Acute Crit Care.  2020 Feb;35(1):46-50. 10.4266/acc.2017.00024.

Successful percutaneous coronary intervention with extracorporeal membrane oxygenation support after right coronary artery dissection in an eisenmenger syndrome patient

• Kim BG
• Cho SW
• Nah JC

• KMID: 2500951
• DOI: http://doi.org/10.4266/acc.2017.00024

Abstract

The presentation of coronary artery disease in a patient with Eisenmenger syndrome (ES) is relatively rare. Cardiogenic shock due to coronary artery dissection during percutaneous coronary intervention (PCI) can be more critical in these patients. Here, we report a case of successful PCI under mechanical circulation support in a patient with ES who experienced potentially fatal right coronary artery dissection. This case emphasizes that use of extracorporeal membrane oxygenation (ECMO) can lead to successful management of critical complication during PCI, and that the immediate decision to apply of ECMO is important in ES patients who face impending cardiogenic shock with acute heart failure.

Keyword

Eisenmenger complex; extracorporeal membrane oxygenation; percutaneous coronary intervention

Figure

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  Figure 1. Baseline examination. (A) Electrocardiography showing sinus rhythm and right ventricular hypertrophy. (B) Echocardiography. Apical four chamber view showing right atrial and ventricular dilatation and atrial septal defect. (C) Coronary angiography. Angiographic image showing significant luminal narrowing in the mid to distal right coronary artery. LV: left ventricle; RV: right ventricle; LA: left atrium; RA: right atrium.

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  Figure 2. Angiography after guiding catheter engagement. (A) The cine showing angiographic haziness at the proximal right coronary artery and contrast stain suggesting dissection at the ostium (arrow). (B) Collapsed and invisible coronary vessel lumen due to dissection.

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  Figure 3. Direct percutaneous coronary intervention under extracorporeal membrane oxygenation support. (A) Successful wiring through the true lumen. (B) Direct stenting at the proximal to mid right coronary artery (RCA) to cover the dissection (white arrows, Onyx 3.5×18 mm). (C) Direct stenting at the RCA ostium (white arrowheads, Onyx 3.5×18 mm). (D) Direct stent deployment at the mid to distal RCA (yellow arrowheads, Onyx 3.0×38 mm).

Reference

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