Giesler Gregory M, Gomez Jaime S, Letsou George, Vooletich Mary, Smalling Richard W
Division of Cardiovascular Medicine, University of Texas Health Science Center and Memorial Herman Heart and Vascular Institute, Houston, Texas, USA.
Catheter Cardiovasc Interv. 2006 Aug;68(2):263-6. doi: 10.1002/ccd.20846.
A 57-year-old female suffered an acute inferior ST segment elevation myocardial infarction. The patient failed thrombolysis and was urgently transferred for rescue percutaneous coronary intervention of the right coronary artery. She decompensated after reperfusion of the occluded RCA and developed cardiogenic shock from severe right heart failure refractory to IABP support and maximal pressors. A percutaneous right ventricular assist device was successfully implanted, which improved mean arterial pressure to a viable range and allowed withdrawal of inotropic medications. Right ventricular failure after infarction remains difficult to manage and has a high mortality. Intraaortic balloon pump and LVAD support have not proven beneficial in cardiogenic shock secondary to RV infarction. This is a report of the first insertion of a percutaneous right ventricular assist device for right ventricular support in a human. Further evaluation is warranted to evaluate the potential benefits of such a device as well as optimal timing of initiation of RV support.
一名57岁女性发生急性下壁ST段抬高型心肌梗死。患者溶栓治疗失败，紧急转院接受右冠状动脉的急诊经皮冠状动脉介入治疗。闭塞的右冠状动脉再灌注后，她出现失代偿，并因严重的右心衰竭导致心源性休克，对主动脉内球囊反搏支持和最大剂量升压药治疗无效。成功植入了经皮右心室辅助装置，该装置将平均动脉压提高到了可维持生命的范围，并允许停用强心药物。心肌梗死后的右心室衰竭仍然难以处理，死亡率很高。主动脉内球囊泵和左心室辅助装置在右心室梗死继发的心源性休克中尚未证明有益。本文报告了首例在人体中植入经皮右心室辅助装置以支持右心室的情况。有必要进行进一步评估，以评估这种装置的潜在益处以及右心室支持开始的最佳时机。
