Hsu Y S, Tamai H, Odawara K, Yamagata T, Ueda K, Tomita T, Koya M, Motohara S, Uehata H
Department of Cardiology, Shiga Medical Center for Adult Disease, Moriyama.
J Cardiol. 1990;20(2):493-8.
A case who developed rupture in a diagonal branch of the left anterior descending coronary artery (LAD) during percutaneous transluminal coronary angioplasty (PTCA) is reported here. The present case was 80-year-old man with severe focal stenosis of the LAD at its junction with a diagonal branch. PTCA for the LAD lesion was successfully performed, but occlusion of the diagonal branch developed later. A subsequent ECG showed elevation of an ST segment in a VL, and PTCA for the diagonal branch was attempted. A 018 Hi-torque floppy guide wire was introduced into the occluded diagonal branch, and its dilatation was attempted using a 2 mm Simpson-Robert catheter. During a maximal pressure of 120 psi, a deformity was found at the distal end of the balloon. Post-PTCA angiograms showed rupture of the diagonal arterial branch, and mild to moderate pericardial effusion was observed by echocardiography. The patient experienced transient hypotension (60 mmHg at systolic), but his condition gradually stabilized after the administration of only a pressor medication. Neither pericardiocentesis nor emergency surgery was performed. The next day, follow-up angiograms showed diagonal branch occlusion at the proximal portion of the rupture site. His clinical course was satisfactory with spontaneous resolution of pericardial effusion and mild elevation of his cardiac enzymes (CPK = 243IU). In this case, it was concluded that the cause of coronary arterial rupture was the difference in diameters of the coronary artery (1 mm) and the balloon catheter (2 mm). This was the first rupture case experienced among 750 PTCA sites (0.13%).(ABSTRACT TRUNCATED AT 250 WORDS)
本文报道了1例在经皮腔内冠状动脉成形术（PTCA）过程中左前降支冠状动脉（LAD）对角支发生破裂的病例。该病例为一名80岁男性，LAD与其对角支交界处存在严重局限性狭窄。LAD病变的PTCA成功实施，但随后对角支出现闭塞。随后的心电图显示VL导联ST段抬高，遂尝试对对角支进行PTCA。将一根018高扭矩软头导丝插入闭塞的对角支，并使用2mm的Simpson-Robert导管尝试对其进行扩张。在120psi的最大压力下，发现球囊远端出现变形。PTCA术后血管造影显示对角动脉支破裂，超声心动图观察到轻度至中度心包积液。患者出现短暂性低血压（收缩压60mmHg），但仅给予升压药物后病情逐渐稳定。未进行心包穿刺或急诊手术。第二天，随访血管造影显示破裂部位近端的对角支闭塞。其临床病程良好，心包积液自行消退，心肌酶轻度升高（CPK = 243IU）。在本病例中，冠状动脉破裂的原因被认为是冠状动脉（1mm）与球囊导管（2mm）直径不同。这是750个PTCA病例中首例发生破裂的病例（0.13%）。（摘要截选至250字）
