Hosseinian Leila, Levin Matthew A, Fischer Gregory W, Anyanwu Anelechi C, Torregrossa Gianluca, Evans Adam S
1Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY. 2Department of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Crit Care Med. 2015 Jan;43(1):e19-22. doi: 10.1097/CCM.0000000000000769.
The Total Artificial Heart (Syncardia, Tucson, AZ) is approved for use as a bridge-to-transplant or destination therapy in patients who have irreversible end-stage biventricular heart failure. We present a unique case, in which the inferior vena cava compression by a total artificial heart was initially masked for days by the concurrent placement of an extracorporeal membrane oxygenation cannula.
This is the case of a 33-year-old man admitted to our institution with recurrent episodes of ventricular tachycardia requiring emergent total artificial heart and venovenous extracorporeal membrane oxygenation placement.
This interesting scenario highlights the importance for critical care physicians to have an understanding of exact anatomical localization of a total artificial heart, extracorporeal membrane oxygenation, and their potential interactions. In total artificial heart patients with hemodynamic compromise or reduced device filling, consideration should always be given to venous inflow compression, particularly in those with smaller body surface area. Transesophageal echocardiogram is a readily available diagnostic tool that must be considered standard of care, not only in the operating room but also in the ICU, when dealing with this complex subpopulation of cardiac patients.
全人工心脏（Syncardia，图森，亚利桑那州）已被批准用于患有不可逆终末期双心室心力衰竭的患者，作为过渡到心脏移植或作为终末期治疗手段。我们报告了一例独特病例，其中全人工心脏对下腔静脉的压迫最初因同时放置体外膜肺氧合插管而被掩盖了数天。
这是一名33岁男性患者，因反复发生室性心动过速入住我院，需要紧急植入全人工心脏并进行静脉-静脉体外膜肺氧合。
这个有趣的病例突出了重症监护医生了解全人工心脏、体外膜肺氧合的确切解剖定位及其潜在相互作用的重要性。对于血流动力学受损或装置充盈减少的全人工心脏患者，应始终考虑静脉回流受压情况，尤其是在体表面积较小的患者中。经食管超声心动图是一种易于获得的诊断工具，在处理这类复杂的心脏病患者时，不仅在手术室，而且在重症监护病房都应被视为标准的护理手段。
