Chahal Anwar A, Kim Min-Young, Borg Alexander N, Al-Najjar Yahya
Anwar A Chahal, Min-Young Kim, Alexander N Borg, Yahya Al-Najjar, Department of Cardiology, Blackpool Victoria Hospital, Blackpool FY3 8LP, United Kingdom.
World J Cardiol. 2014 Nov 26;6(11):1223-6. doi: 10.4330/wjc.v6.i11.1223.
We report an unusual case of an isolated right ventricular infarction with haemodynamic compromise caused by spontaneous isolated proximal occlusion of the right ventricular branch of the right coronary artery (RCA), successfully treated by balloon angioplasty. A 58-year-old gentleman presented with epigastric pain radiating into both arms. Electrocardiograph with right ventricular leads confirmed ST elevation in V4R and a diagnosis of isolated right ventricular infarction was made. Urgent primary percutaneous intervention was performed which revealed occlusion of the right ventricular branch of the RCA. During the procedure, the patient's blood pressure dropped to 80/40 mmHg, and echocardiography showed impaired right ventricular systolic function. Despite aggressive fluid resuscitation, the patient remained hypotensive, continued to have chest pain and persistent electrocardiograph changes, and hence balloon angioplasty was performed on the proximal right ventricular branch which restored flow to the vessel and revealed a severe ostial stenosis. This was treated with further balloon angioplasty which restored TIMI 3 flow with resolution of patient's symptoms. Repeat echocardiography showed complete resolution of the ST-elevation in leads V4R and V5R and partial resolution in V1. Subsequent dobutamine-stress echocardiography at 4 wk showed good left and right ventricular contractions. The patient was discharged after a 3-d in-patient stay without any complications.
我们报告了一例罕见病例，患者因右冠状动脉（RCA）右心室分支近端自发孤立性闭塞导致孤立性右心室梗死并伴有血流动力学损害，经球囊血管成形术成功治疗。一名58岁男性因上腹部疼痛放射至双臂就诊。右心室导联心电图证实V4R导联ST段抬高，诊断为孤立性右心室梗死。紧急进行了首次经皮介入治疗，结果显示RCA右心室分支闭塞。在手术过程中，患者血压降至80/40 mmHg，超声心动图显示右心室收缩功能受损。尽管积极进行了液体复苏，但患者仍处于低血压状态，持续胸痛且心电图持续改变，因此对右心室分支近端进行了球囊血管成形术，恢复了血管血流，并发现严重的开口处狭窄。进一步进行球囊血管成形术治疗，恢复了TIMI 3级血流，患者症状缓解。复查超声心动图显示V4R和V5R导联ST段抬高完全消失，V1导联部分消失。随后在4周时进行的多巴酚丁胺负荷超声心动图显示左、右心室收缩良好。患者住院3天后出院，无任何并发症。
