From the Divisions of Pediatric Cardiovascular Surgery.
Pediatric Cardiology.
ASAIO J. 2021 Sep 1;67(9):e157-e159. doi: 10.1097/MAT.0000000000001330.
Ventricular assist device (VAD) management continues to be a challenge in the presence of restrictive physiology. Left atrial (LA) decompression is not satisfactory even with good function and position of the left ventricular cannula. We describe an alternate approach with LA cannulation via the left atrial appendage (LAA) as a rescue strategy in a patient who had restrictive physiology, in our case was secondary to viral myocarditis acute systolic heart failure with subsequent insidious diffuse endomyocardial fibrosis and superimposed massive calcification, causing inadequate emptying of the left ventricle despite optimal VAD apical cannula position.
心室辅助装置（VAD）管理在存在限制性生理的情况下仍然是一个挑战。即使左心室插管功能良好且位置正确，左心房（LA）减压也不理想。我们描述了一种通过左心耳（LAA）进行 LA 插管的替代方法，作为一名患有限制性生理的患者的抢救策略，在我们的病例中，这是继发于病毒性心肌炎的急性收缩性心力衰竭，随后出现隐匿性弥漫性心肌纤维化和叠加的大量钙化，导致尽管 VAD 心尖插管位置最佳，但左心室排空不足。
