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, R. A., Sanna, T., Rebuzzi, A. G., Massetti, M., Crea, F., Liuzzo, G., Camilli M., Ciampi P., Pedicino D., Montone R. A., Sanna T. (ORCID:0000-0002-5760-6885), Rebuzzi A. G. (ORCID:0000-0002-9873-957X), Massetti M. (ORCID:0000-0002-7100-8478), Crea F. (ORCID:0000-0001-9404-8846), Liuzzo G. (ORCID:0000-0002-5714-0907), Camilli, M., Ciampi, P., Pedicino, D., D'Aiello, A., Mazza, A., Montone, R. A., Sanna, T., Rebuzzi, A. G., Massetti, M., Crea, F., Liuzzo, G., Camilli M., Ciampi P., Pedicino D., Montone R. A., Sanna T. (ORCID:0000-0002-5760-6885), Rebuzzi A. G. (ORCID:0000-0002-9873-957X), Massetti M. (ORCID:0000-0002-7100-8478), Crea F. (ORCID:0000-0001-9404-8846), and Liuzzo G. (ORCID:0000-0002-5714-0907)
- 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.
- Published
- 2021