Masuyama S, Matsuda M, Soeda T, Yuasa S, Shimizu K
Department of Cardiovascular Surgery, Matsue Red Cross Hospital, Matsue, Japan.
Kyobu Geka. 2005 Sep;58(10):861-4.
Acute myocardial infarction, as a result of coronary malperfusion caused by acute type A aortic dissection, has been identified as one of significant factors relating to operative mortality. This complication could be diagnosed with a combination of electrocardiography and echocardiography in acute phase. However, the indication of coronary angiography and/or intervention has been controversial as it is time-consuming and renders additional stress to a critical patient requiring an emergency operation. We report a case of myocardial infarction successfully treated with percutaneous transluminal coronary angioplasty (PTCA) at first, after that, recognition of dissection of aorta necessitated subsequent surgical therapy. In this particular case, coronary intervention in advance proved to be mandatory.
急性A型主动脉夹层导致冠状动脉灌注不良所致的急性心肌梗死，已被确认为与手术死亡率相关的重要因素之一。这种并发症在急性期可通过心电图和超声心动图联合诊断。然而，冠状动脉造影和/或干预的指征一直存在争议，因为这既耗时，又会给需要紧急手术的重症患者带来额外压力。我们报告一例首先成功接受经皮冠状动脉腔内血管成形术（PTCA）治疗的心肌梗死病例，之后，由于认识到主动脉夹层，需要进行后续手术治疗。在这个特殊病例中，预先进行冠状动脉干预被证明是必要的。
