Szarszoi Ondrej, Maly Jiri, Turek Daniel, Urban Marian, Skalsky Ivo, Riha Hynek, Maluskova Jana, Pirk Jan, Netuka Ivan
Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, 140 21 Prague 4, Czech Republic.
Tex Heart Inst J. 2012;39(5):615-7.
A patient with dilated cardiomyopathy and no history of thromboembolic events received a surgically implanted axial-flow left ventricular assist device. After implantation, transesophageal echocardiography revealed a giant thrombus on the lateral and anterior aspects of the left ventricle. The inflow cannula inserted through the apex of the left ventricle was not obstructed, and the device generated satisfactory blood flow. Laboratory screening for thrombophilia showed protein S deficiency, heterozygous factor V Leiden mutation, and heterozygous MTHFR C667T mutation. During the entire duration of circulatory support, no significant suction events were detected, and the patient was listed for heart transplantation. Ventricular assist device implantation can unmask previously undiagnosed thrombophilia; therefore, it should be necessary to identify thrombophilic patients before cardiac support implantation.
一名患有扩张型心肌病且无血栓栓塞事件病史的患者接受了手术植入的轴流左心室辅助装置。植入后，经食管超声心动图显示左心室侧壁和前壁有巨大血栓。经左心室心尖插入的流入插管未受阻，装置产生了满意的血流。血栓形成倾向的实验室筛查显示蛋白S缺乏、杂合子因子V莱顿突变和杂合子亚甲基四氢叶酸还原酶C667T突变。在整个循环支持期间，未检测到明显的抽吸事件，该患者被列入心脏移植名单。心室辅助装置植入可能会揭示先前未被诊断出的血栓形成倾向；因此，在心脏支持植入前识别血栓形成倾向患者是必要的。
