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  1. 120 Mechanical Circulatory Support in InterventricularSeptum Rupture: Rescue Therapy or Bridge?Gianpaolo Romano,1Cristiano Amarelli,1Ciro Maiello,1Nicola Galdieri,1Antonella Capasso,1Giuseppe Santoro,2 Maurizio Cappelli Bigazzi,2Luca S De Santo,1Michelangelo Scardone.11Department ofCardiovascular Surgery and Transplants, Monaldi Hospital, Napoli, Italy;2Department of Cardiology, Monaldi Hospital, Naples, Italy. Background: Posterior Interventricular Septum Rupture (IVSR) is associated with a massive necrosis of right ventricle. New techniques of surgical repair lowered the incidence of postoperative shunt but residual myocardial function after surgery is often poor. On the other hand stabilization with counterpulsationto warrant surgery on an healed tissue is not always possible. Mechanical Circulatory Support after surgery may be temporarily necessary but recovery is unlikely; to avoid undue costs and damages to myocardium related to surgery and to uneffective myocardial protection, ECMO may be used as a bridge to the optimal therapy when myocardial function is really poor. Matherials: During 2011 of 8 patients referred for IVSRs 5 patient were refused for emergent surgery due to the excessive surgical risks. Three of these patients underwent ECMO implantation as bridge to the optimal therapy. Results: In 2 patients in age for Heart Transplantation, after the recovery of a good end-organ perfusion and a fast extubation, recovery of myocardial function was not achieved despite myocardial unloading, so the patients underwent successful Heart Transplantation. The third patient had a severe neurological dysfunction but recovered a good myocardial function and underwent successful Amplatzer implantation with a minimal residual shunt. This patient died after ECMO removal for cardiogenic shock; unfortunately this patient didn’t underwent coronary angiography so we had no data on the extent of the coronary lesions. Conclusions: The summary of the 3 cases of posterior Postinfarctual IVSRs suggest that ECMO implantation as a bridge to surgery may warrant the choose of the optimal treatment for a challenging pathology.

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