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患者女性,47岁。活动后心悸、气短6年,心电图诊断窦性心律伴完全性左束支传导阻滞、超声心动图提示扩张型心肌病,行心脏再同步化治疗(CRT)。按手术操作程序行CRT安置术。术中在逆行冠状静脉窦造影时见造影剂向心包腔内弥散,数个心动周期后迅速遍布心影外缘,诊断:冠状静脉夹层合并穿孔。立即停止手术,送CCU观察,术后7天再次行CRT安置术,手术顺利。术后1年随访,心功能改善,心腔变小。
Patient female, 47 years old. Palpitations, shortness of breath after 6 years, ECG diagnosis of sinus rhythm with complete left bundle branch block, echocardiography, dilated cardiomyopathy, cardiac resynchronization therapy (CRT). According to surgical procedures CRT placement. Surgery in retrograde coronary sinus angiography see contrast agent diffuse to the pericardial cavity, several cardiac cycles quickly around the outer edge of the heart shadow, diagnosis: coronary vein dissection and perforation. Immediately stop the operation, send CCU observation, 7 days after CRT CRT placement again, the operation goes well. After 1 year of follow-up, cardiac function improved, the heart chamber becomes smaller.