Vanek Tomas, Kolesar Miroslav, Nejedly Michal, Jirmar Radovan
Department of Cardiac Surgery, 3rd Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, FNKV, Srobarova 50, 100 34 Prague 10, Czech Republic.
Interact Cardiovasc Thorac Surg. 2008 Aug;7(4):648-50. doi: 10.1510/icvts.2008.176883. Epub 2008 Apr 8.
We present a case of a 62-year-old male patient (coronary heart disease, and stenosis of aortic valve) with severe left ventricular dysfunction (left ventricular ejection fraction 20%, left ventricular end-diastolic diameter 80 mm, end-diastolic volume 329 ml) who developed giant electrical storm (on the whole 115 episodes of pulseless ventricular tachycardia treated by antiarrhythmics and electrical discharges) with low-elevation of cardiac biomarkers. The patient was referred to emergent cardiac surgery (double coronary bypass grafting, aortic valve replacement, and implantation of left ventricular epicardial electrode). Levosimendan and intraaortic balloon counterpulsation were used for successful weaning from the cardiopulmonary bypass; no other arrhythmia appeared in the post-bypass period. Postoperatively no arrhythmic events were detected, and repeated echocardiographic examinations of the patient in good general condition showed gradual improvement of left ventricular ejection fraction (30-35%), likewise in other parameters (left ventricular end-diastolic diameter 72 mm, end-diastolic volume 285 ml).
我们报告一例62岁男性患者（患有冠心病和主动脉瓣狭窄），其左心室功能严重不全（左心室射血分数20%，左心室舒张末期直径80mm，舒张末期容积329ml），出现了巨大电风暴（总共115次无脉性室性心动过速发作，通过抗心律失常药物和电除颤治疗），且心脏生物标志物轻度升高。该患者被转诊至急诊心脏外科手术（双冠状动脉搭桥术、主动脉瓣置换术和左心室心外膜电极植入术）。使用左西孟旦和主动脉内球囊反搏成功脱离体外循环；体外循环后未出现其他心律失常。术后未检测到心律失常事件，对总体状况良好的患者进行的多次超声心动图检查显示左心室射血分数逐渐改善（30 - 35%），其他参数（左心室舒张末期直径72mm，舒张末期容积285ml）亦是如此。
