Ueno Daisuke, Nomura Tetsuya, Ono Kenshi, Sakaue Yu, Hori Yusuke, Yoshioka Kenichi, Kikai Masakazu, Keira Natsuya, Tatsumi Tetsuya
Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Nantan, Kyoto, Japan.
Am J Case Rep. 2019 Aug 7;20:1155-1158. doi: 10.12659/AJCR.917217.
BACKGROUND Ventricular rupture is a complication of acute myocardial infarction (AMI) that results in hemopericardium and cardiac tamponade and has a high mortality rate. Most cases involve the left ventricular free wall, and there have been few previous reports of solitary right ventricular free wall rupture. This report is of a case of fatal right ventricular free wall rupture during percutaneous coronary intervention (PCI) for inferior acute myocardial infarction (AMI). CASE REPORT A 76-year-old woman underwent emergency coronary angiography following inferior AMI. During angiography and attempted percutaneous coronary intervention (PCI), sudden onset of cardiac arrest occurred due to cardiac tamponade. Blood was drained from the pericardium by pericardiocentesis. Despite of advanced cardiac support, the patient died. The post mortem findings showed a solitary right ventricular free wall rupture due to inferior myocardial infarction. CONCLUSIONS A rare case is presented of right ventricular free wall rupture following AMI that occurred during PCI. This case demonstrates that early diagnosis and management are required to prevent patient mortality.
背景 心室破裂是急性心肌梗死（AMI）的一种并发症，可导致心包积血和心脏压塞，死亡率很高。大多数病例累及左心室游离壁，既往关于孤立性右心室游离壁破裂的报道很少。本报告为1例因下壁急性心肌梗死接受经皮冠状动脉介入治疗（PCI）期间发生致命性右心室游离壁破裂的病例。病例报告 一名76岁女性因下壁AMI接受了急诊冠状动脉造影。在血管造影及尝试进行PCI过程中，因心脏压塞突然发生心脏骤停。通过心包穿刺从心包引流出血液。尽管给予了高级心脏支持，患者仍死亡。尸检结果显示因下壁心肌梗死导致孤立性右心室游离壁破裂。结论 本文报告1例罕见的AMI后PCI期间发生右心室游离壁破裂的病例。该病例表明，需要早期诊断和处理以防止患者死亡。
