Left heart temporary mechanical circulatory support via left mini-thoracotomy is a feasible option for cardiogenic shock in patients with an inaccessible anterior mediastinum and poor peripheral access.
May offer an alternative MCS route in patients with inaccessible mediastinum and poor peripheral access; hypothesis-generating and requires prospective validation.
BACKGROUND: Left heart mechanical circulatory support (MCS) through the left chest via the pulmonary vein and descending thoracic aorta is a good option for patients with an inaccessible anterior mediastinum and/or poor peripheral access. MATERIALS AND METHODS: We report the case of a 19-year-old small female with a newly discovered bulky primary mediastinal diffuse large B-cell lymphoma (PMBL) who developed refractory inverted Takotsubo cardiomyopathy (TC) with cardiogenic shock. RESULTS: Temporary MCS was implemented in order to stabilize the patient and proceed with a chemotherapy treatment. Given the patient's oncologic "frozen" mediastinum and the presence of poor peripheral arterial access, the left heart temporary MCS was successfully implanted through a left mini-thoracotomy via the left inferior pulmonary vein and descending thoracic aorta. CONCLUSIONS: This is the first report of temporary MCS to treat inverted TC and diffuse PMBL.
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Zeballos et al. (2012) studied this question.
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