左侧胸骨旁小切口左心减压在儿科体外膜氧合中的应用
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摘要
目的探讨左侧胸骨旁小切口左心减压,在体外膜氧合(ECMO)支持下的儿童暴发性心肌炎患者应用的可行性和有效性。方法回顾2017年7月至2018年10月本中心3例采用左侧胸骨旁小切口左心减压的暴发性心肌炎患儿的病历资料,分析经胸骨旁小切口左心减压对心功能影响和预后。结果 3例患儿左心减压手术过程顺利,术中未出现大出血。左心减压术后左心进行性增大停止,收缩功能明显改善。2例存活出院,1例死亡。结论静脉-动脉ECMO支持下严重心功能不全患儿,左侧胸骨旁小切口左心减压术是有效的,并能改善左心功能。
Objective To evaluate the efficacy and feasibility of left atrial decompression via minithoracotomy in pediatric patients with fulminant myocarditis undergoing extracorporeal membrane oxygenation( ECMO). Methods From July 2017 to October2018,3 children with acute fulminant myocarditis underwent ECMO support for cardiac failure and received left atrial decompression via minithoracotomy in our center. Their cardiac function and outcomes were analysed after the left arterial decompression. Results Left atrial decompression surgery was safely performed in all 3 children. Their left ventricular function improved and left heart stopped dilating further. Case 1 and case 3 survived to hospital discharge and case 2 died for severe brain damage. Conclusion For pediatric patients with severe left ventricular dysfunction,ECMO support with left atrial decompression via minithoracotomy is effective in improving their left ventricular function.
Objective To evaluate the efficacy and feasibility of left atrial decompression via minithoracotomy in pediatric patients with fulminant myocarditis undergoing extracorporeal membrane oxygenation( ECMO). Methods From July 2017 to October2018,3 children with acute fulminant myocarditis underwent ECMO support for cardiac failure and received left atrial decompression via minithoracotomy in our center. Their cardiac function and outcomes were analysed after the left arterial decompression. Results Left atrial decompression surgery was safely performed in all 3 children. Their left ventricular function improved and left heart stopped dilating further. Case 1 and case 3 survived to hospital discharge and case 2 died for severe brain damage. Conclusion For pediatric patients with severe left ventricular dysfunction,ECMO support with left atrial decompression via minithoracotomy is effective in improving their left ventricular function.
引文
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[2] Jung SY,Shin HJ,Jung JW,et al. Extracorporeal life support can be a first-line treatment in children with acute fulminant myocarditis[J]. Interact Cardiovasc Thorac Surg,2016,23(2):247-252.
[3] Kim HE,Junq JW,Shin YR,et al. Left atrial decompression by percutaneous left atrial venting cannula insertion during venoarterial extracorporeal membrane oxygenation support[J]. Korean J Thorac Cardiovasc Surg,2016,49(3):203-206.
[4] Hacking DF,Best D,d’Udekem Y,et al. Elective decompression of the left ventricle in pediatric patients may reduce the duration of venoarterial extracorporeal membrane oxygenation[J]. Artif Organs,2015,39(4):319-326.
[5] Yamamoto M,Oshima Y,Matsuhisa H,et al. Left atrial decompression via minithoracotomy during extracorporeal life support[J].The Annals of Thoracic Surgery(2018),doi:https://doi. org/10.1016/j.athoracsur. 2018. 07. 084.
[6] Matsushima S,Oshima Y,Maruo A,et al. A left anterior extrapleural approach to adjust right ventricle-pulmonary artery shunt flow using hemostatic clips after the norwood operation[J]. J Card Surg,2015,30(6):532-534.
[7] Kotani Y,Chetan D,Rodrigues W,et al. Left atrial decompression during venoarterial extracorporeal membrane oxygenation for left ventricular failure in children:current strategy and clinical outcomes[J]. Artif Organs,2012,37(1):29-36.
[2] Jung SY,Shin HJ,Jung JW,et al. Extracorporeal life support can be a first-line treatment in children with acute fulminant myocarditis[J]. Interact Cardiovasc Thorac Surg,2016,23(2):247-252.
[3] Kim HE,Junq JW,Shin YR,et al. Left atrial decompression by percutaneous left atrial venting cannula insertion during venoarterial extracorporeal membrane oxygenation support[J]. Korean J Thorac Cardiovasc Surg,2016,49(3):203-206.
[4] Hacking DF,Best D,d’Udekem Y,et al. Elective decompression of the left ventricle in pediatric patients may reduce the duration of venoarterial extracorporeal membrane oxygenation[J]. Artif Organs,2015,39(4):319-326.
[5] Yamamoto M,Oshima Y,Matsuhisa H,et al. Left atrial decompression via minithoracotomy during extracorporeal life support[J].The Annals of Thoracic Surgery(2018),doi:https://doi. org/10.1016/j.athoracsur. 2018. 07. 084.
[6] Matsushima S,Oshima Y,Maruo A,et al. A left anterior extrapleural approach to adjust right ventricle-pulmonary artery shunt flow using hemostatic clips after the norwood operation[J]. J Card Surg,2015,30(6):532-534.
[7] Kotani Y,Chetan D,Rodrigues W,et al. Left atrial decompression during venoarterial extracorporeal membrane oxygenation for left ventricular failure in children:current strategy and clinical outcomes[J]. Artif Organs,2012,37(1):29-36.