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1例无ST段改变的左心室巨大假性动脉瘤保守治疗病例。

A case of conservative management for left ventricular giant pseudoaneurysm without ST segment changes.

作者信息

Ousaka Daiki, Obara Naruki, Fujiwara Megumi, Nakagawa Koushi, Teraoka Akira, Kasahara Shingo, Oozawa Susumu

机构信息

Department of Cardiovascular Surgery, Okayama University School of Medicine, Dentistry Pharmaceutical Science, Okayama, Japan.

Department of Clinical Laboratory, Teraoka Memorial Hospital, Hiroshima, Japan.

出版信息

J Cardiol Cases. 2018 Feb 9;17(5):167-170. doi: 10.1016/j.jccase.2018.01.006. eCollection 2018 May.

Abstract

Left ventricular (LV) rupture after myocardial infarction (MI) occasionally results in formation of LV pseudoaneurysm (LVPA) which is prone to rupture because of its thin wall. However, cases of LVPA without ST changes including segment elevation in electrocardiogram (ECG) are rare. In this case, we describe a patient who had relatively mild symptoms and giant LVPA with no specific ECG changes following MI with a confirmed diagnosis via transthoracic echocardiography. Although surgical treatment options are often recommended, conservative therapy was adopted, following which the patient had been well-medicated using antihypertensive drugs and anticoagulants. < Left ventricular pseudoaneurysm (LVPA) is usually accompanied by ST segment changes on electrocardiogram (ECG) due to myocardial damage. However, we should take into account a LVPA without ECG specific changes, so echocardiography is better to be considered for an identification. Although many LVPA patients undergo surgery because of risk for rupture, some cases with stable hemodynamic status can have long-term survival with conservative therapy such as anti-hypertension and coagulation.>.

摘要

心肌梗死(MI)后左心室(LV)破裂偶尔会导致左心室假性动脉瘤(LVPA)形成,因其壁薄而易于破裂。然而,左心室假性动脉瘤患者心电图(ECG)无ST段改变(包括抬高)的情况较为罕见。在此病例中,我们描述了一名患者,其症状相对较轻,患有巨大左心室假性动脉瘤,心肌梗死后心电图无特异性改变,经胸超声心动图确诊。尽管通常推荐手术治疗方案,但我们采取了保守治疗,之后患者一直使用降压药和抗凝剂进行良好治疗。<左心室假性动脉瘤(LVPA)通常因心肌损伤而伴有心电图(ECG)ST段改变。然而,我们应考虑到无心电图特异性改变的左心室假性动脉瘤,因此最好考虑通过超声心动图进行识别。尽管许多左心室假性动脉瘤患者因破裂风险而接受手术,但一些血流动力学稳定的病例通过抗高血压和抗凝等保守治疗可长期存活。>

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引用本文的文献

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Left ventricular pseudoaneurysm.左心室假性动脉瘤。
J Am Coll Cardiol. 1998 Sep;32(3):557-61. doi: 10.1016/s0735-1097(98)00290-3.
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Clinical profile and outcome in 52 patients with cardiac pseudoaneurysm.52例心脏假性动脉瘤患者的临床特征与预后
Ann Intern Med. 1998 Feb 15;128(4):299-305. doi: 10.7326/0003-4819-128-4-199802150-00010.
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Prospective correlative study of ventricular aneurysm. Mechanistic concept and clinical recognition.
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