Acute and Critical Care

Review Article

Cardiology
Left ventricle unloading during veno-arterial extracorporeal membrane oxygenation: review with updated evidence: Yongwhan Lim, Min Chul Kim, In-Seok Jeong; Acute Crit Care. 2024;39(4):473-487. Published online November 18, 2024; DOI: https://doi.org/10.4266/acc.2024.00801

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Abstract PDF: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is widely used to treat medically refractory cardiogenic shock and cardiac arrest, and its usage has increased exponentially over time. Although VA-ECMO has many advantages over other mechanical circulatory supports, it has the unavoidable disadvantage of increasing retrograde arterial flow in the afterload, which causes left ventricular (LV) overload and can lead to undesirable consequences during VA-ECMO treatment. Weak or no antegrade flow without sufficient opening of the aortic valve increases the LV end-diastolic pressure, and that can cause refractory pulmonary edema, blood stagnation, thrombosis, and refractory ventricular arrhythmia. This hemodynamic change is also related to an increase in myocardial energy consumption and poor recovery, making LV unloading an essential management issue during VA-ECMO treatment. The principal factors in effective LV unloading are its timing, indications, and modalities. In this article, we review why LV unloading is required, when it is indicated, and how it can be achieved.

Case Reports

Cardiology
Successful extracorporeal membrane oxygenation treatment of catecholamine-induced cardiomyopathy-associated pheochromocytoma: a case report: Sangshin Park, Min Kim, Dae In Lee, Ju-Hee Lee, Sangmin Kim, Sang Yeub Lee, Jang-Whan Bae, Kyung-Kuk Hwang, Dong-Woon Kim, Myeong-Chan Cho, Dae-Hwan Bae; Acute Crit Care. 2024;39(1):194-198. Published online May 11, 2022; DOI: https://doi.org/10.4266/acc.2021.01158

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The main mechanism of Takotsubo cardiomyopathy (TCM) is catecholamine-induced acute myocardial stunning. Pheochromocytoma, a catecholamine-secreting tumor, can cause several cardiovascular complications, including hypertensive crisis, myocardial infarction, toxic myocarditis, and TCM. A 29-year-old woman presented to our hospital with general weakness, vomiting, dyspnea, and chest pain. The patient was nullipara, 28 weeks’ gestation, and had a cachexic morphology. Her cardiac enzyme levels were elevated and bedside echocardiography showed apical akinesia, suggesting TCM. The next day, she could not feel the fetal movement, and an emergency cesarean section was performed. After delivery, the patient experienced cardiac arrest and was transferred to the intensive care unit for cardiopulmonary resuscitation (CPR). Spontaneous circulation returned after 28 minutes of CPR, but cardiogenic shock continued, and extracorporeal membrane oxygenation (ECMO) was initiated. On the third day of ECMO maintenance, left ventricular ejection fraction improved and blood pressure stabilized. On the eighth day after ECMO insertion, it was removed. However, complications of the left leg vessels occurred, and several surgeries and interventions were performed. A left adrenal gland mass was found on computed tomography and was removed while repairing the leg vessels. Pheochromocytoma was diagnosed and left adrenalectomy was performed.

Citations

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Mechanical Circulatory Support Strategies in Takotsubo Syndrome with Cardiogenic Shock: A Systematic Review
Johanna K. R. von Mackensen, Vanessa I. T. Zwaans, Ahmed El Shazly, Karel M. Van Praet, Roland Heck, Christoph T. Starck, Felix Schoenrath, Evgenij V. Potapov, Joerg Kempfert, Stephan Jacobs, Volkmar Falk, Leonhard Wert
Journal of Clinical Medicine.2024; 13(2): 473. CrossRef

Cardiology
Acute fulminant myocarditis following influenza vaccination requiring extracorporeal membrane oxygenation: Youn-Jung Kim, Jun-Il Bae, Seung Mok Ryoo, Won Young Kim; Acute Crit Care. 2019;34(2):165-169. Published online November 7, 2018; DOI: https://doi.org/10.4266/acc.2017.00045

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27 Web of Science
29 Crossref

Abstract PDF

The inactivated influenza vaccination is generally safe with mostly mild side effects. We report a rare but fatal adverse event following influenza vaccination. A previously healthy 27-yearold woman who received the influenza vaccination 3 days before presenting to the emergency department had rapidly aggravating dyspnea and mental deterioration. She was diagnosed as having acute fulminant myocarditis with refractory cardiogenic shock, which was successfully managed with veno-arterial extracorporeal membrane oxygenation. The cardiac function of the patient recovered in 3 weeks.

