Conference Proceeding - Restricted Access
Journal of the American College of Cardiology
Background: COVID-19 patients can develop acute respiratory distress syndrome (ARDS). Pulmonary hypertension from ARDS can lead to acute right heart failure (ARHF). Treatment options are limited for these patients. Case: A 32 year-old-male presented with shortness of breath and was found to have COVID-19. Hospital course involved hypoxia leading to intubation and eventually support with veno-venous (V-V) extracorporeal membrane oxygenation (ECMO). Hemodynamics improved, but he decompensated requiring multiple vasopressors. Transthoracic echocardiogram (TTE) demonstrated ARHF (Figure 1A) that was confirmed with placement of swan-ganz catheter (RA 23, RV 81/17, PA 83/55, PAPi 1.2). Decision-making: It was believed that the ARHF was due to ARDS and V-V ECMO. Patient was switched to veno-arterial-veno ECMO with initially improved hemodynamics. However, he again decompensated and repeat TTE now showed an underfilled LV. In an attempt to decrease right heart pressures and allow for improved cardiac output, atrial septostomy was performed along with placement of Impella CP (Figure 1B). There was an immediate improvement in hemodynamics (RA 9, PA 60/36, PAPi 2.36) without worsening hypoxia (Figure 1C). Unfortunately, patient developed an intracranial hemorrhage and passed away. Conclusion: This case highlights the utility of atrial septostomy in ARHF. Atrial septostomy can be considered as a bridge to recovery for patients with ARDS from COVID-19 who develop ARHF until the respiratory system heals.
Gudiati S, Hanson I. Atrial septostomy used to treat acute right heart failure in COVD-19 patient on ECMO. J Am Coll Cardiol. 2022 Mar8;79(9 Suppl):2358.