Fukumoto H, Nishimoto T, Hashimoto T, Morita H
Department of Thoracic and Cardiovascular Surgery, Osakafu Mishima Critical Care Medical Center, Takatsuki, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1992 Jul;40(7):1105-9.
A 74-year-old woman had acute anteroseptal myocardial infarction. Tissue plasminogen activator (t-PA) was infused intravenously about five hours later from the onset of myocardial infarction. Six hours after the infusion of t-PA her blood pressure fell suddenly with the appearance of a grade 3/6 holosystolic murmur. There was a prominent step up of oxygen saturation in the right ventricle which indicated the presence of a left-to-right shunt. Intraaortic balloon pumping for the support of cardiac function was ineffective. At the emergent operation concomitant rupture of the left ventricular free wall and interventricular septum was seen and successfully repaired. She could be weaned from cardiopulmonary bypass easily with the aid of the intraaortic balloon pumping. Her postoperative course was uneventful. The postoperative angiography showed good left ventricular wall motion without any residual shunt.
一名74岁女性发生急性前间隔心肌梗死。心肌梗死发病约5小时后静脉输注组织型纤溶酶原激活剂（t-PA）。输注t-PA 6小时后，她的血压突然下降，并出现3/6级全收缩期杂音。右心室氧饱和度显著升高，提示存在左向右分流。主动脉内球囊反搏支持心功能无效。急诊手术时发现左心室游离壁和室间隔同时破裂，并成功修复。借助主动脉内球囊反搏，她能够轻松脱离体外循环。术后过程顺利。术后血管造影显示左心室壁运动良好，无残余分流。
