Extracorporeal Membrane Oxygenation-IMPELLA（ECPELLA）により救命しえた劇症型心筋炎の1 例 ：治療ストラテジーの提案
症例は61歳男性，入院の約1週間前からの感冒様症状と呼吸困難で他院を受診．心機能低下と心筋トロポニンI上昇から心筋炎を疑われ当院へ転院搬送となった．救急到着時，血圧88/63 mmHg，脈拍104回/分，安静時12誘導心電図は広範なST上昇を伴う促進性接合部調律を示した．経胸壁心臓超音波検査では顕著な心筋浮腫を伴う全周性の壁運動低下（LVEF 10％）を認めた．低拍出症候群による多臓器不全を呈しており緊急でIMPELLA CPを挿入した．正常冠動脈であったことから劇症型心筋炎と臨床診断した．右心カテーテル検査の結果，肺動脈拍動指数（Pulmonary Artery Pulsatility in...
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| Published in | 心臓 Vol. 56; no. 1; pp. 67 - 76 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
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公益財団法人 日本心臓財団
15.01.2024
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| Online Access | Get full text |
| ISSN | 0586-4488 2186-3016 |
| DOI | 10.11281/shinzo.56.67 |
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| Abstract | 症例は61歳男性，入院の約1週間前からの感冒様症状と呼吸困難で他院を受診．心機能低下と心筋トロポニンI上昇から心筋炎を疑われ当院へ転院搬送となった．救急到着時，血圧88/63 mmHg，脈拍104回/分，安静時12誘導心電図は広範なST上昇を伴う促進性接合部調律を示した．経胸壁心臓超音波検査では顕著な心筋浮腫を伴う全周性の壁運動低下（LVEF 10％）を認めた．低拍出症候群による多臓器不全を呈しており緊急でIMPELLA CPを挿入した．正常冠動脈であったことから劇症型心筋炎と臨床診断した．右心カテーテル検査の結果，肺動脈拍動指数（Pulmonary Artery Pulsatility index；PAPi） 0.5と右心不全の合併を認めたため，体外式膜型人工肺（Veno-Atrial ExtraCorporeal Membrane Oxygenation；V-A ECMO）を追加挿入した．第4病日より心収縮の改善を認め，第5病日にはV-A ECMOを離脱．第7病日にはIMPELLA CPを抜去した．心筋生検結果から劇症型心筋炎の診断が確定した．以降の経過は良好であり，第32病日に独歩で自宅退院となった．PAPiを含む血行動態指標を考慮し，適切にIMPELLA CPとV-A ECMOを併用することで救命しえた劇症型心筋炎の1例を報告する． |
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| AbstractList | 症例は61歳男性，入院の約1週間前からの感冒様症状と呼吸困難で他院を受診．心機能低下と心筋トロポニンI上昇から心筋炎を疑われ当院へ転院搬送となった．救急到着時，血圧88/63 mmHg，脈拍104回/分，安静時12誘導心電図は広範なST上昇を伴う促進性接合部調律を示した．経胸壁心臓超音波検査では顕著な心筋浮腫を伴う全周性の壁運動低下（LVEF 10％）を認めた．低拍出症候群による多臓器不全を呈しており緊急でIMPELLA CPを挿入した．正常冠動脈であったことから劇症型心筋炎と臨床診断した．右心カテーテル検査の結果，肺動脈拍動指数（Pulmonary Artery Pulsatility index；PAPi） 0.5と右心不全の合併を認めたため，体外式膜型人工肺（Veno-Atrial ExtraCorporeal Membrane Oxygenation；V-A ECMO）を追加挿入した．第4病日より心収縮の改善を認め，第5病日にはV-A ECMOを離脱．第7病日にはIMPELLA CPを抜去した．心筋生検結果から劇症型心筋炎の診断が確定した．以降の経過は良好であり，第32病日に独歩で自宅退院となった．PAPiを含む血行動態指標を考慮し，適切にIMPELLA CPとV-A ECMOを併用することで救命しえた劇症型心筋炎の1例を報告する． |
| Author | 大井, 拓馬 後藤, 弘樹 間宮, 章 神崎, 泰範 岩脇, 友哉 下條, 一樹 中川, 雄太 荒尾, 嘉人 柴田, 直紀 宮澤, 宏幸 唐澤, 星人 森田, 康弘 吉岡, 直輝 森島, 逸郎 渡邊, 直樹 |
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| References | 11）Basir MB, Schreiber T, Dixon S, et al：Feasibility of early mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock：The Detroit cardiogenic shock initiative. Catheter Cardiovasc Interv 2018；91：454-461 5）Kondo T, Okumura T, Shibata N, et al：Differences in Prognosis and Cardiac Function According to Required Percutaneous Mechanical Circulatory Support and Histological Findings in Patients With Fulminant Myocarditis：Insights From the CHANGE PUMP 2 Study. J Am Heart Assoc 2022；11：e023719 4）Kanaoka K, Onoue K, Terasaki S, et al：Features and Outcomes of Histologically Proven Myocarditis With Fulminant Presentation. Circulation 2022；146：1425-1433 6）田邊すばる，安藤博彦，中野雄介，ほか：循環補助用ポンプカテーテルIMPELLA CPにて救命し得た劇症型心筋炎の1例．