Skhirtladze K, Zimpfer D, Zuckermann A, Dworschak M
Department of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel 18–20, Vienna, Austria.
Thorac Cardiovasc Surg. 2012 Jun;60(4):293-4. doi: 10.1055/s-0030-1270900. Epub 2011 Mar 29.
We report a case of a child with familial cardiomyopathy who contracted H1N1 influenza followed by cardiovascular collapse requiring immediate arteriovenous ECMO support. Despite the lack of experience with heart transplantation (HTx) soon after H1N1 infection, HTx was considered as an exit strategy since restoration of cardiac function was considered unlikely. In contrast to the most common indication for ECMO use in patients with H1N1 infection, early ECMO support in cases with infection-induced myocardial decompensation may be lifesaving. Additionally, this report shows that urgent heart transplantation in a patient on ECMO support can be performed safely after recent H1N1 infection and simultaneous heparin-induced thrombocytopenia, which has not been reported before. This case also indicates that H1N1 vaccination should be considered for potential transplantation candidates to prevent severe infection.
我们报告了一例患有家族性心肌病的儿童病例，该儿童感染甲型H1N1流感后出现心血管衰竭，需要立即进行动静脉体外膜肺氧合（ECMO）支持。尽管在甲型H1N1感染后不久进行心脏移植（HTx）缺乏经验，但由于认为心脏功能不太可能恢复，HTx被视为一种退出策略。与甲型H1N1感染患者使用ECMO的最常见指征不同，对于感染诱发心肌代偿失调的病例，早期ECMO支持可能挽救生命。此外，本报告表明，在最近感染甲型H1N1且同时存在肝素诱导的血小板减少症的情况下，接受ECMO支持的患者可以安全地进行紧急心脏移植，此前尚无此类报告。该病例还表明，应考虑为潜在的移植受者接种甲型H1N1疫苗，以预防严重感染。
