Li-Chin Sung a, b, Bee-Song Chang c, Ji-Hung Wang b
aDivision of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
bDivision of Cardiology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
cDivision of Cardiovascular Surgery, Department of Surgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
Abstract
We report a diabetic man with prior coronary artery bypass grafting (CABG) who underwent coronary angiography (CAG) because of medically refractory unstable angina. CAG revealed severe stenosis of the left circumflex artery (LCX) and the right coronary artery (RCA), patent artery graft to the left anterior descending artery and total occlusion of saphe-nous venous grafts to the RCA and LCX. During percutaneous coronary intervention (PCI), the patient suffered from circulatory collapse. We postponed the procedure and placed an intra-aortic balloon pump (IABP); however, the patient remained hemodynamically unstable. He was rescued by PCI with extracorporeal membrane oxygenation (ECMO) support. No major cardiovascular event was reported during the 6-month follow-up period since treatment. We have learned that PCI in patients with prior CABG and severe left ventricular dysfunction has a high risk of inducing cardiogenic shock when an IABP is used. ECMO should be considered for these patients when PCI is performed on the vessels that supply only viable and contractile myocardium.
Keywords
Cardiogenic shock; Coronary artery bypass grafting; Extracorporeal membrane oxygenation; Percutaneous coronary intervention
