Vu Vu Hoang, Truong Hung Phi, Tran Hoa, Cao Khang Dang, Duong Bao Thien, Tran Thuy Thanh Thi, Truong Binh Quang
Medicine Faculty, University of Medicine and Pharmacology at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
Interventional Cardiology Department, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam.
Front Cardiovasc Med. 2024 Aug 21;11:1451194. doi: 10.3389/fcvm.2024.1451194. eCollection 2024.
Iatrogenic left main coronary artery (LMCA) dissection resulting from cardiac surgery is a rare complication. Its early detection is challenging and often poses a significant threat to the patient's life. However, evidence regarding the most effective management strategy for this condition remains limited at present.
We present a case of 65-year-old female patient who developed cardiogenic shock after mechanical aortic valve replacement surgery associated acute myocardial infraction. Despite concurrent coronary artery bypass graft (CABG) surgery, the patient's condition remained unimproved. Subsequent coronary angiography revealed extensive LMCA dissection involving the left circumflex (LCx) artery. Percutaneous coronary intervention (PCI) guided by intravascular ultrasound (IVUS) led to an immediate improvement in hemodynamic status. The patient was successfully discharged after 22 days of treatment.
Iatrogenic LMCA dissection is an uncommon complication following cardiac surgery. It can manifest in a variety of ways, including as incidental findings, cardiogenic shock or sudden cardiac arrest. The precise prevalence rates of causes linked to cardiac surgery remain largely unknown due to the scarcity of reported cases and the absence of research on this issue. Currently, a definitive management strategy for this condition has not been established. However, previous reported clinical cases provide insight that CABG could be considered if coronary artery dissection is detected during cardiac surgery. Upon postoperative identification, diagnostic coronary angiography and PCI may be feasible alternatives.
心脏手术导致的医源性左冠状动脉主干（LMCA）夹层是一种罕见的并发症。其早期检测具有挑战性，常常对患者生命构成重大威胁。然而，目前关于这种情况最有效的管理策略的证据仍然有限。
我们报告一例65岁女性患者，她在机械主动脉瓣置换手术后发生心源性休克，并伴有急性心肌梗死。尽管同时进行了冠状动脉旁路移植术（CABG），患者的病情仍未改善。随后的冠状动脉造影显示广泛的LMCA夹层累及左旋支（LCx）动脉。血管内超声（IVUS）引导下的经皮冠状动脉介入治疗（PCI）使血流动力学状态立即得到改善。经过22天的治疗，患者成功出院。
医源性LMCA夹层是心脏手术后罕见的并发症。它可以有多种表现形式，包括偶然发现、心源性休克或心脏骤停。由于报告病例稀少且缺乏对此问题的研究，与心脏手术相关的病因的确切患病率仍然很大程度上未知。目前，尚未确立针对这种情况的明确管理策略。然而，先前报道的临床病例提供了一些见解，即如果在心脏手术期间检测到冠状动脉夹层，可以考虑进行CABG。术后确诊后，诊断性冠状动脉造影和PCI可能是可行的替代方案。
