Lots of interesting abstracts and cases were submitted for TCTAP & AP VALVES 2020 Virtual. Below are accepted ones after thoroughly reviewed by our official reviewers. Don¡¯t miss the opportunity to explore your knowledge and interact with authors as well as virtual participants by sharing your opinion!
* The E-Science Station is well-optimized for PC.
We highly recommend you use a desktop computer or laptop to browse E-posters.
CASE20191029_012
| CORONARY - Acute Coronary Syndromes (STEMI, NSTE-ACS) | |
| Single Access for Primary PCI and VAECMO in Post Cardiac Arrest Patient | |
| Ivan Man Ho Wong1 | |
| Queen Elizabeth Hospital, Hong Kong, China1, | |
|
[Clinical Information]
- Patient initials or identifier number:
CCC
-Relevant clinical history and physical exam:
The patient, who was a 72-year-old gentleman with good past health, was admitted to our hospital for unstable angina. Shortly after admission, he developed witnessed in-hospital cardiac arrest. CPR was successful with downtime around 5 minutes. ECG after resuscitation showed inferior STEMI. Primary PCI was activated.
-Relevant test results prior to catheterization:
- Relevant catheterization findings:
Right femoral arterial and venous access were used. Contralateral injection showed critical stenosis at left iliac artery. Upon diagnostic catheter engagement at ostium LMN, patient developed cardiac arrest again with CPR commenced. Diagnostic angiogram showed critical ostium LMN disease. VAECMO was started with right femoral access exchanged to 17Fr arterial and 21 Fr venous cannula.
 5FSEM3X2.avi 5FSEM49G.avi |
|
|
[Interventional Management]
- Procedural step:
In view of no other alternative arterial access, we decided to puncture the arterial cannula of VAECMO for further coronary interventions. With temporary cross clamping of the ECMO circuit, placement of 6Fr arterial sheath into 17Fr arterial cannula was successful. There was no peri-sheath leakage or ECMO flow impairment.
Diagnostic angiogram of RCA showed acute total occlusion at dRCA. PCI with DES was done from dRCA to oRCA. PCI to left coronary was also performed in view of critical LMN lesion. PCI with DES from mLAD to oLMN was performed. We subsequently switched to bailout TAP strategy for left main bifurcation in view of pinching of oLCX. After PCI, the 6Fr arterial sheath was removed en bloc with short segment of arterial cannula. VAECMO circuit was then reestablished. The patient was transferred to ICU for further VAECMO support. Subsequent TEE showed poor LVEF with inadequate aortic valve opening. We decided to use IABP for LV unloading. Left femoral access was used. Two peripheral stents were deployed at left iliac artery. IABP was successfully inserted afterwards. Repeated echocardiogram showed serial improvement of LVEF back to normal. VAECMO and IABP were weaned off at post PCI day 6 and 7 respectively. However, the patient developed severe pneumonia and he succumbed on post PCI day 24. 5FSEM4GT.avi 5FSEM4A4.avi 5FSEM4FQ.avi- Case Summary:
Our case showed that coronary intervention through puncture of arterial cannula of VAECMO was feasible. No peri-sheath leakage or ECMO flow impairment was noted. IABP, as one of the LV unloading methods for VAECMO, was successfully inserted after contralateral iliac stenting.
|
|
0