Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
Pediatric Cardiology and Cardiac Surgery 39(4): 236-243 (2023)

症例報告Case Report

拡張型心筋症に対し体外設置型補助人工心臓を装着し,心臓移植に至った男児のリハビリテーションRehabilitation of a Boy with an Extracorporeal Ventricular Assist Device for Dilated Cardiomyopathy Who Had Undergone a Heart Transplant

1東京大学医学部附属病院 リハビリテーション部Department of Rehabilitation, The University of Tokyo Hospital ◇ Tokyo, Japan

2東京大学医学部附属病院 小児科Department of Pediatrics, The University of Tokyo Hospital ◇ Tokyo, Japan

3東京大学医学部附属病院 心臓外科Department of Cardiac Surgery, The University of Tokyo Hospital ◇ Tokyo, Japan

受付日:2023年9月15日Received: September 15, 2023
受理日:2024年1月5日Accepted: January 5, 2024
発行日:2023年12月31日Published: December 31, 2023

体外設置型補助人工心臓(ventricular assist device: VAD) EXCOR Pediatric (EXCOR)装着後,心臓移植に至った小児患者のリハビリテーション(リハビリ)の経験を報告する.拡張型心筋症の7歳男児.上気道症状,腹痛にて近医を受診,左心の著明な拡大と収縮不良を認め当院転院.転院後7日目に持続性心室頻拍(ventricular tachycardia: VT)へ移行しVAD (Rota flow)装着,翌日EXCORへ移行した.術後4日目よりリハビリ開始.著しい筋力低下を認めていたため段階的に離床を進め,術後140日目には1 kmの連続歩行も可能となった.術後7カ月に倦怠感が増悪,術後11カ月には重度の大動脈閉鎖不全症(aortic insufficiency: AI)と両心不全の増悪を合併,術後20カ月からは持続性VTのまま経過,AIと持続性VTによりフォンタン循環様の病態となり,リハビリにおける運動負荷の調整を要した.持続性VTとなって以降は自覚・他覚症状,心・肝機能の状況に応じて運動負荷を調整した.術後716日に心臓移植術を実施,移植術後は速やかに離床を進め,1日1.5 km程度の歩行能力,体力を獲得し,移植術後34日で自宅退院に至った.長期の移植待機期間中に右心不全,不整脈といった合併症に伴い,VADサポート下であっても心不全が増悪する可能性がある.リハビリにより更なる心不全増悪を招かないよう,運動負荷の調整を行うことが重要であった.

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.

Key words: severe heart failure; ventricular assist device; pediatric; complication

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