A 79-year-old woman was admitted in the emergency department as late comer in cardiogenic shock due to subacute non-ST-elevation myocardial infarction, which clinically occurred 8 days prior. Coronary angiography depicted occlusion of a small circumflex artery. Revascularization was deemed unreasonable in the light of normal CK and elevated LDH/troponin serum levels. The patient was haemodynamically compromised with elevated lactate and imminent renal and liver failure. Acute Physiology and Chronic Health Evaluation (APACHE II) Score was 25 points corresponding to an in-hospital mortality of 51%. Percutaneous mechanical circulatory support (Impella CP) was implanted and haemodynamics stabilized over 48 h along with recovery of renal as well as liver function. However, cardiac functional recovery was hampered by severe mitral regurgitation (MR) with concomitant prolapse of the posterior leaflet. Our Heart Team decision was to perform percutaneous mitral valve repair with the MitraClip system under Impella support (Panel A). Prior to MitraClip, left atrial pressure (LAP) was elevated indicating severe MR. As the performance level of the Impella was decreased, systemic arterial pressure decreased, and LAP even further increased (Panel B). Implantation of two clips reduced MR to a mild degree, and the dependence of LAP on systemic arterial pressure and Impella support was attenuated (Panel C). The Impella was weaned and explanted the same day. The patient was discharged at New York Heart Association (NYHA) II 7 days after admission.

中文翻译：

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机械循环支持是紧急结构干预的桥梁

一名79岁的妇女因亚急性非ST抬高型心肌梗死而入院，因心源性休克而来得较晚，临床前8天就发生了这种情况。冠状动脉造影描绘了一条小的回旋动脉闭塞。鉴于正常CK和升高的LDH /肌钙蛋白血清水平，血运重建被认为是不合理的。该患者血液动力学受损，乳酸升高，即将出现肾功能衰竭和肝功能衰竭。急性生理和慢性健康评估（APACHE II）得分为25分，相当于医院内死亡率为51％。植入经皮机械循环支持（Impella CP），并在48小时内使血流动力学稳定，同时恢复肾脏以及肝功能。然而，严重的二尖瓣反流（MR）伴有后叶的脱垂，阻碍了心脏功能的恢复。我们的心脏小组决定在Impella的支持下使用MitraClip系统进行经皮二尖瓣修复（面板A）。在进行MitraClip之前，左心房压力（LAP）升高表明严重的MR。随着Impella性能水平的降低，全身动脉压降低，LAP进一步升高（图B）。植入两个夹子可将MR降低至中等程度，并且LAP对全身动脉压和Impella支持的依赖性减弱（图C）。当天，Impella断奶并移出。入院后7天，患者已在纽约心脏协会（NYHA）II出院。