Luo Ming, Lin Jing, Qin Zhen, Du Lei
Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China.
Medicine (Baltimore). 2017 Jan;96(1):e5627. doi: 10.1097/MD.0000000000005627.
Ebstein anomaly is a common congenital heart disease that may induce severe tricuspid regurgitation and dilation of the "atrialized" portion of the right ventricle. Patients who undergo surgery to correct Ebstein anomaly are at high risk of postoperative right-sided heart failure, yet little is known about what pre-, peri-, or postoperative procedures may help reduce this risk.
Here, we describe 3 cases of adults with Ebstein anomaly who underwent corrective surgery and in whom right-sided heart failure occurred with severe tricuspid regurgitation detected by transesophageal echocardiography.
Ebstein anomaly.
Various approaches were applied to prevent right heart failure: perioperative control of atrial and ventricle arrhythmia, protection of myocardium, reduction of right-side cardiac workload after cardiopulmonary bypass, and mechanical support for right heart.
One of the 3 patients died, another experienced kidney failure despite postoperative support on extracorporeal membrane oxygenation, and the third patient survived without complications.
Our case series suggests that surgical prognosis can be improved through aggressive preoperative treatment, vasoactive and anti-arrhythmia medications, and comprehensive measures designed to reduce myocardial injury, prevent myocardial edema, and reduce pre- and afterload on the right ventricle.
埃布斯坦畸形是一种常见的先天性心脏病，可导致严重的三尖瓣反流及右心室“心房化”部分扩张。接受埃布斯坦畸形矫正手术的患者术后发生右侧心力衰竭的风险很高，但对于术前、术中和术后哪些操作可能有助于降低这种风险却知之甚少。
在此，我们描述3例接受矫正手术的成年埃布斯坦畸形患者，经食管超声心动图检测发现他们发生了右侧心力衰竭并伴有严重的三尖瓣反流。
埃布斯坦畸形。
采用了多种方法预防右心衰竭：围手术期控制心房和心室心律失常、保护心肌、减少体外循环后右侧心脏工作负荷以及对右心进行机械支持。
3例患者中1例死亡，另1例尽管术后接受体外膜肺氧合支持仍出现肾衰竭，第3例患者存活且无并发症。
我们的病例系列表明，通过积极的术前治疗、血管活性和抗心律失常药物以及旨在减少心肌损伤、预防心肌水肿并降低右心室前后负荷的综合措施，可以改善手术预后。
