Журнал клинических случаев

Early Implementation of Veno-Venous Hemofiltration and Use of Rotational Atherectomy in a Patient with ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock: A Case Report

Abstract

Monika Durak, Marek Tomala, Bartłomiej Adam Nawrotek, Andrzej Machnik and Jacek Legutko

Background: We report the case of a patient with Cardiogenic Shock (CS) in a course of acute Right Ventricular (RV) Myocardial Infarction (MI) following occlusion of the proximal Right Coronary Artery (RCA). Our case highlights the use of Continuous Veno-Venous Hemofiltration (CVVH) as a novel routine treatment option for Acute Kidney Injury (AKI) in the setting of CS and the use of Rotational Atherectomy (RA) in patients with MI. This finding has important implications for patient treatment plans in the future.

Case summary: The patient was treated with the primary Percutaneous Coronary Intervention (PCI) using three drug-eluting stents in the main RCA and strong right ventricular branch. RA was used to facilitate lesion expansion and stent implantation because of massive calcification. Six hours after the procedure, AKI manifested as anuria, required CVVH for four days until hemodynamic stabilization and restoration of diuresis. Six weeks after MI, the patient underwent coronary artery bypass surgery due to advanced coronary disease in the left coronary artery. There were no peri-or post-procedural complications, and at the end of a cardiac rehabilitation program, the patient was discharged.

Conclusion: RA of calcifications in the infarct-related artery may remain the only option for delivering a stent, and thus maintain patency of the supplied coronary vessel, which is essential for hemodynamically unstable patients. RA can be a safe option if extreme precautions like using small burr sizes and low speeds are used. CVVH may be the first-choice option in patients otherwise treated with RV mechanical circulatory support.