Jeng Eric I, Parker Alex M, Bleiweis Mark S
Department of Surgery, Division of Thoracic and Cardiovascular Surgery, College of Medicine, University of Florida, Gainesville, Florida, USA.
Department of Medicine, Division of Cardiology, College of Medicine, University of Florida, Gainesville, Florida, USA.
J Card Surg. 2021 Apr;36(4):1569-1571. doi: 10.1111/jocs.15232. Epub 2020 Dec 16.
Fulminant myocarditis is a rapidly progressive myocardial inflammation that commonly requires advanced circulatory support therapies. We report our management of a 36-year-old gentleman with fulminant myocarditis who we managed with extracorporeal membranous oxygenation (ECMO) and subsequently durable bi-ventricular assist devices as a bridge to heart transplantation. The patient was admitted after a 1-week history of malaise with severe lethargy, jugular venous distension to greater than 10 cm, and troponin elevation to greater than 27 K. He was taken immediately for a heart catheterization which showed no obstructive coronary disease, and hemodynamics consistent with bi-ventricular failure. We proceeded with ECMO for hemodynamic support, utilizing a mini-thoracotomy for cannulation. A Protek Duo Rapid Deployment (LivaNova) was inserted via a modified Seldinger technique through the left ventricular apex, terminating in the ascending aorta. Percutaneous right IJ bicaval via a y-ed Avalon Elite (Getinge) was employed for venous drainage. This case highlights an alternate strategy for central walking veno-arterial ECMO in a patient presenting with fulminant myocarditis with a platform that minimizes upper/lower extremity over/under perfusion complications, while providing sternal sparring antegrade arterial flow with simultaneous ventricular unloading/venting.
暴发性心肌炎是一种迅速进展的心肌炎症，通常需要先进的循环支持治疗。我们报告了对一名36岁暴发性心肌炎男性患者的治疗情况，我们使用体外膜肺氧合（ECMO）对其进行治疗，随后使用耐用的双心室辅助装置作为心脏移植的桥梁。该患者在出现1周的不适症状后入院，伴有严重嗜睡、颈静脉扩张超过10厘米，肌钙蛋白升高超过27K。他立即接受了心脏导管检查，结果显示无阻塞性冠状动脉疾病，血流动力学符合双心室衰竭。我们采用ECMO进行血流动力学支持，通过微创开胸进行插管。通过改良的塞丁格技术，经左心室尖部插入一个Protek Duo快速部署装置（LivaNova），其末端位于升主动脉。经皮右颈内静脉双腔插管，通过一个Y形Avalon Elite（Getinge）进行静脉引流。该病例突出了一种在暴发性心肌炎患者中进行中心行走静脉 - 动脉ECMO的替代策略，该平台可将上肢/下肢灌注过多/过少并发症降至最低，同时提供胸骨 sparing 顺行动脉血流，同时实现心室卸载/排气。
