Bahlmann Edda, Schneider Carsten, Vitali Serdoz Laura, Hoffmann-Riem Martin, Broemel Thomas, Kuck Karl-Heinz
Department of Cardiology, St Georg Hospital, Hamburg, Germany.
J Am Soc Echocardiogr. 2006 May;19(5):578.e5-8. doi: 10.1016/j.echo.2005.12.014.
This report describes a 68-year-old patient with a subacute myocardial infarction and antiphosholipid syndrome. He developed an intramyocardial dissecting hemorrhage involving the left ventricular apex and multiple left ventricular thrombus formations, documented by contrast echocardiography and magnetic resonance imaging. By use of transthoracic echocardiography, spontaneous retraction of the dissecting hemorrhage could be detected. Severe coronary 3-vessel disease was successfully treated by coronary artery bypass grafting. During follow-up of 16 months, the dissecting hematoma could not been detected. Under initiation of anticoagulant treatment with Coumadin, the patient was in stable clinical condition and improved in New York Heart Association class from III to II. The pathophysiology, diagnosis, and management of this potentially highly lethal complication is reviewed.
本报告描述了一名患有亚急性心肌梗死和抗磷脂综合征的68岁患者。他发生了累及左心室心尖的心肌内夹层出血和多个左心室血栓形成，经对比超声心动图和磁共振成像证实。通过经胸超声心动图，可以检测到夹层出血的自发回缩。严重的冠状动脉三支病变通过冠状动脉旁路移植术成功治疗。在16个月的随访期间，未检测到夹层血肿。在开始使用香豆素进行抗凝治疗后，患者临床状况稳定，纽约心脏协会心功能分级从III级改善至II级。本文对这种潜在的高致死性并发症的病理生理学、诊断和管理进行了综述。
