Use of VA-ECMO in the Prenatal Period in a Patient with Acute Myocardial Infarction Complicated by Cardiogenic Shock: Case Report

The aim is to demonstrate the successful use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in a patient developing acute myocardial infarction (AMI) and cardiogenic shock due to spontaneous coronary artery dissection in the third trimester of pregnancy.

Patient and investigative techniques. We analyzed laboratory and hemodynamic parameters, mechanical ventilation settings and ECMO circuit parameters in a 32-week pregnant woman with acute myocardial infarction and cardiogenic shock caused by spontaneous coronary artery dissection. We reviewed all stages of patient’s management from hospital admission, including initiation of ECMO, performing of cesarean section under extracorporeal support, and patient's transportation to tertiary center for heart transplantation.

Results. The use of VA-ECMO in a patient with AMI at 32 weeks of gestation provided biventricular circulatory support, which allowed to stabilize severe cardiogenic shock and safely place coronary stents, providing sufficient placental blood flow to preserve the life of the fetus. A cesarean section (CS) was performed under VA-ECMO support resulting in delivery of a live baby-girl weighing 1.8 kg with an Apgar score of 5/6. The mother was transported after CS to the V. I. Shumakov National Medical Research Center for Transplantation and Artificial Organs, Ministry of Health of the Russian Federation, where emergency orthotopic heart transplantation (OHT) was performed.

Conclusion. We present a case report of spontaneous coronary artery dissection leading to AMI and cardiogenic shock and requiring life-saving circulatory support with VA-ECMO. The case demonstrates the urgent need of both treatment arms including established protocol of coronary angiography with percutaneous coronary intervention, and timely employed individual approach, that include VA-ECMO, intra-aortic balloon pump, and left ventricular decompression. The use of high-tech methods and a professionally employed multidisciplinary approach saved the lives of both the mother and the child.

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