Citations

Citations to this article as recorded by

Clinical Characteristics and Mechanisms of Acute Myocarditis
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Circulation Research.2024; 135(2): 397. CrossRef
Endosomal Toll-Like Receptors intermediate negative impacts of viral diseases, autoimmune diseases, and inflammatory immune responses on the cardiovascular system
Fatemeh Sadat Tabatabaei, Melika Shafeghat, Amirali Azimi, Ashley Akrami, Nima Rezaei
Expert Review of Clinical Immunology.2024; : 1. CrossRef
Clinical Manifestations and Adverse Cardiovascular Events in Patients with Cardiovascular Symptoms after mRNA Coronavirus Disease 2019 Vaccines
William D. Kim, Min Jae Cha, Subin Kim, Dong-Gil Kim, Jae-Jin Kwak, Sung Woo Cho, Joon Hyung Doh, Sung Uk Kwon, June Namgung, Sung Yun Lee, Jiwon Seo, Geu-ru Hong, Ji-won Hwang, Iksung Cho
Yonsei Medical Journal.2024; 65(11): 629. CrossRef
Active surveillance for adverse events of influenza vaccine safety in elderly cancer patients using self-controlled tree-temporal scan statistic analysis
Na-Young Jeong, Chung-Jong Kim, Sang Min Park, Ye-Jee Kim, Joongyub Lee, Nam-Kyong Choi
Scientific Reports.2023;[Epub] CrossRef
The Incidence of Myocarditis Following an Influenza Vaccination: A Population-Based Observational Study
Wen-Hwa Wang, Kai-Che Wei, Yu-Tung Huang, Kuang-Hua Huang, Tung-Han Tsai, Yu-Chia Chang
Drugs & Aging.2023; 40(2): 145. CrossRef
Comparison of COVID-19 Vaccine-Associated Myocarditis and Viral Myocarditis Pathology
Kamron Reza Hamedi, Gannett Loftus, Lawson Traylor, Richard Goodwin, Sergio Arce
Vaccines.2023; 11(2): 362. CrossRef
Myocarditis and autoimmunity
Akira Matsumori
Expert Review of Cardiovascular Therapy.2023; 21(6): 437. CrossRef
Cardiovascular magnetic resonance (CMR) and positron emission tomography (PET) imaging in the diagnosis and follow-up of patients with acute myocarditis and chronic inflammatory cardiomyopathy
Federico Caobelli, Jordi Broncano Cabrero, Nicola Galea, Philip Haaf, Christian Loewe, Julian A. Luetkens, Giuseppe Muscogiuri, Marco Francone
The International Journal of Cardiovascular Imaging.2023; 39(11): 2221. CrossRef
Clinical Syndromes Related to SARS-CoV-2 Infection and Vaccination in Pediatric Age: A Narrative Review
Maria Vincenza Mastrolia, Camilla De Cillia, Michela Orlandi, Sarah Abu-Rumeileh, Ilaria Maccora, Valerio Maniscalco, Edoardo Marrani, Ilaria Pagnini, Gabriele Simonini
Medicina.2023; 59(11): 2027. CrossRef
Acute Lymphocyte Myocarditis Associated with Influenza Vaccination
Ryo Nakamura, Shin-ichi Ando, Seiya Kato, Toshiaki Kadokami
Internal Medicine.2022; 61(15): 2307. CrossRef
Clinically Suspected Myocarditis Temporally Related to COVID-19 Vaccination in Adolescents and Young Adults: Suspected Myocarditis After COVID-19 Vaccination
Dongngan T. Truong, Audrey Dionne, Juan Carlos Muniz, Kimberly E. McHugh, Michael A. Portman, Linda M. Lambert, Deepika Thacker, Matthew D. Elias, Jennifer S. Li, Olga H. Toro-Salazar, Brett R. Anderson, Andrew M. Atz, C. Monique Bohun, M. Jay Campbell, M
Circulation.2022; 145(5): 345. CrossRef
Myocarditis following rAd26 and rAd5 vector‐based COVID‐19 vaccine: case report
Farah Naghashzadeh, Shadi Shafaghi, Atosa Dorudinia, Seyed Alireza Naji, Majid Marjani, Ahmad Amin, Arezoo Mohamadifar, Sima Noorali, Babak Sharif Kashani
ESC Heart Failure.2022; 9(2): 1483. CrossRef
Myocarditis following COVID-19 vaccination in adolescents and adults: a cumulative experience of 2021
Onyedika J. Ilonze, Maya E. Guglin
Heart Failure Reviews.2022; 27(6): 2033. CrossRef
Chest Pain and Suspected Myocarditis Related to COVID-19 Vaccination in Adolescents—A Case Series
Da-Eun Roh, Hyejin Na, Jung-Eun Kwon, Insu Choi, Yeo-Hyang Kim, Hwa-Jin Cho
Children.2022; 9(5): 693. CrossRef
Cardiac Adverse Events after Vaccination—A Systematic Review
Kanak Parmar, Sai Subramanyam, Gaspar Del Rio-Pertuz, Pooja Sethi, Erwin Argueta-Sosa
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COVID-19 Vaccination and the Rate of Immune and Autoimmune Adverse Events Following Immunization: Insights From a Narrative Literature Review
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Sipuleucel‐T associated inflammatory cardiomyopathy: a case report and observations from a large pharmacovigilance database
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A Case of Fatal Mechanical Mitral Valve Leaflet Fracture Embolization: A Case Report: Won Yik Lee, Jong Myeon Hong, Jang Whan Bae; Korean J Crit Care Med. 2011;26(2):101-104.; DOI: https://doi.org/10.4266/kjccm.2011.26.2.101

