经皮房间隔造口左心引流在静-动脉体外膜肺氧合治疗中的应用

目的观察经皮房间隔造口术在静-动脉体外膜肺氧合(V-A ECMO)治疗中的左心引流效果,探讨其安全性、有效性。方法回顾性分析2017年3月至2019年1月9例接受V-A ECMO治疗时以房间隔造口手术进行左心引流的患者临床资料,其中男5例,女4例;年龄12~72岁。心脏外科术后顽固性低心排血量综合征4例,重症病毒性心肌炎3例,急性心肌梗死2例。记录患者基础资料、手术数据、转归与随访结果等临床资料。结果全组患者均成功完成经皮房间隔造口术,平均手术时间42.2 min。术后出现前纵隔血肿1例。ECMO辅助期间无肺水肿或血栓形成事件,无再做治疗关闭房间隔造口。结论经皮房间隔造口手术可安全有效地进行左心引流,利于严重左心衰患者术后恢复。

Application of ballon atrial septostomy for left heart venting during extracorporeal membrane oxygenation

Objective To discuss whether balloon atrial septostomy(BAS)can provide safe and effective left ventricular venting for venoarterial extracorporeal membrane oxygenation(V-A ECMO).Methods From March 2017 to January 2019,9 patients received BAS for left ventricular venting during V-A ECMO treatment in our hospital,including 5 males and 4 females,aged 12-72 years.There were 3 cases of severe myocarditis,4 cases of low cardiac output after cardiac surgery,and 2 cases of acute myocardial infarction.Basic data,procedure data,outcome and follow-up were recorded.Results BAS were successfully performed in 9 patients.Procedure time on average was 42.2 min.Anterior mediastinal hematoma occurred in 1 case.There were no other procedure-related complications in the rest cases.No pulmonary edema or thrombosis occurred in all 9 cases during ECMO.No closure procedure was performed.Conclusion BAS is a safe and effective method for left ventricular venting.The procedure is conductive to the recovery of patients with severe left heart failure.