Sethi G K, Scott S M, Takaro T
J Thorac Cardiovasc Surg. 1979 May;77(5):760-7.
Until recnetly, coronary arterial perfusion was one of the best methods to protect myocardium during aortic valve replacement. However, the insertion of perfusion cannulas may produce immediate traumatic lesions and late stenosis of the coronary arteries, with grave consequences. Two patients with normal coronary arteries prior to operation developed obstruction of the maximal left main coronary artery following aortic replacement. One of these patients represents the first case of iatrogenic coronary arterial stenosis in which the aortic valve was replaced with a porcine bioprosthesis. Accelerating angina pectoris and ventricular arrhythmias were the presenting clinical manifestations. Aorta-coronary bypass grafting to the left anterior descending and circumflex coronary arteries was successfully performed in one patient, while the other patient died before investigative procedures could be undertaken. Any patient whose aortic valve has been replaced and who develops angina pectoris a few months after operation should be suspected of having developed stenosis of the proximal coronary artery. Coronary angiography should be perfomed promptly. Once the lesion is recognized, the operaiton should be performed posthaste because these lesions are life threatening owing to their proximal location and rapid evolution.
直到最近，冠状动脉灌注仍是主动脉瓣置换术中保护心肌的最佳方法之一。然而，灌注插管的插入可能会立即造成创伤性损伤，并导致冠状动脉后期狭窄，后果严重。两名术前冠状动脉正常的患者在主动脉置换术后出现了最大的左主冠状动脉阻塞。其中一名患者代表了首例医源性冠状动脉狭窄病例，该病例中主动脉瓣被猪生物瓣膜置换。加速型心绞痛和室性心律失常是主要临床表现。一名患者成功地进行了左前降支和回旋支冠状动脉的主动脉-冠状动脉搭桥术，而另一名患者在能够进行检查之前就死亡了。任何接受主动脉瓣置换术且术后几个月出现心绞痛的患者都应怀疑发生了近端冠状动脉狭窄。应立即进行冠状动脉造影。一旦发现病变，应立即进行手术，因为这些病变因其近端位置和快速发展而危及生命。
