Marangoni Ludovica, Serra Walter, Borrello Bruno, Vezzani Antonella, Ramelli Andrea, Cattabiani Maria Alberta
Cardiology Unit ,University Hospital of Parma.
University Hospital Parma.
Acta Biomed. 2020 Sep 7;91(3):e2020080. doi: 10.23750/abm.v91i3.8726.
The incidence of complications of coronary perforation varied significantly among studies probably due to population heterogeneity and interventional techniques applied in each centre. Free wall rupture, cardiac tamponade and miocardial infarction are the most feared. The treatment of perforation remains a challenge of every cath- lab team. The management strategies range from observation to urgent operation depending on patient's hemodynamic status, severity and location of the perforation, coronary anatomy, interventional practice and equipment in each centre and operators' skills on-site. In this case an extracorporeal circulation and cardioplegic arrest with anterograde hot blood cardioplegia was done. A composite Dacron with autologous pericardium patch was used for left ventricular free wall rupture repair and the geometry of the left ventricle was restored. Subsequently aorta was declamped; the patient was weaned from CEC and a good spontaneous hemodynamic was recovered.
冠状动脉穿孔并发症的发生率在不同研究中差异显著，这可能是由于人群异质性以及各中心所应用的介入技术不同。游离壁破裂、心脏压塞和心肌梗死是最令人担忧的情况。穿孔的治疗仍然是每个心导管实验室团队面临的挑战。管理策略从观察到紧急手术不等，这取决于患者的血流动力学状态、穿孔的严重程度和位置、冠状动脉解剖结构、每个中心的介入操作和设备以及现场操作人员的技能。在这个病例中，进行了体外循环和使用顺行温血心脏停搏液的心脏停搏。使用带自体心包补片的复合涤纶补片修复左心室游离壁破裂，并恢复了左心室的形态。随后松开主动脉夹；患者脱离体外循环，恢复了良好的自主血流动力学。
