Al Fagih A, Al Ghamdi S A, Dagriri K, Al Zahrani G
Prince Sultan Cardiac Center, Department of Adult Cardiology, Riyadh, Kingdom of Saudi Arabia.
Clin Med Res. 2010 Jul;8(2):96-8. doi: 10.3121/cmr.2010.874.
A woman, aged 48 years, with severe rheumatic mitral stenosis and uncontrolled permanent atrial fibrillation (AF) underwent preoperative assessment of coronary arteries. Invasive coronary angiography was not possible because of occluded common iliac artery and bilateral radial spasm. Transesophageal echocardiogram showed a very large mobile left atrial appendage clot, precluding cardioversion. The severe motion artifacts during cardiac CT angiography (64 slices) due to atrial fibrillation were overcome by controlling rhythm and rate through insertion of a temporary pacemaker via right femoral vein, and slowing heart rate below 65 beats per minute by intravenous metoprolol (25 mg) and verapamil (5 mg). Clear pictures of all coronary arteries as well as the left atrial appendage clot were obtained. The temporary pacemaker was removed after eight hours. Uneventful mechanical mitral valve replacement and maze procedure were performed and the patient was discharged in a stable condition.
一名48岁女性，患有严重的风湿性二尖瓣狭窄且永久性房颤控制不佳，接受了冠状动脉术前评估。由于髂总动脉闭塞和双侧桡动脉痉挛，无法进行有创冠状动脉造影。经食管超声心动图显示左心耳有一个非常大的活动血栓，无法进行心脏复律。通过经右股静脉插入临时起搏器控制心律和心率，并静脉注射美托洛尔（25毫克）和维拉帕米（5毫克）使心率降至65次/分钟以下，克服了心脏CT血管造影（64层）时因房颤导致的严重运动伪影。获得了所有冠状动脉以及左心耳血栓的清晰图像。八小时后取出临时起搏器。顺利进行了机械二尖瓣置换术和迷宫手术，患者出院时情况稳定。
