Kroshus T J, Kshettry V R, Hertz M I, Everett J E, Bolman R M
Division of Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis 55455.
Ann Thorac Surg. 1995 Apr;59(4):995-7. doi: 10.1016/0003-4975(94)00734-o.
Right ventricular outflow tract obstruction, or "suicide right ventricle," rarely has been observed after single or bilateral single-lung transplantation for the treatment of Eisenmenger syndrome. We describe our experience in 2 patients with Eisenmenger syndrome in whom right ventricular outflow tract obstruction developed, in 1 after single-lung transplantation and ventricular septal defect repair and in the other after bilateral single-lung transplantation. Both patients suffered progressive deterioration and hemodynamic instability that was unresponsive to aggressive medical therapy. Diagnosis was confirmed in both patients by transesophageal echocardiography. Operative intervention was undertaken 72 and 24 hours after transplantation, and consisted of myectomy and outflow tract patching. One patient survived; the other died intraoperatively. The index of suspicion for this problem should be high during the intraoperative performance of transesophageal echocardiography, as well as during direct gradient measurement, with consideration of immediate management of severe right ventricular outflow tract obstruction at the time of transplantation.
右心室流出道梗阻，即“自杀性右心室”，在单肺或双侧单肺移植治疗艾森曼格综合征后很少见。我们描述了2例艾森曼格综合征患者出现右心室流出道梗阻的经历，1例在单肺移植和室间隔缺损修复后出现，另1例在双侧单肺移植后出现。两名患者均出现进行性恶化和血流动力学不稳定，积极的药物治疗无效。经食管超声心动图证实了两名患者的诊断。移植后72小时和24小时进行了手术干预，包括心肌切除术和流出道修补术。1例患者存活；另1例在术中死亡。在术中进行经食管超声心动图检查以及直接梯度测量时，对此问题的怀疑指数应较高，并考虑在移植时立即处理严重的右心室流出道梗阻。
