Comment
Functional improvement of the RV after normalization of loading conditions under the support of temporary RVAD systems has been described but were rarely used in cases of isolated acute-on-chronic s-RVF due to rapidly exacerbated PAH and is still controversial.4, 5 Despite an extremely high PAP in our patient, we saw no signs of pulmonary edema or hemorrhage.
This case demonstrates a successful two-step treatment of a patient with acute-on-chronic RVF due to severe primary PAH with implantation of a percutaneous RVAD system combined with a regular veno-arterial ECMO set-up for biventricular support in on-going resuscitation which may be a safe and feasible treatment for patients with these critical clinical conditions, however, further clinical investigation is required.