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急性心肌梗死后室间隔穿孔继以乳头肌破裂：静脉-动脉体外膜肺氧合的疗效

Ventricular septal perforation followed by papillary muscle rupture with acute myocardial infarction: efficacy of venoarterial extracorporeal membrane oxygenation.

作者信息

Ushioda Ryohei, Fujii Atsuko, Shirakawa Makoto, Shirasaka Tomonori, Kikuchi Shinsuke, Kamiya Hiroyuki, Kanamori Taro

机构信息

Department of Cardiovascular Surgery, Kawaguchi Cardiovascular and Respiratory Hospital, Saitama, Japan.

Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan.

出版信息

J Surg Case Rep. 2020 Jul 31;2020(7):rjaa188. doi: 10.1093/jscr/rjaa188. eCollection 2020 Jul.

DOI:10.1093/jscr/rjaa188
PMID:32760487
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7394127/
Abstract

The occurrence of multiple mechanical complications after myocardial infarction in the same patient may be extremely rare, and the surgical strategy may be very complex because each mechanical complication can be extremely fatal. The case of a patient who underwent repair of a ventricular septal perforation by venoarterial extracorporeal membrane oxygenation (VA-ECMO), then mitral valve replacement and VA-ECMO for papillary muscle rupture 2 weeks after the ventricular septal perforation repair, is reported. Immediate preoperative stabilization with VA-ECMO may play a crucial role in treating multiple mechanical complications after myocardial infarction.

摘要

同一患者心肌梗死后出现多种机械并发症的情况可能极为罕见，而且手术策略可能非常复杂，因为每种机械并发症都可能极其致命。本文报道了一例患者，该患者先通过静脉-动脉体外膜肺氧合（VA-ECMO）进行室间隔穿孔修复，然后在室间隔穿孔修复术后2周因乳头肌破裂进行二尖瓣置换及VA-ECMO治疗。术前立即使用VA-ECMO进行稳定治疗可能在治疗心肌梗死后的多种机械并发症中发挥关键作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a148/7394127/0bfc0de09886/rjaa188f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a148/7394127/c3ea201998af/rjaa188f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a148/7394127/113c55f76bbe/rjaa188f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a148/7394127/0bfc0de09886/rjaa188f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a148/7394127/c3ea201998af/rjaa188f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a148/7394127/113c55f76bbe/rjaa188f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a148/7394127/0bfc0de09886/rjaa188f3.jpg

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本文引用的文献

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The role of extracorporeal membrane oxygenation in an acute basal ventricular septal rupture.体外膜肺氧合在急性基底室间隔破裂中的作用
Eur J Cardiothorac Surg. 2020 Apr 1;57(4):799-800. doi: 10.1093/ejcts/ezz235.
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Preoperative Extracorporeal Membrane Oxygenation for Postinfarction Ventricular Septal Defect.梗死后置入室间隔缺损术前体外膜肺氧合治疗
Innovations (Phila). 2019 Feb;14(1):75-79. doi: 10.1177/1556984518823633. Epub 2019 Feb 11.
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Postinfarction ventricular septal defect: right ventricular approach-the extended "sandwich" patch.
心肌梗死后室间隔缺损：右心室入路——扩展的“三明治”补片。
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Mechanical complications after percutaneous coronary intervention in ST-elevation myocardial infarction (from APEX-AMI).ST 段抬高型心肌梗死患者经皮冠状动脉介入治疗后的机械并发症（来自 APEX-AMI 研究）。
Am J Cardiol. 2010 Jan 1;105(1):59-63. doi: 10.1016/j.amjcard.2009.08.653.
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Ann Thorac Surg. 2004 Nov;78(5):e77-8. doi: 10.1016/j.athoracsur.2003.09.114.
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Surgical repair of an impending rupture of left ventricular (LV) aneurysm with septal perforation and rupture of papillary muscle after acute myocarial infarction.急性心肌梗死后左心室（LV）室壁瘤伴间隔穿孔及乳头肌破裂即将破裂的外科修复术。
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