Rangel A, Chávez E, Marín G, Verdin R, Baduí E
Departamento de Hemodinamia, Hospital de Especialidades Centro Medico La Raza IMSS, México, D.F.
Rev Invest Clin. 1997 Jul-Aug;49(4):287-94.
We describe two women with interventricular septal rupture secondary to a myocardial infarction due to a total obstruction of the anterior descendent coronary artery. With the aim to stabilize the hemodynamic state of the patients before the surgical closure of the defect, we inserted a balloon-catheter introducing it to the left ventricle from the aorta and inflating it in the right ventricle after passing it through the septal orifice. After occlusion, we observed decreases in the pulmonary to systemic blood flow ratio (6% in one patient and 26% in the other) and in the arteriovenous blood flow shunt (8 and 31%); a 10% systemic blood flow increase was observed in one patient. Since the pulmonary arterial pressure did not change and the pulmonary blood flow increased, an increase of the pulmonary arterial resistance was observed but no modification of the pulmonary and systemic arterial pressure occurred. In the following days, the oxymetric differences between the pulmonary artery and the right atrium showed a tendency to remain below the figures before occlusion and the pulmonary blood flow and pressure showed a tendency to decrease. One patient died 14 days after the surgical closure of the rupture, and the other, seven days after the balloon occlusion of the rupture before any surgery. We present the physiological evolution of the patients.
我们描述了两名因前降支冠状动脉完全阻塞导致心肌梗死继发室间隔破裂的女性患者。为了在手术闭合缺损前稳定患者的血流动力学状态，我们插入了一根球囊导管，将其从主动脉引入左心室，并在通过间隔孔后在右心室中充气。封堵后，我们观察到肺循环与体循环血流比值降低（一名患者降低6%，另一名患者降低26%）以及动静脉血流分流减少（分别为8%和31%）；一名患者体循环血流增加了10%。由于肺动脉压未改变且肺血流量增加，观察到肺动脉阻力增加，但肺和体循环动脉压未发生改变。在接下来的几天里，肺动脉与右心房之间的血氧差异显示出保持在封堵前数值以下的趋势，肺血流量和压力显示出下降的趋势。一名患者在破裂手术闭合后14天死亡，另一名患者在任何手术前破裂球囊封堵后7天死亡。我们展示了患者的生理演变过程。
