Isolated right ventricular infarction due to occlusion of the right ventricular branch in the absence of percutaneous coronary intervention

Isolated right ventricular myocardial infarction accounts for only 3% of all infarctions. It has previously been reported as a complication of percutaneous coronary intervention involving the right coronary artery secondary to occlusion of the right ventricular branch. In the present report, a patient is described in whom isolated right ventricular myocardial infarction developed due to occlusion of the right ventricular branch of the right coronary artery in the absence of percutaneous intervention.     

Treatment of right ventricular perforation during percutaneous coronary intervention

Percutaneous coronary intervention (PCI) is widely used to treat stenotic coronary arteries caused by coronary heart disease. Coronary artery perforation is a rare but dreaded complication of PCI. Here, we report the successful treatment of a patient with coronary perforation of the right ventricular cavity. To our knowledge, this is the first report of its kind.The patient was a 69-year-old woman with intermittent chest tightness and chest pain of about five years’ duration who was hospitalised for severe chest tightness and pain persisting for three days. She had a history of hypertension and hyperlipidaemia; routine admission examination showed no other abnormalities. Results of routine blood, urine and stool tests, liver and kidney function, clotting time, electrocardiogram, chest radiography and echocardiography were normal.Although coil embolisation rather than balloon is safe and effective for treating coronary artery perforation, it may be not the best choice overall. If the perforation breaks through into the right ventricle, we may just monitor closely rather than treat. That course may be beneficial for patients in that it reduces the risk of myocardial cell necrosis. This case provides useful information for the treatment of such patients in the future.     

急性右室心肌梗死扩容不充分患者直接介入治疗术中经股静脉鞘管扩容的体会

目的：探讨急性右室心肌梗死（ARVI）扩容不充分患者直接介入治疗术(PCI)中经股静脉鞘管快速扩容的可行性和安全性。方法：40例因ARVI行PCI的患者随机分为实验组（经股静脉鞘扩容）和对照组（常规经外周静脉扩容），每组各20例，对比两组术中血压的变化及血管活性药物的使用情况。结果：实验组术中血压下降幅度低于对照组（9.2±6.77 vs 14.9±10.1，P<0.05），血管活性药物的使用比率也明显少于对照组（20% vs 50%，P<0.05）实验组手术时间短于对照组（63.5±16.3 vs 78.0±9.5，P<0.05）。结论：ARVI患者PCI过程中经股静脉鞘扩容快速、有效、安全可行。     

Isolated right ventricular aneurysm following right ventricular infarction

A 78-year-old man with atherosclerotic heart disease developed extensive right ventricular infarction fibrosis with aneurysm formation following right coronary artery occlusion. No symptoms of right-sided heart failure were present. Postmortem examination revealed that 40% of the right ventricle, 11% of the septum and 7% of the left ventricular free wall were infarcted due to right coronary artery occlusion. This is the first documented case of isolated aneurysm of the right ventricle following infarction and it demonstrates that even extensive right ventricular destruction may be present without symptoms.     

Isolated right ventricular infarction.

The literature on isolated right ventricular infarction is reviewed and local experience is reported. Chronic lung disease is an important risk factor. Chest pain and breathlessness are common. Syncope and sudden collapse can also occur. Rhythm disorders include sinus bradycardia, atrial fibrillation and ventricular tachycardia or fibrillation. Atrioventricular block is rare. Hypotension and a right-sided fourth heart sound are common. Cautious use of slow-release nitroglycerin is not hazardous in the absence of hypotension. High doses of steroids and anticoagulants can be helpful. The prognosis is usually good, although sudden collapse can occur due to ventricular fibrillation, rupture of the right ventricular free wall or massive pulmonary embolism.     

Preserving left ventricular function during percutaneous coronary intervention

The heart failure epidemic is predominantly an effect of widespread coronary disease, better treatment of coronary heart disease and an aging population. While coronary intervention prevents left ventricular systolic dysfunction (LVSD) by preventing or limiting myocardial damage, it can also be a cause of (iatrogenic) LVSD. Limiting myocardial damage during coronary intervention may well be the next important step that interventional cardiologists need to take by qualifying each procedure as high or low risk for the induction of LVSD and using an appropriate strategy that minimizes the risk of LVSD. This article discusses the various options of limiting LVSD during coronary intervention.     

