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病例报告:非体外循环冠状动脉搭桥术中,经房间隔缺损的血流术中逆转导致低氧血症。

Case report: Intraoperative reversal of flow through an atrial septal defect presenting as hypoxemia during off-pump coronary artery bypass grafting.

作者信息

Zhao Yun, Mi Chaorui, Xie Juan, Li Hui

机构信息

Department of Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, China.

Department of Academic Affairs, The Second Xiangya Hospital, Central South University, Changsha, China.

出版信息

Front Cardiovasc Med. 2023 Jul 31;10:1085755. doi: 10.3389/fcvm.2023.1085755. eCollection 2023.

DOI:10.3389/fcvm.2023.1085755
PMID:37583587
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10423918/
Abstract

The co-existence of atrial septal defect and coronary artery disease in a patient is rare in clinical practice. In the combined surgery of off-pump coronary artery bypass grafting and atrial septal defect closure, the unusual cardiac positions may affect the direction of blood shunting between the atriums, leading to more complex hemodynamic changes. Here, we report a case of a 67-year-old female who underwent refractory hypoxemia related to heart position in such a combined operation.

摘要

在临床实践中,患者同时存在房间隔缺损和冠状动脉疾病的情况较为罕见。在非体外循环冠状动脉搭桥术和房间隔缺损封堵联合手术中,心脏位置异常可能会影响心房之间的血液分流方向,导致更复杂的血流动力学变化。在此,我们报告一例67岁女性患者,在这种联合手术中因心脏位置问题出现难治性低氧血症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95e9/10423918/287c31e27920/fcvm-10-1085755-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95e9/10423918/287c31e27920/fcvm-10-1085755-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95e9/10423918/287c31e27920/fcvm-10-1085755-g001.jpg

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本文引用的文献

1
Atrial septal defect in adulthood: a new paradigm for congenital heart disease.成人房间隔缺损:先天性心脏病的新范例。
Eur Heart J. 2022 Jul 21;43(28):2660-2671. doi: 10.1093/eurheartj/ehab646.
2
Atherosclerosis: current pathogenesis and therapeutic options.动脉粥样硬化:当前的发病机制和治疗选择。
Nat Med. 2011 Nov 7;17(11):1410-22. doi: 10.1038/nm.2538.
3
Monitoring cardiac output trends with end-tidal carbon dioxide pressures in off-pump coronary bypass.监测非体外循环冠状动脉旁路移植术中心肌输出量趋势与呼气末二氧化碳压力
Ann Thorac Surg. 2011 May;91(5):e81-2. doi: 10.1016/j.athoracsur.2010.12.039.
4
Coronary artery bypass grafting in adults with congenital heart disease.先天性心脏病成人患者的冠状动脉旁路移植术。
J Card Surg. 2010 Nov;25(6):629-32. doi: 10.1111/j.1540-8191.2010.01110.x. Epub 2010 Oct 4.
5
Off-pump coronary artery bypass grafting with device closure of atrial septal defect.非体外循环冠状动脉旁路移植术联合封堵器治疗房间隔缺损。
Ann Thorac Surg. 2010 Nov;90(5):1727-9. doi: 10.1016/j.athoracsur.2009.12.044.
6
Arterial-to-end-tidal carbon dioxide tension difference in children with congenital heart disease.先天性心脏病患儿的动脉血与呼气末二氧化碳分压差值
J Cardiothorac Vasc Anesth. 2006 Apr;20(2):196-201. doi: 10.1053/j.jvca.2005.11.008.
7
Transesophageal echocardiographic and oxymetric evidence of intraoperative reversal of flow through a patent foramen ovale during an off-pump coronary artery bypass grafting.
J Clin Anesth. 2005 Dec;17(8):617-20. doi: 10.1016/j.jclinane.2005.01.010.