1. Use of Levosimendan as bridge therapy to surgical correction of post-infarction ventricular septal defect: a case report.
- Author
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Camilli M, Ciampi P, Pedicino D, D'Aiello A, Mazza A, Montone RA, Sanna T, Rebuzzi AG, Massetti M, Crea F, and Liuzzo G
- Subjects
- Aged, Cardiac Surgical Procedures, Humans, Male, Simendan administration & dosage, Ventricular Septal Rupture diagnosis, Ventricular Septal Rupture surgery, Simendan therapeutic use, Ventricular Septal Rupture drug therapy
- 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 anterior 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.
- Published
- 2021
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