■在全腔肺动脉的成年患者中使用主动脉内球囊反搏(IABP)的证据有限,或Fontan循环。
■一名二十多岁的Fontan循环患者出现败血症,肺炎,和肺水肿.他出生时左心室发育不全,房室间隔缺损,和发育不良的主动脉弓,在他出生后的头几年就建立了完整的腔肺循环。抗生素护理治疗的标准,无创通气支持,loop利尿剂,并启动了加压药。由于持续的肺充血和增加的全身疲劳,通过股动脉放置IABP,以卸载衰竭的全身心室.继发于IABP治疗,平均动脉压上升,可以引入血管舒张的硝普钠。超过4天的IABP治疗,患者的一般情况和心室收缩功能明显改善。
■此病例表明IABP治疗对于Fontan循环患者的恢复很重要,肺炎,和心力衰竭。我们建议在IABP治疗期间,实现了每搏输出量的增加和心室充盈压力的降低,从而增加了Fontan患者肺血流的中心性经肺压力梯度。需要更明确的证据来证实我们的假设。
UNASSIGNED: There is limited evidence for the use of an intra-aortic balloon pump (IABP) in adult patients with a total cavopulmonary, or Fontan circulation.
UNASSIGNED: A patient in his twenties with a Fontan circulation presented with sepsis, pneumonia, and pulmonary oedema. He was born with a hypoplastic left ventricle, atrioventricular septal defect, and hypoplastic aortic arch, and a total cavopulmonary circulation had been established within his first years of life. Standard of care treatment with antibiotics, non-invasive ventilatory support, loop diuretics, and vasopressors was initiated. Due to persistent pulmonary congestion and increasing general fatigue, an IABP was placed via a femoral artery to offload the failing systemic ventricle. Secondary to IABP treatment, mean arterial pressure rose, and vasodilatory nitroprusside could be introduced. Over 4 days of IABP treatment, the patient\'s general condition and ventricular systolic function improved significantly.
UNASSIGNED: This
case suggests that IABP treatment was important in the recovery of our patient with a Fontan circulation, pneumonia, and heart failure. We propose that during IABP treatment, an increase in stroke volume and a reduction in ventricular filling pressure is achieved, thereby increasing the transpulmonary pressure gradient that is central to pulmonary blood flow in Fontan patients. More definitive evidence is necessary to confirm our hypotheses.