• Journal of Chest Surgery
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• v.44 no.4
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• pp.273-278
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• 2011

Despite aggressive treatment, the mortality rate of cardiogenic shock with acute myocardial infarction (AMI) is high. We performed extracorporeal membrane oxygenation (ECMO) prior to coronary reperfusion, and evaluated the early clinical results and risk factors. Materials and Methods: From May 2006 to November 2009, we reviewed the medical records of 20 patients in cardiogenic shock with AMI (mean age $67.7{\pm}11.7$ yrs, M : F 14 : 6). After initially performing ECMO using the CAPIOX emergency bypass system ($EBS^{(R)}$Terumo, Tokyo, Japan), patients underwent coronary reperfusion (coronary artery bypass grafting, 13; percutaneous coronary intervention, 7). Results: All patients were in a cardiogenic shock state, cardiopulmonary resuscitations (CPR) were performed for fourteen patients (mean CPR time $20.8{\pm}26.0$ min). The mean time from vascular access to the initiation of ECMO was $17.2{\pm}9.4$ min and mean support time was $3.8{\pm}4.0$ days. Fourteen patients were able to be weaned from ECMO and ten patients were discharged (mean admission duration $50.1{\pm}31.6$ days). Patients survived on average $476.6{\pm}374.6$ days of follow-up. Longer CPR and support time, increased cardiac enzyme, lower ejection fraction, lower albumin, and major complications were the risk factors of mortality (p<0.05). Conclusion: The early application of ECMO prior to coronary reperfusion and control of risk factors allowed for good clinical results in cardiogenic shock with AMI.

• Journal of Yeungnam Medical Science
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• v.34 no.2
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• pp.285-289
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• 2017

Pheochromocytoma can present with various symptoms including cardiogenic shock and cardiac arrest. Particularly, in cases of cardiogenic shock of unknown origin, pheochromocytoma should be considered. A 20-year-old woman without any medical history visited our emergency department due to nausea, vomiting, headache, and chest pain. Echocardiography revealed severe left ventricular dysfunction. Mechanical ventilation and veno-arterial extracorporeal membrane oxygenation (ECMO) were implemented owing to her unstable vital signs. For unstable vital sign and cardiogenic shock in a young woman without any previous medical history, pheochromocytoma was considered and diagnosed based on elevated levels of catecholamine derivatives in a 24-hour urine sample. Cardiac function recovered and ECMO was discontinued on the 5th day of hospitalization. She later underwent an elective adrenalectomy and no recurrence was found during the follow-up period. We reported a case of pheochromocytoma which was presented with cardiogenic shock in a young woman with no concomitant disease, and successfully treated with ECMO followed by an elective adrenalectomy.

• Neonatal Medicine
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• v.28 no.2
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• pp.77-82
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• 2021

We present the case of a healthy 28-day-old female full-term neonate who was admitted to the neonatal intensive care unit for severe metabolic acidosis, hypoglycemia, and an initial sinus rhythm. The first diagnostic hypothesis was hypovolemic shock, and fluid resuscitation was started immediately. During fluid therapy, cardiovascular collapse occurred with supraventricular tachycardia. The latter was successfully treated with adenosine and beta-blockers. After 8 days, electrocardiography showed ventricular pre-excitation, and Wolff-Parkinson-White syndrome was diagnosed. A novel variant of the MYL2 gene that is related to hypertrophic cardiomyopathy and conduction defect was found after discharge. Cardiogenic shock should be considered, despite being a rare cause of shock in neonates.