小剂量阿托品对急性右冠状动脉梗塞介入治疗术中再灌注心律失常的影响

目的观察小剂量阿托品对急性右冠状动脉梗塞急诊冠状动脉(简称冠脉)介入治疗术中再灌注心律失常的影响。方法 128例冠脉造影显示急性右冠脉闭塞致心肌梗死(简称心梗)患者,分为阿托品组(66例)和对照组(62例),阿托品组冠脉开通前给予小剂量阿托品0.5 mg静脉注射,对照组不给予阿托品干预,观察两组再灌注心律失常发生情况。结果阿托品组发生再灌注心律失常27例,其中快速心律失常16例,缓慢心律失常11例,术后低血压13例,对照组发生再灌注心律失常47例,其中快速心律失常15例,缓慢心律失常32例,术后低血压24例,两组缓慢性心律失常和低血压发生率有显著差异(P<0.05),而两组快速心律失常发生率无统计学差异。结论对急性右冠脉心梗患者,急诊开通冠脉前,给予小剂量阿托品可以减少再灌注引起的缓慢性心律失常及低血压的发生率。     

C-reactive protein and myocardial infarction during percutaneous coronary intervention

OBJECTIVE: To evaluate the prognostic information of preprocedural C-reactive protein (CRP) levels in serum to predict myocardial infarction during percutaneous coronary interventions (PCI). DESIGN: Prospective study. SETTING: University hospital. PATIENTS: A total of 400 consecutive patients with normal serum troponin T levels (0.05 microg L-1. RESULTS: Eighty-three patients (21%) experienced a myocardial infarction during PCI. The median value of CRP before the procedure was 1.83 (0.12-99.7) mg L-1. No difference was seen in CRP levels before PCI between patients without or with myocardial infarction during PCI. Multivariate analysis identified stent implantation (OR 2.68, 95% CI 1.18-7.28, P = 0.03), procedure time (OR 2.15, 95% CI 1.28-3.67, P < 0.005) and complications during the procedure (OR 3.62, 95% CI 1.72-7.58, P < 0.001) as independent predictors of myocardial infarction during PCI. CONCLUSION: Increased CRP levels in serum before PCI were not associated with myocardial infarction during the procedure. Furthermore, patients with an expected long procedure and a high probability of stent implantation have an increased risk of developing myocardial infarction during PCI. This finding may be useful to help the operator to decide the antithrombotic regime before, during and after the procedure and the need for observation after the procedure.     

Isolated right ventricular infarction resulting from thrombotic occlusion of a hypoplastic right coronary artery

Three cases of isolated right ventricular infarction resulting from thrombotic occlusion of a hypoplastic right coronary artery were found in 4,000 consecutive autopsies performed at Tokyo Metropolitan Geriatric Hospital. The incidence of isolated right ventricular infarction was 0.08%. The clinical profile of the first case was characterized by shock, pulmonary congestion, pleural effusion, decreased V1R and V2R on ECG, a small elevation of CPK and transaminase, elevation of fibrin degenerative products and decreased platelet count. The patient responded to volume expansion, heparin and catecholamines. One year later she died from cerebral bleeding. In the second case, mild aortic regurgitation and atrial fibrillation were present. He died suddenly during an episode of pneumonia. In the third case, there was chronic obstructive lung disease, atrial fibrillation and lung cancer. He died of respiratory failure. On autopsy, the coronary arteries revealed a marked left dominant and right hypoplastic pattern in all cases. The right coronary artery perfused only the free wall of the right ventricle. Complete occlusion of the hypoplastic right coronary artery resulted in isolated right ventricular infarction. In addition, chronic pulmonary disease and arrhythmia may be contributory.     

Isolated right ventricular infarction: a diagnostic challenge

Right ventricular involvement during myocardial infarction of the diaphragmatic and posterior wall of the left ventricle is not an infrequent complication, but isolated right ventricular infarction is rare. We report a case of rupture of the anterior wall of right ventricle and tamponade due to infarction at this site. The lack of characteristic clinical and electrocardiographic findings made the isolated right ventricular infarction a diagnostic challenge.     

