IABC AND REVASCULARIZATION IN ACUTE RIGHT VENTRICULAR FAILURE DUE TO PULMONARY EMBOLISM

TYPE: Case Report TOPIC: Critical Care INTRODUCTION: Acute pulmonary embolism (PE) with high risk of death is combined with acute right ventricular (RV) failure and shock. Current recommendations are not conclusive for the use of intraaortic balloon counterpulsation (IABC). The RV failure can be exacerbated with significant coronary artery disease. CASE PRESENTATION: A 68 year old male presented with acute chest pain, shock, desaturation, negative T-waves in the precordial leads. He had prior inferior STEMI, CKD, COPD. Coronary angiography - LM 60% stenosis; LAD proximal 70%, mid – 90%; RCA – CTO. EF 39%. Pulmo-angiography – thrombosis of the right inferior pulmonary artery. Local fibrinolysis was done with actilyse per protocol. Acute kidney injury and shock followed and the vasopressors titrated upwards. The patient refused operative treatment. He underwent complete revascularization and implantation of IABC. On the 5th day he was intubated because of pneumonia with acute respiratory failure. The hemodynamics and the renal function were restored, IABC removed. Extubation was not possible because of the pneumonia. On the 15th day, the patient was diagnosed with severe sepsis, with positive blood cultures, tracheal aspirate with multiresistant pseudomonas aeruginosa. DIC followed with poor prognosis for the patient. DISCUSSION: IABC and full revascularization of the patient issued coronary perfusion at the time of shock due to RV failure. It helped to overcome acute RV ischemia and elevated telediastolic pressure with temporary beneficial effect. The final prognosis was poor because of the severe sepsis and DIC. CONCLUSIONS: The possible beneficial effect of complete revascularization with/without IABC in acute RV failure should be explored further. DISCLOSURE: Nothing to declare. KEYWORD: acute right ventricular failure