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S 224
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Emergency coronary thrombectomy for complete thrombotic occlusion of an unprotected left main coronary artery in acute myocardial infartion
Department of Internal Medicine, Masan Samsung Hospital1, Devision of Cardiology, Cardiac and Vascular Center, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
*Yong Hwan Park,1, Sang Yeub Lee, Jung Hyuk Kim, Bong Gun Song, Young Bin Song, Jin-Ho Choi
Acute myocardial infarction (AMI) due to left main coronary artery (LMCA) occlusion carries a grave prognosis. Patients with this condition are hemodynamically unstable, in cardiogenic shock due to a large area of myocardium being in jeopardy and demanding immediate therapeutic intervention. Thrombolysis, percutaneous coronary intervention with stenting or cardiac bypass surgery are traditional treatment options, but the aspiration thrombectomy is still debating. We report a case of complete thrombotic occlusion of an unprotected left main coronary artery in acute myocardial infartion and cardiogenic shock treated successfully by thrombectomy without stenting. Case: A 46-year-old male smoker with no past medical history of any disease presented to a local hospital with a two hour history of sudden continuous sqeezing chest pain radiating to his back and associated cold sweating, nausea and vomiting. He was hypotensive (blood pressure 80/60 mmHg) and ECG showed hyperacute tall T and ST depression in precordial leads, ST depression in II, III, aVF and ST elevation in I, aVL. After supported by intraaortic balloon pump, coronary angiography was done. It showed a total occlusion at the distal of LMCA and normal right coronary artery.
Thrombectomy was done and large red thrombi were extracted. Thrombolysis in myocardial infarction (TIMI) 3 flow was restored and no significant residual stenosis in the angiography. Angiography and intravascular ultrasound done after 10 days revealed no thrombus and significant residual stenosis.
― F-204 ―
Combined apical hypertrophic cardiomyopathy with acute myocardial infaction due to multiple coronary thrombosis
Eulji University School of Medicine
*Kyung-Tae Jung, Soon-Chang Park, Yoo-Jung Choi, Sang Lee, Kyung-Jin Lee, Jung-Hee Kim, Hyun-soo Yoon
Introduction: Apical hypertrophic cardiomyopathy is a variant of hypertrophic cardiomyopathy(HCM) characterized by a spade-shape configuration on echocardiography. It often accompanies a quite normal or even larger coronary arteriogram. Therefore, acute myocardial infarction with significant atherosclerosis is rarely reported in patients with apical HCM. Also there was no report of apical HCM combined acute myocardial infarction with multiple coronary thrombosis.
We report a first case of apical HCM, who developed acute myocardial infarction due to multiple coronary thrombosis. Case report: A 47-year-old man was admitted to ER due to chest pain. Apical hypertrophic cardiomyopathy was diagnosed at 1 year ago. His life history included no smoking or alcohol intake. On physical examination, blood pressure was 114/70 mmHg, pulse rate 70/min, and respiratory rate 15/min. On auscultation of chest, S1 and S2 sound were normal without heart murmur. Laboratory studies revealed total cholesterol of 174 mg/dl, triglyceride of 42 mg/dl, HDL-cholesterol of 68 mg/dl, glucose of 96 mg/dl, and uric acid of 8.1 mg/dl. The electrocardiogram showed regular sinus rhythm with ST elevations in the lateral leads and ST depression in anterior chest leads (Fig. 1). On cardiac enzyme test, CK-MB and troponin-T level markedly elevated. The echocadiography revealed typical spade-shaped configuration and marked increased apical wall thickness. Anterior, septum and apical wall motions showed hypo-akinetic feature (Fig. 2). Hemodynamic study did not reveal LV outflow tract obstruction. The coronary arteriogram revealed distal total obstruction with thrombi of left anterior descending, diagonal, left circumflex, and obtuse marginal arteries (Fig. 3). Abciximab and heparin IV infusion were done with temporary pacemaker insertion. Percutaneous coronary angioplasty on first diagonal artery and LAD with 2.5 ballooning was tried but no effect was observed, then suction catheter showed successful effect. Obstuse marginal artery was successfully treated with suction catheter. And then intracoronary urokinase 200.000 units were instilled. 2 days later, a follow up coronary arteriogram improved coronary blood flow.
