Mohamedali B, Tatooles A, Bhat G
Division of Cardiology and Division of Cardiovascular Surgery, University of Illinois Hospitals and Health Sciences System, Advocate Christ Medical Center, Chicago, IL, USA
Division of Cardiology and Division of Cardiovascular Surgery, University of Illinois Hospitals and Health Sciences System, Advocate Christ Medical Center, Chicago, IL, USA.
Perfusion. 2014 Nov;29(6):483-7. doi: 10.1177/0267659114538482. Epub 2014 Jun 10.
Techniques to support patients with cardiogenic shock continue to improve. Patients with intracardiac thrombi pose a potential for additional complications. Novel methods of biventricular support are necessary to manage these patients.
Two patients with refractory cardiogenic shock and left ventricular apical thrombi underwent mechanical circulatory support (MCS) as a bridge to decision, with a left ventricular assist device (LVAD) and extracorporeal mechanical oxygenation (ECMO). Instead of the conventional LV apical cannulation for LVAD, the left atrium (LA) was cannulated. The LA cannula was then integrated with the ECMO circuit via a 'Y' connection to a percutaneous right atrial cannula, enabling optimal drainage of both sides into one circuit through a single CentriMag® pump and ECMO into the aorta.
The first patient was converted to a durable LVAD and transplanted, while the second patient was explanted, after demonstrating significant LV recovery.
We demonstrated the use of MCS as a bridge to decision in patients with LV thrombi, utilizing biatrial cannulation with a 'Y' connection to drain both right- and left-sided circulation through a single circuit and pump.
支持心源性休克患者的技术不断改进。患有心内血栓的患者存在出现额外并发症的可能性。需要新的双心室支持方法来治疗这些患者。
两名患有难治性心源性休克和左心室心尖血栓的患者接受了机械循环支持（MCS）作为决策桥梁，使用左心室辅助装置（LVAD）和体外膜肺氧合（ECMO）。与LVAD传统的左心室心尖插管不同，此次对左心房（LA）进行了插管。然后，将左心房插管通过“Y”形连接与经皮右心房插管接入ECMO回路，通过单个CentriMag®泵和ECMO实现双侧血液经一个回路最佳引流至主动脉。
第一名患者转换为永久性LVAD并接受了移植，而第二名患者在左心室显示出显著恢复后进行了装置移除。
我们展示了MCS作为左心室血栓患者决策桥梁的应用，利用双心房插管和“Y”形连接，通过单个回路和泵引流左右两侧循环。
