Weaning from percutaneous cardiopulmonary support with olprinone in a patient with severe left ventricular dysfunction associated with aortic regurgitation

Percutaneous cardiopulmonary support system (PCPS) is one of the most powerful modalities of treatment for patients with acute heart failure. The system, however, can fail to improve hemodynamics in a patient with aortic valve insufficiency resulting in left ventricular overdistension. We present a 54-year-old patient who was slated for coronary artery bypass grafting and aortic valve replacement for left main coronary artery occlusion and aortic valve regurgitation due to aortitis syndrome. Prior to cardiac surgical procedures, balloon catheter dilatation was performed to treat bilateral carotid artery stenosis. Two days after the catheter intervention, the patient suddenly presented with cardiopulmonary collapse and was resuscitated with PCPS and maximal pharmacological therapy. Immediately after the resuscitation, he suffered severe lung edema. Transthoracic echocardiogram revealed an overdistended left ventricle along with worsened aortic regurgitation. Aggressive afterload reduction therapy was conducted with a maximal dose of olprinone together with other catecholamines. After introduction of olprinone, the fraction of aortic regurgitation was reduced, and left ventricular contractility was improved, which, at least in part, helped the patient to become independent of extracorporeal circulation devices.