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首例因第一间隔支孤立性自发性冠状动脉夹层导致的急性心肌梗死：病例报告

Acute myocardial infarction due to isolated spontaneous coronary artery dissection in the first septal branch: a case report.

作者信息

Tanimura Kosuke, Matsutera Ryo, Nakajima Kenji, Takaoka Hideyuki

机构信息

Department of Cardiology, Aijinkai Takatsuki General Hospital, 1-3-13 Kosobe-cho, Takatsuki, Osaka 569-1192, Japan.

出版信息

Eur Heart J Case Rep. 2025 Jul 14;9(7):ytaf339. doi: 10.1093/ehjcr/ytaf339. eCollection 2025 Jul.

DOI:10.1093/ehjcr/ytaf339
PMID:40718652
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12291164/
Abstract

BACKGROUND

Myocardial infarction due to isolated spontaneous dissection in the septal branch of the coronary arteries is a rare cause of myocardial infarction with non-obstructive coronary artery disease and is challenging to diagnose.

CASE SUMMARY

A 61-year-old woman presenting with acute chest pain exhibited slight ST-segment elevation in leads V1-3 on electrocardiography. Echocardiography revealed mild hypokinetic septal wall motion. Contrast-enhanced computed tomography demonstrated a low-contrast area in the posterior septum. Emergency coronary angiography revealed delayed flow and stenosis in the first septal branch of the left anterior descending coronary artery. Intravascular ultrasound demonstrated a circumferential haematoma without an intimal tear or double lumen at the stenotic site. No balloon angioplasty or stent implantation was required because the flow delay in the septal branch disappeared after intravascular ultrasound procedure. The patient was conservatively managed with single antiplatelet therapy, calcium channel blocker, and statin. After 1 month, follow-up coronary computed tomography angiogram confirmed vascular patency of the first septal branch without narrowing, and the patient showed no recurrence.

DISCUSSION

Myocardial infarction due to isolated spontaneous coronary dissection in the septal branch of the coronary arteries is an often overlooked cause of myocardial infarction with non-obstructive coronary artery disease. Therefore, intravascular imaging and contrast-enhanced computed tomography should be performed in cases of myocardial infarction with a non-obstructive coronary artery to locate the site of infarction and identify the cause.

摘要

背景

冠状动脉间隔支孤立性自发夹层导致的心肌梗死是无阻塞性冠状动脉疾病性心肌梗死的罕见病因，诊断具有挑战性。

病例摘要

一名61岁女性因急性胸痛就诊，心电图显示V1 - 3导联ST段轻度抬高。超声心动图显示室间隔壁运动轻度减弱。对比增强计算机断层扫描显示后间隔有低对比度区域。急诊冠状动脉造影显示左前降支第一间隔支血流延迟和狭窄。血管内超声显示狭窄部位有环形血肿，无内膜撕裂或双腔。由于血管内超声检查后间隔支血流延迟消失，无需进行球囊血管成形术或支架植入。患者接受单一抗血小板治疗、钙通道阻滞剂和他汀类药物保守治疗。1个月后，随访冠状动脉计算机断层扫描血管造影证实第一间隔支血管通畅无狭窄，患者无复发。

讨论

冠状动脉间隔支孤立性自发冠状动脉夹层导致的心肌梗死是无阻塞性冠状动脉疾病性心肌梗死常被忽视的病因。因此，对于无阻塞性冠状动脉的心肌梗死病例，应进行血管内成像和对比增强计算机断层扫描以定位梗死部位并确定病因。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e67e/12291164/1700ad7683c3/ytaf339f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e67e/12291164/49c4d80d0dfa/ytaf339il2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e67e/12291164/89178501e3ab/ytaf339f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e67e/12291164/f035c2f1e830/ytaf339f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e67e/12291164/b98f8e1b4fbf/ytaf339f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e67e/12291164/170b6d035b59/ytaf339f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e67e/12291164/1700ad7683c3/ytaf339f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e67e/12291164/49c4d80d0dfa/ytaf339il2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e67e/12291164/89178501e3ab/ytaf339f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e67e/12291164/f035c2f1e830/ytaf339f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e67e/12291164/b98f8e1b4fbf/ytaf339f3.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e67e/12291164/1700ad7683c3/ytaf339f5.jpg

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本文引用的文献

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Acute Myocardial Infarction Caused by Spontaneous Coronary Artery Dissection of the First Septal Perforator.第一间隔支自发性冠状动脉夹层导致的急性心肌梗死
JACC Case Rep. 2023 Apr 21;14:101833. doi: 10.1016/j.jaccas.2023.101833. eCollection 2023 May 17.
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Isolated septal myocardial infarction with non-obstructive coronary arteries.孤立性间隔心肌梗死伴非阻塞性冠状动脉病变。
Eur Heart J. 2023 Aug 7;44(30):2873. doi: 10.1093/eurheartj/ehad252.
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Diagnostic pathways in myocardial infarction with non-obstructive coronary artery disease (MINOCA).
非阻塞性冠状动脉疾病（MINOCA）所致心肌梗死的诊断途径
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