Staged Management with Transcatheter Aortic Valve Replacement in a Patient with ST-Segment Elevation Myocardial Infarction, Low-Gradient Aortic Stenosis, and Recurrent Cardiogenic Shock: A Case Report
- 1Department of Cardiology, Peking University Third Hospital, Beijing Key Laboratory of Cardiovascular Receptor Research, Key Laboratory of Molecular Cardiology, Ministry of Education, Key Laboratory of Cardiovascular Molecular Biology and Peptide Modulators, National Health Commission of the People’s Republic of China, Beijing 100191, China
Abstract
Background and Clinical Significance: Cardiogenic shock after successful culprit-vessel revascularization may remain multifactorial when important structural heart disease coexists. Case Presentation: We report an 81-year-old man with extensive anterior ST-segment elevation myocardial infarction, low-gradient calcific aortic stenosis (AS) with reduced left ventricular ejection fraction, and cardiogenic shock. Primary percutaneous coronary intervention of a completely occluded proximal left anterior descending artery was performed under intra-aortic balloon pump (IABP) support. Echocardiography showed an aortic valve area of 0.53 cm2, a mean transvalvular gradient of 25 mmHg, and a left ventricular ejection fraction of 32%. Although the findings raised concern for a classical low-flow, low-gradient AS phenotype, the low-flow state and true-severe AS could not be formally confirmed because stroke-volume index, dobutamine stress echocardiography, and standardized CT calcium scoring were unavailable. After IABP removal on day 6, profound recurrent shock with lactic acidosis and multiorgan hypoperfusion developed on day 10. IABP reinsertion was followed by improvement in systemic perfusion, whereas brief trial-off periods reproduced hemodynamic and symptomatic deterioration. TAVR was performed on day 24 after recovery of end-organ function, discontinuation of vasoactive drugs, partial platelet recovery, and completion of CT-based procedural planning. IABP was removed the next day, and the patient was discharged on day 30 with an ejection fraction of 42%. Conclusions: Recurrent shock after successful culprit-vessel reperfusion should prompt reassessment for persistent structural hemodynamic burdens. Temporary support may serve as a bridge to recovery and individualized procedural planning in selected patients, but the observed improvement after TAVR represents a temporal association in a multifactorial shock state and should not be interpreted as evidence for routine IABP use in infarct-related cardiogenic shock or a predetermined delay before valve intervention.
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BibTeX
@article{li2026staged,
title = {{Staged Management with Transcatheter Aortic Valve Replacement in a Patient with ST-Segment Elevation Myocardial Infarction, Low-Gradient Aortic Stenosis, and Recurrent Cardiogenic Shock: A Case Report}},
author = {Zhongheng Li and Weili Teng and Ruining Li and Liyun He and Dan Li and Lincheng Yang and Mengsha Gao and Ling Xu and Yupeng Wang and Ming Cui and Lijie Sun},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218218},
url = {https://www.mdpi.com/2077-0383/15/21/8218},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Staged Management with Transcatheter Aortic Valve Replacement in a Patient with ST-Segment Elevation Myocardial Infarction, Low-Gradient Aortic Stenosis, and Recurrent Cardiogenic Shock: A Case Report
AU - Zhongheng Li
AU - Weili Teng
AU - Ruining Li
AU - Liyun He
AU - Dan Li
AU - Lincheng Yang
AU - Mengsha Gao
AU - Ling Xu
AU - Yupeng Wang
AU - Ming Cui
AU - Lijie Sun
PY - 2026
DA - 2026/10/22
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218218
UR - https://www.mdpi.com/2077-0383/15/21/8218
AB - Background and Clinical Significance: Cardiogenic shock after successful culprit-vessel revascularization may remain multifactorial when important structural heart disease coexists. Case Presentation: We report an 81-year-old man with extensive anterior ST-segment elevation myocardial infarction, low-gradient calcific aortic stenosis (AS) with reduced left ventricular ejection fraction, and cardiogenic shock. Primary percutaneous coronary intervention of a completely occluded proximal left anterior descending artery was performed under intra-aortic balloon pump (IABP) support. Echocardiography showed an aortic valve area of 0.53 cm2, a mean transvalvular gradient of 25 mmHg, and a left ventricular ejection fraction of 32%. Although the findings raised concern for a classical low-flow, low-gradient AS phenotype, the low-flow state and true-severe AS could not be formally confirmed because stroke-volume index, dobutamine stress echocardiography, and standardized CT calcium scoring were unavailable. After IABP removal on day 6, profound recurrent shock with lactic acidosis and multiorgan hypoperfusion developed on day 10. IABP reinsertion was followed by improvement in systemic perfusion, whereas brief trial-off periods reproduced hemodynamic and symptomatic deterioration. TAVR was performed on day 24 after recovery of end-organ function, discontinuation of vasoactive drugs, partial platelet recovery, and completion of CT-based procedural planning. IABP was removed the next day, and the patient was discharged on day 30 with an ejection fraction of 42%. Conclusions: Recurrent shock after successful culprit-vessel reperfusion should prompt reassessment for persistent structural hemodynamic burdens. Temporary support may serve as a bridge to recovery and individualized procedural planning in selected patients, but the observed improvement after TAVR represents a temporal association in a multifactorial shock state and should not be interpreted as evidence for routine IABP use in infarct-related cardiogenic shock or a predetermined delay before valve intervention.
SN - 2077-0383
ER -