Cardiogenic shock secondary to mitral stenosis treated by balloon mitral valvuloplasty

Mechanical Circulatory Support in Cardiogenic Shock due to Structural Heart Disease

Despite advances in cardiovascular care, managing cardiogenic shock caused by structural heart disease is challenging. Patients with cardiogenic shock are critically ill upon presentation and require early disease recognition and rapid escalation of care. Temporary mechanical circulatory support provides a higher level of care than current medical therapies such as vasopressors and inotropes. This review article focuses on the role of hemodynamic monitoring, mechanical circulatory support, and device selection in patients who present with cardiogenic shock due to structural heart disease. Early initiation of appropriate mechanical circulatory support may reduce morbidity and mortality.

Emergencies in valve disease

PURPOSE OF REVIEW

This review will deal with strategies for emergency management of patients with valve disease, a situation that is now rare but remains a very challenging problem: valvular patients are often elderly with a high frequency of comorbidity; furthermore, there is a growing proportion of previously operated patients who present with further problems.

RECENT FINDINGS

The main treatment is valve replacement, however, the conservative surgical approach is developing, and, more recently, percutaneous interventional techniques have been introduced. Percutaneous mitral commissurotomy is an established treatment for mitral stenosis whereas transcatheter aortic valve implantation, which is presently at the evaluation phase, shows promise.

SUMMARY

The keys to success are establishing a rapid diagnosis based mainly on echocardiography followed by early intervention. Every effort should be made to avoid performing intervention in an emergency setting, as it is always of high risk. Strategies include better patient and physician education in order to decrease the incidence of endocarditis and prosthetic-related complications such as thromboembolism and considering earlier intervention when symptoms or objective signs of ventricular dysfunction are observed in patients with known valve disease.

Percutaneous mitral commissurotomy using the metallic valvulotome technique in a critically ill adult

A 25-year-old man presented with cardiogenic shock secondary to rheumatic mitral stenosis. Despite aggressive medical treatment he continued to deteriorate. This report describes the successful use of the metallic valvulotome technique for mitral commissurotomy in the context of a critically ill patient.