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主动脉根部手术并发冠状动脉壁内血肿的转归：一例报告

Fate of a coronary artery intramural haematoma complicating aortic root surgery: a case report.

作者信息

Folino Giulio, Scaffa Raffaele, Salica Andrea, De Paulis Ruggero

机构信息

Department of Cardiac Surgery, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy.

Department of Cardiac Surgery, San Giovanni di Dio e Ruggi d'Aragona, Largo Città di Ippocrate, 84131 Salerno, Italy.

出版信息

Eur Heart J Case Rep. 2020 Sep 4;4(5):1-5. doi: 10.1093/ehjcr/ytaa285. eCollection 2020 Oct.

DOI:10.1093/ehjcr/ytaa285
PMID:33426446
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7780453/
Abstract

BACKGROUND

Coronary intramural haematoma (CIH) is an uncommon but potentially life-threatening complication during aortic root surgery (such as Bentall procedure). Depending on its extension it can lead to cardiogenic shock. Documented reports of this complication are lacking in literature.

CASE SUMMARY

In the report we present a case of CIH and its management and we show a stepwise imaging of the healing process that gives an insight of the fate of CIHs.

DISCUSSION

This case raises awareness of CIH as differential diagnosis for myocardial ischaemia during aortic root surgery. It underlines the effectiveness of immediate surgical revascularization, highlights the potential temporary role of coronary artery bypass graft that can stabilize the acute coronary syndrome and may give time to the CIH to reabsorb and native coronary circulation to re-establish.

摘要

背景

冠状动脉壁内血肿（CIH）是主动脉根部手术（如Bentall手术）期间一种罕见但可能危及生命的并发症。根据其扩展情况，它可导致心源性休克。文献中缺乏关于这种并发症的记录报告。

病例总结

在本报告中，我们展示了一例冠状动脉壁内血肿及其处理情况，并展示了愈合过程的逐步影像学表现，从而深入了解冠状动脉壁内血肿的转归。

讨论

该病例提高了对冠状动脉壁内血肿作为主动脉根部手术期间心肌缺血鉴别诊断的认识。它强调了立即进行手术血运重建的有效性，突出了冠状动脉旁路移植术在稳定急性冠状动脉综合征方面可能发挥的临时作用，这可能为冠状动脉壁内血肿的吸收以及自身冠状动脉循环的重建争取时间。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2130/7780453/c543aa051471/ytaa285f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2130/7780453/0a75d0730cbd/ytaa285f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2130/7780453/2e96acc3bf63/ytaa285f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2130/7780453/975f82628910/ytaa285f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2130/7780453/c543aa051471/ytaa285f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2130/7780453/0a75d0730cbd/ytaa285f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2130/7780453/2e96acc3bf63/ytaa285f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2130/7780453/975f82628910/ytaa285f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2130/7780453/c543aa051471/ytaa285f4.jpg

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本文引用的文献

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Early and Long-Term Outcomes in Patients Undergoing Cardiac Surgery Following Iatrogenic Injuries During Percutaneous Coronary Intervention.经皮冠状动脉介入治疗致医源性损伤后行心脏手术患者的早期和长期结局。
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Eur Heart J. 2018 Sep 21;39(36):3353-3368. doi: 10.1093/eurheartj/ehy080.
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Coronary Intramural Hematoma Presenting as Acute Coronary Syndrome.
表现为急性冠状动脉综合征的冠状动脉壁内血肿
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