Hamayel Hamza, Ismail Yahya, Majadla Sajed, Hamshari Yousef, Daralammouri Yunis
Department of Internal Medicine, An-Najah National University Hospital, Nablus, State of Palestine.
Department of Cardiology, An-Najah National University Hospital, Nablus, State of Palestine.
Case Rep Cardiol. 2021 Jul 29;2021:5522501. doi: 10.1155/2021/5522501. eCollection 2021.
Acute total occlusion of the left main coronary artery (LMCA) is a fatal event; most patients die before reaching hospitals. Few of them reach the hospital alive. Revascularization of the LMCA can be achieved by surgical intervention or percutaneous coronary intervention with unknown optimal modality. However, mortality of those patients is very high even with either; few cases reported successful management of acute total occlusion of the LMCA including our patient. . A 56-year-old male patient who is a smoker presented with typical chest pain worsened 2 hours prior to admission. He was hemodynamically stable, but he had respiratory failure due to pulmonary edema. An electrocardiogram showed anterior ST-elevation myocardial infarction. He was given loading doses of dual antiplatelet agents, in addition to respiratory support, then transferred immediately to the cardiac catheterization laboratory. Urgent cardiac catheterization showed total occlusion of the LMCA. Recanalization was done successfully, and a stent was inserted in the LMCA and left anterior descending artery. The patient developed cardiogenic shock during the procedure. An intra-aortic balloon pump (IABP) was applied which improved his hemodynamic status and enhanced his coronary flow. He is clinically improved, there was resolution of ST elevation, and cardiogenic shock gradually resolved. IABP was removed, and the patient was discharged in good general condition.
Survival after acute total occlusion of the LMCA is very rare. The good outcome in this patient is attributed to early recognition and timely successful intervention, with good respiratory and hemodynamic support. The surgical and anaesthesia team should be on stand-by until complete revascularization and stabilization of the patient are achieved.
左主干冠状动脉（LMCA）急性完全闭塞是一种致命事件；大多数患者在到达医院之前死亡。很少有人能活着到达医院。LMCA的血运重建可通过手术干预或经皮冠状动脉介入治疗实现，最佳方式尚不清楚。然而，即使采用其中任何一种方法，这些患者的死亡率都非常高；很少有病例报道成功处理LMCA急性完全闭塞，包括我们的患者。一名56岁男性吸烟者，入院前2小时出现典型胸痛且加重。他血流动力学稳定，但因肺水肿出现呼吸衰竭。心电图显示前壁ST段抬高型心肌梗死。除给予呼吸支持外，还给予了负荷剂量的双联抗血小板药物，然后立即转至心导管实验室。紧急心导管检查显示LMCA完全闭塞。成功进行了再通，并在LMCA和左前降支置入了支架。患者在手术过程中发生心源性休克。应用了主动脉内球囊反搏（IABP），改善了他的血流动力学状态并增加了冠状动脉血流。他的临床症状有所改善，ST段抬高消失，心源性休克逐渐缓解。IABP撤除，患者出院时一般情况良好。
LMCA急性完全闭塞后存活非常罕见。该患者的良好预后归因于早期识别、及时成功干预以及良好的呼吸和血流动力学支持。手术和麻醉团队应随时待命，直到患者实现完全血运重建并稳定下来。
