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題名 | Stent Jail of Sinus Node Artery: A Rare Cause of Sick Sinus Syndrome-- A Case Report=竇房結動脈支架牢獄及病實症候群--一病例報告 |
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作者 | 焦焦孝; 蕭相江; 陳雲亮; 江志桓; 丁予安; | 書刊名 | Acta Cardiologica Sinica |
卷期 | 14:2 民87.04-06 |
頁次 | 頁99-104 |
分類號 | 415.3161 |
關鍵詞 | 冠狀動脈內血管支架置放術; 竇房結動脈; 病竇症候群; Intracoronary stenting; Sinus node artery; Sick sinus syndrome; |
語文 | 英文(English) |
中文摘要 | 背景:病竇症候群鮮由缺血性心臟病所造成。本文報告一因右冠狀動脈近端放置支 架導致竇房結動脈牢獄而造成永久性病竇症候群之病例。 病例表現:一位65歲男性榮民患有三條冠狀動脈及輕微左主冠狀動脈疾病患有心絞痛症 狀。其右冠狀動脈近端之嚴重狹窄病灶受創於心導管而剝裂,造成竇房結動脈開口後以下之 動脈急性閉塞。該血管因此而置放一Palmaz-Schatz支架,而該支架涵蓋竇房結動脈開口之 近端血管及剝裂之病灶。該血管主幹血流恢復正常,但被支架禁閉之竇房結動脈之血流卻被 阻滯。雖臨床上無任何發生心肌梗塞之證據,卻造成持續性頻發竇性心律休止。因此病患接 受VVI永久性心律調節器之置放。 結論:置放冠狀動脈血管內支架常有涵蓋側枝血管,偶有產生問題之情形。支架若造成竇 房結動脈血流受阻,可造成永久性病竇症候群。此種病例在以往文獻中並無報告。支架型式 之選擇及其置放之位置對於預防此種併發症或許是重要的。 |
英文摘要 | Background: Ischemic heart disease is rarely a cause of sick sinus syndrome. A case of sick sinus syndrome developed from sinus node artery jailed by right coronary artery (RCA) stenting with a Palmaz-Schatz stent is presented. Methods and Results: A 65-year-old man with three-vessel coronary artery disease (CAD) and mild left main stenosis suffered from recurrent chest pain. A stenotic lesion of the proximal RCA was dissected by the guiding catheter and developed acute closure. Rescue coronary stenting was performed with the use of Johnson and Johnson Palmaz-Schatz stent which covered the proximal part of the RCA and the origin of the sinus node artery. Blood flow to the RCA was regained but the sinus node artery was blocked. There was no clinical evidence of myocardial infarction after coronary intervention. However, persistent and frequent sinus pauses were noted afterward. Therefore, the patient was implanted with a VVI mode permanent pacemaker. Conclusions: Intracoronary stenting usually covers side branch of coronary arteries, and sometimes causes problems. Blockade of blood flow to the sinus node artery by a stent jail can induce sick sinus syndrome. Such cases have not been reported in the literature. Type of stent and position of deployment may be important in avoiding such complication. |
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