Tanimoto Kazuki, Kido Takashi, Taira Masaki, Watanabe Takuji, Narita Jun, Ishida Hidekazu, Ishii Ryo, Ueno Takayoshi, Miyagawa Shigeru
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Department of Pediatrics, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
J Artif Organs. 2025 Mar;28(1):90-94. doi: 10.1007/s10047-024-01456-w. Epub 2024 Jul 15.
Ventricular-assist device therapy for small patients with congenital heart disease is challenging due to its complex anatomy and hemodynamics. We describe a 3-year-old patient with heart failure with truncus arteriosus in the palliative stage. The patient underwent palliative right ventricular outflow tract reconstruction following bilateral pulmonary artery banding. At 6 months of age, the patient developed severe truncal valve regurgitation and left ventricular dysfunction. Emergent truncal valve replacement with a mechanical valve was performed, but left ventricular dysfunction persisted. At 3 years of age, the patient developed acute progression of heart failure triggered by influenza infection. The patient was intubated and transferred to our center to determine the indication for heart transplantation. On the second day after admission, signs of multiorgan failure appeared. Emergent ventricular-assist device implantation for both ventricles was performed with truncal valve closure, ventricular septal defect closure, atrial septal defect closure, and re-right ventricular outflow tract reconstruction. The right ventricular-assist device was successfully removed on the seventh postoperative day. Due to the small pulmonary arteries, severe pulmonary stenosis persisted after ventricular-assist device implantation, but it gradually improved with multiple pulmonary angioplasties. The patient was registered in the Japanese organ transplant network and is awaiting a donor organ in a stable condition.
对于患有先天性心脏病的小儿患者，心室辅助装置治疗具有挑战性，因为其解剖结构和血流动力学较为复杂。我们描述了一名处于姑息治疗阶段、患有心力衰竭合并共同动脉干的3岁患者。该患者在双侧肺动脉环扎术后接受了姑息性右心室流出道重建。6个月大时，患者出现严重的共同动脉干瓣膜反流和左心室功能障碍。紧急进行了机械瓣膜置换术以置换共同动脉干瓣膜，但左心室功能障碍持续存在。3岁时，患者因流感感染引发心力衰竭急性进展。患者接受了气管插管并被转至我们中心以确定心脏移植的指征。入院后第二天，出现多器官功能衰竭迹象。紧急进行了双心室辅助装置植入术，并同时关闭了共同动脉干瓣膜、室间隔缺损和房间隔缺损，以及再次进行右心室流出道重建。术后第七天成功移除了右心室辅助装置。由于肺动脉细小，心室辅助装置植入术后严重的肺动脉狭窄持续存在，但通过多次肺血管成形术逐渐有所改善。该患者已被列入日本器官移植网络，目前在稳定状态下等待供体器官。
