经房间隔穿刺行二尖瓣经导管缘对缘修复术前引发的致命性冠状动脉痉挛：一例病例报告
Fatal coronary artery spasm triggered before transseptal puncture for mitral transcatheter edge-to-edge-repair: a case report.
作者信息
Mo Yujing, Li Jie, Luo Jianfang, Dong Haojian
机构信息
Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106, Zhongshaner Rd, Yuexiu Disctict, Guangzhou, Guangdong 510080, China.
出版信息
Eur Heart J Case Rep. 2022 Dec 27;7(1):ytac483. doi: 10.1093/ehjcr/ytac483. eCollection 2023 Jan.
BACKGROUND
Transient ST-segment elevation or coronary artery spasm during transseptal catheterization has been previously described. Most cases were either reversible or asymptomatic.
CASE SUMMARY
We present a case of severe multiple coronary artery spasms with advanced atrioventricular block and ventricular fibrillation during compression of the fossa ovalis by a sheath catheter, before the performance of the transseptal puncture procedure for mitral transcatheter edge-to-edge-repair.
DISCUSSION
The mechanical effects of forward tension from transseptal puncture on the interatrial vagal network could be the most possible explanation for the occurrence of this phenomenon.
背景
以往曾有关于经房间隔导管插入术期间短暂性ST段抬高或冠状动脉痉挛的描述。大多数病例要么是可逆的，要么是无症状的。
病例摘要
我们报告一例在经导管二尖瓣缘对缘修复的经房间隔穿刺术前，鞘管压迫卵圆窝时发生严重多发性冠状动脉痉挛，并伴有高度房室传导阻滞和心室颤动的病例。
讨论
经房间隔穿刺产生的向前张力对房间迷走神经网的机械作用可能是这一现象发生的最合理的解释。
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