Severe cardiac insufficiency as a result of complicated myocardial infarction - choice of therapy

Abstract

On 28th January 2004 patient P.T., aged 56, suffered an extensive and complicated anterolateral myocardial infarction with low output syndrome and double ventricular tachycardia interrupted by electrical cardioversion. Emergency coronary angiography and percutaneous coronary intervention of the left anterior descending artery with a result of 100%Æ5% and left circumflex with a result of 99%→0% were performed with simultaneous implantation of stents at the Royal Perth Hospital in Australia. The patient required intubation, intra-aortal counterpulsatio, ECG assessment, blood pressure measurement and invasive haemodynamic monitoring (CI, CO, PAWP, PAP). On the fifth day, in the face of lack of haemodynamic improvement, an additional infusion of levosimendan was added to the infusion of noradrenalin and dobutamine, which resulted in a slight transient improvement in the clinical status of the patient. In view of the unsatisfactory haemodynamic parameters and following a preliminary qualification for cardiac transplant (OHTx), a mechanical device supporting the function of the left ventricle was implanted without complications into the abdominal cavity on the 30th day of hospitalisation. On 15th April 2005 OHTx was performed with good clinical results.