Isolated right ventricular infarction after modified Cabrol operation

We report the case of a 27-year-old woman with a rare presentation of right ventricular failure secondary to isolated right ventricular myocardial infarction, 3 weeks after an uncommon surgical procedure, the modified Cabrol operation. Her medical history also included a Ross procedure at the age of 12 years. On the basis of her subacute presentation and a consultation with cardiac surgeons, we decided on medical management. Follow-up echocardiography at 6 months revealed that the right ventricular systolic function remained severely impaired, but the patient was asymptomatic with excellent functional capacity.We review the surgical techniques of aortic graft replacement and their respective complications. We also discuss the impact of conservative and reperfusion strategies on prognosis and long-term outcomes in the setting of right ventricular infarction.     

急性心肌梗死直接冠状动脉介入治疗中的无复流现象研究

目的探讨急性ST段抬高性心肌梗死(STEMI)直接冠状动脉介入治疗时对无复流现象的临床疗效.方法54个月期间对232例STEMI实施直接PCI,25例(10.8%)梗死相关动脉(IRA)出现无复流现象.冠状动脉内处理包括注射各种药物、生理盐水或动脉血冲洗和主动脉气囊反搏术.结果25例无复流患者中,男18例,女7例,平均年龄60.7岁(34-85岁).16例发生在右冠状动脉,其中14例IRA粗大.20例合并有高血压病(其中14例还合并2型糖尿病),18例合并高脂血症.经过处理,17例IRA为3级TIMI前向血流,以后临床经过良好.6例为TIMI 2级血流,4例术后临床经过良好,2例分别在术后4 h和70h死亡.2例TIMI 0-1级血流,术中死亡.结论直接PCI的无复流发生率为10.8%,死亡率达16%.无复流主要见于IRA为粗大右冠状动脉并且合并高血压病以及高脂血症的患者.无复流的处理应当是综合性的,但并非总是有效.     

急性心肌梗死直接与联合冠状动脉入治疗的比较

目的比较尿激酶静脉溶栓联合冠状动脉(冠脉)介入治疗(PCI)术与直接PCI术对急性心肌梗死(AMI)的有效性和安全性。方法64例首次ST段抬高AMI(STelevationmyocarialinfarc-tion,STEMI)患者随机分为直接PCI组(直接PCI治疗)和联合PCI组(在尿激酶静脉溶栓基础上联合直接PCI治疗)。PCI术治疗前后行冠脉造影、心电图检查,观察梗死相关血管(IRA)前向血流,测定心肌梗死溶栓治疗临床试验(TIMI)血流、TIMI心肌灌注分级(TMPG),计算冠脉造影灌注积分(APS)和心电图ST段回落程度,评估心外膜血管和心肌灌注情况,对两组患者介入术前IRA通畅率、住院期间出血并发症、急性缺血事件发生率及出院前左心室功能进行比较。用线性回归分析评价ST段回落程度与APS的相关性。结果PCI术前联合PCI组冠脉再通率显著高于直接PCI组(68.8%比37.6%,P<0.05),其中完全再通率在两组间比较差异有统计学意义(46.9%比21.9%,P<0.05);联合PCI组心肌再灌注率显著高于直接PCI组(71.9%比37.4%,P<0.01),其中完全心肌再灌注率在两组间比较差异有统计学意义(46.9%比21.9%,P<0.05)。PCI术后两组IRA的TIMI血流3级比较差异无统计学意义(90.6%比87.5%,P>0.05),但比较TMPG差异有统计学意义(93.8%比75.0%,P<0.05),其中TMP3级有明显差异(65.6%比37.5%,P<0.05);联合PCI组APS10~12分(心肌完全再灌注)与直接PCI组比较差异有统计学意义(P<0.01)。介入治疗后出院前联合PCI组的LVEF值明显大于直接PCI组。联合PCI组ST段完全回落比例明显高于直接PCI组。线性回归分析评价ST段回落程度与APS之间有显著相关性(相关系数r=0.961,P<0.001),住院期间两组均无死亡病例、严重出血及急性缺血事件发生。结论联合PCI术较直接PCI术可获得更好的IRA开通、心肌组织和微循环灌注及心功能的明显改善。APS结合TIMI血流分级和TMPG可较好地完整评价心外膜血管和心肌灌注情况,并与心电图ST段回落程度有显著相关性。