Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2012 Oct;75(10):543-6. doi: 10.1016/j.jcma.2012.07.010. Epub 2012 Sep 15.
The left ventricular assist device (LVAD) is a battery-operated, mechanical pump-type device that helps in maintaining the pumping ability of a failing heart. Thromboembolism poses a significant risk during and after LVAD implantation. It occurs in up to 35% of patients with adverse sequelae. We present the case of a 75-year-old man who underwent coronary artery bypass graft surgery and LVAD implantation for acute myocardial ischemia and severe left ventricular dysfunction. However, subsequent transthoracic echocardiographic examination revealed an LVAD thrombus, and LVAD removal was suggested following the failure of thrombolytic therapy. After the LVAD cannula was removed, transesophageal echocardiography (TEE) revealed a residual thrombus in the left atrium. Thrombectomy was successfully performed by opening the left atrium with cardiopulmonary bypass. We believe that TEE monitoring aided the implantation and removal of the LVAD device. In this case, we found that TEE not only helped in monitoring the ventricular function but also in detecting other problems such as the residual thrombus. We strongly recommend TEE monitoring during the entire LVAD-removal procedure, particularly for patients who need to undergo LVAD removal because of thrombosis formation.
左心室辅助装置（LVAD）是一种电池驱动的机械泵式装置，有助于维持衰竭心脏的泵血功能。血栓栓塞在 LVAD 植入期间和之后都存在很大的风险。多达 35%的患者会出现不良后果。我们报告了一例 75 岁男性的病例，他因急性心肌缺血和严重左心室功能障碍接受了冠状动脉旁路移植术和 LVAD 植入。然而，随后的经胸超声心动图检查显示 LVAD 血栓，溶栓治疗失败后建议移除 LVAD。在 LVAD 插管移除后，经食管超声心动图（TEE）显示左心房残留血栓。通过体外循环打开左心房成功进行了血栓切除术。我们认为 TEE 监测有助于 LVAD 装置的植入和移除。在本例中，我们发现 TEE 不仅有助于监测心室功能，还能检测到其他问题，如残留血栓。我们强烈建议在整个 LVAD 移除过程中进行 TEE 监测，特别是对于因血栓形成而需要进行 LVAD 移除的患者。
