Acute ventricular septal defect treated with an Impella recovery as a 'bridge therapy' to heart transplantation

Abstract

We present the case of a 59-year-old male, admitted to hospital for cardiogenic shock due to massive infero-lateral myocardial infarction. Angiography showed occlusion of the right coronary artery and widespread critical lesions of both the anterior descending and circumflex artery. Echocardiography showed inferior akinesia with a large posterior ventricular septal defect (VSD). The haemodynamic instability induced us to use a left ventricular assist device (L-VAD) like Impella for easiness of its percutaneous implantation and for its duration. We obtained the stabilisation of the patient and the improvement of the clinical conditions. The location of the ventricular septal defect (VSD), from one side, and the serious and widespread coronaropathy (not suitable for any kind of revascularisation), from the other side, led us to choose heart transplantation for this patient. Heart transplantation was performed on the 12th day after myocardial infarction without complication and the patient was discharged on the 35th postoperative day. In our opinion, when the position of the VSD is unseemly and there coexists a widespread coronaropathy not eligible for revascularisation, heart transplantation may represent an efficacious alternative. Moreover, the use of L-VAD, reducing interventricular shunt and ensuring an adequate cardiac output, allows to obtain clinical stabilisation before heart transplantation. © 2007 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.