Yoda Masataka, Hata Mitsumasa, Sezai Akira, Minami Kazutomo
Department of Thoracic and Cardiovascular Surgery, The Cardiovascular Institute Hospital, Tokyo, Japan.
Ann Thorac Cardiovasc Surg. 2009 Dec;15(6):408-11.
The left ventricular assist system (LVAS) is often used for end-stage heart failure. However, in severe lung disorder, the patient needs extracorporeal membrane oxygenation (ECMO) because oxygenation using only a ventricular assist system (VAS) is insufficient. We report a successful case of combining the use of LVAS and right VAS (RVAS) with ECMO.
A 40-year-old female developed cardiogenic shock secondary to end-stage dilated cardiomyopathy, and percutaneous cardiopulmonary support (PCPS) was initiated. An echocardiogram showed a low ejection fraction (11%), and she underwent implantation of an LVAS (Toyobo Ventricular Assist System). She also required a RVAS with ECMO shunting between the right and left atrium because there was insufficient oxygenation resulting from pulmonary dysfunction followed by severe lung edema.
Pulmonary function recovered successfully, and the RVAS-ECMO was removed after 7 days of support. There were no complications after operation, such as infection, bleeding, or systemic embolization.
LVAS combined with RVAS-ECMO in right and left atrial cannulation is a useful option for patients with severe pulmonary damage.
左心室辅助系统（LVAS）常用于终末期心力衰竭。然而，在严重肺部疾病中，由于仅使用心室辅助系统（VAS）进行氧合不足，患者需要体外膜肺氧合（ECMO）。我们报告一例成功将LVAS和右心室辅助系统（RVAS）与ECMO联合使用的病例。
一名40岁女性因终末期扩张型心肌病继发心源性休克，启动了经皮心肺支持（PCPS）。超声心动图显示射血分数低（11%），她接受了LVAS（东洋纺心室辅助系统）植入。由于肺功能障碍继发严重肺水肿导致氧合不足，她还需要在右心房和左心房之间进行ECMO分流的RVAS。
肺功能成功恢复，在支持7天后移除了RVAS-ECMO。术后无感染、出血或全身栓塞等并发症。
LVAS联合右心房和左心房插管的RVAS-ECMO对严重肺损伤患者是一种有用的选择。
