Inoue Takafumi, Nishimura Takashi, Murakami Arata, Itatani Keiichi, Takaoka Tetsuhiro, Kitahori Kazuo, Umeki Akihide, Takezoe Toshiko, Kashiwa Koichi, Kyo Shunei, Ono Minoru
Department of Cardiothoracic Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan.
J Artif Organs. 2011 Sep;14(3):253-6. doi: 10.1007/s10047-011-0572-x. Epub 2011 May 20.
The mid-term and long-term results of left ventricular assist device (LVAD) implantation for small children are still unsatisfactory. There have been few reports of LVAD implantation for more than a month in children weighing under 5 kg. We report the case of a 4-month-old female infant who survived for 2 months after being diagnosed with dilated cardiomyopathy (DCM) with extracorporeal centrifugal pump support. In recent years, although pumps designed for small children have been introduced and are used as a bridge to transplantation or recovery, mid-term or long-term mechanical support for small children with heart failure is still difficult. We managed to successfully provide support for a low-body-weight child with a centrifugal pump over a mid-term period. We achieved acceptable control of thrombosis, but eventually the infant died of sepsis. Autopsy revealed no prominent thrombosis in the perfusion cannula, drainage cannula, the pump, or the left ventricle. This is the first case report of LVAD support with the centrifugal pump, ROTAFLOW(®) (Maquet, Rastatt, Germany), for 2 months in a child weighing under 5 kg. Our method may potentially save severe heart failure children who need mid-term LVAD support.
小儿左心室辅助装置（LVAD）植入的中期和长期效果仍不尽人意。对于体重不足5千克的儿童，LVAD植入超过一个月的报道很少。我们报告了一例4个月大的女婴，在被诊断为扩张型心肌病（DCM）并接受体外离心泵支持后存活了2个月。近年来，尽管已推出专为小儿设计的泵，并用作移植或恢复的桥梁，但为患有心力衰竭的小儿提供中期或长期机械支持仍然困难。我们成功地用离心泵为一名低体重儿童提供了中期支持。我们实现了对血栓形成的可接受控制，但最终婴儿死于败血症。尸检显示，灌注插管、引流插管、泵或左心室均无明显血栓形成。这是第一例关于在体重不足5千克的儿童中使用离心泵ROTAFLOW（®）（德国马奎特公司，拉施塔特）进行LVAD支持2个月的病例报告。我们的方法可能会挽救需要中期LVAD支持的重症心力衰竭儿童。
