Severe heart failure patients are sometimes complicated with alveolar hemorrhage due
to pulmonary congestion. Patients with alveolar hemorrhage have high pulmonary vascular
resistance, so LVAD attachment induces relative right heart failure which may require
right heart system assist. In such cases, hemodynamic management becomes very difficult.
With high pulmonary perfusion as well as intensive anti-coagulation therapy, alveolar
hemorrhage might worsen. Furthermore, it is difficult to tell whether the cause of
alveolar hemorrhage is pulmonary congestion or other diseases like organized pneumonia.
Our present strategy for particularly severe heart failure is as follows: we adopt
central ECMO support with RA drainage and ascending aorta perfusion to get adequate
circulatory flow support. At the same time, LV venting from the apex is also used
to release pulmonary congestion, which leads to recover pulmonary function, and reduce
pulmonary vascular resistance. And as a next step, we aim to maintain hemodynamics
by supporting left heart system only. Recently, we experienced 2 severe heart failure
cases complicated with alveolar hemorrhage whose etiologies were hard to differentiate,
which were successfully treated according to our strategy. Here, we are going to report
these 2 cases with some discussions.
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