Numata Satoshi, Yamazaki Sachiko, Tsutsumi Yasushi, Ohashi Hirokazu
Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan.
Interact Cardiovasc Thorac Surg. 2014 Jan;18(1):143-4. doi: 10.1093/icvts/ivt455. Epub 2013 Oct 20.
We report the case of a patient who developed severe cardiogenic shock during the open repair of a ruptured abdominal aortic aneurysm. After controlling the bleeding from the ruptured aneurysm, the electrocardiogram exhibited ST-T elevation and bradycardia. A median sternotomy was performed, and cardiopulmonary bypass was established. Under cardiopulmonary bypass support, the patient successfully underwent a Y-shaped graft replacement. The venous and arterial cannulae were recannulated through the femoral artery and vein. The chest and abdomen were closed in the usual fashion. Five hours after admission to the intensive care unit, cardiopulmonary bypass was weaned successfully, and the patient was extubated 1 day after surgery. Postoperative coronary angiography showed severe vasospastic angina of the right coronary artery, which might have caused cardiogenic shock during the aneurysm repair. The patient had an uneventful recovery period and was discharged on the 14th postoperative day without neurological complications.
我们报告了一例在开放性修复破裂腹主动脉瘤过程中发生严重心源性休克的患者。在控制破裂动脉瘤的出血后，心电图显示ST段抬高和心动过缓。实施了正中胸骨切开术，并建立了体外循环。在体外循环支持下，患者成功接受了Y形移植物置换。通过股动脉和股静脉重新插入静脉和动脉插管。胸部和腹部按常规方式关闭。入住重症监护病房5小时后，成功撤离体外循环，患者术后1天拔管。术后冠状动脉造影显示右冠状动脉严重血管痉挛性心绞痛，这可能是动脉瘤修复过程中心源性休克的原因。患者恢复过程顺利，术后第14天出院，无神经并发症。
