Gaba Prakriti, Kaneko Tsuyoshi, Kochar Ajar, Sung Jonathan, O'Gara Patrick T, Bhatt Deepak L
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
Eur Heart J Case Rep. 2021 Nov 23;5(12):ytab464. doi: 10.1093/ehjcr/ytab464. eCollection 2021 Dec.
Mitral valve (MV) repair or replacement surgery is indicated for a variety of conditions. Although uncommon, damage to the left circumflex (LCx) coronary artery, which courses in close proximity to the MV annulus, is a devastating complication.
This report describes the case of a 63-year-old woman following re-operative MV replacement. Shortly after being transferred to the surgical intensive care unit after MV replacement, her EKG was notable for persistent inferolateral ST-segment elevations and reciprocal ST-segment depressions. Emergency transthoracic echocardiogram revealed a reduced left ventricular ejection fraction of 35-40% and mid to distal lateral wall motion hypokinesis. She was emergently taken to the cardiac catheterization laboratory where coronary angiography demonstrated complete occlusion of her mid LCx artery. She underwent urgent percutaneous coronary intervention of the lesion and was started on dual antiplatelet treatment, anticoagulation for comorbid atrial fibrillation, as well as guideline directed medical therapy with improvement in her EKG changes and cardiac function.
Prompt diagnosis and recognition of LCx injury is crucial. Management involves immediate percutaneous recanalization or surgical coronary bypass grafting.
二尖瓣（MV）修复或置换手术适用于多种病症。虽然罕见，但与二尖瓣环紧邻走行的左旋支（LCx）冠状动脉损伤是一种灾难性并发症。
本报告描述了一名63岁女性再次进行二尖瓣置换手术后的病例。二尖瓣置换术后不久被转入外科重症监护病房，其心电图表现为持续性下侧壁ST段抬高及对应导联ST段压低。急诊经胸超声心动图显示左心室射血分数降低至35% - 40%，侧壁中远端运动减弱。她被紧急送往心脏导管实验室，冠状动脉造影显示其左旋支动脉中段完全闭塞。她接受了病变的紧急经皮冠状动脉介入治疗，并开始接受双联抗血小板治疗、针对合并房颤的抗凝治疗以及指南指导的药物治疗，心电图改变和心功能均有改善。
及时诊断和识别左旋支损伤至关重要。治疗包括立即进行经皮再通或外科冠状动脉搭桥术。
