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经皮引流局部双房血肿致既往冠状动脉旁路移植术患者局部填塞:一例报告

Percutaneous drainage of a localized biatrial haematoma causing regional tamponade in a patient with prior coronary artery bypass graft surgery: a case report.

作者信息

Achim Alexandru, Toia Damien, Leibundgut Gregor

机构信息

Klinik für Kardiologie, Medizinische Universitätsklinik, Kantonsspital Baselland, Rheinstasse 26, 4410 Liestal, Switzerland.

出版信息

Eur Heart J Case Rep. 2022 Jul 28;6(8):ytac316. doi: 10.1093/ehjcr/ytac316. eCollection 2022 Aug.

Abstract

BACKGROUND

Regional cardiac tamponade presented as posterior extrapericardial haematomas compressing both atria, with cardiogenic obstructive shock due to inflow abolition is a rare cause of post-percutaneous coronary intervention vascular collapse.

CASE SUMMARY

We present such a case where computed tomography-guided anterior pericardiocentesis decompressed the atria and restored cardiac output.

DISCUSSION

Prior coronary artery bypass grafting should not be considered protective from cardiac tamponade in patients in whom perforation occurs, because loculated effusions can develop beneath adhesions of the pericardium and compress various cardiac structures (such as the left atrium or the right ventricle); they appear several hours after the intervention and cause atypical haemodynamic manifestations.

摘要

背景

局部心脏压塞表现为心包外后方血肿压迫双侧心房,因血流流入受阻导致心源性梗阻性休克,是经皮冠状动脉介入术后血管崩溃的罕见原因。

病例摘要

我们报告了这样一例病例,计算机断层扫描引导下的前心包穿刺术使心房减压并恢复了心输出量。

讨论

对于发生穿孔的患者,既往冠状动脉旁路移植术不应被视为可预防心脏压塞,因为心包粘连下方可形成局限性积液并压迫各种心脏结构(如左心房或右心室);这些积液在介入治疗后数小时出现,并导致非典型血流动力学表现。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/835d/9382567/d8cb5568d7f0/ytac316f1.jpg

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