Grigorov Mladen, Mathbout Mohammad, Fahsah Ibrahim, Ghafghazi Shahab
Department of Internal Medicine, University of Louisville School of Medicine, Louisville, Kentucky, 40202.
Division of Cardiovascular Medicine, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, 40202.
Glob Cardiol Sci Pract. 2020 Dec 31;2020(3):e202035. doi: 10.21542/gcsp.2020.35.
Coronary interventions are one of the most commonly performed procedures in interventional medicine. They have provided a life-prolonging and -saving solution, but are not without their own complications. These, although rare, do occur and are important to recognize in order to promptly and efficiently provide a solution to prevent catastrophic consequences to the patient. We present a 70-year-old male with a past medical history significant for hypertension, hyperlipidemia, and myasthenia gravis; who presented to the hospital with substernal, pressure-like chest pain with associated nausea and diaphoresis. He was found to have ST segment elevations in anterolateral leads, prompting catherization lab activation revealing left anterior descending (LAD) artery stenosis. Percutaneous intervention via balloon dilation and stent placement was performed with periprocedural mid-intervention hemodynamic collapse occurring. Subsequent left ventricular (LV) angiography was performed revealing preserved LV function without perforation - however a rim of contrast was noted surrounding the LV. Thus, hemodynamic collapse was recognized as result of cardiac tamponade with pericardial drain emergently inserted resulting in hemodynamic recovery. Our case aims to present a case of vascular perforation with the uniqueness in our diagnostic approach via fluoroscopic imaging.
冠状动脉介入治疗是介入医学中最常进行的手术之一。它们提供了一种延长生命和挽救生命的解决方案，但并非没有自身的并发症。这些并发症虽然罕见，但确实会发生，认识到它们很重要，以便迅速有效地提供解决方案，防止对患者造成灾难性后果。我们报告一名70岁男性，既往有高血压、高脂血症和重症肌无力病史；因胸骨后压榨样胸痛伴恶心和出汗入院。发现他前侧壁导联ST段抬高，促使激活导管室，显示左前降支（LAD）动脉狭窄。通过球囊扩张和支架置入进行经皮介入治疗，术中出现围手术期血流动力学崩溃。随后进行左心室（LV）血管造影，显示左心室功能保留，无穿孔——然而，在左心室周围发现一圈造影剂。因此，血流动力学崩溃被确认为心包填塞的结果，紧急插入心包引流管后血流动力学恢复。我们的病例旨在通过透视成像展示一例血管穿孔病例及其独特的诊断方法。
