Kar Saibal, Ibebuogu Uzoma N, Conte Antonio Hernandez
Heart Institutue at Cedars-Sinai Medical Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
J Invasive Cardiol. 2012 May;24(5):E101-3.
This case report describes a patient who sustained a post-myocardial infarction ventricular septal defect (VSD) with an associated left ventricular aneurysm who developed cardiogenic shock and required an intra-aortic balloon pump for hemodynamic stabilization. After deployment of a single Amplatzer occluder (AGA Medical), a residual VSD measuring 0.5 cm was noted. Therefore, a second Amplatzer occluder was deployed and a minimal residual VSD remained. The patient remained hemodynamically stable throughout the procedure and was subsequently extubated with removal of intra-aortic balloon pump. Post-discharge, the patient was readmitted with congestive heart failure. A third Amplatzer device was deployed to ameliorate the recurrent VSD shunt. At 9-week follow-up, transthoracic echocardiogram was performed and findings included: 1) left ventricular ejection fraction of 62%; 2) appearance of 3 Amplatzer devices along the interventrcular septum seated well with no motion and residual shunt; 3) moderate diastolic dysfunction with pseudonormal left ventricular filling pattern; and 4) no valvular abnormalities. The patient had increased exercise tolerance with no shortness of breath at rest or with exertion. This case demonstrates the utility and viability of multiple Amplatzer device deployment as a means of repairing a large post-myocardial infarction VSD and recurrent VSDs.
本病例报告描述了一名患者，该患者发生心肌梗死后室间隔缺损（VSD）并伴有左心室室壁瘤，出现心源性休克，需要主动脉内球囊泵来稳定血流动力学。在植入单个Amplatzer封堵器（AGA Medical公司）后，发现残余室间隔缺损为0.5厘米。因此，又植入了第二个Amplatzer封堵器，仅残留极小的室间隔缺损。患者在整个手术过程中血流动力学保持稳定，随后拔除气管插管并移除主动脉内球囊泵。出院后，患者因充血性心力衰竭再次入院。植入了第三个Amplatzer装置以改善复发性室间隔缺损分流。在9周随访时，进行了经胸超声心动图检查，结果包括：1）左心室射血分数为62%；2）沿室间隔可见3个Amplatzer装置，位置良好，无活动且无残余分流；3）中度舒张功能障碍，左心室充盈模式呈假性正常化；4）无瓣膜异常。患者运动耐量增加，静息或运动时均无气短症状。本病例证明了多次植入Amplatzer装置作为修复大面积心肌梗死后室间隔缺损和复发性室间隔缺损的一种方法的实用性和可行性。
