Provaznik Zdenek, Holzamer Andreas, Camboni Daniele, Rupprecht Leopold, Resch Markus, Wittmann Sigrid, Schmid Christof, Floerchinger Bernhard
Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany.
J Thorac Dis. 2017 Dec;9(12):5288-5294. doi: 10.21037/jtd.2017.10.113.
Less invasive procedures have replaced open surgical treatment in many cardiovascular disorders. During these interventions, iatrogenic cardiac perforation may ensue, which is a severe complication and requires immediate diagnostic assessment and treatment.
From March 2011 to April 2016, all patients referred to the Dept. of Cardio-thoracic Surgery with the diagnosis of iatrogenic perforation of myocardial wall or great vessels were included into the retrospective study. Complications during transapical transcutaneous aortic valve replacements (TAVR) procedures and percutaneous coronary intervention (PCI) were excluded from analysis. Symptoms, therapeutic strategy, intraoperative findings, and outcome were evaluated.
Forty-four patients suffered from myocardial wall or vessel perforation. Most common site of perforation were right (n=26; 59.1%) and left (n=8; 18.2%) ventricle. Other structures were involved in ten cases (22.7%). Open surgical treatment was required in 27 cases (61.4%). Mortality after left and right ventricular laceration was 75.0% and 11.5%, respectively. Most common cause of death was cardiocirculatory failure (n=5).
Iatrogenic perforation of myocardial wall or central vessels during percutaneous interventional procedures is a rare but life-threatening complication. Despite immediate treatment efforts, mortality is high, particularly after left ventricular laceration.
在许多心血管疾病的治疗中，侵入性较小的手术已取代了开放性手术治疗。在这些干预过程中，可能会发生医源性心脏穿孔，这是一种严重的并发症，需要立即进行诊断评估和治疗。
2011年3月至2016年4月，所有被诊断为医源性心肌壁或大血管穿孔并转诊至心胸外科的患者均纳入回顾性研究。经心尖经皮主动脉瓣置换术（TAVR）和经皮冠状动脉介入治疗（PCI）过程中的并发症被排除在分析之外。对症状、治疗策略、术中发现和结果进行了评估。
44例患者发生心肌壁或血管穿孔。最常见的穿孔部位是右心室（n = 26；59.1%）和左心室（n = 8；18.2%）。其他结构有10例受累（22.7%）。27例（61.4%）需要进行开放性手术治疗。左心室和右心室撕裂后的死亡率分别为75.0%和11.5%。最常见的死亡原因是心循环衰竭（n = 5）。
经皮介入手术过程中医源性心肌壁或中心血管穿孔是一种罕见但危及生命的并发症。尽管立即进行了治疗，但死亡率很高，尤其是左心室撕裂后。
