Okada S, Kaneko T, Ezure M, Satoh Y, Hasegawa Y, Koike N, Okonogi S, Takihara H, Adachi H
Department of Cardiovascular Surgery, Gunma Prefectural Cardiovascular Center, Maebashi, Japan.
Kyobu Geka. 2009 Mar;62(3):241-5.
A 65-year-old man was admitted to the hospital because of effort chest pain, 8 years after he received coronary artery bypass grafting [CABG: left internal thoracic artery (LITA) to left anterior descending artery (LAD), saphenous vein graft (SVG) to first diagonal branch (D1) and SVG to postero-lateral branch (PL)]. Emergent coronary angiography revealed right coronary artery occlusion with well patent bypass grafts. Percutaneus coronary intervention (PCI) was performed successfully, but 9 hours later, ventricular septal perforation (VSP) was occurred. Swan-Ganz catheter revealed that pulmonary to systemic blood flow ratio (Qp/Qs) was 2.6. In spite of intensive medical care, his hemodynamics was gradually exacerbated. Subsequent intracavitary repair with equine pericardial patch, sutured using interrupted mattress sutures with felt pledgets, was performed. He had an uneventful recovery thereafter, extubated and weaned from an intra-aortic balloon pumping at the 1st day. He was discharged from hospital on the 27th postoperative day.
一名65岁男性因劳力性胸痛入院，其在接受冠状动脉旁路移植术（CABG：左乳内动脉[LITA]至左前降支动脉[LAD]、大隐静脉移植血管[SVG]至第一对角支动脉[D1]以及SVG至后外侧支动脉[PL]）8年后发病。急诊冠状动脉造影显示右冠状动脉闭塞，旁路移植血管通畅良好。成功进行了经皮冠状动脉介入治疗（PCI），但9小时后发生了室间隔穿孔（VSP）。 Swan-Ganz导管检查显示肺循环与体循环血流量之比（Qp/Qs）为2.6。尽管给予了积极的医疗护理，但其血流动力学仍逐渐恶化。随后使用马心包补片进行了腔内修复，采用带毡垫的间断褥式缝合进行缝合。此后他恢复顺利，术后第1天拔除气管插管并停止主动脉内球囊反搏。术后第27天出院。
