Membrane Oxygenation With Impella

Keywords: coronavirus, COVID-19, left ventricular unloading

Left ventricular (LV) unloading has been associated with improved survival in patients treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO).¹ This case visually demonstrates the effect of LV unloading in a 30-year-old male, with a history of coronavirus disease 2019 (COVID-19) myocarditis. The patient developed COVID-19 and subsequently developed nonischemic cardiomyopathy with an LV ejection fraction of 10% to 15% (baseline echo; Figure 1, Video 1). He did poorly in the outpatient setting and was admitted to an outside hospital with heart failure symptoms. He was subsequently transferred to our hospital for escalation of care and consideration of advanced heart failure therapies. Upon arrival to our institution, the patient experienced a cardiac arrest with refractory ventricular fibrillation. Given his young age, VA-ECMO was inserted at bedside. The patient was brought to the cardiac catheterization lab for LV unloading with Impella due to inadequate aortic valve opening and LV smoke. On the following day, the patient had low-flow alarms. Echocardiogram demonstrated complete obliteration of the LV cavity (Figure 2, Video 2). The patient was transfused 2 units of red blood cells and given intravenous fluids with improvement in flow. The case nicely demonstrates the effect of LV unloading in the setting of VA-ECMO.

Affiliations and Disclosures

From the ¹Division of Interventional Cardiology, Henry Ford Hospital, Detroit, Michigan; and ²Division of Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Basir reports grant support from Abiomed, Chiese, and Zoll; consultant fees/honoraria from Abbott Vascular, Abiomed, Boston Scientific, Cardiovascular Systems, Inc, Chiesi, Seranas, and Zoll. The remaining  authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted April 11, 2022.

Address for correspondence: Lina Ya’Qoub, MD, Henry Ford Hospital, 2799 E. Grand Boulevard, Detroit, MI 48202. Email: yaqoublina1989@gmail.com

Reference

1. Schrage B, Becher PM, Bernhardt A, et al. Left ventricular unloading is associated with lower mortality in patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation: results from an international, multicenter cohort study. Circulation. 2020;142(22):2095-2106. doi:10.1161/CIRCULATIONAHA.120.048792

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