Takamura Takeshi, Dohi Kaoru, Satomi Akitoshi, Mori Kazuki, Moriwaki Keishi, Sugimoto Tadafumi, Horiguchi Masahide, Sakabe Shigetoshi, Kawamura Akihiro, Seko Tetsuya, Kasai Atsunobu, Ito Masaaki
Department of Cardiology, Ise Red Cross Hospital, 1-471-2 Funae, Ise, Mie 516-0008, Japan.
Department of Molecular and Laboratory Medicine, Mie University Graduate School of Medicine, Tsu, Japan.
J Cardiol Cases. 2012 Aug 9;6(5):e137-e140. doi: 10.1016/j.jccase.2012.07.003. eCollection 2012 Nov.
An 81-year-old woman had undergone percutaneus coronary intervention to mid left anterior descending coronary artery with a drug-eluting stent for effort angina pectoris. Although she had remained asymptomatic for 3 years, she developed cardiogenic shock following acute myocardial infarction due to stent thrombosis. Her condition deteriorated despite successful revascularization and an initiation of intra-aortic balloon pump (IABP). Transthoracic echocardiography examination revealed systolic anterior motion of the anterior mitral leaflet which caused severe left ventricular outflow tract obstruction (LVOTO) and moderate mitral regurgitation. Discontinuation of IABP resulted in immediate and complete recovery from cardiogenic shock and echocardiography revealed no LVOTO. These findings may shed new light on the underlying mechanism responsible for deteriorating LVOTO and yield new insights into the assessment and the treatment of cardiogenic shock with dynamic LVOTO.
一名81岁女性因劳力性心绞痛接受经皮冠状动脉介入治疗，在左前降支冠状动脉中段植入药物洗脱支架。尽管她3年来一直无症状，但因支架血栓形成导致急性心肌梗死后发生心源性休克。尽管成功进行了血运重建并启动了主动脉内球囊反搏（IABP），她的病情仍恶化。经胸超声心动图检查显示二尖瓣前叶收缩期向前运动，导致严重的左心室流出道梗阻（LVOTO）和中度二尖瓣反流。停用IABP后，心源性休克立即完全恢复，超声心动图显示无LVOTO。这些发现可能为LVOTO恶化的潜在机制提供新的线索，并为动态LVOTO的心源性休克的评估和治疗提供新的见解。
