RESUMO
A 62-year-old man presented with an anterior ST elevation myocardial infarction and underwent primary percutaneous coronary intervention to an occluded diagonal artery. Following stenting, a type III distal guidewire-induced coronary perforation of the diagonal branch was recognized with extravasation of contrast into the pericardial space. Prolonged balloon inflations proximal to the site of the perforation were unsuccessful. Subcutaneous fat was therefore harvested from the patients upper thigh under local anesthetic and embolized through an Export catheter into the distal diagonal vessel, resulting in the immediate cessation of leak through the site of perforation. We discuss the technical aspects of this technique as well as alternative methods of distal embolization and the potential complications that must be considered.
Assuntos
Infarto Miocárdico de Parede Anterior/terapia , Vasos Coronários/lesões , Embolização Terapêutica/métodos , Traumatismos Cardíacos/terapia , Intervenção Coronária Percutânea/efeitos adversos , Gordura Subcutânea/transplante , Lesões do Sistema Vascular/terapia , Infarto Miocárdico de Parede Anterior/diagnóstico , Autoenxertos , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Coxa da Perna , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/etiologiaAssuntos
Infarto do Miocárdio , Infarto do Miocárdio sem Supradesnível do Segmento ST , Infarto do Miocárdio com Supradesnível do Segmento ST , Aspirina/uso terapêutico , Plaquetas , Eletrocardiografia , Mortalidade Hospitalar , Humanos , Infarto do Miocárdio/tratamento farmacológico , Sistema de Registros , Resultado do TratamentoRESUMO
Intra-aortic balloon pumps (IABP) are commonly used in the setting of an acute myocardial infarction that is complicated by cardiogenic shock or mechanical complications such as a ventricular septal defect or papillary muscle rupture. IABP has also been shown to be useful in patients with refractory and hemodynamically unstable ventricular arrhythmias and refractory post-myocardial infarction angina. We report a case in which IABP was used in a patient with dilated cardiomyopathy and normal coronary arteries, who presented with persistent, recurrent and refractory ventricular tachycardia. His ventricular tachycardia settled immediately with the use of IABP therapy. He subsequently had an implantable defibrillator. The use of IABP is associated with favorable changes in the left ventricular wall tension and reduction in afterload, which could reduce the excitability of the myocardium, thus making it less prone to arrhythmias. The use of IABP is relatively safe and should be considered in patients with refractory ventricular arrhythmias, even if it is not associated with ischemia.
Assuntos
Cardiomiopatia Dilatada/complicações , Vasos Coronários/anatomia & histologia , Balão Intra-Aórtico , Taquicardia Ventricular/cirurgia , Disfunção Ventricular Esquerda/etiologia , Antiarrítmicos/uso terapêutico , Angiografia Coronária , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Resultado do TratamentoRESUMO
Percutaneous occlusion techniques of secundum type atrial septal defects have recently become the treatment of choice, delivering excellent results and being associated with a low rate of early and late complications. The investigators report an unusually delayed presentation of acute right heart failure due to Amplatzer septal device embolisation into the main pulmonary artery, 2 years after implantation.