Department of Pediatrics, The Ohio State University, Nationwide Children's Hospital, Columbus, Ohio 43205, USA.
Ann Thorac Surg. 2012 Aug;94(2):626-8. doi: 10.1016/j.athoracsur.2011.12.086. Epub 2012 May 10.
We report on an acute myocardial injury caused by thrombotic emboli during off-pump bilateral sequential lung transplantation in a 15-year-old female patient with end-stage cystic fibrosis. A few minutes after reperfusion of the right (second sequential) allograft, the patient developed hemodynamic collapse, including hypotension, acute akinesis of the anterior and lateral myocardial walls, and severe mitral regurgitation. Thrombus was noted within the left atrium and ventricle on intraoperative transesophageal echocardiogram. After emergent cannulation for cardiopulmonary bypass, the patient underwent left cardiac catheterization with AngioJet rheolytic thrombectomy and removal of the clot from the distal left anterior descending coronary artery. Reperfusion was established without the need for stent placement or further intervention. The patient required short-term life support with venoarterial extracorporeal membrane oxygenation.
我们报告了一例 15 岁女性终末期囊性纤维化患者在非体外循环双侧序贯肺移植中因血栓栓塞引起的急性心肌损伤。在右肺（第二序贯）移植物再灌注后几分钟，患者出现血流动力学崩溃，包括低血压、前壁和侧壁心肌急性运动障碍以及严重的二尖瓣反流。术中经食管超声心动图显示左心房和左心室有血栓。在紧急进行体外循环插管后，对患者进行了左心导管检查，采用 AngioJet 旋切血栓切除术，并从左前降支冠状动脉远端取出血栓。无需支架置入或进一步干预即可恢复再灌注。患者需要短期生命支持，使用静脉-动脉体外膜肺氧合。
