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Case Report
Tricky papillary muscle rupture sequelae navigated by evidence-based therapies using ECMO and Impella
1 Resident Physician, Internal Medicine, Northeast Georgia Medical Center, Gainesville, GA, USA
2 FACC, Program Director, Cardiovascular Medicine Fellowship Program and Medical Director, Heart Failure Treatment and Recovery Center, Georgia Heart institute, Gainesville, GA, USA
Address correspondence to:
Christine Sykalo
DO, 743 Spring St NE, Suite 700, Gainesville, GA 30501,
USA
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Article ID: 100012C03CS2022
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How to cite this article
Sykalo C, Herrera M, Adams A, Egolum U. Tricky papillary muscle rupture sequelae navigated by evidence-based therapies using ECMO and Impella. Edorium J Cardiol 2022;6(2):1–5.ABSTRACT
This case illustrates an atypical mitral valve prolapse presentation with superimposed stress of acute respiratory distress syndrome (ARDS) as well as the importance of extracorporeal membrane oxygenation therapy (ECMO) as a bridge to definitive surgical intervention. Switching from venovenous (VV) to venoarterial (VA) ECMO allowed bypass of the pulmonary circulation and provided cardiac support to assist in systemic circulation in the setting of severe mitral regurgitation with mitral valve prolapse. However, VA ECMO increases afterload, thus an Impella was used to offload the left ventricle and provide forward flow. Relying on evidence-based medicine for each modality despite its complexity also optimized this patient’s chance for recovery. Thereby, we demonstrate a complex case of ARDS, mitral valve prolapse secondary to myocardial infarction, and subsequent multiple arrhythmic arrests, where successful VV and VA ECMO resuscitation afforded bridge therapy to definitive surgical management. Our patient showed promising results, and we would like to encourage this strategy to bridge patients requiring surgical intervention.
Keywords: Cardiac critical care, ECMO, Impella, Valve replacement
SUPPORTING INFORMATION
Author Contributions
Christine Sykalo - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Martin Herrera - Substantial contributions to conception and design, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Alex Adams - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Ugochukwu Egolum - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Christine Sykalo et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
