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Acute marginal branch occlusion presenting with anterior wall ST segment elevation during percutaneous coronary intervention of the mid right coronary artery 经皮冠状动脉介入治疗期间急性边缘支闭塞表现为前壁ST段抬高
Pub Date : 2021-01-01 DOI: 10.15761/JCCR.1000156
K. Tan, Chan K Hui
A 78-year-old male, ex-smoker, with a history of hypertension and hyperlipidemia presented with a one-month duration of worsening angina on exertion. Standard 12 L ECG showed sinus rhythm with early repolarization pattern in the anterolateral leads. Coronary angiography showed minor luminal irregularities in the left coronary vessels (Figure 1 A & B) while the RCA showed high grade non-thrombotic 90% lesion in its mid segment (Figure 2A arrow) followed by another high grade 90% stenosis in the RPDA branch (Figure 2B). A small calibre acute marginal branch (AMB) with an 80% ostial stenosis was noted to take off from the diseased mid RCA segment (Figure 2A arrowhead). Ad hoc percutaneous coronary intervention (PCI) of both the RPDA and mid RCA was carried out.
78岁男性,前吸烟者,有高血压和高脂血症病史,运动时心绞痛加重,持续1个月。标准12l心电图显示窦性心律伴前外侧导联早期复极。冠状动脉造影显示左冠状血管轻微腔内不规则(图1 A和B),而RCA在其中段显示90%的高度非血栓性病变(图2A箭头),随后在RPDA分支显示另一个90%的高度狭窄(图2B)。观察到一个小口径急性边缘分支(AMB)从患病的RCA中段脱落,狭窄程度为80%(图2A箭头)。经皮冠状动脉介入治疗(PCI)包括rda和中期RCA。
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引用次数: 0
Case reports of antegrade and retrograde iatrogenic coronary spiral dissection complicating percutaneous coronary intervention: Keep calm and carry on! 经皮冠状动脉介入治疗合并顺、逆行医源性冠状动脉夹层病例报告:保持冷静,坚持下去!
Pub Date : 2021-01-01 DOI: 10.15761/jccr.1000165
Riccardo Iorio, Giuseppe Terlizzese, A. Pizzuto, E. Greco, Giuseppe Massimo Sangiorgi
Iatrogenic dissection during PCI represents one of the most fearing complication of interventional cardiology, since abrupt hemodynamic instability and patient compromise may occur related to coronary occlusion. In this emergency situation, different hemodynamic support devices and interventional skills, are needed in order to promptly recover the patient from cardiogenic shock, especially when the left coronary three is involved by the dissection. We report herein two different iatrogenic retrograde, and antegrade dissections, one involving both left anterior descending artery, left circumflex and aortic bulb and the second characterized by abrupt closure of left main associated with severe hemodynamic compromise and ventricular fibrillation storm which required continuous DC shocks, Impella and ECMO devices support to stabilize the patient. Both cases were successfully managed percutaneously. Different techniques and tricks in order to re-open the vessels are described. We conclude that in case of iatrogenic coronary dissection, a “keep calm and carry on” strategy should be adopted by the interventional cardiologist team in order to solve such dramatic complication.
PCI期间的医源性夹层是介入心脏病学中最可怕的并发症之一,因为突发的血流动力学不稳定和患者妥协可能与冠状动脉闭塞有关。在这种紧急情况下,需要不同的血流动力学支持装置和介入技术,以便迅速恢复患者的心源性休克,特别是当左冠状动脉三段被剥离时。我们在此报告了两例不同的医源性逆行和顺行夹层,其中一例涉及左前降支、左旋和主动脉球囊,另一例以左主干突然关闭为特征,伴有严重的血流动力学损害和心室颤动风暴,需要持续的直流电击、Impella和ECMO设备支持来稳定患者。两例均经皮成功处理。不同的技术和技巧,以重新打开血管描述。我们认为,对于医源性冠状动脉夹层,介入医师团队应采取“保持冷静,继续进行”的策略,以解决这一严重并发症。
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引用次数: 0
Electrical Impedance Tomography: Monitoring of Pulmonary Ventilation in Pediatric Cardiac Postoperative 电阻抗断层扫描:监测小儿心脏术后肺通气
Pub Date : 2021-01-01 DOI: 10.15761/jccr.1000170
Carolina Vieira de Campos, Paula Vieira Vincenzi Gaiolla, Marcelo Bisegli Jatene, C. Johnston, W. Brunow de Carvalho
The electrical impedance tomography (EIT) is a bedside monitoring tool that noninvasively visualizes local ventilation and arguably lung perfusion distribution. Is a non-invasive radiation-free monitoring technique that provides images based on tissue electrical conductivity of the chest [1]. Some studies [2,3] including adult patients have applied EIT in the context of the preoperative, intraoperative period, extending to the postoperative follow-up of several clinical situations. However, so far there are no scientific publications in this context in the pediatric age group.
