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Tesi etd-01052022-194853

Type of thesis
Master univ. II liv.
Author
VIZZARI, GIAMPIERO
E-mail address
giampierovizzari@hotmail.it
URN
etd-01052022-194853
Title
ECMO assistance during high-risk TAVI in the COVID-19 Era
Structure
Istituto di Scienze della Vita
Course
Corsi Alta Formazione - PERCUTANEOUS INTERVENTIONAL TREATMENT OF STRUCTURAL HEART DISEASES
Committee
relatore Prof. BERTI, SERGIO
Membro Prof. MICARI, ANTONIO
Keywords
  • aortic stenosis
  • cardiogenic shock
  • COVID-19
  • Extracorporeal Membrane Oxygenation
  • SARS-CoV-2
  • Transcatheter Aortic Valve Implantation
Exam session start date
21/01/2022;
Availability
parziale
Abstract
An 87 years old woman, with history of dyslipidemia and permanent Atrial Fibrillation referred to our Emergency Department with complain of dyspnea and chest pain. COVID-19 molecular test resulted positive and Computed Tomography scan of the lungs showed ground-glass opacity and consolidations with pleural effusion and severe calcification of the aortic valve. Transthoracic echocardiogram showed eccentric Left Ventricular hypertrophy with diffuse hypokinesia (Ejection Fraction 20-25%), ectatic ascending aorta (45 mm), severe Low Flow-Low Gradient aortic stenosis (AVAi 0.19 cm2) and moderate regurgitation, moderate-severe mitral regurgitation. During long hospitalization in the COVID-19 Unit she experienced worsening of respiratory status with pulmonary oedema, hypotension and acute kidney injury, requiring intra-venous dobutamine and diuretics. After COVID-19 negativization, she moved to our Coronary Care Unit. Coronary angiography showed no significant stenoses in the main vessels. In the following days the patient underwent a new clinical deterioration with dyspnea, hypotension (blood pressure 85/50 mmHg), oliguria and ankle swelling, requiring O2 therapy and Dobutamine infusion. We decided to perform a “Rescue” TAVI procedure, facilitated by Extracorporeal Membrane Oxygenation (ECMO). After Veno-Arterial-ECMO cannulation, we implanted a 34 mm Evolut R (Medtronic) TAVI prosthesis, post-dilated with 24 mm balloon for under-expansion due to massive calcification. During both self-expandable TAVI delivery and balloon inflation the patient underwent two phases of cardiac arrest, supported by ECMO without any symptom. Since percutaneous valve replacement the patient’s recovery was fast with rapid ECMO removal and discontinuation of inotropic therapy. Few weeks later, at follow-up examination, she appeared asymptomatic, in excellent clinical conditions.
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