Lossnitzer Dirk, Schwenger Vedat, Lehrke Stephanie, Giannitsis Evangelos, Zeier Martin, Katus Hugo A, Steen Henning
Division of Cardiology, Pneumology and Angiology, Department of Internal Medicine III, University of Heidelberg, 69120 Heidelberg, Germany.
Case Rep Med. 2010;2010:645236. doi: 10.1155/2010/645236. Epub 2011 Jan 17.
We report the case of a 68-year-old man suffering from incremental hepatic and renal failure one month after anterior myocardial infarction. Cardiac MRI showed a pronounced apical post-AMI aneurysm, a moderate to severe mitral and tricuspid regurgitation as well as a hemodynamically highly significant 12 mm apical ventricular septal defect with a left-to-right ventricular shunt of almost 63% as the underlying cause. Heart X-ray revealed a severe LAD in-stent restenosis. CAPD catheter drainage of hydroperitoneum due to congestive liver and renal failure was provided in combination with intensified CAPD hemodialysis. Heart surgery was performed where the apical aneurysm was excised, the mitral valve was reconstructed, the IVSD was closed and the subtotally in-stent occluded LAD was bypassed. Post-surgery, the ascites were significantly reduced, and CAPD hemodialysis therapy could be terminated since the renal function gradually improved (MDRD = 25 mL/min). To our knowledge, for the first time we report successful CAPD catheter drainage of hydroperitoneum in combination with CAPD hemodialysis.
我们报告了一例68岁男性患者的病例，该患者在急性前壁心肌梗死后1个月出现进行性肝肾功能衰竭。心脏磁共振成像显示有明显的心尖部心肌梗死后室壁瘤、中度至重度二尖瓣和三尖瓣反流，以及一个血流动力学上高度显著的12毫米的心尖部室间隔缺损，左向右心室分流近63%，这是潜在病因。心脏X线检查显示严重的左前降支支架内再狭窄。由于充血性肝肾功能衰竭，进行了持续性非卧床腹膜透析（CAPD）导管引流腹腔积液，并联合强化CAPD血液透析。进行了心脏手术，切除心尖部室壁瘤，重建二尖瓣，关闭室间隔缺损，并绕过几乎完全支架闭塞的左前降支。术后，腹水明显减少，由于肾功能逐渐改善（改良饮食肾疾病公式估算肾小球滤过率=25毫升/分钟），CAPD血液透析治疗可以终止。据我们所知，我们首次报告了成功进行CAPD导管引流腹腔积液并联合CAPD血液透析。
