DẪN LƯU THẤT TRÁI QUA VAN ĐỘNG MẠCH CHỦ (TACV) ĐIỀU TRỊ QUÁ TẢI THẤT TRÁI Ở BỆNH NHÂN SỐC TIM ĐƯỢC HỖ TRỢ VA-ECMO: BÁO CÁO CA LÂM SÀNG

Abstract

Left ventricular (LV) distension is a serious complication in patients with cardiogenic shock supported by venoarterial extracorporeal membrane oxygenation (VA-ECMO), leading to pulmonary edema, thrombus formation, and impaired myocardial recovery. Transaortic catheter venting (TACV) is a minimally invasive strategy that may effectively address this condition. We report the case of a 39-year-old female with acute myocarditis complicated by cardiogenic shock and out-of-hospital cardiac arrest, who was placed on VA-ECMO after unsuccessful cardiopulmonary resuscitation. The patient developed significant LV distension with severe pulmonary edema, closed aortic valve, and an elevated left ventricular end-diastolic pressure (LVEDP) of 36 mmHg. TACV was performed 26 hours after ECMO initiation using a modified Guiding 8Fr catheter inserted across the aortic valve into the LV cavity. Following the intervention, LVEDP decreased from 36 mmHg to 22 mmHg within 30 minutes and to 16–17 mmHg after 24 hours, with complete resolution of pulmonary edema. The patient was successfully weaned from ECMO on day 6 and discharged in stable condition on day 28. This case highlights that TACV is an effective and safe approach for LV unloading in cardiogenic shock patients on VA-ECMO, offering a feasible solution for resource-limited settings.