Panoulas Vasileios, Monteagudo-Vela María, Kalogeras Konstantinos, Simon Andre
Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London UB9 6JH, United Kingdom.
Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London UB9 6JH, United Kingdom.
World J Cardiol. 2020 Apr 26;12(4):155-160. doi: 10.4330/wjc.v12.i4.155.
Often in patients with significant three-vessel or left main disease there is coexistent significant peripheral disease rendering them poor candidates for percutaneous left ventricular support during revascularization. Evidence on the management of such cases is limited.
We describe a case of such a patient with critical distal left main disease and chronically occluded right coronary artery who presented with chest pain and a non-ST elevation myocardial infarction and had significantly impaired left ventricular function. With the aid of our cardiothoracic surgeons a cut down subclavian Impella 5.0 was inserted and high risk rotablation percutaneous coronary intervention carried out successfully.
This case highlights the need for cross-specialty collaborations in such high-risk cases were alternative access is needed for insertion of large bore mechanical circulatory support devices.
在患有严重三支血管病变或左主干病变的患者中，常常并存严重的外周血管病变，这使得他们在血运重建期间接受经皮左心室支持的条件不佳。关于此类病例管理的证据有限。
我们描述了这样一例患者，患有严重的左主干远端病变和慢性闭塞的右冠状动脉，出现胸痛和非ST段抬高型心肌梗死，左心室功能严重受损。在我们心胸外科医生的帮助下，插入了切开的锁骨下Impella 5.0，并成功进行了高风险的旋磨冠状动脉介入治疗。
该病例凸显了在这类高风险病例中跨专业合作的必要性，即需要通过其他途径来插入大口径机械循环支持装置。
