Cofer B R, Warner B W, Stallion A, Ryckman F C
Division of Pediatric Surgery, Children's Hospital Medical Center, Cincinnati, OH.
J Pediatr Surg. 1993 May;28(5):669-72. doi: 10.1016/0022-3468(93)90028-j.
While most patients with viral myocarditis have a relatively uncomplicated clinical course, a small number of patients will present with cardiogenic shock unresponsive to standard medical therapy. We describe the clinical course of three patients who developed profound cardiac failure secondary to a documented viral myocarditis. Each patient was managed using venoarterial (VA) extracorporeal membrane oxygenation (ECMO) support using the right common carotid artery/internal jugular vein for cannulation. While undergoing ECMO support, each patient developed elevated left-sided cardiac chamber pressures with resultant pulmonary edema. This was managed by balloon atrial septostomy in two cases and combined blade/balloon atrial septostomy in one case. Excellent decompression of the left heart was achieved in each patient. Two patients were successfully weaned from ECMO and are currently alive, with one demonstrating residual cardiac dysfunction. One patient developed global myocardial necrosis and ultimately died. This small series demonstrates a role for ECMO in the management of cardiac failure due to acute viral myocarditis unresponsive to medical therapy. Our experience also suggests that balloon atrial septostomy may be useful to decompress the left atrium and ventricle of patients with acute myocarditis while on ECMO.
虽然大多数病毒性心肌炎患者的临床病程相对简单，但少数患者会出现对标准药物治疗无反应的心源性休克。我们描述了三名因确诊病毒性心肌炎继发严重心力衰竭患者的临床病程。每名患者均采用经右颈总动脉/颈内静脉插管的静脉-动脉（VA）体外膜肺氧合（ECMO）支持治疗。在接受ECMO支持期间，每名患者的左心腔压力均升高，继而出现肺水肿。两例患者通过球囊房间隔造口术治疗，一例患者采用联合刀片/球囊房间隔造口术治疗。每名患者的左心均实现了良好的减压。两名患者成功脱离ECMO，目前存活，其中一名存在残余心脏功能障碍。一名患者发生全心心肌坏死，最终死亡。这一小系列病例表明，ECMO在治疗对药物治疗无反应的急性病毒性心肌炎所致心力衰竭中具有作用。我们的经验还表明，球囊房间隔造口术可能有助于在患者接受ECMO治疗时对急性心肌炎患者的左心房和左心室进行减压。
