Sparks Aaron T, Kawabori Masashi, Chen Frederick Y, Couper Gregory S
From the Department of Cardiac Surgery, Tufts Medical Center, Boston, Massachusetts.
ASAIO J. 2023 Mar 1;69(3):e125-e127. doi: 10.1097/MAT.0000000000001792. Epub 2022 Aug 9.
A 56 year old female with a history of rheumatic mitral stenosis (MS) presented with severe pulmonary edema. Transthoracic echocardiogram demonstrated severe MS (mean valve area 0.5 cm 2 , mean gradient of 16 mm Hg) with preserved left ventricular ejection fraction. Right heart catheterization demonstrated elevated pulmonary artery (PA) pressures of 110/80 mm Hg and a wedge pressure of 40 mm Hg. Mechanical circulatory support (MCS) was initiated with extracorporeal left atrial to femoral artery bypass. MCS allowed preoperative unloading of the left atrium. The volume status and lung congestion were optimized before surgery. In addition, pulmonary hypertension reversibility was demonstrated with significantly lower PA pressures after initiation of MCS. Intraoperatively, the MCS left atrial inflow cannula was pulled back into the right heart and used as a venous cannula for cardiopulmonary bypass. Successful mitral valve replacement was performed. Postoperatively, the mitral valve mean gradient was 3 mm Hg.
一名有风湿性二尖瓣狭窄（MS）病史的56岁女性出现严重肺水肿。经胸超声心动图显示严重二尖瓣狭窄（平均瓣口面积0.5平方厘米，平均压差16毫米汞柱），左心室射血分数保留。右心导管检查显示肺动脉（PA）压力升高至110/80毫米汞柱，楔压为40毫米汞柱。通过体外左心房至股动脉旁路开始机械循环支持（MCS）。MCS使术前左心房得以减负。手术前对容量状态和肺部充血情况进行了优化。此外，启动MCS后PA压力显著降低，证明了肺动脉高压的可逆性。术中，将MCS左心房流入插管拉回到右心并用作体外循环的静脉插管。成功进行了二尖瓣置换术。术后，二尖瓣平均压差为3毫米汞柱。
