手术补片裂开后经皮闭合心肌梗死后左心室假性动脉瘤
Percutaneous Closure of Postinfarct Left Ventricular Pseudoaneurysm After Surgical Patch Dehiscence.
作者信息
Traynor Bryan P, Ali Hassan Syed M, Attumalil Thomas, Gamal Amr, Almalki Yazeed, Sarak Bradley, Ong Geraldine, Alnasser Sami, Verma Subodh, Fam Neil P
机构信息
Structural Heart Program, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Department of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
出版信息
JACC Case Rep. 2025 Apr 2;30(7):103389. doi: 10.1016/j.jaccas.2025.103389.
BACKGROUND
Left ventricular free wall rupture is a life-threatening mechanical complication of ST-segment elevation myocardial infarction. In patients with a timely diagnosis, emergent surgical patch repair is the cornerstone of management; re-rupture, surgical patch dehiscence, and left ventricular pseudoaneurysm (LVPA) are potential late complications after surgery.
CASE SUMMARY
A 72-year-old man presented with NYHA functional class III dyspnea 4 months after surgical patch repair. We report, to our knowledge, the first case of successful percutaneous closure of LVPA resulting from surgical patch dehiscence.
DISCUSSION
LVPA after surgical repair is a serious late complication. Multimodality imaging and careful case planning allowed for successful device closure with excellent clinical outcome.
TAKE-HOME MESSAGES: Multimodality cardiac imaging is essential for accurate diagnosis and management of acute left ventricular free wall rupture and LVPA resulting from surgical patch dehiscence. Percutaneous closure of LVPA after surgical patch dehiscence is an effective and safe alternative to redo surgery.
背景
左心室游离壁破裂是ST段抬高型心肌梗死的一种危及生命的机械性并发症。对于及时诊断的患者，紧急手术修补是治疗的基石；再破裂、手术补片裂开和左心室假性动脉瘤（LVPA）是手术后潜在的晚期并发症。
病例摘要
一名72岁男性在手术补片修补术后4个月出现纽约心脏协会（NYHA）心功能III级呼吸困难。据我们所知，我们报告了首例因手术补片裂开导致的LVPA经皮成功封堵的病例。
讨论
手术修复后的LVPA是一种严重的晚期并发症。多模态成像和仔细的病例规划使得成功进行器械封堵并取得了良好的临床结果。
要点
多模态心脏成像对于准确诊断和处理急性左心室游离壁破裂以及手术补片裂开导致的LVPA至关重要。手术补片裂开后经皮封堵LVPA是再次手术的一种有效且安全的替代方法。
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