日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

We report the experience of physical therapy in a pediatric patient who had undergone heart transplantation after wearing an extracorporeal ventricular assist device (VAD), EXCOR Pediatric (EXCOR). In February year X, a 7-year-old boy with dilated cardiomyopathy presented to a nearby hospital with upper respiratory tract symptoms and abdominal pain. He was transferred to our hospital because of significant enlargement and poor contraction of the left region of the heart. The main diagnosis on the 7th day after the transfer was ventricular tachycardia (VT). He was fitted with a left VAD (Rota Flow), which was converted to EXCOR the following day. On postoperative day 4, we initiated rehabilitation. With significant improvement in muscle strength, he was gradually permitted to get out of bed, and by postoperative day 140, he walked 1 km continuously. His fatigue worsened at the 7th postoperative month. At 11th, complications of severe aortic regurgitation and bilateral heart failure worsened. At 20th, he developed sustained VT. Moreover, his right heart failure worsened, and his hemodynamics were dependent on VAD. After sustained VT developed, the exercise load was adjusted according to his subjective and objective symptoms and cardiac and hepatic function. Heart transplantation was performed 716 days following VAD placement. After the transplant, he could swiftly get out of bed and walk 1.5 km continuously. Complications including right heart failure and arrhythmia that occur during the long waiting period for transplantation may exacerbate heart failure, even with VAD support. Adjusting the exercise load so that PT does not exacerbate heart failure is imperative.