Lee Jennifer K, Ing Caleb
From the Department of Anesthesiology, Columbia University Medical Center, New York, New York.
A A Case Rep. 2016 Mar 1;6(5):127-9. doi: 10.1213/XAA.0000000000000271.
Ventricular assist devices (VADs) are associated with conditions that may complicate the perioperative course of pediatric heart transplants. A 7-year-old girl with dilated cardiomyopathy supported by a Toyobo-NCVC left VAD (Toyobo-National Cardiovascular Center, Osaka, Japan), a pulsatile extracorporeal device, and preoperatively anticoagulated with warfarin presented for orthotopic heart transplant. The course was complicated by persistent bleeding treated with prothrombin complex concentrate and refractory postbypass vasoplegia treated with methylene blue. Preoperative anticoagulation and the presence of a VAD are associated with postbypass coagulopathy and vasoplegia. We describe a case in which these conditions were successfully treated with no thrombotic complications and minimal need of vasopressors for hemodynamic stability.
心室辅助装置（VADs）与一些可能使小儿心脏移植围手术期过程复杂化的情况相关。一名7岁扩张型心肌病女童，由一种东洋纺 - NCVC左心室辅助装置（日本大阪东洋纺 - 国立心血管中心）支持，这是一种搏动性体外装置，术前使用华法林抗凝，前来接受原位心脏移植。该过程出现了持续出血，用凝血酶原复合物浓缩剂治疗，以及体外循环后难治性血管麻痹，用亚甲蓝治疗。术前抗凝和VAD的存在与体外循环后凝血病和血管麻痹有关。我们描述了一个病例，其中这些情况通过无血栓形成并发症且维持血流动力学稳定所需血管升压药最少的方式成功得到治疗。
