1 Cardiac Rupture Caused by Myocardial Infarction in the Diagonal Branch Area: Evaluation by Cardiac Multislice Computed Tomography: A Case Report 1 1 2 2 Nobuaki Kentaro Ken Masatoshi Naoyuki Yoshito Shigeru Tatsuro Susumu Keisuke Takaaki SUZUKI, MD MOTOYOSHI, MD KOZUMA, MD SUZUKI, MD YOKOYAMA, MD YAMAMOTO, MD SUZUKI, MD 1 KAMINAGA, MD 1 ISHIKAWA, MD 2 UEDA, MD 2 ISSHIKI, MD, FJCC Abstract A 75-year-old woman was admitted to the emergency room because of hypotension and loss of consciousness induced by cardiac tamponade. Electrocardiography revealed ST elevation and laboratory data showed elevation of serum creatine kinase and troponin I. The patient was referred to the cardiology department 5 days later. Cardiac catheterization revealed ventricular aneurysm in the anterior wall, significant stenosis 75% in the left anterior descending coronary artery and subtotal stenosis 99% in the diagonal branch. Cardiac multislice computed tomography suggested that the ventricular pseudoaneurysm was probably due to cardiac rupture caused by myocardial infarction in the diagonal area. Subsequently, aneurysmectomy and coronary artery bypass graft surgery were performed. Cardiac multislice computed tomography is useful for evaluating coronary artery and cardiac rupture. J Cardiol 2005 Aug ; 46 2 : 71 76 Key Words Aneurysms pseudoaneurysm Computed tomography multislice Myocardial infarction, pathophysiology cardiac rupture 15% 1 39.3% 2 90% å 30 45% 3 5 1 2 : 173 8606 2 11 1 Departments of Internal Medicine, 1 Radiology, and 2 Cardiovascular Surgery, Teikyo University, School of Medicine, Tokyo Address for correspondence : ISSHIKI T, MD, FJCC, Department of Internal Medicine, Teikyo University, School of Medicine, Kaga 2 11 1, Itabashi-ku, Tokyo 173 8606; E-mail: isshiki@med.teikyo-u.ac.jp Manuscript November 16, 2004 ; revised January 11, 2005; accepted January 12, 2005 71
72 Fig. 1 Electrocardiograms on admission and after drainage of the pericardium A : On admission. B: After drainage of the pericardium. 6 computed tomography: CTmultisector 7 8 CT 1 75 : 2004 4 2 å 140ml å 90/55mmHg CT ST I 5 : 141 cm 49.5 kg 122/78 mmhg 78/min : RBC 347 10 4 / l Hb 10.4g/dl WBC 8,300/ l Plt 11.6 10 4 / l AST 97IU/l ALT 66 IU/l LDH 282 IU/l CK 590IU/l CK- MB 92IU/l BUN 16.7 mg/dl Cr 0.86 mg/dl CRP 4.91mg/dl I 13.59 ng/ml BNP 299 pg/ml X : 55% : a L STå
73 Fig. 2 Left ventriculograms Left: Systole. Right : Diastole. Fig. 3 Coronary arteriograms Arrowheads : 75% stenosis in the left anterior descending coronary artery and subtotal in the diagonal branch. Left: Right coronary artery. Right : Left coronary artery. ST 2 5 ST ST Fig. 1 : : CT Fig. 2 99% 75%
74 Fig. 4 Cardiac multislice computed tomograms Arrowheads: pseudoaneurysm. LA left atrium; LV left ventricle; RV right ventricle. Dor Fig. 5 Fig. 5 Surgical operation Arrowheads: pseudoaneurysm. LAD left anterior descending coronary artery ; PA pseudoaneurysm. Fig. 3CT Fig. 4 1 4 99% CT CT al-saadon 9å
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