Kokyu to Junkan Volume 44, Issue 8 (August 1996)

A Case of Mitral Stenosis Associated with Acute Myocardial Infarction Demonstrated Coronary Thromboembolism which was unable to be Treated Successfully by Intracoronary Thrombolytic Therapy Hideji Tanaka 1 , Yoshikazu Hiasa 1 , Masato Tanimoto 1 , Tatehumi Takahashi 1 , Satoshi Katoh 1 , Kouichi Kishi 1 , Tatsuya Wada 1 , Tsukasa Aihara 1 1Division of Cardiology, Komatsushima Red Cross Hospital Keyword: 冠動脈血栓塞栓 , 僧帽弁狭窄症 , 血栓溶解療法 , coronary thromboembolism , mitral stenosis , thrombolysis pp.873-876
Published Date 1996/8/15
DOI https://doi.org/10.11477/mf.1404900016
  • Abstract
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A 72-year-old woman with a history of transient cerebral ischemic attack was reported. She was diagnosed as having mitral stenosis with atrial fibrilla-tion but angiographically normal coronary arteries in 1988. Since then, she has had anticoagulant therapy to control symptoms. In February 1994, complaining of chest pain, she was diagnosed on ECG as having acute inferior myocardial infarction. Emergency coronary angiography 4 hours after onset showed total occlusion suggesting thromboembolism at the distal portion of the right coronary artery (#4AV). Intracoronary throm-bolysis using t-PA was performed immediately, but recanalization was not successful. The angiogram after 17 days revealed no stenosis at this occluded portion. Acute myocardial infarction associated with mitral stenosis despite the performance of intracoronary thrombolysis has been reported in seven cases including this case. In the acute phase, thrombolysis alone could not bring about recanalization, but in the chronic stage stenosis was not present. Moreover, in most of the cases, the obstructive portion of the coronary artery was distal and its perfusive myocardium was small. Our case suggested that acute myocardial infarction with mitral stenosis should be treated by conventional therapy rather than by thrombolysis.

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44巻8号 (1996年8月)
電子版ISSN 1882-1200 印刷版ISSN 0452-3458 医学書院