Taniyasu N, Seino R, Sawatani O, Yano T, Inoue S, Haruta S, Miyazawa Y, Koyanagi H
Department of Cardiovascular Surgery, Sendai Cardiovascular Center, Japan.
Kyobu Geka. 1996 Jul;49(7):583-6.
A 69-year-old woman with combined valvular heart disease (mitral regurgitation and aortic regurgitation), ascending aortic aneurysm, and atrial fibrillation underwent double valve replacement (DVR) and, ascending aortic wall plication. The postoperative thrombo-test level was around 20%. The ST elevation on ECG (II, III, aVFm, V4 approximately V6) with chest pain were recognized on the 13 th postoperative day. She was diagnosed as having acute myocardial infarction, and percutaneous transluminal coronary recanalization was performed immediately. The coronary angiogram showed occlusion at the left anterior descending branch (#8). This lesion could be recanalized by 6,000 U plasminogen pro activator (pro-UK) administration. The cineangiogram on the 35th postoperative day, revealed complete recanalization of this occlusion. Several cases of acute myocardial infarction associated with valvular heart diseases has been reported previously in Japan. However, there has been no report, except for this case, demonstrating occlusion in the coronary artery after prosthetic replacement and successful PTCR. So, this case is the first report on that point.
一名69岁患有心脏瓣膜病（二尖瓣反流和主动脉瓣反流）、升主动脉瘤及心房颤动的女性接受了双瓣膜置换术（DVR）及升主动脉壁折叠术。术后血栓检测水平约为20%。术后第13天，心电图（II、III、aVF导联及V4至V6导联）出现ST段抬高并伴有胸痛。她被诊断为急性心肌梗死，并立即进行了经皮腔内冠状动脉再通术。冠状动脉造影显示左前降支（#8）闭塞。通过给予6000单位纤溶酶原激活剂前体（pro-UK）使该病变再通。术后第35天的血管造影电影显示该闭塞病变完全再通。此前在日本曾报道过几例与心脏瓣膜病相关的急性心肌梗死病例。然而，除了本病例外，尚无关于人工瓣膜置换术后冠状动脉闭塞及成功进行经皮腔内冠状动脉再通术（PTCR）的报道。因此，就这一点而言，本病例为首例报道。