电阻抗断层扫描(EIT)是一种床边监测工具,可以无创地显示局部通气和肺灌注分布。是一种非侵入性无辐射监测技术,提供基于胸部组织电导率的图像。包括成人患者在内的一些研究[2,3]将EIT应用于术前、术中,并扩展到多种临床情况的术后随访。然而,到目前为止,还没有科学出版物在这方面的儿童年龄组。
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引用次数: 0
Levosimendan for management of cardiogenic shock with electrical storm - A case report 左西孟旦治疗心源性电风暴休克1例报告
Pub Date : 2021-01-01 DOI: 10.15761/JCCR.1000157
A. Rougé, J. Monségu
Background: Levosimendan, an inotrope and vasodilator, is a second-line treatment for cardiogenic shock. One of its main advantages is its prolonged effect compared to Dobutamine. Case presentation: Our reports show two cases of successful treatment with levosimendan involving patients presenting in a state of cardiogenic shock with electrical storm, which had never been described before. Levosimendan infusion, with no initial bolus dose, enabled us to correct the low cardiac output in both cases, with no secondary rhythm disturbances. Apart from the absence of any pro-arrhythmic effect, infusion of Levosimendan allowed a double angioplasty to be performed under optimal haemodynamic conditions in the first case; and provided us sufficient time to reflect on implantable cardioverter defibrillator implantation with resynchronization due to its conversion into active metabolites in the second case. Conclusion: Through the neutral effects of levosimendan on heart rhythm and the absence of Myocardial oxygen consumption (MvO2) increasing, these two cases show the feasibility and safety of levosimendan treatment in this indication; and emphasise levosimendan’s lack of pro-arrhythmic effect when used without a bolus dose. its its prolonged effect This discusses two clinical cases of patients to care with shock and treated by Levosimendan. these two cases, we will discuss the absence of a pro-arrhythmic effect.
背景:左西孟旦,一种收缩性药物和血管扩张剂,是治疗心源性休克的二线药物。与多巴酚丁胺相比,它的主要优点之一是效果持久。病例介绍:我们的报告显示了两例左西孟旦治疗成功的病例,患者表现为心源性休克伴电风暴状态,这在以前从未被描述过。左西孟旦输注,没有初始大剂量,使我们纠正了两例低心输出量,没有继发性节律障碍。除了没有任何促心律失常的作用外,左西孟旦的输注允许在最佳血流动力学条件下进行双血管成形术;并为我们提供了足够的时间来反思植入式心律转复除颤器植入与再同步,因为它在第二例中转化为活性代谢物。结论:通过左西孟旦对心律的中性作用和心肌耗氧量缺乏症(MvO2)的增加,说明左西孟旦治疗该适应症的可行性和安全性;并强调左西孟旦在不给药的情况下缺乏促心律失常的作用。本文讨论两例左西孟旦治疗休克患者的临床护理。这两种情况下,我们将讨论缺乏促心律失常的影响。
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引用次数: 0
Unsuspected Iatrogenic Occlusion of Left Main Coronary Artery 意外医源性左冠状动脉主干闭塞
Pub Date : 2021-01-01 DOI: 10.15761/jccr.1000169
R. Bhardwaj, S. Asotra, Rajeev Marwah, Ravi Kumar
We present a case, who was being subjected to coronary angiography, as per protocol before aortic valve replacement. Just after left coronary angiography, patient had cardiac arrest. When there was no response to 15 minutes of CPR, check angiography showed left main occlusion at ostium. Patient had successful angioplasty to left main coronary artery
我们提出一个病例,谁是受到冠状动脉造影,按照协议前主动脉瓣置换术。就在左冠状动脉造影后,病人心脏骤停。当心肺复苏术15分钟无反应时,检查血管造影显示左主口闭塞。患者左主干血管成形术成功
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引用次数: 0
Posterior reversible encephalopathy syndrome with spinal cord involvement 脊髓受累后可逆性脑病综合征
Pub Date : 2021-01-01 DOI: 10.15761/JCCR.1000153
F. Serrano, M. Henry-Feugeas, E. Vidal-Petiot, Philippa C. Lavallée
Posterior reversible encephalopathy syndrome (PRES) is a disorder related to an acute impairment of cerebral flow autoregulation that causes brain hyperperfusion and blood-brain barrier breakdown, leading to vasogenic edema affecting typically the posterior part of the brain usually related to acute severe hypertension [1]. Usual clinical presentation includes headaches, vomiting, encephalopathy, visual blurring and seizures. Diagnosis is confirmed by brain MRI showing vasogenic edema with usually a bilateral parieto-occipital pattern although brain oedema could affect other parts of the brain. Ten years ago, a case of reversible edema of the spinal cord has been reported in a patient with PRES associated to malignant hypertension (PRES-SCI, PRES with spinal cord involvement).
