急性左主干闭塞病例报告庞文跃.ppt

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1、Case Report病例报告,Shengjing Hospital of China Medical University中国医科大学附属盛京医院Wenyue Pang庞文跃,Patient name:PanXX,Sex:Male,Age:64 years 患者潘XX，男，64Was hospitalized with the chief complaint“remittent chest pain for 5 years with attenuation for 1 week”.因“间断胸痛5年，加重1周”为主诉入院,Clinic Data 临床资料,Clinic Data 临床资料,Pa

2、st history:hypertension for 7 years.Smoke 20 cigarettes per day for 30 years.既往有高血压病史7年。吸烟20支/天30年Physical examination:BP150/95mmHg，the cardiac boarder enlarged to the left and lower.HR 72 bpm,without cardiac murmur.体检：BP150/95mmHg，心界左下扩大，HR72次/分，无杂音,Clinic Data 临床资料,ECG：Leads V1-V5 ST segments depr

3、essed for 0.05mV ECG：V1-V5导联ST段下移0.05mV；PDE：LV=57.4mm；EF=61%,Clinic Data 临床资料,Coronary artery CT：Left major-left anterior descending(LAD)branch proximal and medial segments severe stenosis;left circumflex(LCX)proximal segment moderate stenosis.冠脉CT：左主干-前降支近中段重度狭窄；旋支近段中度狭窄。,Clinic Data 临床资料,临床诊断：1.冠心

4、病：不稳定心绞痛 2.高血压病3级Clinical diagnosis:1.coronary heart disease:unstable angina pectoris 2.Hypertension,Coronary Angiography 影像,Coronary Angiography 影像,Coronary Angiography 影像,Coronary Angiography,In the preparation of right coronary angiography,before angiographic catheter reached the orifice of the r

5、ight coronary artery,BP depression,from 135/85 mmHg to 80/40 mmHg in 30 seconds.准备右冠造影过程中，造影导管未到达右冠开口时，患者血压下降，30秒内由135/85下降到80/40,No obvious changes of HR 心率无明显减慢No obvious changes was observed in the leads of electrocardiography(ECG)monitoring.心电监测导联未见明显变化。The patient said chest skin itch,without c

6、hest pain.患者自述胸前皮肤搔痒，无胸痛,What happened?发生什么了？,Pressure monitoring pathway leakage?压力监测通道漏气？contrast media hypersensitivity？造影剂过敏？Vagal reflex?迷走反射？Occlusion of left coronary artery？左冠闭塞？,The patients HR dropped to 35 bpm 患者心率下降至35次/分Chest pain onset 开始出现胸痛,acute left major occlusion！急性左主干闭塞！,Which f

7、irst?首先做什么？,IABP/Temporary cardiac pacing,then PCI IABP/临时起搏器，然后PCIPCI 首先PCIDrug 药物抢救Other 其他,Management 处理,XB3.5GC Catheter was emergently sent in,approving the 100%occlusion of left major(LM)body part.紧急予XB3.5GC导管送入，证实左主干体部100%闭塞遗憾：没有留下影像 Regret:no video made,GC:XB3.5 GW:BMW STENT:3.5*18mm Cypher,

8、IABP 3.0*13 Cypher,3.0*18 Cypher,PCI治疗四:LCX,3.0*23 Cypher T支架技术,after Kiss balloon,右冠造影,Follow up 随访（14 months）,Ophthalmalgia when movement 活动时牙痛Diagnosis:angina pectoris 诊断：心绞痛Management:angiography 处理：造影,How to manage?,PCICABGDrugOther,3.0*10 cutting balloon,3.0*10 cutting balloon,LCX:3.5*18Indeavor step by step crush,LM-LAD:3.5*15 Indeavor,Kissing balloon,Follow up 随访结果(22 m),CT:normal 冠脉支架内未见明显狭窄,Thanks,