PDF(Pubmed)
Abstract：
A 70-year-old man with dilated cardiomyopathy underwent left ventricular assist device (LVAD) implantation, using a HeartWare ventricular assist device, as a bridge to candidacy. After 26 months, computed tomography (CT) angiography indicated stenosis in the LVAD outflow graft; however, the patient was asymptomatic, prompting a decision to manage his condition with close monitoring. Ten months later, the patient presented with dizziness and low-flow alerts. Subsequent CT angiography revealed a critical obstruction involving the entire LVAD outflow graft. The patient underwent emergency surgery, during which an organized seroma causing the graft obstruction was found between a wrapped expanded polytetrafluoroethylene (ePTFE) graft and a Dacron outflow graft. The covering of the outflow graft was removed, along with the organized seroma. Following removal of the ePTFE wrap and decompression of the outflow graft, normal LVAD flow was reestablished. The practice of wrapping the outflow graft with synthetic material, commonly done to facilitate later redo sternotomy, may pose a risk for outflow graft obstruction.
摘要：
一名70岁的扩张型心肌病患者接受了左心室辅助装置（LVAD）植入，使用HeartWare心室辅助装置,作为候选人的桥梁。26个月后,计算机断层扫描（CT）血管造影显示LVAD流出移植物狭窄；然而，病人无症状,促使决定通过密切监测来管理他的病情。十个月后,患者出现头晕和低流量警报。随后的CT血管造影显示涉及整个LVAD流出移植物的严重阻塞。病人接受了紧急手术,在此期间，在包裹的膨化聚四氟乙烯（ePTFE）移植物和涤纶流出移植物之间发现了导致移植物阻塞的有组织的血清肿。去除流出移植物的覆盖物，还有有组织的血清肿。在移除ePTFE包裹物并减压流出移植物后，正常LVAD血流重建。用合成材料包裹流出移植物的做法，通常是为了方便以后再行胸骨切开术，可能会造成流出移植物阻塞的风险。
