PDF(Pubmed)
Abstract：
We encountered a case of frequent nonsustained polymorphic ventricular tachycardia (NSPVT) due to hemodynamically unstable chronic thromboembolic pulmonary hypertension (CTEPH). A 78-year-old woman was taking anticoagulants for CTEPH. She had refused specific treatment for CTEPH, including pulmonary vasodilators, because she was then asymptomatic. She fell and sustained a femoral neck fracture, and she was referred to our hospital in anticipation of a surgical repair. Her condition on admission was complicated by respiratory failure, and electrocardiogram monitoring showed frequent NSPVT. A right heart catheterization revealed high mean pulmonary artery pressure with severely reduced cardiac output. Pulmonary angiography showed bilateral stenosis and multiple obstructions. Because NSPVT was attributed to low cardiac output syndrome caused by CTEPH, rescue balloon pulmonary angioplasty (BPA) was performed, and riociguat treatment was initiated. Afterward, the NSPVT resolved. This case suggests that the combination of rescue BPA with riociguat therapy might be an immediate and effective treatment for patients with inoperable CTEPH and severe hemodynamic instability.
摘要：
由于血流动力学不稳定的慢性血栓栓塞性肺动脉高压（CTEPH），我们遇到了一例频繁的非持续性多形性室性心动过速（NSPVT）。一名78岁的妇女正在服用抗凝血剂治疗CTEPH。她拒绝了CTEPH的特殊治疗,包括肺血管扩张剂,因为她当时没有症状.她摔倒了，股骨颈骨折，她被转诊到我们医院，期待手术修复。她入院时的病情因呼吸衰竭而复杂，心电图监测显示频繁的NSPVT。右心导管检查显示平均肺动脉压高，心输出量严重减少。肺动脉造影显示双侧狭窄及多发梗阻。因为NSPVT归因于CTEPH引起的低心输出量综合征，进行了救援球囊肺血管成形术（BPA），并开始了riociguat治疗。之后,NSPVT解决了。这种情况表明，对于无法手术的CTEPH和严重的血流动力学不稳定的患者，抢救BPA与利奥西加治疗的组合可能是一种立即有效的治疗方法。
