Resuscitation from Right Ventricular Infarction

By November 2005, interventional cardiologist Alan Heldman was down to a last-ditch option for 86-year-old Pauline Eichen. In the decade since Eichen had had her first heart attack, her right coronary artery seemed determined to narrow—despite repeated dilation and stenting to keep the vessel open. When Eichen arrived at the hospital last fall with chest pain, Heldman again used a drug-eluting stent to widen her artery. But within days, her chest pain returned, and this time, the artery was occluded. What’s more, her stunned right ventricle was barely pumping, launching a cascade of shock, kidney failure and plummeting blood pressure unresponsive to four vasopressors given simultaneously.

Fortunately for Eichen—who was deemed unable to withstand the open-chest surgery required to implant a right ventricular assist device—Heldman had another solution. For months, he’d been discussing with cardiac surgeon John Conte and coronary care unit director Steven Schulman a novel role for a new left ventricular assist. These VADs, which don’t require surgical implantation, take over for the heart’s main pumping chamber, extracting blood from the left atrium and sending it on to the rest of the body. Normally, the device is connected to the heart via two cannulae: one tube threaded into the left atrium; the other, placed in the iliac artery.

But Eichen’s deterioration was a result of right heart failure. So, catheterizing both femoral veins, Heldman advanced the cannulae to her right atrium and right pulmonary artery and connected them to the VAD. “The results,” he says, “were dramatic. Within 10 minutes, her blood pressure went up by 20 points, we could wean off the four vasopressors, and her urine output resumed.”

After three days, Aiken’s right ventricle was clearly recovering from its infarction, and the VAD was disconnected. The intervention, Heldman says, allowed Eichen to survive a heart attack that was otherwise unsurvivable.