Sellers Alexander M, Alam Ferdous, Bennetts Jayme S, Lehman Sam J, Sinhal Ajay R
Department of Cardiology, Central Adelaide Local Health Network, Port Road, Adelaide, South Australia 5000, Australia.
Whyalla Hospital and Health Service, Wood Terrace, Whyalla, South Australia 5600, Australia.
Eur Heart J Case Rep. 2022 Dec 6;7(1):ytac465. doi: 10.1093/ehjcr/ytac465. eCollection 2023 Jan.
Obesity is a global health problem of increasing prevalence with a broad range of multisystem complications. An under-recognized complication of severe obesity is the potential haemodynamic compromise that may arise due to pathological external compression of the inferior vena cava whilst lying in the supine position, a phenomenon known as obesity-induced vena cava compression syndrome.
A 56-year-old independent woman presented to a rural Australian hospital for routine dressing care for bilateral lymphoedema on a background of class III morbid obesity (weight 197 kg, body mass index 68.55 kg/m) and aortic stenosis. Whilst laid in the supine position with both legs elevated to aid lower limb venous return, the patient developed angina with associated troponin rise (15 to 75 to 332 ng/L) and inferolateral territory ischaemic changes on electrocardiogram. The pain then resolved shortly after restoring the patient to the upright position. A transthoracic echocardiogram showed critical bicuspid aortic stenosis. Computerized tomography coronary angiogram showed no significant coronary artery disease. Following multidisciplinary discussions, a transcatheter aortic valve insertion was performed via a transfemoral approach. Post-procedure, she went into atrial fibrillation, she was cardioverted into a sinus rhythm with new left bundle branch block. There were no complications otherwise, and the patient was discharged home following a brief period of convalescence.
We describe a case of suspected obesity-induced vena cava compression syndrome precipitating a type 2 myocardial infarction in a pre-load dependent patient with critical bicuspid valve aortic stenosis. This case highlights a potential haemodynamic consequence of morbid obesity in the supine position.
肥胖是一个全球范围内患病率不断上升的健康问题，会引发一系列多系统并发症。严重肥胖一个未得到充分认识的并发症是，仰卧位时下腔静脉可能因病理性外部压迫而出现血流动力学损害，这一现象被称为肥胖诱导的腔静脉压迫综合征。
一名56岁的独立女性因III级病态肥胖（体重197千克，体重指数68.55千克/平方米）和主动脉瓣狭窄，前往澳大利亚一家乡村医院接受双侧淋巴水肿的常规换药护理。当患者双腿抬高呈仰卧位以促进下肢静脉回流时，出现心绞痛，肌钙蛋白升高（从15升至75再升至332纳克/升），心电图显示下侧壁缺血性改变。将患者恢复至直立位后不久，疼痛缓解。经胸超声心动图显示重度二叶式主动脉瓣狭窄。计算机断层扫描冠状动脉造影显示无明显冠状动脉疾病。经过多学科讨论后，通过经股动脉途径进行了经导管主动脉瓣植入术。术后，患者出现房颤，经复律转为窦性心律，并伴有新出现的左束支传导阻滞。除此之外无其他并发症，患者经过短暂恢复期后出院回家。
我们描述了一例疑似肥胖诱导的腔静脉压迫综合征病例，该综合征在一名依赖前负荷且患有重度二叶式主动脉瓣狭窄的患者中引发了2型心肌梗死。该病例突出了病态肥胖在仰卧位时潜在的血流动力学后果。
