Kitahara Hiroto, Nawata Kan, Kinoshita Osamu, Itoda Yoshifumi, Kimura Mitsutoshi, Yamauchi Haruo, Ono Minoru
Department of Cardiac Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan.
J Artif Organs. 2016 Dec;19(4):392-395. doi: 10.1007/s10047-016-0921-x. Epub 2016 Jul 18.
We successfully managed a splenic injury and delayed splenic rupture in a patient with an implantable left ventricular assist device (iLVAD). A 42-year-old man with an iLVAD for idiopathic dilated cardiomyopathy was admitted to our department complaining of dizziness. Laboratory data showed severe anemia, and computed tomography demonstrated a traumatic splenic injury. Following conservative treatment, partial splenic embolization was performed. Fifteen days after the intervention, the patient went into hemorrhagic shock due to delayed splenic rupture. Emergency total splenic embolization was performed, and total splenectomy was conducted later to prevent re-bleeding or abscess formation. His postoperative course was uneventful, and he was discharged on postoperative day 22. Finally, he underwent orthotropic heart transplantation without post-splenectomy sepsis or thrombotic complications 472 days after splenectomy. Splenic injury should be considered as a possible complication of iLVAD. In addition, careful follow-up after transcatheter arterial embolization for splenic injury is essential for managing delayed splenic rupture.
我们成功处理了一名植入左心室辅助装置（iLVAD）患者的脾损伤及延迟性脾破裂。一名因特发性扩张型心肌病植入iLVAD的42岁男性因头晕入住我科。实验室检查显示严重贫血，计算机断层扫描显示外伤性脾损伤。经过保守治疗后，进行了部分脾栓塞术。介入治疗15天后，患者因延迟性脾破裂发生失血性休克。进行了急诊全脾栓塞术，随后进行了全脾切除术以防止再次出血或脓肿形成。他术后恢复顺利，术后第22天出院。最后，在脾切除术后472天，他接受了原位心脏移植，未出现脾切除术后败血症或血栓并发症。脾损伤应被视为iLVAD的一种可能并发症。此外，对于脾损伤经导管动脉栓塞术后进行仔细随访对于处理延迟性脾破裂至关重要。
