Division of Cardiothoracic and Vascular Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria.
Wien Klin Wochenschr. 2011 Jan;123(1-2):58-60. doi: 10.1007/s00508-010-1516-9. Epub 2011 Jan 21.
We describe an instructive case of a 79-year-old patient with a giant coronary aneurysm and a second smaller aneurysm with an uncommon symptomatology. Giant coronary artery aneurysms (>2 cm diameter) are rare pathologic entities with a prevalence of 0.02%. They either can be congenital malformations or are atherosclerotic in origin. Although spontaneous rupture of giant coronary artery aneurysms has been reported, they generally remain silent or induce myocardial ischemia. Our patient, however, showed no signs of myocardial malperfusion but transient position-dependent pre-syncope. The cardiologic work-up and the intraoperative considerations regarding patient management are described. During surgery, manipulation of the giant coronary artery aneurysm caused impairment of right ventricular function and regional wall hypokinesia, as assessed by transesophageal echocardiography. Venous cannulation of the right atrium was thus abandoned and extracorporeal circulation was established via the femoral vein. Subsequent dissection and surgical repair were uneventful and further recovery of the elderly patient was uncomplicated. This case underlines that once the diagnosis is established, proper perioperative management enables successful surgical treatment even of patients of advanced age.
我们描述了一例 79 岁患者的典型病例，该患者存在巨大冠状动脉瘤和第二个较小的动脉瘤，且具有不同寻常的症状。巨大冠状动脉瘤（>2 厘米直径）是罕见的病理实体，发病率为 0.02%。它们可以是先天性畸形，也可以是动脉粥样硬化引起的。尽管已经报道了巨大冠状动脉瘤的自发性破裂，但它们通常保持沉默或导致心肌缺血。然而，我们的患者没有心肌灌注不良的迹象，但表现为短暂的体位性预晕厥。描述了患者心脏检查和术中管理的考虑因素。在手术过程中，通过经食管超声心动图评估，巨大冠状动脉瘤的操作导致右心室功能受损和区域性壁运动减弱。因此，放弃了右心房的静脉插管，并通过股静脉建立了体外循环。随后的剥离和手术修复过程顺利，老年患者进一步恢复良好。这个病例强调，一旦确立诊断，适当的围手术期管理可以使即使是高龄患者也能成功进行手术治疗。
