In vivo Visualization of the Blood Separation in the Left Ventricular Chamber; A Case of Fulminant Myocarditis Requiring Veno-arterial Extracorporeal Membrane Oxygenation
In vivo Visualization of the Blood Separation in the Left Ventricular Chamber; A Case of Fulminant Myocarditis Requiring Veno-arterial Extracorporeal Membrane Oxygenation
复制标题
左心室血液分离的体内可视化；
DOI：
10.1007/s00134-016-4502-5
复制
发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Ito H.
中科院分区：
文献类型：
--
作者：
Iwakawa H;Watanabe H;Iino T;Ito H.
一位33岁的女性被诊断为暴发性心肌炎。超声心动图显示严重的左心室（LV）运动功能减退，伴弥漫性室壁运动异常（射血分数，20%）（图1a）。患者的血流动力学迅速恶化，伴有缺氧和无法测量的血压;因此，我们进行了静脉动脉体外膜肺氧合（VA-ECMO）、使用主动脉内球囊泵插管和静脉输注肝素。VA-ECMO流量维持在3-4 L/min，活化部分凝血活酶时间为98 s。仅在开始VA-ECMO后3小时，超声心动图显示主动脉瓣关闭和左心室沉降。由于比重的差异，沉淀物明显分离为上清液和污泥组分，模拟血液分离（图1 B，c，视频1）。尽管主动脉瓣关闭，仍观察到血液通过二尖瓣移动（图1d）;这可能防止了LV流入道中的淤渣形成。尽管进行了血栓切除术并植入了LV辅助装置，但患者仍发生了致命性多器官衰竭。病理尸检证实心肌炎（图1 e）。在严重心肌功能不全的患者中，VA-ECMO循环处于非生理性
A 33-year-old woman was admitted with a clinical diagnosis of fulminant myocarditis. Echocardiography showed severe left ventricular (LV) hypokinesis, with diffuse wall motion abnormalities (ejection fraction, 20%)(Fig. 1 a). The patient developed rapidly worsening hemodynamics with hypoxia and an unmeasurable blood pressure; we therefore performed venoarterial extracorporeal membrane oxygenation (VA-ECMO), intubation with use of an intra-aortic balloon pump, and intravenous heparin infusion. The VA-ECMO flow was maintained at 3–4 L/min. The activated partial thromboplastin time was 98 s. Only 3 h after initiating VA-ECMO, echocardiography revealed aortic valve closure and sedimentation in the LV chamber. The sedimentation was clearly separated into supernatant and sludge components as a result of the difference in specific gravity, mimicking blood separation (Fig. 1 b, c, Video 1). Despite the aortic valve closure, blood movement through the mitral valve was still observed (Fig. 1 d); this might have prevented sludge formation in the LV inflow tract. Despite thrombectomy and implantation of an LV assist device, the patient developed fatal multiorgan failure. Pathology autopsy confirmed myocarditis (Fig. 1 e). In patients with severe myocardial dysfunction, VA-ECMO circulation in a nonphysiological