Kohli Utkarsh, Pumphrey Karen L, Ahmed Aziez, Das Srikant
Division of Pediatric Cardiology, University of Chicago School of Medicine, Chicago, IL, USA.
Arkansas Children's Hospital, Little Rock, AR, USA.
J Electrocardiol. 2018 Nov-Dec;51(6):1067-1070. doi: 10.1016/j.jelectrocard.2018.09.008. Epub 2018 Sep 17.
A 13 kg, 20 month-old, Caucasian girl, presented with cardiomyopathy, biventricular dysfunction and pre-excitation on electrocardiogram. She had normal intracardiac anatomy with severely dilated left ventricle and severely diminished biventricular function (Fig. 1). She was treated with milrinone and epinephrine infusions, mechanical ventilation and listed for heart transplant. She underwent Berlin Heart EXCOR biventricular assist device (BiVAD) placement (30 ml LVAD and 25 ml RVAD pumps). No supraventricular tachycardia (SVT) was inducible or noted during her hospitalization. First ablation attempt without BiVAD support was unsuccessful; however, 18 days post BiVAD implantation, another electrophysiology study and successful radiofrequency ablation of a right anterolateral accessory pathway was performed on BiVAD support. After successful ablation and loss of pre-excitation, the cardiac dysfunction rapidly improved with initial improvement noted as early as 48 h after the successful ablation. Due to recovery of cardiac function, a BiVAD wean protocol was initiated and BiVAD explantation was performed 48 days after the implant (30 days after the successful ablation). To the best of our knowledge, this is the first report of successful BiVAD explantation.
一名13千克、20个月大的白种女孩，患有心肌病、双心室功能障碍且心电图显示有预激。她的心内解剖结构正常，但左心室严重扩张，双心室功能严重减退（图1）。她接受了米力农和肾上腺素静脉输注、机械通气治疗，并被列入心脏移植名单。她接受了柏林心脏EXCOR双心室辅助装置（BiVAD）植入（左心室辅助装置30毫升，右心室辅助装置25毫升泵）。住院期间未诱发或发现室上性心动过速（SVT）。首次在无BiVAD支持下的消融尝试未成功；然而，在BiVAD植入后18天，在BiVAD支持下进行了另一项电生理研究，并成功对右前外侧旁路进行了射频消融。成功消融且预激消失后，心脏功能迅速改善，最早在成功消融后48小时就有初步改善。由于心脏功能恢复，启动了BiVAD撤离方案，并在植入后48天（成功消融后30天）进行了BiVAD取出术。据我们所知，这是成功取出BiVAD的首例报告。
