Abstract
BACKGROUND: Refractory cardiogenic shock (CS), despite successful reperfusion of myocardial infarction, carries a poor prognosis and high mortality. The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a treatment for refractory CS is widely adopted, but can cause catastrophic complications owing to unopposed retrograde blood flow. CASE SUMMARY: A 78-year-old man diagnosed with subacute inferior myocardial infarction and multiple comorbidities experienced refractory CS even after successful reperfusion, necessitating VA-ECMO implantation. However, VA-ECMO resulted in left ventricle (LV) distention syndrome, which warranted LV decompression. A combined decompression strategy using a microaxial-flow pump (MAFP) on top of balloon atrial septostomy (BAS) was implemented, effectively improving the patient's clinical condition. DISCUSSION: Combining BAS and MAFP enables direct left atrium monitoring, synergistically improving hemodynamics and oxygenation through simultaneous venting and unloading. TAKE-HOME MESSAGE: MAFP on top of BAS is an effective and safe decompression strategy to alleviate LV distention syndrome that can be applied in catastrophic clinical conditions.