Yamagishi I, Sakurada T, Sato T, Abe Y, Izumi M, Abe T
Department of Cardiovascular Surgery, Akita Medical Center, 6-17 Senshu Kubotamachi, Akita 010-0874, Japan.
Ann Thorac Cardiovasc Surg. 1998 Apr;4(2):91-5.
Coronary artery rupture has been known as one of the complications of coronary balloon angioplasty. In this report, we describe a case of coronary artery rupture, who underwent emergency surgery for hemostasis and coronary revascularization. A 67-year-old-male with frequent angina attacks was admitted to our institution for possible coronary angioplasty. Coronary angiogram showed diffuse disease of the mid left anterior descending artery (LAD), with two 90% stenosis. Conventional balloon angioplasty was performed, however, coronary artery rupture occurred while the stent was expanded with a 3.5 mm balloon catheter. Though pericardial drainage improved his hemodynamic state, subsequent coronary angiogram revealed leakage of contrast medium. Emergency surgery was determined at this point for hemostasis and revascularization of the LAD. The revascularization was completed with the left internal thoracic artery (LITA) to the LAD. On the contrary, since the epicardial hemorrhage around the proximal LAD did not spread any further after systemic heparinization, the epicardial surface was covered with a piece of oxidazed cellulose and fibrin glue. After the surgery, the hemodynamic state improved gradually. Postoperative coronary angiogram revealed an aneurysm of the LAD, as well as excellent LITA-LAD patency.
冠状动脉破裂一直被认为是冠状动脉球囊血管成形术的并发症之一。在本报告中，我们描述了一例冠状动脉破裂患者，该患者接受了紧急手术以止血并进行冠状动脉血运重建。一名67岁男性，频繁发作心绞痛，因可能需要进行冠状动脉血管成形术而入住我院。冠状动脉造影显示左前降支（LAD）中段弥漫性病变，有两处90%狭窄。进行了传统的球囊血管成形术，然而，当用3.5毫米球囊导管扩张支架时发生了冠状动脉破裂。尽管心包引流改善了他的血流动力学状态，但随后的冠状动脉造影显示有造影剂渗漏。此时决定进行紧急手术以止血并对LAD进行血运重建。通过将左乳内动脉（LITA）吻合到LAD完成了血运重建。相反，由于全身肝素化后LAD近端周围的心外膜出血没有进一步扩散，在心外膜表面覆盖了一片氧化纤维素和纤维蛋白胶。手术后，血流动力学状态逐渐改善。术后冠状动脉造影显示LAD有一个动脉瘤，以及LITA-LAD吻合口通畅良好。
