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在急性心肌梗塞机械并发症的紧急手术后使用Impella 5.5进行左心室卸载疗法:病例报告

Kenji Iino¹, Yoshitaka Yamamoto², Hideyasu Ueda²

¹Department of Cardiovascular Surgery, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan. knj.iino@gmail.com.

Journal of cardiothoracic surgery

|June 26, 2024

概括

在急性心肌梗塞 (AMI) 机械并发症的紧急手术后,Impella 5.5有效地卸载左心室 (LV). 将Impella与VA-ECMO结合使用有助于管理心室隔膜破裂 (VSR) 和右心衰竭.

科学领域:

心脏病学心脏病学
心脏外科手术心脏外科手术
机械循环支持机械循环支持

背景情况:

在急性心肌梗塞 (AMI) 之后的左心室自由壁破裂 (LVFWR) 和心室隔膜破裂 (VSR) 的手术死亡率很高.
左心室 (LV) 卸载至关重要,以减少脆弱修复部位的压力,并预防出血和补丁脱落等并发症.
AMI的机械并发症需要先进的治疗策略来改善患者的治疗结果.

研究的目的:

评估Impella 5.5对左心室 (LV) 卸载在急性心肌梗塞 (AMI) 机械并发症的紧急手术患者的疗效.
评估Impella 5.5和静脉脉外体膜氧化 (VA-ECMO) 在管理复杂病例,包括右心衰竭病例的联合使用.

主要方法:

介绍了两例急性心肌梗塞 (AMI) 机械并发症 (LVFWR和VSR) 的患者.
在紧急手术修复后,为左心室 (LV) 卸载植入了Impella 5.5.
一名患者还接受了动脉外体膜氧化 (VA-ECMO) 治疗并发性右心衰竭.

主要成果:

Impella 5.5 促进了 LV 卸载,降低了壁面张力,并最大限度地减少了手术后的脉动性.
术后成像证实,在LVFWR病例中,LV修复部位的对比度没有泄漏.
在用Impella 5.5和VA-ECMO管理的VSR病例中,在术后没有检测到残留的分流.

结论:

在急性心肌梗塞 (AMI) 的机械并发症需要紧急手术的患者中,Impella 5.5 作为左心室 (LV) 卸载的有效工具.
佩拉5.5和VA-ECMO的组合为管理心室隔膜破裂 (VSR) 与相关的右侧心力衰竭提供了一种可行的策略.

关键词:

剧烈的心肌梗塞急性心肌梗塞这就是Impella Impella.左心室自由壁的破裂.室腔隔膜破裂室腔隔膜破裂

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