体外膜肺氧合治疗左冠状动脉异常起源于肺动脉患儿术后休克1例并文献复习

Extracorporeal membrane oxygenation treat postcardiotomy shock of anomalous origin of left coronary artery from pulmonary artery:a case report

目的 报告1例左冠状动脉起源于肺动脉(ALCAPA)患儿心脏术后休克(PCS)使用体外膜肺氧合(ECMO)治疗成功的案例及文献复习.方法 对2017年上海市儿童医院心胸外科收治的1例诊断为ALCAPA并行左冠状动脉异常起源矫治术及ECMO治疗的患儿的临床资料进行分析,并文献回顾及前景展望.结果 4个月大男孩,因"生长发育迟缓4个月,咳嗽4天"入院,入院后予以强心,利尿,控制肺部炎症等治疗,完善心脏超声及CTA,确诊为左冠状动脉异常起源于肺动脉,在体外循环下行"左冠状动脉异常起源矫治术",术后出现反复室颤,心脏衰竭,休克,无法撤离体外循环,遂行ECMO治疗(左心耳及右心耳插管引流;升主动脉插管灌注).生命体征平稳后逐渐下调ECMO流量,于术后第8天撤离ECMO(LVEF 37%),术后第29天出院(LVEF 50%).结论 尽早发现并及时手术处理对ALCAPA患者的预后至关重要.近年来国内ECMO用于治疗儿童心脏术后休克呈增加趋势,ECMO治疗成功的关键是早期实施,小儿多学科协作的ECMO管控模式有助于总体成功率的提高.

Objective Report one case of child with postcardiotomy shock (PCS)of left coronary artery originated from pulmonary artery (ALCAPA)was treated by extracorporeal membrane oxygenation (ECMO). Methods The clinical data of one patient with ALCAPA experienced left coronary artery transplantation and EC- MO in the Children's Hospital of Shanghai in 2017were analyzed,then the literatures and prospect were re- viewed.Results A 4months old boy was admitted to hospital for "4months of growth retardation,4days of coughing".After admission,he was treated with myocardial contractility strengthening,diuresis and control of pulmonary inflammation.He was diagnosed as ALCAPA after cardiac ultrasound and CTA.The left coronary ar- tery transplantation under extracorporeal circulation was operated on hin.Then recurrent ventricular fibrillation, heart failure and shock after operation can not be evacuated from cardiopulmonary bypass.The ECMO treatment (left atrial appendage and fight atrial appendage intubation drainage,ascending aorta cannula perfusion)was per- formed immediately.After stable vital signs,ECMO flow was gradually reduced and ECMO (LVEF 37%)was evacuated on the 8th day after operation and discharged on the 29th day after operation(LVEF 50%).Conclusion Early detection and timely operation is very important for the prognosis of patients with ALCAPA.In recent years, ECMO used to treat children's PCS has been increasing at home.The key to the success of ECMO treatment is ear- ly implementation.The ECMO with multidisciplinary collaboration will help to improve the overall success rate.