Fujita Tomoyuki, Kobayashi Junjiro, Hata Hiroki, Seguchi Osamu, Sato Takuma, Yanase Masanobu, Murata Yoshihiro, Sunami Haruki, Nakatani Takeshi
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan.
J Artif Organs. 2013 Mar;16(1):98-100. doi: 10.1007/s10047-012-0661-5. Epub 2012 Sep 18.
A patient underwent aortic valve closure for de novo aortic insufficiency that had deteriorated to severe insufficiency during six months of support with a continuous flow left ventricular assist device (cf-LVAD). Aortic insufficiency was initially noted one month after LVAD implantation, and then deterioration quickly developed. Right heart catheterization revealed that when the rotational speed of the cf-LVAD was increased, the cardiac index was decreased by an increase in regurgitant volume, as shown by echocardiography. During surgery, fusion and shortening of the aortic leaflets as well as left coronary ostial occlusion were observed. Direct aortic closure improved hemodynamics. Thrombus formation on the aortic valve shown by echocardiography in the early postoperative period may be a trigger of aortic insufficiency. Control of the cf-LVAD rotational speed is likely required to prevent aortic insufficiency.
一名患者因新发主动脉瓣关闭不全接受了主动脉瓣关闭术，该主动脉瓣关闭不全在使用连续血流左心室辅助装置（cf-LVAD）支持的六个月期间恶化为严重关闭不全。主动脉瓣关闭不全最初在LVAD植入后一个月被发现，随后迅速恶化。右心导管检查显示，当cf-LVAD的转速增加时，心脏指数因反流容积增加而降低，超声心动图显示了这一点。手术中观察到主动脉瓣叶融合、缩短以及左冠状动脉开口闭塞。直接主动脉瓣关闭改善了血流动力学。术后早期超声心动图显示的主动脉瓣血栓形成可能是主动脉瓣关闭不全的一个触发因素。可能需要控制cf-LVAD的转速以预防主动脉瓣关闭不全。
