Nixdorff U, Rupprecht H J, Mohr-Kahaly S, Wittlich N, Oelert H, Schmied W, Meyer J
II. Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universität, Mainz.
Z Kardiol. 1994 Jul;83(7):495-501.
A 63-year-old male patient suffered an acute myocardial infarction entirely confined to the posterior wall. As symptoms persisted and cardiogenic shock developed immediate heart catheterization was performed, which demonstrated an occlusion of the left circumflex branch. Right-heart catheterization demonstrated an enlarged v-wave. Thus, acute infarct associated mitral regurgitation was suspected. In the catheterization laboratory transesophageal echocardiography including Doppler- and contrast echocardiography was then performed, which revealed the diagnosis of posterior papillary muscle rupture. The patient proceeded immediately to emergency surgery during which mitral valve replacement with a St. Jude prothesis was performed in addition to venous bypass revascularization of the occluded and a further stenosed coronary artery. The postoperative follow-up was without any complications and the patient recovered satisfactorily from the acute event. This case demonstrates the excellent diagnostic utility of emergency transesophageal echocardiography in the situation of infarct related myocardial rupture, which has to precede the life-saving operation.
一名63岁男性患者发生急性心肌梗死，梗死区域完全局限于后壁。由于症状持续且出现心源性休克，遂立即进行心脏导管检查，结果显示左旋支闭塞。右心导管检查显示v波增大。因此，怀疑存在急性梗死相关的二尖瓣反流。随后在导管室进行了经食管超声心动图检查，包括多普勒和造影超声心动图，结果明确诊断为后乳头肌破裂。患者立即接受急诊手术，术中除了对闭塞且进一步狭窄的冠状动脉进行静脉搭桥血运重建外，还使用圣犹达人工瓣膜进行了二尖瓣置换。术后随访未出现任何并发症，患者从急性事件中顺利康复。该病例表明，急诊经食管超声心动图在梗死相关心肌破裂的情况下具有出色的诊断效用，这对于挽救生命的手术至关重要。
