Masaki Nobuyuki, Arakawa Koh, Yamagishi Tadashi, Tahara Takanori, Miyazaki Kouji, Shibuya Toshio, Hatori Nobuo, Yoshizu Hiroshi, Tanaka Tutomu, Ohsuzu Fumitaka
First Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan.
Circ J. 2002 Aug;66(8):769-72. doi: 10.1253/circj.66.769.
A 65-year-old man was admitted to the National Defense Medical College Hospital for acute anterolateral myocardial infarction and cardiogenic shock. Emergency coronary angiography demonstrated occlusion of the proximal left anterior descending artery. Primary percutaneous transluminal coronary angioplasty (PTCA) was successfully performed with the support of intra-aortic balloon pumping (IABP) and medical treatment to stabilize the patient's blood pressure. On the second hospital day, the patient suffered cardiac tamponade. Pericardiocentesis showed bloody fluid and revealed that an oozing-type of left ventricular rupture had occurred after the myocardial infarction. Cardiogenic shock persisted after successful removal of the pericardial effusion. Although the heparinization required during percutaneous cardiopulmonary support (PCPS) can increase pericardial effusion, PCPS was initiated to correct the systemic hypoperfusion; a surgical team was on standby in case massive pericardial effusion resulted, but fortunately that did not occur, and cardiac function recovered. The patient was weaned successfully from PCPS and IABP and has remained in a satisfactory condition for over 1 year. PCPS contributed to the patient's recovery from cardiac shock and may have decreased the effusion from the oozing-type rupture by reducing ventricular wall tension.
一名65岁男性因急性前侧壁心肌梗死和心源性休克入住国防医科大学医院。急诊冠状动脉造影显示左前降支近端闭塞。在主动脉内球囊反搏（IABP）支持及药物治疗以稳定患者血压的情况下，成功进行了急诊经皮冠状动脉腔内血管成形术（PTCA）。住院第二天，患者发生心脏压塞。心包穿刺抽出血性液体，提示心肌梗死后发生了渗出型左心室破裂。成功抽出心包积液后，心源性休克仍持续存在。尽管经皮心肺支持（PCPS）期间所需的肝素化可增加心包积液，但仍启动PCPS以纠正全身低灌注；手术团队随时待命以防出现大量心包积液，所幸未发生这种情况，心脏功能得以恢复。患者成功撤掉PCPS和IABP，至今状况良好已超过1年。PCPS有助于患者从心源性休克中恢复，可能通过降低心室壁张力减少了渗出型破裂的积液。