后路可逆性脑病综合征(PRES)是一种与脑血流自身调节急性损伤相关的疾病,可引起脑高灌注和血脑屏障破坏,导致血管源性水肿,通常影响脑后部,通常与急性重度高血压[1]有关。通常的临床表现包括头痛、呕吐、脑病、视觉模糊和癫痫发作。脑MRI显示血管源性水肿,通常表现为双侧顶骨-枕骨模式,尽管脑水肿可影响脑的其他部位。十年前,报道了一例与恶性高血压相关的PRES患者出现可逆性脊髓水肿(press - sci, PRES伴脊髓受累)。
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引用次数: 0
Case report of dissection of the right coronary artery due to uncontrolled rotational movement of the guiding catheter: A twist in the story 导尿管旋转不受控制导致右冠状动脉夹层的病例报告:故事中的一个转折
Pub Date : 2021-01-01 DOI: 10.15761/jccr.1000166
Ala Abu Dogosh, J. Weinstein, D. Zahger, C. Cafri
Catheter-induced coronary artery dissection is a rare complication with potentially life-threatening consequences. It has been described in less than 0.1% of patients undergoing coronary angiography [1-3]. Technical reasons (type of catheter, catheter position, deep intubation) as well an anatomical/histological predisposition (ostial disease, vessel orientation, vessel size, type of collagen fibers) contribute to its development [4-7]. Contact between the tip of the catheter and the arterial wall promoting intimal disruption and subsequent penetration of contrast during the injection is the basic substrate for this phenomenon.
导管诱导的冠状动脉夹层是一种罕见的并发症,可能危及生命。在接受冠状动脉造影的患者中,只有不到0.1%的患者出现了这种情况[1-3]。技术原因(导管类型、导管位置、深插管)以及解剖/组织学易感性(口部疾病、血管定向、血管大小、胶原纤维类型)导致其发生[4-7]。在注射过程中,导管尖端与动脉壁之间的接触促进内膜破裂并随后渗透造影剂是这种现象的基本基础。
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引用次数: 0
Different findings after PCI with both DES and BVS in a patient with coronary artery ectasia - A case report 冠状动脉扩张患者行PCI后DES和BVS的不同表现- 1例报告
Pub Date : 2021-01-01 DOI: 10.15761/jccr.1000172
H. Ebelt, Alexandra Offhaus, Matthias Wiora, Andreas Schwenzky
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引用次数: 0
Mandibular distraction of free iliac crest bone graft as treatment in a patient with a history of gunshot wound. Case Report 下颌骨牵引游离髂骨移植物治疗枪伤患者1例。病例报告
Pub Date : 2021-01-01 DOI: 10.15446/cr.v7n2.88563
Jaime Andrés Jiménez-Álvarez, Jesus Andrés Duque-Montealegre, José Manuel Valdés-Reyes
Introduction: The combination of non-vascularized iliac crest bone graft and distraction osteogenesis in a second surgical intervention has only been described to achieve alveolar ridge augmentation. This technique is not recommended to treat bone defects of the jaws caused by firearm projectile. Case presentation: 40-year-old woman with a segmental mandibular defect in the mandible body caused by the impact of a firearm projectile at the age of 1 year. The patient developed a severe Class II dentofacial anomaly that required a two-stage treatment; she underwent mandibular reconstruction with free iliac crest bone graft followed by a bilateral mandibular distraction at the level of the iliac crest bone graft. With these interventions, a remarkable improvement of the patient's malformation was achieved. Conclusion: Horizontal distraction of the free iliac crest bone graft is a safe and predictable procedure to treat dentolabial anomalies requiring mandibular reconstruction. This procedure was performed in the patient without complications. Further studies on the effectiveness of this technique are required.