• Journal of Yeungnam Medical Science
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• v.17 no.1
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• pp.31-38
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• 2000

Background: We sought to examine the use and outcomes of early intraaortic balloon counterpulsation(IABP) combined with early reperfusion therapy in patients presenting cardiogenic shock complicated acute myocardial infarction. The usc of IABP in patients with cardiogenic shock is widely accepted. However there is not ample information on the use of this technique in patients with cardiogenic shock who arc treated with reperfusion therapy in Korea. Materials and Methods: Twenty-eight patients presented with cardiogenic shock were classified into two groups: the early IABP group (insertion within 12 hours after AMI onset time) and the late IABP group (insertion after 12 hours). We compared In-hospital mortality between the two groups (early IABP group vs late IABP group). Results: Two groups showed no significant difference in clinical feature and coronary angiographic results. Among total 28 patients, 7 patients were treated with thrombolytic therapy and 21 patients with PTCA. Insertion site bleeding, fever, thrombocytopenia were reported as some of the complications of IABP insertion. In-hospital mortalities in the early IABP group and late IABP group were 4 patients(25%) and 8 patients(66%), respectively(p<0.05). Early IABP insertion and early PTCA showed lower hospital mortality rates. There was significant difference in the time to PTCA after AMI onset between the two groups(p<0.05). Conclusion: IABP appears to be useful in patients presenting cardiogenic shock unresponsive medical therapy. Early IABP insertion and early reperfusion therapy may reduce in-hospital mortality rates of post-MI cardiogenic shock patients.

• Journal of Chest Surgery
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• v.37 no.12
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• pp.1003-1009
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• 2004

Mechanical circulatory support (MCS) has been used for myocardium failure, but moreover, it may be essential for the life support in cardiac arrest or cardiogenic shock. Many commercial devices can be used effectively for the long-term support. However, there are some limitations in the aspects of the cost and technical support by production company. Short-term support with centrifugal type has been reported numerously with the purpose of bridging to heart transplantation or recovery. We successfully treated 5 patitents who were in the status of cardiogenic shock (n=3) or arrest (n=2) with the technique of extracorporeal life support system (ECLS) or left ventricular assist device (LVAD) using the centrifugal type pump. The MCS were performed emergently (n=2) under cardiac arrest caused by ischemic heart disease, and urgently (n=3) under cardiogenic shock with ischemic heart disease (n=1) or acute fulminant viral myocarditis (n=2). All patients were weaned from MCS. Complications related to the use of MCS were bleeding and acute renal failure, but there were no major complications related to femoral cannulations. Mechanical circulatory support may be essential for the life support and rescue in cardiac arrest or cardiogenic shock.

• Journal of Chest Surgery
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• v.51 no.6
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• pp.406-409
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• 2018

Aortocaval fistula (ACF) occurs in <1% of all abdominal aortic aneurysms (AAAs), and in 3% to 7% of all ruptured AAAs. The triad of clinical findings of AAA with ACF are abdominal pain, abdominal machinery bruit, and a pulsating abdominal mass. Other findings include pelvic venous hypertension (hematuria, oliguria, scrotal edema), lower-limb edema with or without arterial insufficiency or venous thrombus, shock, congestive heart failure, and cardiac arrest. Surgery is the main treatment modality. We report successful surgical treatment in a patient with a ruptured AAA with ACF who presented with cardiogenic shock.

• Journal of Chest Surgery
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• v.25 no.4
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• pp.424-428
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• 1992

Post-AMI VSD is an infrequent but often catastrophic complication of acute myocardial infarction In general, the mortality is associated with end organ failure due to low output syndrome. Therefore, a stable hemodynamic is necessary to prevent the end organ failure. If a supportive therapy does not accomplish it, surgical intervention should be considered. Recently, we have experinced a case of post-AMI VSD with cardiogenic shock. Early recognition and surgical repair of post-AMI VSD gave us a good result. Postoperative result was satisfactory and recovery was uneventful. We believe that early surgical repair can be lifesaving in the case of post-AMI VSD with cardiogenic shock.

