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Circulatory support with right ventricular assist device and intra-aortic balloon counterpulsation in patient with right ventricle failure after pulmonary embolectomy

Romuald Lango^a, Maciej Micha Kowalik^a,*, Katarzyna Klajbor^a and Jan Rogowski^b

^a Department of Cardiac Anaesthesiology, Medical University of Gdask, ul. Dbinki 7, 80-211, Gdask, Poland
^b Department of Cardiac and Vascular Surgery, Medical University of Gdask, Poland

*Corresponding author. Tel.: +48 58 349 2483; fax: +48 58 349 2471.

E-mail address: mkowalik{at}amg.gda.pl (M.M. Kowalik).

Severe pulmonary embolism may lead to acute right ventricular failure despite immediate surgical embolectomy, which is regarded as the treatment of choice after recent CABG surgery. We report a case of a patient with massive pulmonary thromboembolism which resulted in acute right ventricular failure following early surgical embolectomy. Pulmonary embolism developed two days after an elective off-pump CABG surgery. We observed severe circulatory collapse which resulted in cardiac arrest and proved refractory to pharmacological treatment after immediate cardiopulmonary resuscitation. Intra-aortic balloon pumping was used in an attempt to improve hemodynamic performance during surgical skin preparation. After the completion of the embolectomy and failure to wean the patient from CPB, upon clinical signs of low cardiac output and akinetic right ventricle, the decision was made to support its function with a centrifugal pump. The substantial improvement of the right ventricular function observed in the next 24 h allowed weaning the patient from right ventricle support. In spite of hemodynamic recovery, the patient remained in a coma on discharge from the cardiac-surgical ICU after 18 days, and died 10 days later from systemic infection.

Key Words: Pulmonary embolism; Cardiopulmonary resuscitation; Right ventricular dysfunction; Right ventricle assist device; Intra-aortic balloon pumping; Cardiac output low