Prvi slučaj hirurške revaskularizacije miokarda i endarterektomije desne karotidne arterije u istom aktu kod bolesnika sa hemofilijom A
Sažetak
Uvod. Hemofilija A je najčešći nasledni poremećaj koagulacije koji nastaje zbog deficita faktora VIII. Opšte je prihvaćeno da ljudi sa hemofilijom imaju smanjenu incidencu koronarne bolesti, uglavnom zbog protektivnog efekta narušenog sistema koagulacije nasuprot patogenetskim mehanizama za razvoj akutnog koronarnog sindroma. Prikaz bolesnika. Muškarac star 53 godine sa blagom hemofilijom A [FVIII 22% (blaga forma – više od 5%–40% od normale)] hospitalizovan je zbog učestalih anginoznih bolova u miru. Selektivna koronarografija je pokazala tešku trosudovnu koronarnu bolest koja je zahtevala hitnu hiruršku revaskularizaciju miokarda. Kolor dopler krvnih sudova vrata je pokazao hemodinamski značajnu stenozu na desnoj karotidnoj arteriji. Posle konsultacije sa kardiohirurgom, hematologom i vaskularnim hirurgom, zbog povećanog rizika od krvarenja odlučeno je da se hirurška revaskularizacija miokarda i endarterektomija desne karotidne arterije rade u istom aktu. Operacije su urađene uz supstituciju koncentratom faktora VIII. Najpre je urađena endarterektomija desne karotidne arterije, a zatim je iskorišćena leva arterija mamarija kao graft na levu prednju descendentnu arteriju, kao i dva venska grafta na prvu optuzu u marginalnu granu i zadnje descendentne grane. Tokom intervencije nije bilo hemoragijskih komplikacija, niti potrebe za transfuzijom krvi. Bolesnik je otpušten kući sa antitrombocitnom terapijom (acetilsalicilna kiselina, 50 mg). Zaključak. Bolesnici sa hemofilijom nisu zaštićeni od razvoja ateroskleroze. U cilju obezbeđivanja zadovoljavajuće hemostaze, kardiohirurške operacije kod ovih bolesnika, predstavljaju pravi izazov za ceo medicinski tim. Adekvatna supstitucija koncentratom FVIII osigurava adekvatnu hemostazu i daje mogućnost za primenu antitrombocitne terapije.
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