经皮冠状动脉腔内成形术并发冠状动脉穿孔

目的 :探讨经皮冠状动脉腔内成形术 (PTCA)并发冠状动脉穿孔的发生及其适当处理对策。　　方法 :对我院进行的所有 PTCA病例发生冠状动脉穿孔者进行回顾性分析。　　结果 :共行 PTCA治疗 172 8例 ,并发冠状动脉穿孔 6例 ,均为完全闭塞性病变 ,发生率为 0 .35 %。3例漏入心包 ,2例形成冠状动脉左心室瘘 ,1例形成冠状动脉右心室瘘。经球囊长时间加压扩张 ,穿孔全部闭合 ;无一例需要进行心包穿刺引流和急诊冠状动脉旁路移植术及死亡。　　结论 :PTCA并发冠状动脉穿孔并不常见 ,只要及时发现 ,恰当处理 ,可以避免严重并发症的发生。

Coronary Arterial Perforation Complicated by Percutaneous Transluminal Coronary Angioplasty

Objective:To approach the incidence and treatment of coronary arterial perforation. Methods:Patients treated by percutaneous transluminal coronary angioplasty(PTCA)were retrospectively analyzed. Results:Among 1 728 patients undergoing PTCA,6 cases were complicated by coronary arterial perforation,the incidence was 0 35%.The lesion for all 6 cases was total occlusion.A leakage of contrast medium into the pericardial space was observed in 3 cases,the formation of a fistula between the coronary artery and the ventricular cavity in 3 cases(left in 1 case and right in 2 cases).The perforation was occluded by long time balloon inflation in all 6 cases.No pericardiocentesis and emergency coronany artery bypass grafting (CABG) was needed and no death occured. Conclusion:Coronary arterial perforation complicated by PTCA was not common,rapid diagnosis and active treatment are very important in order to avoid severe complications.