Balon angioplastika srčane vene kod bolesnika lečenog primenom kardioresinhronizacione terapije
Sažetak
Uvod. Kardioresinhronizaciona terapija (CRT) smanjuje smrtnost i broj hospitalizacija kod bolesnika sa simptomatskom srčanom insuficijencijom i blokom leve grane (LBBB) koji su na optimalnoj terapiji lekovima. Jedan od razloga za „nereagovanje” (non-response) posle ugradnje CRT pejsmekera može biti neuspeh u postizanju optimalnog položaja elektrode koja stimuliše levu komoru zbog izražene krivine ili stenoze/okluzije ciljne vene. Prikaz bolesnika. Prikazan je muškarac, starosti 79 godina, New York Heart Association (NYHA) klase III, sa atrijalnom fibrilacijom, hroničnim koronarnim sindromom (CSS) i preležanim infarktom miokarda koji je hirurški revaskularizovan sa implantacijom veštačke mehaničke aortne valvule. Bolesniku je indikovana ugradnja CRT pejsmejkera a venogramom mu je detektovana ostijalno/proksimalna teška krivina i stenoza posterolateralne vene koronarnog sinusa, anatomski jedine vene za optimalnu stimulaciju leve komore. Posle balon-angioplastike zakrivljenog i stenotičnog dela ciljne vene sa komplijantnim balonom 4.0 × 30 mm, postignuta je zadovoljavajuća i stabilna pozicija kvadriplolarne elektrode za stimulaciju leve komore. Zaključak. U nekim slučajevima CRT, komplijantna balon angioplastika bi mogla biti siguran i efikasan način za prevazilaženje teške stenoze vene koronarnog sinusa.
Reference
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