心臓 2022；54：387-395 13）Saku K, Kakino T, Arimura T, et al：Total Mechanical Unloading Minimizes Metabolic Demand of Left Ventricle and Dramatically Reduces Infarct Size in Myocardial Infarction. PLoS One 2016；11：e0152911 3）Morishima I, Sassa H, Sone T, et al：A case of fulminant myocarditis rescued--by long-term percutaneous cardiopulmonary support. Jpn Circ J 1994；58：433-438 14）Suga H, Hayashi T, Shirahata M：Ventricular systolic pressure-volume area as predictor of cardiac oxygen consumption. Am J Physiol 1981；240：H39-H44 15）O’Neill WW, Schreiber T, Wohns DH, et al：The current use of Impella 2.5 in acute myocardial infarction complicated by cardiogenic shock：results from the USpella Registry. J Interv Cardiol 2014；27：1-11 8）Korabathina R, Heffernan KS, Paruchuri V, et al：The pulmonary artery pulsatility index identifies severe right ventricular dysfunction in acute inferior myocardial infarction. Catheter Cardiovasc Interv 2012；80：593-600 17）Patel SM, Lipinski J, Al-Kindi SG, et al：Simultaneous Venoarterial Extracorporeal Membrane Oxygenation and Percutaneous Left Ventricular Decompression Therapy with Impella Is Associated with Improved Outcomes in Refractory Cardiogenic Shock. ASAIO J 2019；65：21-28 19）Batchelor RJ, Wheelahan A, Zheng WC, et al：Impella versus Venoarterial Extracorporeal Membrane Oxygenation for Acute Myocardial Infarction Cardiogenic Shock：A Systematic Review and Meta-Analysis. J Clin Med 2022；11：3955 1）日本循環器学会：2023年改訂版心筋炎の診断・治療に関するガイドライン．https://www.j-circ.or.jp/cms/wp-content/uploads/2023/03/JCS2023_nagai.pdf（cited 2023 Sep 01 7）Pappalardo F, Scandroglio AM, Latib A：Full percutaneous biventricular support with two Impella pumps：the Bi-Pella approach. ESC Heart Fail 2018；5：368-371 16）Pappalardo F, Schulte C, Pieri M, et al：Concomitant implantation of Impella® on top of veno-arterial extracorporeal membrane oxygenation may improve survival of patients with cardiogenic shock. Eur J Heart Fail2017；19：404-412 18）Ouweneel DM, Eriksen E, Sjauw KD, et al：Percutaneous Mechanical Circulatory Support Versus Intra-Aortic Balloon Pump in Cardiogenic Shock After Acute Myocardial Infarction. J Am Coll Cardiol 2017；69：278-287 12）Zein R, Patel C, Mercado-Alamo A, et al：A Review of the Impella Devices. Interv Cardiol 2022；17：e05 10）Van Linthout S, Tschöpe C：Inflammation - Cause or Consequence of Heart Failure or Both? Curr Heart Fail Rep 2017；14：251-265 9）Tschöpe C, Van Linthout S, Klein O, et al：Mechanical Unloading by Fulminant Myocarditis：LV-IMPELLA, ECMELLA, BI-PELLA, and PROPELLA Concepts. J Cardiovasc Transl Res 2019；12：116-123 20）Lim HS, Gustafsson F：Pulmonary artery pulsatility index：physiological basis and clinical application. Eur J Heart Fail 2020；22：32-38 2）Tsuboi H, Sone T, Sassa H, et al：Rescue of a patient with fulminant myocarditis by percutaneous extracorporeal bypass. Jpn J Med 1990；29：519-522 |
| References_xml | – reference: 14）Suga H, Hayashi T, Shirahata M：Ventricular systolic pressure-volume area as predictor of cardiac oxygen consumption. Am J Physiol 1981；240：H39-H44 – reference: 8）Korabathina R, Heffernan KS, Paruchuri V, et al：The pulmonary artery pulsatility index identifies severe right ventricular dysfunction in acute inferior myocardial infarction. Catheter Cardiovasc Interv 2012；80：593-600 – reference: 6）田邊すばる，安藤博彦，中野雄介，ほか：循環補助用ポンプカテーテルIMPELLA CPにて救命し得た劇症型心筋炎の1例．