Coma-Canella I, Gamallo C, Martinez Onsurbe P, Lopez-Sendon J
Unidad Coronaria, Hospital La Paz, Madrid, Spain.
Eur Heart J. 1988 May;9(5):534-40. doi: 10.1093/oxfordjournals.eurheartj.a062540.
Isolated right ventricular infarction has been found in cases of right ventricular hypertrophy, but there are no reports on right ventricular infarction secondary to massive pulmonary embolism. Six autopsied patients with massive pulmonary embolism and pure right ventricular infarction, suspected to be secondary to the embolism, were selected from a population of 216 autopsies. Pulmonary embolism was the suspected diagnosis in five cases due to typical clinical, electrocardiographic and haemodynamic data. Right ventricular infarction was a post-mortem finding, not previously diagnosed. In every case the thickness of the right ventricular myocardium was normal. The necrosis of the right ventricle was transmural in four cases and subendocardial in two and the entire right ventricular wall (anterolateral as well as posterior) was involved. No mural thrombi were present and in no case did the necrosis involve the left ventricle. In one case the coronary arteries were normal, in the other five significant lesions of the right or left coronary arteries were observed. These lesions may have been, in part, responsible for the necrosis of the right ventricle when the massive pulmonary embolism was added. We conclude that right ventricular infarction may be secondary to pulmonary hypertension in the setting of massive pulmonary embolism, even in the absence of right ventricular hypertrophy and with normal or stenotic coronary arteries.
在右心室肥厚病例中已发现孤立性右心室梗死，但尚无继发于大面积肺栓塞的右心室梗死的相关报道。从216例尸检病例中选取了6例经尸检证实为大面积肺栓塞且单纯右心室梗死（怀疑继发于栓塞）的患者。由于典型的临床、心电图和血流动力学数据，5例病例的疑似诊断为肺栓塞。右心室梗死是尸检结果，此前未被诊断。在每例病例中，右心室心肌厚度均正常。右心室坏死4例为透壁性，2例为心内膜下，整个右心室壁（前外侧和后壁）均受累。未发现壁血栓，坏死均未累及左心室。1例病例冠状动脉正常，其他5例观察到右冠状动脉或左冠状动脉有明显病变。当合并大面积肺栓塞时，这些病变可能部分导致了右心室坏死。我们得出结论，即使在没有右心室肥厚且冠状动脉正常或狭窄的情况下，大面积肺栓塞时右心室梗死也可能继发于肺动脉高压。
