Use of Levosimendan as bridge therapy to surgical correction of post-infarction ventricular septal defect: a case report

Tommaso Sanna, Massimo Massetti, Filippo Crea, Giovanna Liuzzo, Massimiliano Camilli, Pellegrino Ciampi, Daniela Pedicino, Rocco Antonio Montone, Antonio Giuseppe Rebuzzi

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

– OBJECTIVE: Ventricular septal defect (VSD) is an uncommon but frequently fatal complication following acute myocardial infarction. In medically treated patients, mortality rates exceed 90%, while the surgical repair is associated with better outcomes, even though optimal surgical timing is still under debate. CASE REPORT: We present the case of a 78-years-old man with no previous remarkable cardiological history admitted to our Emergency Department with the diagnosis of anteri- or ST-elevation myocardial infarction and significant reduction of left ventricular ejection fraction. The emergency coronary angiography showed sub-occlusion of the left anterior descending coronary artery, treated with stent implantation. The post-procedural echocardiography unveiled the presence of an apical VSD with a large left-to-right shunt, significant right ventricular overload and dysfunction. An intra-aortic balloon pump (IABP) was positioned and, after Heart Team evaluation, a delayed surgical approach was planned. As a bridge to the intervention Levosimendan infusion was administered, on top of IABP support, and a significant improvement in bi-ventricular function and pressure profiles was obtained. Cardiac surgery was successfully performed 9 days after the admission without periprocedural complications. CONCLUSIONS: This unique case supports the use of Levosimendan as a valid pharmacological strategy for perioperative management of VSD.
Lingua originaleEnglish
pagine (da-a)3296-3299
Numero di pagine4
RivistaEuropean Review for Medical and Pharmacological Sciences
Volume25
DOI
Stato di pubblicazionePubblicato - 2021

Keywords

  • Acute myocardial infarction
  • Aged
  • Cardiac Surgical Procedures
  • Heart failure
  • Humans
  • Levosimendan
  • Male
  • Personalized medicine
  • Simendan
  • Ventricular Septal Rupture
  • Ventricular septal defect

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