Zhang Dengshen, Shi Jun, Hou Jianglong, Guo Yingqiang
Department of Cardiovascular Surgery, West China Hospital of Sichuan University, No.37 Guo Xue Alley, Chengdu, Sichuan, 610041, People's Republic of China.
BMC Surg. 2019 Aug 23;19(1):118. doi: 10.1186/s12893-019-0579-4.
Multiple coronary artery dissection is rare after cardiac surgery. It is difficult to recognize and is easily misdiagnosed as low output syndrome as a result of cardiopulmonary bypass (CPB).
A 43-year-old woman who had undergone cardiac surgery presented with unstable hemodynamics, and progressively increasing lactate, B-type natriuretic peptide, and cardiac enzyme levels, along with electrocardiogram (ECG) changes. Angiography indicated the presence of severe multiple coronary artery dissection, and 3 stents were implanted, which improved the patient's hemodynamic status and cardiac function.
In the present report, we describe our experience with identifying and treating delayed severe multiple coronary artery dissection caused by cardiac surgery. Timely angiography is vital in patients suspected with coronary artery dissection, and percutaneous coronary intervention (PCI) should be considered as a treatment strategy for cases with severe multiple coronary artery dissection and unstable hemodynamics after cardiac surgery.
心脏手术后多发冠状动脉夹层罕见。其难以识别，且由于体外循环（CPB）易被误诊为低心排血量综合征。
一名接受过心脏手术的43岁女性出现血流动力学不稳定，乳酸、B型利钠肽和心肌酶水平逐渐升高，同时伴有心电图（ECG）改变。血管造影显示存在严重多发冠状动脉夹层，遂植入3枚支架，改善了患者的血流动力学状态和心脏功能。
在本报告中，我们描述了识别和治疗心脏手术所致延迟性严重多发冠状动脉夹层的经验。对于疑似冠状动脉夹层的患者，及时进行血管造影至关重要，对于心脏手术后出现严重多发冠状动脉夹层且血流动力学不稳定的病例，应考虑将经皮冠状动脉介入治疗（PCI）作为一种治疗策略。