• Journal of Chest Surgery
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• v.35 no.6
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• pp.449-453
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• 2002

Intra-aortic balloon pump (IABP) is well known for its hemodynamic benefit but still has its own complications. Proper use of IABP is the best way to obtain maximum benefit with low complication rate. Material and Method： Twenty one(men 10, female 11) patients were included in this study among the 100 consecutive adult cardiac surgery patients in our hospital. Eighteen(85.7%) were ischemic heart disease patients. They all received IABP therapy due to postcardiotomy cardiogenic shock according to the well-known indications. Their preoperative conditions, intraoperative factors including hemodynamics, postoperative conditions and IABP-related complications were analyzed. Result： Nineteen patients(90.5%) were successfully weaned from IABP. There were 2 patients of operative death and the mortality rate was 9.5%. Duration of IABP use was 40.7$\pm$24.3 hours. There were 2 cases(9.5 %) of IABP-related vascular complications that required surgical intervention. Conclusion： We concluded that IABP could be used effectively and safely for postcardiotomy cardiogenic shock patients with low complication rate.

• Journal of Chest Surgery
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• v.48 no.3
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• pp.210-213
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• 2015

Venoarterial extracorporeal membrane oxygenation (VA ECMO) is widely used in patients with cardiogenic shock. Insufficient decompression of the left ventricle (LV) is considered a major factor preventing adequate LV recovery. A 40-year-old male was diagnosed with acute myocardial infarction, and revascularization was performed using percutaneous stenting. However, cardiogenic shock occurred, and VA ECMO was initiated. Severe LV failure developed, and percutaneous transaortic catheter venting (TACV) was incorporated into the venous circuit of VA ECMO under transthoracic echocardiography guidance. The patient was successfully weaned from VA ECMO. Percutaneous TACV is an effective, relatively noninvasive, and rapid method of LV decompression in patients undergoing VA ECMO.

• Journal of Chest Surgery
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• v.40 no.3 s.272
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• pp.168-179
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• 2007

Background: The recent trend of an increasing number of patients with acute cardiogenic shock or chronic congestive heart failure following myocardial infarction, as well as the considerable number who can not be weaned from cardiopulmonary bypass after open heart surgery, call for immediate efforts to develop affordable ventricular assist devices that are suitable for the Korean physique. Recently, a pneumatic pulsatile ventricular assist device (VAD), named DKUH-75, has been developed by the Department of Biomedical Engineering, in collaboration with the Department of Thoracic and Cardiovascular Surgery of Dankook University College of Medicine. The feasibility of the DKUH-75 VAD was evaluated on the bases of common hemodynamic variables and echocardiographic measurements in pigs, which are subjected to an acute cardiogenic shock state following myocardial infarction, using a novel coronary artery ligation method employing the ischemic preconditioning concept. Material and Method: Acute cardiogenic shock was induced in 10 Yorkshire Landrace Duroc strain pigs by ligating the left anterior descending coronary artery via an ischemic preconditioning process. The hemodynamic variables were monitored, with epicardial echocardiographic measurements performed before and one hour after the ligation. The DKUH-75 VAD was implanted into 5 pigs one hour after the onset of the shock. The hemodynamic variables and echocardiographic measurements were taken one hour after installation of the VAD. Result: The systolic, diastolic and mean systemic arterial pressures were significantly decreased in all the experimental animals one hour after the ligation. The systolic, diastolic and mean pulmonary arterial pressures were increased (Eds note: this completely contradicts the preceding statement? However, if you mean the non-experimental animals this should be stated?). The left ventricular end diastolic pressure (LVEDP) was increased, but the cardiac index decreased, An increase in the left ventricular end systolic dimension and decreases in the fractional shortening and ejection fraction were observed all animals one hour after the coronary artery ligation. In all 5 of the VAD implanted pigs, the systolic and mean systemic arterial pressures were increased, and the pulmonary arterial pressures decreased one hour after the implantation; the LVEDP decreased, but the cardiac index was significantly increased, In the echocardiographic measurements, the left ventricular end systolic dimension decreased after the implantation of the VAD, but the fractional shortening and ejection fraction significantly increased. Conclusion: Significant improvements in the hemodynamic variables and echocardiographic measurements were observed in the 5 VAD implanted animals one hour after installation, which had been subjected to an acute cardiogenic shock state by ligation of the coronary artery, indicating that the DKUH-75 VAD could help in the recovery of the myocardial function. This suggests that the DKUH-75 VAD is feasible in the short term in relation to an acute cardiogenic shock state due to myocardial infarction.