冠状动脉远端斜支穿孔后长期复发性心包填塞最终经心包切开术解决-亲水导丝的潜在风险。

The Open Cardiovascular Medicine Journal Pub Date : 2017-06-19 eCollection Date: 2017-01-01 DOI:10.2174/1874192401711010061
Rafał Januszek, Krzysztof Bartuś, Radosław Litwinowicz, Artur Dziewierz, Łukasz Rzeszutko
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引用次数: 1

摘要

目的:冠状动脉穿孔(CAP)是经皮冠状动脉介入治疗(pci)的并发症。亲水导丝已被证明可以增加CAP的可能性。根据穿孔的大小,我们采用不同的治疗方法。病例:我们提出一个73岁男性冠状动脉疾病和严重主动脉瓣狭窄的病例。该患者正处于经导管主动脉瓣植入术的合格过程中。不幸的是,在PCI期间发生了LAD第一个对角分支的CAP。最初,突然出血到心包囊主要是抑制。然而,在接下来的几天里,心包出血变得沉默,延长,最终导致手术心包切开术和手术主动脉瓣置换术。结论:本病例表明,在某些病例中,在急性期对CAP进行更积极的血管内治疗可以降低未来根治性手术治疗的可能性。然而,在其他病例中,避免根治性血管内治疗CAP和沿动脉分布的继发性坏死最终导致转行心脏外科手术的风险更高。对CAP严重度进行准确的初步评估,并在PCI术后仔细观察,可改善治疗效果,避免严重并发症的发生。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Coronary Perforation of Distal Diagonal Branch Followed by Prolonged Recurrent Cardiac Tamponade Finally Resolved with Pericardiotomy - the Potential Risk of Hydrophilic Guide-Wires.

Coronary Perforation of Distal Diagonal Branch Followed by Prolonged Recurrent Cardiac Tamponade Finally Resolved with Pericardiotomy - the Potential Risk of Hydrophilic Guide-Wires.

Coronary Perforation of Distal Diagonal Branch Followed by Prolonged Recurrent Cardiac Tamponade Finally Resolved with Pericardiotomy - the Potential Risk of Hydrophilic Guide-Wires.

Purpose: Coronary artery perforation (CAP) is a complication of percutaneous coronary interventions (PCIs). Hydrophilic guide-wires have been shown to increase the probability of CAP. Depending on the size of perforations we adopt different treatments.

Case: We present the case of a 73-year old male with coronary artery disease and severe aortic valve stenosis. The patient was in the process of qualifying for a transcatheter aortic valve implantation. Unfortunately, CAP of the first diagonal branch of the LAD occurred during PCI. Initially, abrupt bleeding to the pericardial sac was primarily restrained. However, in the following days, pericardial bleeding became silent, prolonged and finally resulted in surgical pericardiotomy and surgical aortic valve replacement.

Conclusion: This case depicts that in some cases, more aggressive endovascular treatment of CAP during the acute phase could decrease the probability of future radical surgical treatment. Although, in other cases, avoiding radical endovascular treatment of CAP and secondary necrosis along the distribution of the artery culminates in a higher risk for conversion to a surgical cardiac procedure. Accurate primary assessment of CAP seriousness and careful observation after PCI could improve results and lead to avoiding severe complications.

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