Primarna perkutana intervencija desne koronarne arterije u okolnostima anomalnog porekla leve koronarne arterije iz suprotnog sinusa Valsalva
Sažetak
Uvod. Anomalije koronarnih arterija nisu čest, ali su očekivani nalaz tokom pekutanih koronarnih intervencija (PCI). Za razliku od relativno redovnog prijavljivanja koronarnih anomalija pri dijagnostičkim koronarografijama, one se nedovoljno često prikazuju u izveštajima sa interventnih procedura, posebno u sklopu primarne PCI, kada je upravo njihovo promptno otkrivanje od najveće važnosti. Prikaz bolesnika. Prikazan je muškarac, star 50 godina, sa akutanim infarktom miokarda sa ST elevacijom (STEMI) donjeg zida koji je zahvatio i desnu komoru, kod koga je nađen zajednički ostijum za sve tri koronarne arterije u desnom aortnom sinusu Valsalve. Ova anomalija je ekstremno retka varijanta ishoda koronarnih arterija koja odgovara tipu A4b2c2 Angelinijeve klasifikacije. Istovremeno, ona pripada i kategoriji abnormalnog ishoda koronarnih arterija iz kontralateralnog sinusa Valsalve (ACAOS) sa intraseptalnim kursom proksimalnog dela prednje descendentne arterije. Kod bolesnika je uspešno ugrađen jedan stent obložen lekom, tokom produžene i turbulentne procedure, uz potrebu izmene katetera vodiča, upotrebu privremenog pacemaker-a i pojavu fenomena usporenog koronarnog protoka po otvaranju arterije. Zaključak. Detaljno su prikazani dijagnostički postupci za angiografsko prepoznavanje dominantnih varijanti abnormalnog ishoda koronarnih arterija iz kontralateralnog sinusa Valsalve, kao i praktični aspekti izvođenja perkutanih intervencija kod ovakvih bolesnika. Analizirani su funkcionalni značaj koronarnih anomalija i njihove implikacije na dalju prognozu i terapijski pristup. Predlaženo je usvajanje nove klasifikacije koronanih anomalija, predložene od Angelinijeve grupe, u rutinskoj kliničkoj praksi. Na kraju, potrebno je uključivanje specifične obuke o svim relevantnim aspektima koronarnih anomalija u redovni program obuke interventnih kardiologa.
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