Michalek Pavel, Sebesta Pavel, Stern Michael
Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital, 128 08 Prague, Czech Republic.
Case Rep Vasc Med. 2011;2011:497940. doi: 10.1155/2011/497940. Epub 2011 Dec 18.
We describe the case of an 83-year-old patient requiring repair of a large symptomatic abdominal aortic aneurysm (AAA). The patient was known to have coronary artery disease (CAD) with symptoms and signs of significant myocardial dysfunction, left-heart failure, and severe aortic insufficiency. The procedure was performed with the help of both mechanical and pharmacological circulatory support. Distal perfusion was provided by an axillofemoral bypass with a centrifugal pump, with dobutamine and levosimendan administered as pharmacological inotropic support. The patient's hemodynamic status was monitored with continuous cardiac output monitoring and transesophageal echocardiography. No serious circulatory complications were recorded during the perioperative and postoperative periods. This paper suggests a potential novel approach to combined circulatory support in patients with heart failure, scheduled for open abdominal aortic aneurysm repair.
我们描述了一例83岁需要修复大型有症状腹主动脉瘤（AAA）的患者。已知该患者患有冠状动脉疾病（CAD），伴有明显心肌功能障碍、左心衰竭和严重主动脉瓣关闭不全的症状和体征。手术在机械和药物循环支持的帮助下进行。通过带离心泵的腋股旁路提供远端灌注，并使用多巴酚丁胺和左西孟旦作为药物性变力支持。通过连续心输出量监测和经食管超声心动图监测患者的血流动力学状态。围手术期和术后均未记录到严重的循环并发症。本文提出了一种针对计划进行开放性腹主动脉瘤修复的心力衰竭患者联合循环支持的潜在新方法。
