Abstract：
A 55-year-old man presented to the emergency department with worsening shortness of breath 1 month after a gastrointestinal bleed. He had congestive heart failure, and an electrocardiogram suggested ischemic heart disease involvement. Echocardiography revealed a ventricular septal defect complicated by a left ventricular aneurysm in the inferior-posterior wall. Conservative treatment was started, but hemodynamic collapse occurred on the third day of admission and coronary angiography revealed a revascularizing lesion in the right fourth posterior descending coronary artery. Subsequently, his hemodynamic status continued to deteriorate, even with an Impella CP® heart pump, so ventricular septal defect patch closure and left ventricular aneurysm suture were performed. His condition improved and he was discharged on day 23 of admission and was not readmitted within 6 months after the procedure. Hemodynamic management of ventricular septal defects requires devices that reduce afterload, and clinicians should be aware of the risk of myocardial infarction after gastrointestinal bleeding.
摘要：
一名55岁的男子在胃肠道出血后1个月出现呼吸急促恶化，被送往急诊科。他有充血性心力衰竭,心电图提示缺血性心脏病受累.超声心动图显示室间隔缺损并发下后壁左心室动脉瘤。开始保守治疗，但入院第3天发生血流动力学塌陷,冠状动脉造影显示右侧第4冠状动脉后降支血管重建性病变.随后，他的血液动力学状态继续恶化，即使使用ImpellaCP®心脏泵，因此进行了室间隔缺损补片闭合和左心室动脉瘤缝合。他的病情有所改善，他在入院第23天出院，并且在手术后6个月内没有再次入院。室间隔缺损的血流动力学管理需要减少后负荷的装置，临床医生应注意消化道出血后发生心肌梗死的风险。
