He Zhongliang, Chen Guoxing, He Xueming, He Xiaowen
Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province.
Division of Endocrinology and Metabolism, Department of Medicine, 2nd Affiliated Hospital of Zhejiang University Medical School.
Int Heart J. 2019 Jul 27;60(4):1009-1012. doi: 10.1536/ihj.18-432. Epub 2019 Jun 14.
Spontaneous coronary artery rupture (SCAR) is an extremely rare, life-threatening entity without any previous underlying diseases. The clinical presentation may differ according to the site of the rupture and some patients may deteriorate early into sudden death due to the abrupt evolution of the associated cardiac tamponade and cardiogenic shock. The correct diagnosis of SCAR deserves a high level of suspicion. It may be confirmed as a differential diagnosis in patients with cardiac tamponade using transthoracic echocardiography (TTE) and computed tomography angiography (CTA) following emergency pericardiocentesis, and a definite diagnosis can be achieved by selective angiography. Although SCAR is associated with a dismal prognosis, some patients have recovered through emergency surgical operations or catheter interventions. We report the case of a patient presenting cardiac tamponade and cardiogenic shock due to spontaneous rupture of the circumflex branch of the left coronary artery, which was successfully isolated by bilateral ligation.
自发性冠状动脉破裂（SCAR）是一种极其罕见的、危及生命的病症，之前没有任何潜在疾病。临床表现可能因破裂部位而异，一些患者可能因相关心脏压塞和心源性休克的突然进展而早期恶化至猝死。SCAR的正确诊断需要高度怀疑。在紧急心包穿刺术后，使用经胸超声心动图（TTE）和计算机断层血管造影（CTA）可将其作为心脏压塞患者的鉴别诊断，通过选择性血管造影可实现明确诊断。尽管SCAR的预后不佳，但一些患者通过急诊手术或导管介入治疗得以康复。我们报告一例因左冠状动脉回旋支自发性破裂导致心脏压塞和心源性休克的患者，通过双侧结扎成功隔离破裂部位。
