心臓移植術5ヵ月後に行われた超低体温人工心肺下仮性大動脈瘤修復術の麻酔経験  [in Japanese] Anesthetic Management of a Heart Transplant Recipient Undergoing Ascending Aortoplasty with a Homograft Patch  [in Japanese]

Access this Article

Search this Article

Author(s)

Abstract

  今回,われわれは心臓移植後,比較的早期の超低体温人工心肺下上行大動脈パッチ形成術というまれな症例の麻酔管理を経験した.症例は16歳男性,拡張型心筋症に対して左室補助人工循環装置(left ventricular assist device:LVAD)を装着後,心臓移植が施行され,5ヵ月が経過していた.移植の際,癒着剥離に難渋し上行大動脈にLVADのアウトレットカニューラの一部が遺残した.術後,同部位が感染し仮性動脈瘤となったため,ホモグラフトによる人工血管置換術を施行した.免疫抑制剤の使用による免疫機能低下,感染制御に留意し周術期管理を行った.移植心の心機能は良好であったが,除神経心であることを考慮し,心拍出量を保持するため適切な容量負荷を行うことで安全に麻酔管理を行うことができた.

  A 16 year-old male heart transplant recipient underwent aortoplasty with a homograft patch for pseudoaneurysm of the ascending aorta with extracorporeal circulation (ECC). The patient had undergone cardiac transplantation 5 months before for dilated cardiomyopathy. During this procedure, a piece of an arterial cannula was accidentally left in. Subsequently, this piece developed a pseudoaneurysm due to infection. He had not developed significant transplant complications. His physical status was satisfactory and the preoperative laboratory data were within normal limits apart from anemia (Hb 7.2 g/d<I>l</I>). General anesthesia was induced and maintained with propofol, remifentanil and rocuronium.<br>  The circulatory system was maintained satisfactorily during the peri-operative period by ensuring sufficient fluid preloading in order to maintain adequate cardiac output from the denervated heart.

Journal

  • THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA

    THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA 33(1), 101-105, 2013-01-06

    THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA

References:  6

Codes

  • NII Article ID (NAID)
    10031147877
  • NII NACSIS-CAT ID (NCID)
    AN00330159
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    02854945
  • Data Source
    CJP  J-STAGE 
Page Top