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右心室损伤和肺栓塞：非体外循环冠状动脉旁路移植术中左前降支深部心肌内夹层的危害。

Right ventricular injury and pulmonary embolism: The perils of deep intramyocardial left anterior descending artery dissection in off-pump coronary artery bypass grafting.

机构信息

Department of Cardiothoracic Surgery, NH Rabindranath Tagore International Institute of Cardiac Sciences, Mukundapur, Kolkata, India.

Department of Cardiac Anaesthesiology, NH Rabindranath Tagore International Institute of Cardiac Sciences, Mukundapur, Kolkata, India.

出版信息

Ann Card Anaesth. 2021 Jan-Mar;24(1):99-101. doi: 10.4103/aca.ACA_49_19.

DOI:10.4103/aca.ACA_49_19
PMID:33938844
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8081134/
Abstract

An inadvertent vent in the right ventricle (RV) resulted during dissection of a deep intramyocardial left anterior descending coronary artery (LAD), during off-pump coronary artery bypass grafting (OPCAB), led to pulmonary artery air embolism and hemodynamic instability, requiring conversion to cardiopulmonary bypass (CPB) prior to repair. This required a special maneuver in positioning the patient to identify the RV injury and prevent the pulmonary air embolism.

摘要

在非体外循环冠状动脉旁路移植术（OPCAB）中，解剖左前降支深部心肌内冠状动脉时，无意中造成右心室（RV）出现一个裂口，导致肺动脉空气栓塞和血流动力学不稳定，需要在修复前转为心肺旁路（CPB）。这需要患者采取特殊的体位来识别 RV 损伤并防止肺空气栓塞。

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本文引用的文献

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The intramyocardial left anterior descending artery: prevalence and surgical considerations in coronary artery bypass grafting.心肌内左前降支动脉：冠状动脉旁路移植术中的发生率及手术考量
S Afr J Surg. 2014 Feb;52(1):18-21.
2
Air embolism during off-pump coronary artery bypass graft surgery -A case report-.非体外循环冠状动脉旁路移植术中的空气栓塞——一例报告。
Korean J Anesthesiol. 2012 Jul;63(1):72-5. doi: 10.4097/kjae.2012.63.1.72. Epub 2012 Jul 24.
3
Off-pump and on-pump coronary artery bypass grafting are associated with similar graft patency, myocardial ischemia, and freedom from reintervention: long-term follow-up of a randomized trial.非体外循环冠状动脉旁路移植术和体外循环冠状动脉旁路移植术与相似的移植物通畅率、心肌缺血和免于再次干预相关：一项随机试验的长期随访结果。
Ann Thorac Surg. 2011 Jun;91(6):1836-42; discussion 1842-3. doi: 10.1016/j.athoracsur.2010.12.043.
4
Five-year follow-up of a randomized comparison between off-pump and on-pump stable multivessel coronary artery bypass grafting. The MASS III Trial.非体外循环与体外循环稳定多支冠状动脉旁路移植术的随机对照 5 年随访。MASS III 试验。
Circulation. 2010 Sep 14;122(11 Suppl):S48-52. doi: 10.1161/CIRCULATIONAHA.109.924258.
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Cognitive and cardiac outcomes 5 years after off-pump vs on-pump coronary artery bypass graft surgery.非体外循环与体外循环冠状动脉旁路移植术后5年的认知和心脏结局
JAMA. 2007 Feb 21;297(7):701-8. doi: 10.1001/jama.297.7.701.
6
Marsupialization of intramyocardial left anterior descending artery: a novel approach for easy access during revascularization.心肌内左前降支动脉袋形缝术：一种在血运重建期间便于操作的新方法。
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