Concurrent true inferoposterior left ventricular aneurysmand ventricular septal rupture secondary to inferior myocardial infarction: a case report
Concurrent true inferoposterior left ventricular aneurysmand ventricular septal rupture secondary to inferior myocardial infarction: a case report
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继发下壁心肌梗死并发真性左室后部动脉瘤和室间隔破裂：病例报告
DOI：
10.1093/ehjcr/yty136
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发表时间：
2018-12-01
影响因子：
1
通讯作者：
Zhang, Yun
中科院分区：
文献类型：
--
作者：
Zhang, Pengfei;Pang, Xinyan;Zhang, Yun
摘要背景左室壁瘤(LVA)是心肌梗死(MI)最常见的机械并发症，但很少累及左室下壁或左后壁。室间隔破裂(VSR)可能是心肌梗塞的致命机械并发症，但很少发生在室间隔的后部或下部。因此，LVA和VSR作为同一患者MI的两种机械并发症是极其罕见的。病例概述1例65岁女性，2 前2个月有下壁ST段抬高心肌梗死，未行再通治疗，入院后1 月出现用力呼吸困难。超声心动图和计算机断层扫描显示真正的后位LVA和VSR是MI的并发并发症。这些影像表现在心脏手术中得到证实。在成功进行冠状动脉旁路移植术和心室成形术后，患者很快康复出院。讨论：报告一例罕见的梗塞后LVA后后位并发室间隔破裂病例。经胸和经食道超声心动图和心脏计算机断层扫描是诊断这种罕见疾病的有价值的工具。冠状动脉旁路移植术和心室成形术联合治疗这种通常致命的下壁心肌梗死并发症是有效的。
Abstract Background Although left ventricular aneurysm (LVA) is the most common mechanical complication of myocardial infarction (MI), it rarely involves the inferior or posterior left ventricular wall. Ventricular septal rupture (VSR) may be a fatal mechanical complication of MI but rarely occurs in the posterior or inferior portion of the interventricular septum. Thus, LVA and VSR as two mechanical complications of MI in the same patient are extremely rare. Case summary A 65-year-old woman, who had inferior ST-segment elevation myocardial infarction 2 months before without reperfusion therapy, was admitted with exertional dyspnoea for 1 month. Echocardiography and computed tomography revealed true inferoposterior LVA and VSR as concurrent complications of MI. These imaging findings were confirmed during cardiac surgery. After successful coronary bypass grafting and ventriculoplasty, the patient recovered quickly and was discharged from the hospital. Discussion A rare case of post-infarction inferoposterior LVA with concurrent interventricular septal rupture was reported. Transthoracic and transoesophageal echocardiography and cardiac computed tomography were valuable tools for the diagnosis of this rare condition. Combined coronary bypass grafting and ventriculoplasty were effective in treating this often fatal complication of inferior MI.