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Abstract PDF

The fracture embolization of a mechanical valve is a very rare but potentially fatal event that can cause acute severe valve regurgitation and subsequent decompensated heart failure. Generally, the mechanical valve is durable and semi-permanent. If this is not the case, bacterial endocarditis can occur. However, leaflet fracture embolizations related to mechanical failure may occur in the specific mechanical valve brands associated with the subjects own structural fragilities. In this case, we dealt with a case of fatal Edward-Duromedics mechanical mitral valve leaflet fracture embolization that had been implanted 20 years ago. The patient presented with severe acute heart failure and shock. Severe transvalvular mitral regurgitation and only one valve leaflet was observed in echocardiography. Although the emergency mitral valve replacement was performed under the diagnosis with valve leaflet fracture embolization, the patient was not resuscitated from systolic pump failure and died.

Citations

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A rare case series of mechanical prosthetic heart valve structural deterioration presented as severe mitral regurgitation
Jignesh Kothari, Sandip Lukhi, Utkarsh Sanghavi, Devvrat Desai, Ishan Gohil
Heart, Vessels and Transplantation.2023; 7(Issue 4): 278. CrossRef
An unusual cause of acute mitral regurgitation in TTK Chitra heart valve prosthesis
Muthukumar Sundaram, Aayush Poddar, Ancy Robinson, Soundaravalli Balakrishnan, Muralidharan Srinivasan, Chandrasekar Padmanabhan
Indian Journal of Thoracic and Cardiovascular Surgery.2021; 37(5): 546. CrossRef

Cardiac Transplantation for a Patient with Intra-aortic Balloon Pump and Extracorporeal Membrane Oxygenator due to Cardiogenic Shock after Acute Myocardial Infarction: A Case Report: Jae Hang Lee, Young Ok Lee, Byoung Ju Min, Byung Su Yoo, Ki Bong Kim; Korean J Crit Care Med. 2010;25(3):194-198.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.194

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Abstract PDF: A 66-year-old male patient who suffered from chest pain and dyspnea was admitted to our hospital. He was diagnosed as having an acute myocardial infarction, and recovered from cardiogenic shock after cardiopulmonary-cerebral resuscitation. Under the support of extracorporeal membrane oxygenator (ECMO) he underwent successful percutaneous coronary intervention. After this, an intra-aortic balloon pump (IABP) was inserted to increase coronary perfusion and reduce the impedance to left ventricular ejection. After 6 days, the patient was weaned from ECMO support; however, IABP therapy and infusion of inotropic agents were required to maintain adequate hemodynamic status. One week later, cardiac transplantation was performed successfully without major complications.

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