在与嗜铬细胞瘤危象相关的心源性休克中，通过联合使用静脉-动脉体外膜肺氧合（V-A ECMO）和Impella CP实现快速心肌恢复。
Fast myocardial recovery ensured by the combined use of V-A ECMO and IMPELLA CP in cardiogenic shock related to a pheochromocytoma crisis.
作者信息
Montalto Andrea, Nicolò Francesca, Polizzi Vincenzo, Comisso Marina, Musumeci Francesco
机构信息
Department of Cardiac Surgery and Transplantation, S. Camillo Hospital, Rome, Italy.
出版信息
J Card Surg. 2020 Sep;35(9):2367-2369. doi: 10.1111/jocs.14805. Epub 2020 Jul 27.
BACKGROUND
Pheochromocytoma is a rare catecholamine-secreting tumor derived from chromaffin cells in the adrenal glands. An excessive stimulation of cardiac myocytes, when pheochromocytoma 'crisis' occurs, lead to myocardial damage with cardiogenic shock.
AIM OF THE STUDY
We present the case of a A 28-year old female patient admitted with signs of severe cardiogenic shock. She was successfully supported with extracorporeal membrane oxygenation (ECMO) combined with IMPELLA CP heart pump (Abiomed Danvers, MA), for left ventricular unloading. Mechanical circulatory support (MCS) was used to favour myocardial recovery and avoid cardiac remodeling.
RESULTS
A very fast recovery was observed. The ECMO was discontinued after four days. The IMPELLA-CP was safely removed after six days. A completely myocardial recovery was observed.
CONCLUSIONS
Use of MCS might find an indication in case of PCC as a bridge to myocardial recovery.
背景
嗜铬细胞瘤是一种罕见的分泌儿茶酚胺的肿瘤，起源于肾上腺髓质嗜铬细胞。嗜铬细胞瘤“危象”发生时，对心肌细胞的过度刺激会导致心肌损伤并引发心源性休克。
研究目的
我们报告一例28岁女性患者，因严重心源性休克入院。她成功地接受了体外膜肺氧合（ECMO）联合IMPELLA CP心脏泵（美国马萨诸塞州丹弗斯市的Abiomed公司）治疗，以减轻左心室负荷。采用机械循环支持（MCS）促进心肌恢复并避免心脏重塑。
结果
观察到患者恢复非常迅速。四天后停用ECMO。六天后安全移除IMPELLA-CP。观察到心肌完全恢复。
结论
在嗜铬细胞瘤病例中，使用MCS可能作为心肌恢复的桥梁找到其适应证。
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