Résumé
We reported a case of a 41-year-old woman with a ruptured inferior vena cava (IVC): this was revealed by a swelling in the lower extremities and bursting pain. This condition was diagnosed on laparotomy. The operation involved repair of the IVC tear and thrombectomy. In this patient, a permanent IVC filter had been placed previously due to deep vein thrombosis. The head of the IVC filter had been covered by a fibrous membrane. Entrapment of the thrombus in the IVC filter might have resulted in high venous pressure in the IVC and a subsequent predisposition of the IVC to rupture. The swelling in the legs diminished slowly, and the patient was discharged with oral anticoagulation and elastic stockings. Despite clinical features and computed tomography findings, the physician's awareness of this disease remains the most important factor for early treatment.
Résumé
Circulatory support devices have become an important component for transplantation programs as they successfully bridge unsalvageable patients who would otherwise die. Between October 1997 and April 2001, 6 patients in profound heart failure were treated with a percutaneous cardiopulmonary support system (PCPS), or with ventricular assist device (VAD), or with both PCPS and VAD. Two patients were treated only with a PCPS, and one weaned case survived. Another 2 patients, who had dilated cardiomyopathy, was treated with VAD. They improved hemodynamically, and their general conditions made them fit to be candidates for heart transplantation. Two other patients who had PCPS insertion before VAD died due to multiple organ failure. Before the application of VAD, the levels of total bilirubin were 14.9 and 20.9mg/dl respectively. In acute worsening of hemodynamics, PCPS is useful to maintain total circulation by quick application. However, long-term support with VAD should be considered to resuscitate impaired end-organ function by carefully selecting the timing of a VAD implantation.