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Levitronix双心室辅助装置,用于一名患有急性暴发性心肌炎并伴有小脑梗死患者的康复桥梁。

Levitronix bilateral ventricular assist device, a bridge to recovery in a patient with acute fulminant myocarditis and concomitant cerebellar infarction.

作者信息

Huang Yi-Fan, Hsu Po-Shun, Tsai Chien-Sung, Tsai Yi-Ting, Lin Chih-Yuan, Ke Hong-Yan, Lin Yi-Chang, Yang Hsiang-Yu

机构信息

Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan, Republic of China; Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan, Republic of China.

Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan, Republic of China. Email:

出版信息

Cardiovasc J Afr. 2018;29(3):e1-e4. doi: 10.5830/CVJA-2018-009. Epub 2018 Feb 7.

Abstract

We report on the case of a 27-year-old male who presented to our emergency room with chest tightness, dyspnoea and cold sweats. The 12-lead electrocardiogram showed diffuse ventricular tachycardia with wide QRS complexes. Troponin-I level was elevated to 100 ng/ml. The coronary angiogram showed good patency of all three coronary vessels, and acute fulminant myocarditis was suspected. The patient underwent cardiopulmonary resuscitation in the catheter room and high-dose inotropic support was initiated to stabilise his haemodynamic status. After resuscitation, the patient was in a coma and acute stroke was highly suspected. In addition, deteriorating cardiogenic shock with acute renal failure and pulmonary oedema were also detected. Due to haemodynamic compromise despite high-dose inotropic support, a Levitronix bilateral ventricular assist device (Bi-VAD) was implanted on an emergency basis for circulatory support. Postoperative brain computed tomography revealed acute left cerebellar infarction. Because the patient had left cerebellar infarction with right hemiplegia, heart transplantation was contraindicated. Eventually, cardiac systolic function recovered well and the patient underwent successful Bi-VAD removal after a total of 18 days on Levitronix haemodynamic support. He was weaned from the ventilator two weeks later and was discharged 10 days later.

摘要

我们报告了一例27岁男性患者,他因胸闷、呼吸困难和冷汗前来我院急诊室就诊。12导联心电图显示弥漫性室性心动过速伴宽QRS波群。肌钙蛋白I水平升高至100 ng/ml。冠状动脉造影显示三支冠状动脉通畅良好,怀疑为急性暴发性心肌炎。患者在导管室接受了心肺复苏,并开始给予大剂量的正性肌力药物支持以稳定其血流动力学状态。复苏后,患者处于昏迷状态,高度怀疑发生急性卒中。此外,还检测到心源性休克恶化并伴有急性肾衰竭和肺水肿。尽管给予了大剂量的正性肌力药物支持,但由于血流动力学受损,紧急植入了Levitronix双心室辅助装置(Bi-VAD)以提供循环支持。术后脑部计算机断层扫描显示急性左小脑梗死。由于患者存在左小脑梗死并伴有右偏瘫,心脏移植被列为禁忌。最终,心脏收缩功能恢复良好,在接受Levitronix血流动力学支持共18天后,患者成功移除了Bi-VAD。两周后他脱机,10天后出院。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c138/6282109/824e8a52b79a/cvja-29-e2-g001.jpg

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