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经皮冠状动脉介入治疗后,使用覆膜支架成功处理左前降支埃利斯III型穿孔:成功解决了这一严重并发症。

Successful management of Ellis type III left anterior descending artery perforation following percutaneous coronary intervention by a covered stent: Successfully resolved the dramatic complication.

作者信息

Srinivas Sunil Kumar, Patra Soumya, Ramalingam Rangaraj, Agrawal Navin, Syed Tanveer, Shankarappa Ravindranath K, Manjunath Cholenahalli Nanjappa

机构信息

Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, Karnataka 560069, India.

出版信息

J Cardiovasc Dis Res. 2013 Dec;4(4):245-7. doi: 10.1016/j.jcdr.2014.01.003. Epub 2014 Feb 18.

Abstract

Coronary artery perforation is a rare but catastrophic complication of percutaneous coronary intervention (PCI). Grade III coronary perforation and rupture invariably results in pericardial effusion and tamponade requiring urgent pericardiocentesis. Advances in coronary intervention have increased the opportunity to treat coronary artery perforation. We are reporting a case of 55 years old hypertensive female who presented with effort angina. Coronary angiogram revealed significant stenosis in the left anterior descending coronary artery. Post PCI, she had Ellis type III coronary perforation and pericardial tamponade and cardiogenic shock. The patient was resuscitated, pericardiocentesis done, autologous blood transfusion given and covered stent deployed.

摘要

冠状动脉穿孔是经皮冠状动脉介入治疗(PCI)罕见但灾难性的并发症。Ⅲ级冠状动脉穿孔和破裂必然导致心包积液和心脏压塞,需要紧急心包穿刺。冠状动脉介入技术的进步增加了治疗冠状动脉穿孔的机会。我们报告一例55岁高血压女性,因劳力性心绞痛就诊。冠状动脉造影显示左前降支冠状动脉严重狭窄。PCI术后,她出现了埃利斯Ⅲ型冠状动脉穿孔、心包压塞和心源性休克。患者经复苏、进行心包穿刺、给予自体输血并植入覆膜支架。

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本文引用的文献

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Successful conservative management of coronary artery rupture: role of post pericardiotomy adhesions as a protective barrier.
Cardiovasc Interv Ther. 2013 Jan;28(1):131-4. doi: 10.1007/s12928-012-0130-3. Epub 2012 Sep 15.
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Coronary artery perforations in the contemporary interventional era.冠状动脉穿孔在当代介入时代。
J Interv Cardiol. 2009 Aug;22(4):350-3. doi: 10.1111/j.1540-8183.2009.00469.x.
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Coronary artery perforation during primary PCI: an easily resolved case for a dramatic complication.
Eur Heart J. 2007 Sep;28(17):2109. doi: 10.1093/eurheartj/ehm028. Epub 2007 Apr 4.

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