Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Pathology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas.
Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas.
Am J Cardiol. 2020 Jan 15;125(2):244-250. doi: 10.1016/j.amjcard.2019.10.013. Epub 2019 Oct 28.
There are no publications describing hearts at necropsy containing left ventricular assist devices (LVADs). The purpose was to study the relation of the LVAD cannula to the left ventricular (LV) cavity and wall. We studied the hearts at necropsy of 15 adults who had an LVAD inserted from 4 to 1,423 days (median 60) earlier. In 13 patients, the cannula had been inserted at an angle to the major longitudinal axis of the LV chamber, and in 11 patients, the orifice margin of the cannulas contacted the LV mural endocardium. In 3 patients, the LVAD cannula was inserted into the posterior wall, and, in another into the anterior wall. In the remaining 11 patients, the cannula had been inserted into the LV apex. Despite the insertion of the cannulas into the LV apex, the direction of the insertion was not into the longitudinal axis of the LV cavity in 9 patients. These unusual insertions in some patients may have altered flow into the orifice of the cannula; in others, based on their long postoperative survival, physiologic consequences were almost certainly absent. The presence of considerable quantities of subepicardial adipose tissue and pericardial adhesions from previous cardiac procedures (mainly coronary bypass) potentially interfered with achieving proper alignment of the LVAD cannula during its insertion. Misalignment of the cannulas of the LVAD in the LV cavity appears to be rather frequent.
目前尚无关于尸检心脏中包含左心室辅助装置（LVAD）的文献报道。本研究旨在研究 LVAD 套管与左心室（LV）腔和壁之间的关系。我们研究了 15 名成年人的尸检心脏，这些成年人在 4 至 1423 天（中位数为 60 天）前插入了 LVAD。在 13 名患者中，套管以相对于 LV 腔的主要纵轴的角度插入，在 11 名患者中，套管的孔缘与 LV 心壁内膜接触。在 3 名患者中，LVAD 套管插入后壁，另一名患者插入前壁。在其余 11 名患者中，套管插入 LV 心尖。尽管套管插入 LV 心尖，但在 9 名患者中，插入方向并非进入 LV 腔的纵轴。这些患者的套管插入位置异常，可能改变了套管孔的血流方向；在其他患者中，基于其术后长期存活，几乎可以肯定不存在生理后果。先前心脏手术（主要是冠状动脉旁路移植术）引起的心外膜下脂肪组织和心包粘连的大量存在，可能会干扰 LVAD 套管在插入过程中的正确对准。LVAD 套管在 LV 腔中的错位似乎相当常见。
