Ray Ranjan, Kale Parag P, Ha Richard, Banerjee Dipanjan
From the *Department of Cardiovascular Medicine, Stanford University, Stanford, California; †Stanford Cardiovascular Institute, Stanford University, Stanford, California; ‡Heart Transplant Department, Northern California Kaiser Permanente, Oakland, California; and §Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
ASAIO J. 2014 Jul-Aug;60(4):482-3. doi: 10.1097/MAT.0000000000000087.
Gastrointestinal bleeding because of arteriovenous malformations (AVMs) is an increasingly recognized complication of continuous flow left ventricular assist devices (LVADs). Currently, therapeutic options for LVAD-associated AVMs are limited and often require repeated endoscopic procedures and reduction or cessation of anticoagulation. Thalidomide has been utilized in the treatment of refractory bleeding because of gastrointestinal vascular malformations. Here we describe the case of a 66-year-old man with severe ischemic cardiomyopathy implanted with a continuous flow HeartMate II. His postoperative course was complicated by multiple hospital admissions for gastrointestinal bleeding because of LVAD-associated AVMs refractory to repeated argon plasma laser coagulation. Anticoagulation was discontinued with subsequent pump stoppage because of thrombus requiring urgent surgical pump exchange. Following this, thalidomide was initiated and anticoagulation with warfarin was continued. Since initiation of thalidomide, the patient has not had further gastrointestinal bleeding or evidence of pump thrombus in the subsequent 1 year.
动静脉畸形（AVM）所致的胃肠道出血是持续血流左心室辅助装置（LVAD）越来越被认识到的一种并发症。目前，与LVAD相关的AVM的治疗选择有限，且常常需要重复进行内镜操作以及减少或停用抗凝治疗。沙利度胺已被用于治疗因胃肠道血管畸形所致的难治性出血。在此，我们描述一例66岁重度缺血性心肌病男性患者，植入了持续血流HeartMate II左心室辅助装置。其术后病程因LVAD相关的AVM导致胃肠道出血而多次住院，反复氩等离子体激光凝固治疗无效。因血栓形成需要紧急手术更换泵，抗凝治疗中断并随后停止了泵的运转。在此之后，开始使用沙利度胺并继续使用华法林进行抗凝治疗。自开始使用沙利度胺以来，患者在随后1年中未再发生胃肠道出血，也没有泵血栓形成的证据。
