Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, New York 10029, USA.
Catheter Cardiovasc Interv. 2013 May;81(6):1072-4. doi: 10.1002/ccd.24523. Epub 2012 Aug 22.
A 51-year-old male with untreated hepatitis C infection, cirrhosis, and dilated cardiomyopathy with a HeartMate II LVAD presented with right heart failure and cardiogenic shock, INR of 7, hemolysis, and renal failure. Acute LVAD thrombosis was suspected. Alteplase was injected into the inflow cannula of the LVAD with little effect. Intravenous alteplase was given but failed to restore an adequate pump output, resulting in the need for emergency pump exchange. The patient had an uncomplicated postoperative recovery and was discharged uneventfully. Inspection of the pump identified a thrombus wedged between the spines of the impeller. Our case highlights the challenges in managing pump thrombosis which is often resistant to thrombolysis and may instead rely upon prompt surgical intervention to be resolved.
一位 51 岁男性，患有未经治疗的丙型肝炎感染、肝硬化和扩张型心肌病，伴有 HeartMate II LVAD，出现右心衰竭和心源性休克、INR 为 7、溶血和肾功能衰竭。怀疑急性 LVAD 血栓形成。阿替普酶注入 LVAD 的流入套管中，但效果不大。给予静脉内阿替普酶，但未能恢复足够的泵输出，导致需要紧急泵更换。患者术后恢复顺利，无并发症出院。对泵的检查发现血栓楔入叶轮的脊柱之间。我们的病例突出了管理泵血栓形成的挑战，这种血栓通常对溶栓有抵抗力，可能需要及时的手术干预来解决。
