Liao Xiaozu, Zhong Shi, Huang Weizhao, Li Binfei
Department of Anesthesiology, Zhongshan City People's Hospital, Zhongshan, China.
Department of Cardiac Surgery, Zhongshan City People's Hospital, Zhongshan, China.
Front Surg. 2024 Mar 19;11:1323614. doi: 10.3389/fsurg.2024.1323614. eCollection 2024.
A ruptured sinus of Valsalva aneurysm can lead to rapid heart failure and sudden cardiac death. Management of patients who develop severe heart failure and need to be transferred to a specialized hospital for surgical treatment can be challenging. In patients with severe shock due to a ruptured sinus of Valsalva aneurysm into the right atrium, extracorporeal membrane oxygenation (ECMO) transport is an effective means to ensure patient safety, but increases the right cardiac load. We report the experience of veno-arterial (VA) ECMO transport in the treatment of acute cardiogenic shock caused by rupture of a congenital sinus of Valsalva aneurysm.
We describe the case of an 18-year-old male who began having acute episodes of chest pain, shortness of breath, palpitations, and dizziness 18 h before presenting to the emergency department. An echocardiogram revealed an acute ruptured sinus of Valsalva aneurysm and a shunt to the right atrium. The patient presented with severe shock. VA-ECMO was administered to ensure safe transport to the cardiac center. The outcome of emergency surgical repair was good. The patient was on ECMO for 8 h. He returned to the general ward after 7 days and was successfully discharged after 40 days. He had good exercise tolerance 2 years after surgery and no evidence of heart failure.
Although ECMO transport can increase right cardiac load, it is an effective and safe method to move patients with severe shock caused by a ruptured sinus of Valsalva aneurysm into the right atrium. Methods to decrease right cardiac load, such as decreasing ECMO flow combined with cardiotonic drugs, should be adopted. Successful treatment involves rapid establishment of cardiopulmonary bypass and urgent repair of the ruptured sinus of Valsalva aneurysm.
瓦氏窦瘤破裂可导致快速心力衰竭和心源性猝死。对于出现严重心力衰竭且需要转至专科医院进行手术治疗的患者，其管理颇具挑战性。在因瓦氏窦瘤破裂进入右心房而导致严重休克的患者中，体外膜肺氧合（ECMO）转运是确保患者安全的有效手段，但会增加右心负荷。我们报告静脉 - 动脉（VA）ECMO转运在治疗先天性瓦氏窦瘤破裂所致急性心源性休克中的经验。
我们描述了一名18岁男性的病例，该患者在前往急诊科就诊前18小时开始出现胸痛、气短、心悸和头晕的急性发作。超声心动图显示瓦氏窦瘤急性破裂并向右心房分流。患者出现严重休克。给予VA - ECMO以确保安全转运至心脏中心。急诊手术修复效果良好。患者接受ECMO治疗8小时。7天后返回普通病房，40天后成功出院。术后2年他的运动耐量良好，无心力衰竭迹象。
尽管ECMO转运可增加右心负荷，但它是将因瓦氏窦瘤破裂进入右心房导致严重休克的患者转运的有效且安全的方法。应采用降低右心负荷的方法，如降低ECMO流量并联合使用强心药物。成功的治疗包括快速建立体外循环和紧急修复破裂的瓦氏窦瘤。
