急性左主干闭塞病例报告庞文跃.ppt

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，64 Was 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,Past 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 depressed 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 right 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 chest 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 first? 首先做什么？,IABP /Temporary cardiac pacing, then PCI IABP/临时起搏器，然后PCI PCI 首先PCI Drug 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,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?,PCI CABG Drug Other,3.0*10 cutting balloon,3.0*10 cutting balloon