Idelchik Gary M, Loyalka Pranav, Kar Biswajit
Division of Cardiology, St. Luke's Episcopal Hospital and The Texas Heart Institute, Houston, Texas 77030, USA.
Tex Heart Inst J. 2007;34(2):204-8.
Cardiogenic shock after acute myocardial infarction is associated with a high mortality rate despite modern reperfusion methods and intra-aortic balloon pump support. For myocardial infarction patients in cardiogenic shock that is refractory to intra-aortic ballon pump counterpulsation and pressors (severe refractory cardiogenic shock), there are limited means to rapidly provide additional hemodynamic support. We present the case of a 49-year-old man who presented with an anterior wall acute myocardial infarction complicated by cardiogenic shock. After resuscitation and stabilization with intra-aortic balloon pump and pressor support, the patient underwent successful emergent percutaneous transluminal coronary angioplasty and stenting of the left anterior descending coronary artery. Forty-eight hours later, the patient again went into severe refractory cardiogenic shock; pulseless electrical activity arrest followed. Cardiopulmonary resuscitation was started, and the patient underwent urgent placement of a TandemHeart percutaneous ventricular assist device. The device enabled the reversal of terminal hemodynamic collapse during active cardiopulmonary resuscitation, subsequent stabilization of the patient, and discharge of the patient from the hospital after device removal. In this patient, the percutaneous ventricular assist device was successful in the treatment of severe refractory cardiogenic shock after acute myocardial infarction.
尽管有现代再灌注方法和主动脉内球囊泵支持，但急性心肌梗死后的心源性休克死亡率仍很高。对于主动脉内球囊泵反搏和升压药治疗无效的心源性休克心肌梗死患者（严重难治性心源性休克），迅速提供额外血流动力学支持的手段有限。我们报告一例49岁男性患者，表现为前壁急性心肌梗死合并心源性休克。在通过主动脉内球囊泵和升压药支持进行复苏和稳定后，患者成功接受了急诊经皮冠状动脉腔内血管成形术及左前降支冠状动脉支架置入术。48小时后，患者再次陷入严重难治性心源性休克，随后出现无脉电活动心脏骤停。开始进行心肺复苏，患者紧急置入了TandemHeart经皮心室辅助装置。该装置使患者在积极心肺复苏期间逆转了终末期血流动力学崩溃，随后病情稳定，并在移除装置后出院。在该患者中，经皮心室辅助装置成功治疗了急性心肌梗死后的严重难治性心源性休克。
