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題名 | Primary Stenting of the Left Main Coronary Artery in Acute Myocardial Infarction Complicated by Cardiogenic Shock: Case Report=緊急施行血管支架網置放術於急性左總冠狀動脈阻塞併發心肌梗塞及心因性休克:病例報告 |
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作者 | 葉漢根; 吳炯仁; 謝元凱; 葉國和; 傅懋洋; | 書刊名 | 長庚醫學 |
卷期 | 22:3 1999.09[民88.09] |
頁次 | 頁474-480 |
分類號 | 415.384 |
關鍵詞 | 急性左總冠狀動脈阻塞; 緊急施行左總冠狀動脈血管支架網置放術; Acute left main coronary artery occlusion; Primary left main coronary artery stenting; |
語文 | 英文(English) |
中文摘要 | 雖然左總冠狀動脈血管(left main coronary artery)之急性阻塞在心導管手術之冠狀動 脈攝影檢查非常罕見,但是,此種疾病具有非常高的死亡率,絕大部份病人會因為此種急性 左總冠狀動脈阻塞而發生突發性死亡或死於心因性休克,這是由於惡性心律不整(malignant arrhythm)或心臟唧筒衰竭(pump failure)引起,這種既高又快之死亡率主要原因是當一旦左總 冠狀動脈阻塞,則有大片心肌受傷和損壞。 本文報告一例此種案例,病人因心肌梗塞併發心因性休克而生命垂危。我們對此病人進 行緊急心導管檢查發現心因性休克仍是由於左總冠狀動脈完全阻塞所致,對此病人實施冠狀 動脈氣球擴張術(percutaneous transluminal coronary angioplasty)及血管支架網(primary stenting) 置放術,因而拯救了病人的生命。我們的經驗認為對於急性左總冠狀動脈阻塞緊急施行血管 支架網置放術是一種快速而有效之救命方法。因為此一辦法可使阻塞血管血流暢通,因而有 機會拯救瀕於死亡之心肌,並遏阻心因性休克之不可逆發生。 |
英文摘要 | Although acute left main coronary artery (LMCA) occlusion is a rare angiographic finding, it carries a very high mortality rate and most of the patients with this clinical condition die from sudden death or cardiogenic shock due to malignant arrhythmia or pump failure. The high mortality rate and tendency to lead rapidly to death are chiefly related to extensive myocardial injury. We report a case of cardiogenic shock resulting from acute myocardial infarction. Emergency cardiac catheterization was performed and coronary angiography showed a totally occluded LMCA. Prompt revascularization by means of primary LMCA stenting was successful and the patient was discharged 2 weeks later with only mild congestive heart failure. We suggest that the rapid performance of angiographic studies in this patient with cardiogenic shock was the turning point in saving her life. We also suggest primary LMCA stenting as an effective procedure for saving lives because it may reverse cardiogenic shock and prevent a probable fatel outcome. |
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