Gopaldas Raja R, Patel Kirti P, Livesay James J, Cooley Denton A
Division of Cardiovascular Surgery, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
Tex Heart Inst J. 2009;36(4):316-20.
Cannulation for cardiopulmonary bypass, although seemingly routine, can pose technical challenges. In patients undergoing repeat sternotomy, for example, peripherally established cardiopulmonary bypass may be necessary to ensure safe entry into the chest; however, establishing bypass in this way can sometimes be complicated by patients' body habitus. We describe a technique for direct cannulation of the infrahepatic abdominal vena cava that was required for emergent cardiopulmonary bypass. The patient was a 62-year-old woman who had presented with severely symptomatic left main coronary stenosis 3 months after elective aortic valve replacement. She had gone into cardiogenic shock as general anesthesia was being induced for repeat sternotomy and myocardial revascularization. Emergent establishment of femorofemoral cardiopulmonary bypass was precluded by difficulties in advancing the femoral venous cannula beyond the pelvic brim. Hence, an emergent celiotomy was performed, and the abdominal vena cava was directly cannulated to establish venous drainage for cardiopulmonary bypass. The rest of the operation was uneventful. Our technique for direct cannulation of the infrahepatic abdominal vena cava may be used in exceptional circumstances. Necessary precautions and potential pitfalls are also presented.
体外循环插管尽管看似常规，但可能会带来技术挑战。例如，在接受再次胸骨切开术的患者中，可能需要建立外周体外循环以确保安全进入胸腔；然而，以这种方式建立体外循环有时可能会因患者的体型而变得复杂。我们描述了一种在紧急体外循环时所需的直接肝下腔静脉插管技术。患者为一名62岁女性，在择期主动脉瓣置换术后3个月出现严重症状性左主干冠状动脉狭窄。在为再次胸骨切开术和心肌血运重建诱导全身麻醉时，她发生了心源性休克。由于股静脉插管难以推进至骨盆边缘以外，无法紧急建立股-股体外循环。因此，进行了紧急剖腹术，直接对腔静脉进行插管以建立体外循环的静脉引流。手术的其余部分顺利。我们的直接肝下腔静脉插管技术可在特殊情况下使用。同时也介绍了必要的预防措施和潜在的陷阱。
