Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Catheter Cardiovasc Interv. 2013 Aug 1;82(2):221-9. doi: 10.1002/ccd.24564. Epub 2012 Nov 8.
Management of hemodynamically significant cardiac tamponade will most often require pericardial drainage. In the absence of hemodynamic evidence of tamponade, however, management of a pericardial effusion represents a clinical dilemma. Pericardial leakage of blood may be transient, and extravasation may have stopped by time of echocardiographic assessment. Besides its usefulness in ischemic heart disease, contrast echocardiography might be applied in the context of coronary perforations. We report the use of contrast echocardiography in four cases of coronary perforation without overt signs of cardiac tamponade as a tool to streamline decision making as to whether perform pericardiocentesis or not. Our series demonstrate the clinical utility and effectiveness of echocardiographic contrast imaging to confirm or exclude active bleeding into the pericardial space when not otherwise visible by conventional imaging measures.
治疗血流动力学显著的心包填塞最常需要行心包引流。然而，在心包填塞的血流动力学证据不足的情况下，心包积液的处理则存在临床困境。心包积血可能是一过性的，且在超声心动图评估时漏出可能已经停止。除了在缺血性心脏病中的应用外，对比超声心动图也可用于冠状动脉穿孔的情况下。我们报告了在 4 例无明显心脏压塞体征的冠状动脉穿孔中使用对比超声心动图的情况，该方法可作为一种工具来简化是否进行心包穿刺的决策。我们的系列病例证明了超声心动图对比成像在确认或排除常规影像学检查不可见的心包腔内活动性出血方面的临床实用性和有效性。