心臓 2022；54：387-395 – reference: 16）Pappalardo F, Schulte C, Pieri M, et al：Concomitant implantation of Impella® on top of veno-arterial extracorporeal membrane oxygenation may improve survival of patients with cardiogenic shock. Eur J Heart Fail2017；19：404-412 – reference: 2）Tsuboi H, Sone T, Sassa H, et al：Rescue of a patient with fulminant myocarditis by percutaneous extracorporeal bypass. Jpn J Med 1990；29：519-522 – reference: 17）Patel SM, Lipinski J, Al-Kindi SG, et al：Simultaneous Venoarterial Extracorporeal Membrane Oxygenation and Percutaneous Left Ventricular Decompression Therapy with Impella Is Associated with Improved Outcomes in Refractory Cardiogenic Shock. ASAIO J 2019；65：21-28 – reference: 7）Pappalardo F, Scandroglio AM, Latib A：Full percutaneous biventricular support with two Impella pumps：the Bi-Pella approach. ESC Heart Fail 2018；5：368-371 – reference: 9）Tschöpe C, Van Linthout S, Klein O, et al：Mechanical Unloading by Fulminant Myocarditis：LV-IMPELLA, ECMELLA, BI-PELLA, and PROPELLA Concepts. J Cardiovasc Transl Res 2019；12：116-123 – reference: 3）Morishima I, Sassa H, Sone T, et al：A case of fulminant myocarditis rescued--by long-term percutaneous cardiopulmonary support. Jpn Circ J 1994；58：433-438 – reference: 18）Ouweneel DM, Eriksen E, Sjauw KD, et al：Percutaneous Mechanical Circulatory Support Versus Intra-Aortic Balloon Pump in Cardiogenic Shock After Acute Myocardial Infarction. J Am Coll Cardiol 2017；69：278-287 – reference: 19）Batchelor RJ, Wheelahan A, Zheng WC, et al：Impella versus Venoarterial Extracorporeal Membrane Oxygenation for Acute Myocardial Infarction Cardiogenic Shock：A Systematic Review and Meta-Analysis. J Clin Med 2022；11：3955 – reference: 1）日本循環器学会：2023年改訂版心筋炎の診断・治療に関するガイドライン．https://www.j-circ.or.jp/cms/wp-content/uploads/2023/03/JCS2023_nagai.pdf（cited 2023 Sep 01） – reference: 15）O’Neill WW, Schreiber T, Wohns DH, et al：The current use of Impella 2.5 in acute myocardial infarction complicated by cardiogenic shock：results from the USpella Registry. J Interv Cardiol 2014；27：1-11 – reference: 10）Van Linthout S, Tschöpe C：Inflammation - Cause or Consequence of Heart Failure or Both? Curr Heart Fail Rep 2017；14：251-265 – reference: 5）Kondo T, Okumura T, Shibata N, et al：Differences in Prognosis and Cardiac Function According to Required Percutaneous Mechanical Circulatory Support and Histological Findings in Patients With Fulminant Myocarditis：Insights From the CHANGE PUMP 2 Study. J Am Heart Assoc 2022；11：e023719 – reference: 11）Basir MB, Schreiber T, Dixon S, et al：Feasibility of early mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock：The Detroit cardiogenic shock initiative. Catheter Cardiovasc Interv 2018；91：454-461 – reference: 12）Zein R, Patel C, Mercado-Alamo A, et al：A Review of the Impella Devices. Interv Cardiol 2022；17：e05 – reference: 13）Saku K, Kakino T, Arimura T, et al：Total Mechanical Unloading Minimizes Metabolic Demand of Left Ventricle and Dramatically Reduces Infarct Size in Myocardial Infarction. PLoS One 2016；11：e0152911 – reference: 4）Kanaoka K, Onoue K, Terasaki S, et al：Features and Outcomes of Histologically Proven Myocarditis With Fulminant Presentation. Circulation 2022；146：1425-1433 – reference: 20）Lim HS, Gustafsson F：Pulmonary artery pulsatility index：physiological basis and clinical application. Eur J Heart Fail 2020；22：32-38 |
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| Snippet | 症例は61歳男性，入院の約1週間前からの感冒様症状と呼吸困難で他院を受診．心機能低下と心筋トロポニンI上昇から心筋炎を疑われ当院へ転院搬送となった．救急到着時，血圧88/63... |
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| SubjectTerms | IMPELLA Pulmonary Artery Pulsatility Index V-A ECMO 劇症型心筋炎 |
| Title | Extracorporeal Membrane Oxygenation-IMPELLA（ECPELLA）により救命しえた劇症型心筋炎の1 例 ：治療ストラテジーの提案 |
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