Grieshaber Philippe, Nef Holger, Böning Andreas, Niemann Bernd
Department of Adult and Pediatric Cardiovascular Surgery, University Hospital of Giessen, Giessen, Germany.
Department of Cardiology and Angiology, University Hospital of Giessen, Giessen, Germany.
Thorac Cardiovasc Surg Rep. 2017 Jan;6(1):e5-e9. doi: 10.1055/s-0037-1601315.
Bleeding from bypass anastomosis leakage occurs early after coronary artery bypass grafting. Later, once the anastomosis is covered by intima, spontaneous bleeding is unlikely. A 63-year-old male patient developed a pseudoaneurysm-like, subepicardial late-term bleeding resulting in a hematoma that compromised coronary artery flow by increasing extracoronary pressure. This resulted in severe angina pectoris (Canadian Cardiovascular Society IV) and myocardial ischemia within the affected area. After surgical removal of the hematoma and repair of the anastomosis, the patient's symptoms disappeared and no signs of myocardial ischemia were present. Surgical removal is an efficient therapy for subepicardial hematoma inducing myocardial ischemia.
冠状动脉旁路移植术后早期会发生旁路吻合口漏血。之后，一旦吻合口被内膜覆盖，就不太可能发生自发性出血。一名63岁男性患者出现了假性动脉瘤样的心外膜下晚期出血，形成血肿，通过增加冠状动脉外压力而影响冠状动脉血流。这导致了严重心绞痛（加拿大心血管学会IV级）和受累区域的心肌缺血。手术清除血肿并修复吻合口后，患者症状消失，未出现心肌缺血迹象。手术清除是治疗引起心肌缺血的心外膜下血肿的有效方法。
