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A Case of Successful Recovery from Cardiac Arrest Resulting from Coronary Perforation Nobuhiro Takeuchi 1 , Yoshiharu Nishibori 1 , Takao Maruyama 1 , Kenji Takai 1 , Tetsuo Horimatsu 1 , Shigeki Masuda 1 , Koichi Fujita 1 , Masanori Takada 1 , Toshiaki Hasuike 2 , Takuro Tsukube 3 1Department of Internal Medicine, Division of Cardiology, Kawasaki Hospital 2Hasuike Internal Medicine Clinic 3Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital Keyword: 冠動脈穿孔 , 経皮的心肺補助装置 , 冠動脈バイパス手術 , coronary perforation , PCPS , CABG pp.85-91
Published Date 2013/1/15
DOI https://doi.org/10.11477/mf.1404102139
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 An 83-year-old man with a history of chronic kidney disease and hypertension underwent stent implantation in 90% stenotic lesions of proximal segment and middle segment of left anterior descending artery, in June 2011. In December 2011, chest pain on exertion emerged, so coronary angiography was performed. Coronary angiography(CAG)showed restenosis in the proximal portion of stent implanted in the middle segment of left anterior descending artery and percutaneous coronary intervention was performed. After insertion of a balloon catheter into the re-stenotic lesion, we inflated the balloon at high pressure. Immediately after implantation of a stent to the lesion, coronary perforation occurred. In spite of long inflation of a balloon catheter, the extravasation of contrast medium from the perforated coronary artery could not be stopped. During procedure, he developed incessant ventricular tachycardia and cardiac arrest. Cardiopulmonary resuscitation was initiated and percutaneous cardiopulmonary support system was used. Since transthoracic echocardiography showed massive pericardial effusion, continuous drainage was performed. Soon after that, spontaneous circulation restored. A polytetrafluoroethylen(PTFE)-covered stent was implanted to the perforated coronary artery and CAG showed no retension of contrast medium. Since 100ml per an hour of serosanguineous fluid was drained, operation was thought to be indicated. He was transferred to another hospital and emergent operation was performed. Epicardial bleeding made buldge on the implanted stent. After saphenous vein graft was anastomosed to the distal of left anterior descending artery, left anterior descending artery was ligated proximal to the implanted stent. He was discharged on foot without any complications.


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電子版ISSN 1882-1200 印刷版ISSN 0452-3458 医学書院

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