Department of Pediatrics III, Cardiology, Innsbruck Medical University Hospital, Innsbruck, Austria.
Artif Organs. 2011 Nov;35(11):1105-9. doi: 10.1111/j.1525-1594.2011.01348.x. Epub 2011 Sep 29.
During the past 3 years, seven potential candidates for mechanical circulatory support (MCS) were treated at our center. Ultimately, only one of them needed MCS (extracorporeal membrane oxygenation [ECMO] for 16 days), although 5 years earlier, all would have been considered for MCS at our center. Seven consecutive patients were seen in this period: four toddlers (three suffering from fulminant myocarditis and one with dilated cardiomyopathy associated with spongy myocardium) and three adolescents (two with postmyocarditis cardiomyopathy and one with hypertrophic cardiomyopathy and severe restrictive dysfunction after an ischemic event with cardiopulmonary resuscitation [stunned heart]). All patients presented in acute cardiocirculatory decompensation. All were admitted to the intensive care unit (ICU); all but one were sedated and intubated. A combination of levosimendan, milrinone, and nesiritide was administered to all patients. Use of catecholamines was kept short (<48 h in six individuals). MCS (ECMO, Berlin Heart Excor Pediatric, and Heartware) was always available. MCS initiation was indicated in only one patient, who was developing progressive multiorgan failure (MOF). The three toddlers with myocarditis recovered with complete normalization of myocardial function within 6 months. The fourth toddler is still at the ICU while waiting for transplantation. The three adolescents were listed with high urgency for heart transplantation, and all received a graft within 3 weeks. The adolescent with the stunned heart developed progressive MOF and was successfully supported with ECMO until transplantation. All six patients with completed course were discharged home in New York Heart Association Heart Failure Functional Classification System I condition without neurological deficits. Combined use of levosimendan, milrinone, and nesiritide, avoidance of catecholamines as much as possible, and MCS as backup are the new strategies at our center. This cardioprotective approach gives excellent outcome at lower risk and better cost-effectiveness in our pediatric patients with acute heart failure. Pediatric trials are recommended to evaluate combined use of newer cardioprotective drugs.
在过去的 3 年中，我们中心治疗了 7 名潜在的机械循环支持（MCS）候选者。最终，只有 1 名患者需要 MCS（体外膜氧合[ECMO]治疗 16 天），尽管 5 年前，所有这些患者都可能在我们中心接受 MCS。在这段时间里，连续有 7 名患者：4 名幼儿（3 名患有暴发性心肌炎，1 名患有海绵状心肌相关扩张型心肌病）和 3 名青少年（2 名患有心肌炎后心肌病，1 名患有肥厚型心肌病和缺血事件后心肺复苏[心震]引起的严重限制性功能障碍）。所有患者均出现急性心循环失代偿。所有患者均入住重症监护病房（ICU）；除 1 名患者外，其余患者均给予镇静和插管。所有患者均给予左西孟旦、米力农和奈西立肽联合治疗。6 名患者均在 48 小时内短期使用儿茶酚胺。MCS（ECMO、柏林心脏 Excor 儿科和 Heartware）始终可用。仅 1 名患者出现进行性多器官衰竭（MOF），才开始 MCS。3 名患有心肌炎的幼儿在 6 个月内心肌功能完全正常而康复。第 4 名幼儿仍在 ICU，等待移植。3 名青少年被列为心脏移植的高紧急情况，所有患者均在 3 周内接受了移植。心震的青少年出现进行性 MOF，并成功接受 ECMO 支持直至移植。所有 6 名完成疗程的患者均在纽约心脏协会心力衰竭功能分类系统 I 条件下出院回家，无神经缺陷。我们中心的新策略是联合使用左西孟旦、米力农和奈西立肽，尽可能避免使用儿茶酚胺，并将 MCS 作为后备。这种心脏保护方法使我们的儿科急性心力衰竭患者在较低风险和更好的成本效益下获得了极好的结果。建议进行儿科试验以评估新型心脏保护药物的联合使用。
