The Complication of Coronary Artery Perforation Beyond Cardiac Tamponade During Percutaneous Coronary Intervention: the Review of the Anaphylaxis of Contrast Medium

經心導管介入性治療造成非心臟填塞的冠狀動脈穿孔併發症：造影劑過敏反應的回顧

楊宇佳(Yee-Chia Yeo) ； 黃奭毓(Shih-Yu Huang) ； 陳逸忠(I-Chung Chen)

《輔仁醫學期刊》 11卷1期 (2013/03) Pp. 39-45

摘要

一位72歲的男性，因不穩定型心絞痛接受冠狀動脈造影，其分別各顯示支架內再狹窄和瀰漫性狹窄於第一對角支和左前降支冠狀動脈。由於藥物支架難以通過此兩條冠狀動脈的分叉點，因此我們選擇一個高壓氣球擴張術再去撐開此狹窄處。不幸的是，在成功的支架置入術後，卻發現冠狀動脈穿孔之影像。隨後，在遠端的破裂血管附近，我們利用一個小氣球來擋住血流和使用魚精蛋白將抗凝血之肝素逆轉其作用。然而，病人卻開始抱怨胸悶，他的血壓下降至78/43毫米汞柱。心臟超音波顯示無心包膜積液，但觀察到病人面部水腫。經過適當的過敏性休克的搶救治療後，患者的症狀獲得立刻改善。此嚴重的顯影劑過敏症提醒我們非心包膜填塞之冠狀動脈穿孔併發症危害之重要性。

關鍵字

冠狀動脈穿孔 ； 魚精蛋白 ； 過敏性休克

並列摘要

A 72-year-old male presented with unstable angina and was admitted for a coronary angiography that showed in-stent restenosis and diffuse stenosis at the Diagonal branch (DB1) and the left anterior descending coronary artery (LAD), respectively. A high-pressure balloon was chosen to dilate the bifurcation of DB1 and LAD due to difficult advancement of drug-eluting stent. Unfortunately, a coronary perforation was noted at the distal LAD after successful stenting. Afterward, a small balloon was inflated near the distal perforated LAD and Heparin was reversed with protamine immediately. Nonetheless, the patient started to develop chest tightness and his blood pressure dropped to 78/43 mmHg. The echocardiogram showed no pericardial effusion, but facial edema of the patient was observed. The patient were improved after the appropriate rescue therapy for anaphylactic shock. This catastrophic complication reminds us the importance of any other possible hazards of coronary perforation beyond cardiac tamponade.

並列關鍵字

Coronary perforation ； Protamine ； Anaphylactic shock