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Journal of Medical Case Reports

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Open Access 01-12-2024 | Intra-Aortic Balloon | Case report

Intra-aortic balloon pump still has a role in late-onset myocardial infarction complicated by ventricular septal rupture with intractable heart failure: a case report

Authors: Mochamad Yusuf Alsagaff, Oky Revianto, Yan Efrata Sembiring, Muhammad Insani Ilman, Ryan Enast Intan

Published in: Journal of Medical Case Reports | Issue 1/2024

Abstract

Background

The current guidelines have discouraged the routine use of intra-aortic balloon pump (IABP) in cardiogenic shock complicating acute coronary syndrome (ACS). Since then, the trend of IABP utilization in ACS has been declining. Nevertheless, the guidelines still preserve the recommendation of IABP use in hemodynamic instability or cardiogenic shock caused by post myocardial infarction (MI) ventricular septal rupture (VSR).

Case presentation

A 46-years-old diabetic Southeast Asian female was referred from a peripheral facility with intractable heart failure despite treatment with vasoactive agents and diuretics for five days. The ECG suggested a recent anteroseptal myocardial infarction with normal high-sensitivity troponin-I value. The echocardiography detected a regional wall motion abnormality and a 10 mm wide ventricular septal defect. Invasive coronary angiography revealed a severe two-vessel coronary artery disease. We planned a delayed surgical strategy with preoperative optimization using IABP as a bridge to surgery. IABP implantation followed by significant hemodynamic improvement and rapid resolution of heart failure without any inotrope support. Afterwards, coronary artery bypass grafting (CABG) and VSR surgical repair were performed. We safely removed IABP on the third postoperative day with proper weaning and minimal vasoactive support.

Conclusion

We report a case where IABP still provided benefits for a patient with intractable heart failure caused by undetermined onset MI complicated by VSR. The use of IABP in such a case is in accordance with the recommendation of the current guidelines. Several studies showed that IABP use during preoperative optimization in the case of post-MI VSR was associated with survival benefits.

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Title: Intra-aortic balloon pump still has a role in late-onset myocardial infarction complicated by ventricular septal rupture with intractable heart failure: a case report
Authors: Mochamad Yusuf Alsagaff
Oky Revianto
Yan Efrata Sembiring
Muhammad Insani Ilman
Ryan Enast Intan
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Intra-Aortic Balloon
Heart Failure
Myocardial Infarction
CABG
CABG
Cardiogenic Shock
Cardiogenic Shock
Ventricular Septal Defect
Ventricular Septal Defect
Published in: Journal of Medical Case Reports / Issue 1/2024
Electronic ISSN: 1752-1947
DOI: https://doi.org/10.1186/s13256-023-04284-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Intra-aortic balloon pump still has a role in late-onset myocardial infarction complicated by ventricular septal rupture with intractable heart failure: a case report

Abstract

Background

Case presentation

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Case presentation

Conclusion

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