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Nonocclusive Mesenteric Ischemia Resulting from Acute MyocardialInfarction of Left Main Trunk after the Recovery from Cardiac Arrest by Percutaneous Cardiopulmonary System: A Case Report

Nobuhiro Takeuchi, Yusuke Nomura, Tetsuo Maeda, Hidetoshi Tada and Masanori Takada

A 77-year old male was ambulated to our institution after he had been found unconsciousness in the street. On admission, he complained about severe chest pain. His systolic blood pressure was 58 mmHg; therefore, he was diagnosed to be in cardiogenic shock. A 12-lead electrocardiography (ECG) revealed ST elevation in the lead II, III, aVf, and V1 - V5. The episode of chest pain and abnormal ECG findings led to the diagnosis of AMI. Coronary angiography revealed severe stenosis in the left main trunk (LMT) and the left anterior descending artery (LAD). LMT was considered as the culprit lesion in this case. During the examination, the monitoring ECG revealed cardiac arrest; therefore, cardiac resuscitation was immediately performed using percutaneous cardiopulmonary system. Ventricular fibrillation was evident; following cardiac defibrillation at 360J restored sinus rhythm. Subsequently, intraaortic balloon pumping was placed, and percutaneous coronary intervention was performed; coronary stents were successfully placed in LMT and LAD. Postoperative course was uneventful; however, he emerged with massive melena on day 13. Colonoscopy revealed cast-like stripped mucosa from the ascending to the cecum, which was suggesting of severe intestinal ischemia. Non contrast computed tomography suggested a lower intestinal perforation. Because of his circulatory condition and anticoagulant therapies after AMI, he didn’t become a candidate for surgical treatment. After provided with conservative therapy, he died of multiple organ failure resulting from panperitonitis.