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左主干冠状动脉（LMCA）大隐静脉桥（SVG）Cabrol型吻合术的经皮冠状动脉介入治疗（PCI）保护

Protected Percutaneous Coronary Intervention (PCI) of Cabrol Type Anastomosis of Saphenous Vein Graft (SVG) to the Left Main Coronary Artery (LMCA).

作者信息

Siddiqui Sabah, Ayzenberg Sergey, Sabharwal Nitin, Frankel Robert, Shani Jacob

机构信息

Cardiology, Maimonides Medical Center, Brooklyn, USA.

Cardiology, James J. Peters Va Medical Center, Bronx, USA.

出版信息

Cureus. 2020 Jun 25;12(6):e8829. doi: 10.7759/cureus.8829.

DOI:10.7759/cureus.8829
PMID:32742841
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7384709/
Abstract

The use of percutaneous left ventricular assist devices (VAD) may minimize the risk of hemodynamic compromise during such high-risk percutaneous coronary intervention (PCI) and allow complete revascularization, thus improving outcomes. A good understanding of cardiac hemodynamics is essential in making informed decisions during such cases. A 61-year-old male with an extensive surgical cardiac history including a modified Cabrol type anastomosis with saphenous vein (SVG) conduits to two coronary arteries presented to our hospital with severe substernal chest discomfort and was noted to have diffuse ST depressions along with subtle ST elevations in lead aVR suggestive of diffuse sub-endocardial ischemia. Diagnostic coronary angiography revealed significant stenosis in the Cabrol type SVG grafts and we opted for a protected PCI using Impella (Abiomed, Danvers, MA) support. A significant drop in the blood pressure was noted and despite trouble-shooting, the Impella arterial line tracing remained minimally pulsatile.​ A comprehensive understanding of circulatory support physiology was ultimately crucial in making an informed decision for a successful PCI outcome.

摘要

在这种高风险经皮冠状动脉介入治疗（PCI）期间，使用经皮左心室辅助装置（VAD）可将血流动力学受损的风险降至最低，并实现完全血运重建，从而改善治疗结果。在此类病例中做出明智决策时，深入了解心脏血流动力学至关重要。一名61岁男性，有广泛的心脏手术史，包括采用大隐静脉（SVG）导管对两支冠状动脉进行改良卡布罗尔型吻合术，因严重的胸骨后胸痛前来我院就诊，心电图显示广泛ST段压低，伴aVR导联轻微ST段抬高，提示弥漫性心内膜下缺血。诊断性冠状动脉造影显示卡布罗尔型SVG移植物有严重狭窄，我们选择使用Impella（Abiomed，丹弗斯，马萨诸塞州）支持的保护性PCI。术中发现血压显著下降，尽管进行了故障排除，但Impella动脉导管波形仍几乎无搏动。对循环支持生理学的全面理解最终对于做出明智决策以实现成功的PCI结果至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c554/7384709/5d849057cb63/cureus-0012-00000008829-i09.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c554/7384709/794b6a77f9ef/cureus-0012-00000008829-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c554/7384709/89657387133a/cureus-0012-00000008829-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c554/7384709/44ff17fa4249/cureus-0012-00000008829-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c554/7384709/b74c28d15596/cureus-0012-00000008829-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c554/7384709/9fb8a4fcf448/cureus-0012-00000008829-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c554/7384709/adc671808777/cureus-0012-00000008829-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c554/7384709/a19e43c1a3ef/cureus-0012-00000008829-i07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c554/7384709/15b5f527bbfb/cureus-0012-00000008829-i08.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c554/7384709/5d849057cb63/cureus-0012-00000008829-i09.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c554/7384709/794b6a77f9ef/cureus-0012-00000008829-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c554/7384709/89657387133a/cureus-0012-00000008829-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c554/7384709/44ff17fa4249/cureus-0012-00000008829-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c554/7384709/b74c28d15596/cureus-0012-00000008829-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c554/7384709/9fb8a4fcf448/cureus-0012-00000008829-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c554/7384709/adc671808777/cureus-0012-00000008829-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c554/7384709/a19e43c1a3ef/cureus-0012-00000008829-i07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c554/7384709/15b5f527bbfb/cureus-0012-00000008829-i08.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c554/7384709/5d849057cb63/cureus-0012-00000008829-i09.jpg

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