Tschirkov Alexander, Nikolov Dimitar, Papantchev Vassil
Department of Cardiac Surgery, St. Ekaterina University Hospital, 1431-Sofia, Bulgaria.
Tex Heart Inst J. 2007;34(4):445-8.
When a donor heart is not available during the end stage of heart failure, the implantation of a ventricular assist device is the only therapeutic alternative. Many such devices are designed to provide circulatory support to adults, but very few are available for children and infants, especially in the United States. In children, implantation of ventricular assist devices that are designed for adults carries a high risk of complications, because the low stroke volumes that must be used can result in inadequate pump washout and excessive thromboembolic risk. Herein, we report the case of an 11-year-old boy with congenital heart defects who experienced acute myocardial infarction. Prolonged support with the Berlin Heart excor Pediatric ventricular assist device served as a bridge to recovery. The period after device implantation was challenging, because of the need for prolonged inotropic support, continuous mechanical ventilation, the number of reoperations, and the occurrence of sepsis. Nevertheless, after 29 days, the patient's heart recovered, and the device was explanted. He was discharged from the hospital, in good condition, 30 days after removal of the excor device.
在心力衰竭终末期若无法获得供体心脏,植入心室辅助装置是唯一的治疗选择。许多此类装置旨在为成人提供循环支持,但适用于儿童和婴儿的却很少,尤其是在美国。对于儿童而言,植入为成人设计的心室辅助装置会带来很高的并发症风险,因为必须采用的低心搏量可能导致泵冲洗不足以及血栓栓塞风险过高。在此,我们报告一名患有先天性心脏缺陷的11岁男孩发生急性心肌梗死的病例。使用柏林心脏excor小儿心室辅助装置进行长期支持作为恢复的桥梁。装置植入后的时期充满挑战,这是因为需要长期的强心支持、持续机械通气、多次再次手术以及发生败血症。尽管如此,29天后患者的心脏恢复,装置被取出。在取出excor装置30天后,他状况良好地出院了。