Various problems during long-term percutaneous cardiopulmonary support.
A 54-year-old man with a left ventricular free wall rupture following acute anterior myocardial infarction underwent a repair surgery with percutaneous cardiopulmonary support (PCPS). During surgery and postoperatively, PCPS provided sufficient support flow. The patient was successfully weaned from PCPS on the 15th postoperative day and discharged subsequently. In the management of cardiac rupture patients, PCPS has the merit of preventing rupture progression and the advantage of recovery of pulmonary function. However, there are several problems to solve. The support effectiveness and recovery of the patient's heart should be carefully evaluated. Effective left heart decompression also needs to be established. Heparin-coated circuits still need proper anticoagulation treatment to prevent thrombus formation especially while support flow is low. A circuit construction that allows easier maintenance and safer exchange of oxygenators and pump heads is suggested. Ischemia of the cannulated leg should be prevented by femoral artery perfusion.
Ihno
T
T
Department of Clinical Engineering, Tokyo Metropolitan Hiroo General Hospital, Japan.
Nakagawa
T
T
Furukawa
H
H
Shimizu
K
K
Egi
K
K
Maemura
T
T
Motomiya
T
T
D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000627:therapeutic use; D001550:Benzamidines; D001804:Blood Transfusion, Autologous; D002315:Cardiopulmonary Bypass / Q000379:methods*; D003326:Coronary Circulation / Q000502:physiology; D006146:Guanidines / Q000627:therapeutic use; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D006342:Heart Rupture, Post-Infarction / Q000601:surgery / Q000628:therapy*; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007269:Injections, Intra-Arterial; D007423:Intra-Aortic Balloon Pumping; D007511:Ischemia / Q000517:prevention & control; D007866:Leg / Q000098:blood supply; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy / Q000628:therapy; D010107:Oxygenators, Membrane; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D016896:Treatment Outcome
D000925:Anticoagulants; D001550:Benzamidines; D006146:Guanidines; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator; C032855:nafamostat