Komatsu Ryu, Nagasawa Chinami, Nomura Minoru, Ozaki Makoto
Department of Anesthesiology, Tokyo Women's Medical University, Tokyo 162-8666.
Masui. 2003 Jul;52(7):780-2.
We experienced intra-operative management of a patient with post-myocarditis cardiomyopathy who underwent simultaneous biventricular assist device (BiVAD) placement. Although the BiVAD is considered to replace biventricular pump function, significant discrepancy between the flow of the right ventricular assist device (RVAD) and the left ventricular assist device (LVAD) caused difficulty in post-bypass circulatory management in our case. We administered a vasodilator to decrease pulmonary vascular resistance (PVR) and regurgitant fraction of RVAD flow into right ventricle. Inhaled nitric oxide may provide a favorable decrease of PVR. With BiVAD, comprehensive management including the optimization of systemic blood volume, systemic vascular resistance, PVR and native heart function is essential. Transesophageal echocardiography is useful in intraoperative diagnosis and a guide for decision-making in circulatory management.
我们经历了对一名患有心肌炎后心肌病患者的术中管理，该患者同时接受了双心室辅助装置（BiVAD）植入。尽管BiVAD被认为可替代双心室泵功能，但在我们的病例中，右心室辅助装置（RVAD）和左心室辅助装置（LVAD）的血流存在显著差异，导致体外循环后循环管理困难。我们使用了血管扩张剂以降低肺血管阻力（PVR）和RVAD流入右心室的反流分数。吸入一氧化氮可能有助于降低PVR。对于BiVAD，包括优化全身血容量、全身血管阻力、PVR和心脏自身功能在内的综合管理至关重要。经食管超声心动图在术中诊断及循环管理决策指导方面很有用。
