Key result
Emergency veno-arterial ECMO, levosimendan, and noradrenaline transiently restored perfusion, while surgical myectomy offered a definitive solution for cardiogenic shock in this complex patient.
Case Report (n=1)
In a complex case of obstructive HCM with apical ballooning and cardiogenic shock, VA-ECMO and medical therapy provided transient stabilization prior to definitive surgical myectomy.
May stabilize select obstructive HCM patients in refractory shock; leaves open optimal bridging strategies pending larger studies.
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.)
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Caniato et al. (2021) conducted a case report in Obstructive hypertrophic cardiomyopathy, apical ballooning, and cardiogenic shock (n=1). Emergency veno-arterial extracorporeal membrane oxygenation, levosimendan, noradrenaline, and surgical myectomy was evaluated. Emergency veno-arterial ECMO, levosimendan, and noradrenaline transiently restored perfusion, while surgical myectomy offered a definitive solution for cardiogenic shock in this complex patient.
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