简介:在第二次手术干预中,非血管化髂骨移植物和牵张成骨的结合仅被描述为实现牙槽嵴增大。该方法不建议用于枪弹所致颌骨骨缺损的治疗。病例介绍:40岁女性,1岁时因火器弹丸撞击造成下颌骨体节段性缺损。患者发展为严重的II类牙面异常,需要两个阶段的治疗;她接受了游离髂骨骨移植的下颌骨重建,随后在髂骨骨移植物的水平上进行了双侧下颌骨牵引。通过这些干预措施,患者的畸形得到了显著改善。结论:游离髂骨水平牵引是治疗需要重建下颌骨的牙颌畸形的一种安全、可预测的方法。该手术在患者中进行,无并发症。需要进一步研究这种技术的有效性。
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引用次数: 0
Resistant kawasaki disease in an infant causing giant coronary aneurysms with thrombosis 一例婴儿的耐药性川崎病导致巨大冠状动脉瘤伴血栓形成
Pub Date : 2020-11-12 DOI: 10.15761/JCCR.1000158
A. Anass, Hasbaoui Brahim, S. Salah, Yajouri Abdelhakim, A. Rachid, Hassani Amale, A. Aomar, Faid Soumia
A 13 month-old boy male infant admitted for fever, generalized polymorphous exanthema, hyperemic conjunctivae, and diarrhea. The onset of the disease was approximately 2 weeks before the admission with a generalized polymorphous exanthema for which he received antihistaminic treatment, but after 7 days he associated fever, hyperemic conjunctivae, and diarrhea being admitted in the regional hospital. The fever persisted despite the antibiotic and symptomatic treatment, and therefore he was transferred in our hospital. The clinical exam at the time of admission revealed influenced general status, generalized polymorphous exanthema, hyperemic pharynx, bilateral conjunctivitis, and approximately five diarrheic stools per day. The laboratory tests revealed leukocytosis (27,050/mL), with neutrophilia (19,900/mL), anemia (Hb 6.9 g/dL, Htc 19.7%, MEV 68.6 fL, MEH 24 pg), thrombocytosis (1,111,000/ mL), elevated inflammatory biomarkers (CRP An Abstract Giant coronary artery aneurysms that occur in 0.5 to 1% of patients with Kawasaki disease can be fatal if associated with thrombosis. Some patients may show persistent inflammation and fever despite treatment with repeated doses of intravenous immunoglobulin (IVIG), steroids, and aspirin. This report describes an infant boy with resistant Kawasaki disease who presented with extensive coronary artery involvement and coronary thrombosis. His inflammation was not controlled with multiple doses of IVIG, parenteral and oral steroids, or high-dose aspirin, and he finally needed infliximab, a monoclonal antibody against tumor necrosis factor alpha.
一例13个月大的男婴因发热、全身性多形疹、结膜充血和腹泻入院。患者在入院前约2周发病,伴有广泛性多形性皮疹,并接受了抗组胺药治疗,但7天后,患者出现发热、结膜充血和腹泻,住进了地区医院。尽管抗生素和对症治疗,发烧仍持续,因此他被转移到我们医院。入院时的临床检查显示全身状态受影响,全身性多形样疹,咽部充血,双侧结膜炎,每天约5次腹泻。实验室检查显示白细胞增多(27,050/mL),中性粒细胞增多(19,900/mL),贫血(Hb 6.9 g/dL, Htc 19.7%, MEV 68.6 fL, MEH 24 pg),血小板增多(1,111,000/ mL),炎症生物标志物(CRP)升高。在0.5%至1%的川崎病患者中发生的巨大冠状动脉动脉瘤如果与血栓形成相关,可能是致命的。尽管多次静脉注射免疫球蛋白(IVIG)、类固醇和阿司匹林,一些患者仍可能出现持续的炎症和发烧。本报告描述了一个顽固性川崎病的男婴,他表现出广泛的冠状动脉受累和冠状动脉血栓形成。多剂量IVIG、肠外和口服类固醇或大剂量阿司匹林都无法控制他的炎症,最后他需要英夫利昔单抗,一种抗肿瘤坏死因子α的单克隆抗体。
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引用次数: 0
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Journal of cardiology case reports
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