{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,14]],"date-time":"2026-11-14T02:17:58Z","timestamp":1794622678669,"version":"4.9.1"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2023,8,2]],"date-time":"2023-08-02T00:00:00Z","timestamp":1690934400000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Recently, mechanical support obtained with the combination of venoarterial extracorporeal membrane oxygenation (VA-ECMO) and an Impella device, together referred to as ECPELLA, has been shown to be effective for acute myocardial infarction with cardiogenic shock. However, methods for withdrawing VA-ECMO in acute myocardial infarction cases complicated by right ventricular dysfunction are yet to be established. Here, we report the effective use of inhaled nitric oxide during the weaning of VA-ECMO from the ECPELLA management of a patient with acute myocardial infarction with cardiogenic shock.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>An 81-year-old man with an acute extensive anterior wall myocardial infarction with cardiogenic shock was supported with ECPELLA to improve his haemodynamics. During ECPELLA, the Impella device could not maintain sufficient flow. Echocardiography revealed a small left ventricle and an enlarged right ventricle, indicating acute right heart failure. Inhaled nitric oxide was initiated to reduce right ventricle afterload, which decreased pulmonary artery pressure from 34\/20 to 27\/13\u2005mmHg, improved right and left ventricle sizes, and stabilized the Impella support. Afterward, VA-ECMO could be withdrawn because the Impella alone was sufficient for haemodynamic support.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Inhaled nitric oxide improved right ventricle performance in a patient with severe myocardial infarction with right heart failure supported by ECPELLA. Thus, we suggest that inhaled nitric oxide facilitates the weaning of VA-ECMO from patients with refractory right ventricular dysfunction who are supported by ECPELLA.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytad369","type":"journal-article","created":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T20:01:15Z","timestamp":1690920075000},"source":"Crossref","is-referenced-by-count":6,"title":["Haemodynamic effects of inhaled nitric oxide in acute myocardial infarction complicated by right heart failure under ECPELLA support: case report"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2001-1543","authenticated-orcid":false,"given":"Kosuke","family":"Fujita","sequence":"first","affiliation":[{"name":"Department of Cardiology, Kindai University Hospital , 377-2 Onohigashi Osakasayamashi, 589-8511 Osaka , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masafumi","family":"Ueno","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kindai University Hospital , 377-2 Onohigashi Osakasayamashi, 589-8511 Osaka , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masakazu","family":"Yasuda","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kindai University Hospital , 377-2 Onohigashi Osakasayamashi, 589-8511 Osaka , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuki","family":"Mizutani","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kindai University Hospital , 377-2 Onohigashi Osakasayamashi, 589-8511 Osaka , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuya","family":"Miyoshi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kindai University Hospital , 377-2 Onohigashi Osakasayamashi, 589-8511 Osaka , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6721-1342","authenticated-orcid":false,"given":"Gaku","family":"Nakazawa","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kindai University Hospital , 377-2 Onohigashi Osakasayamashi, 589-8511 Osaka , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,8,2]]},"reference":[{"key":"2023081210351602300_ytad369-B1","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1002\/ejhf.668","article-title":"Concomitant implantation of Impella\u00ae on top of veno-arterial extracorporeal membrane oxygenation may improve survival of patients with cardiogenic shock","volume":"19","author":"Pappalardo","year":"2017","journal-title":"Eur J Heart Fail"},{"key":"2023081210351602300_ytad369-B2","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/j.jacc.2004.05.047","article-title":"Hemodynamic effects of inhaled nitric oxide in right ventricular myocardial infarction and cardiogenic shock","volume":"44","author":"Inglessis","year":"2004","journal-title":"J Am Coll Cardiol"},{"key":"2023081210351602300_ytad369-B3","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1097\/MAT.0b013e31829f0e52","article-title":"Impella to unload the left ventricle during peripheral extracorporeal membrane oxygenation","volume":"59","author":"Cheng","year":"2013","journal-title":"ASAIO J"},{"key":"2023081210351602300_ytad369-B4","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.jcrc.2017.02.014","article-title":"Anticoagulation practices and the prevalence of major bleeding, thromboembolic events, and mortality in venoarterial extracorporeal membrane oxygenation: a systematic review and meta-analysis","volume":"39","author":"Sy","year":"2017","journal-title":"J Crit Care"},{"key":"2023081210351602300_ytad369-B5","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.jccase.2022.03.013","article-title":"Inhaled nitric oxide for ECPELLA management in fulminant myocarditis complicated with severe right ventricular dysfunction: a case report","volume":"26","author":"Oki","year":"2022","journal-title":"J Cardiol Cases"},{"key":"2023081210351602300_ytad369-B6","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.jccase.2022.07.003","article-title":"Concomitant use of VA-ECMO and Impella with inhaled nitric oxide to treat cardiogenic shock after cardiac surgery: a case report","volume":"26","author":"Higashino","year":"2022","journal-title":"J Cardiol Cases"},{"key":"2023081210351602300_ytad369-B7","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1136\/pgmj.2010.103887","article-title":"Right ventricular myocardial infarction: pathophysiology, diagnosis, and management","volume":"86","author":"Kakouros","year":"2010","journal-title":"Postgrad Med J"},{"key":"2023081210351602300_ytad369-B8","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1016\/S0735-1097(85)80340-5","article-title":"Right ventricular myocardial infarction in patients with chronic lung disease: possible role of right ventricular hypertrophy","volume":"5","author":"Kopelman","year":"1985","journal-title":"J Am Coll Cardiol"},{"key":"2023081210351602300_ytad369-B9","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s40635-020-00326-y","article-title":"Unloading using Impella CP during profound cardiogenic shock caused by left ventricular failure in a large animal model: impact on the right ventricle","volume":"8","author":"Josiassen","year":"2020","journal-title":"Intensive Care Med Exp"},{"key":"2023081210351602300_ytad369-B10","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1186\/s12872-021-01992-w","article-title":"Inhaled nitric oxide preserves ventricular function during resuscitation using a percutaneous mechanical circulatory support device in a porcine cardiac arrest model: an echocardiographic myocardial work analysis","volume":"21","author":"Nix","year":"2021","journal-title":"BMC Cardiovasc Disord"},{"key":"2023081210351602300_ytad369-B11","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1046\/j.1365-2362.2002.01049.x","article-title":"Inhaled nitric oxide: more than a selective pulmonary vasodilator","volume":"32","author":"Gianetti","year":"2002","journal-title":"Eur J Clin Investig"},{"key":"2023081210351602300_ytad369-B12","doi-asserted-by":"crossref","first-page":"2161","DOI":"10.1016\/j.athoracsur.2006.06.081","article-title":"Clinical indication for use and outcomes after inhaled nitric oxide therapy","volume":"82","author":"George","year":"2006","journal-title":"Ann Thorac Surg"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytad369\/51026700\/ytad369.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/7\/8\/ytad369\/51101927\/ytad369.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/7\/8\/ytad369\/51101927\/ytad369.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,12]],"date-time":"2023-08-12T10:35:42Z","timestamp":1691836542000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytad369\/7235908"}},"subtitle":[],"editor":[{"given":"Edin","family":"Begic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Raheel","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"A Shaheer","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Franca","family":"Morselli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,8,1]]},"references-count":12,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2023,8,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytad369","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,8]]},"published":{"date-parts":[[2023,8,1]]},"article-number":"ytad369"}}