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European Journal of Heart Failure Advance Access originally published online on May 24, 2009
European Journal of Heart Failure 2009 11(7):721-727; doi:10.1093/eurjhf/hfp068
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Intractable cardiogenic shock in stress cardiomyopathy with left ventricular outflow tract obstruction: is extra-corporeal life support the best treatment?

Massimo Bonacchi*, Massimo Maiani, Guy Harmelin and Guido Sani

Cardiac Surgery, Medical and Surgical Critical Care Department, University of Florence, Viale Morgagni, 85, 50134 Firenze, Italy

* Corresponding author. Tel: +39 338 9855782, Email: massimo.bonacchi{at}unifi.it


  Abstract

We report the use of extra-corporeal cardiopulmonary support (ECLS), in a case of complicating refractory severe cardiogenic shock, in a patient with Tako-tsubo cardiomyopathy (TC). Tako-tsubo cardiomyopathy syndrome is characterized by left ventricular (LV) wall motion abnormalities, usually without coronary artery disease, mimicking the diagnosis of acute coronary syndrome. This ventricular dysfunction is typically reversible in the acute phase, though it can progress into refractory cardiogenic shock with limited therapeutic options available. Here, we report for the first time in a Tako-tsubo patient with refractory cardiogenic shock, the use of ECLS treatment in order to unload the heart, sustain circulation and end-organ perfusion, and promote potential ventricular recovery. Extra-corporeal life support allowed inotropic drug weaning while maintaining end-organ function and supported the patient until myocardial recovery. The patient recovered completely, and a normal LV ejection fraction was documented by 2D echocardiography on day 7. From our experience, ECLS can be an appropriate treatment for severe refractory cardiogenic shock in patients with TC. Extra-corporeal life support was an effective ultimate solution.

Key Words: Tako-tsubo cardiomyopathy • Extra-corporeal life support • Myocardial recovery

Received October 8, 2008; Revised March 30, 2009; Accepted March 31, 2009


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