Ogromna aneurizma leve glavne koronarne arterije
Ogromna aneurizma leve glavne koronarne arterije: naše iskustvo retkog slučaja
Sažetak
Uvod. Aneurizme koronarnih arterija (KA) su retki poremećaji, naročito aneurizme glavnog stabla leve KA. U literaturi je opisano više slučajeva aneurizmi KA, različite lokalizacije, veličine, kliničke slike i načina lečenja. Ne postoji jedinstven stav o najadekvatnijem načinu lečenja kod tih bolesnika. Međutim, i dalje je poželjniji operativni način lečenja, mada je moguć i perkutani način lečenja. Odluka se donosi za svakog bolesnika pojedinačno. Prikazan je redak slučaj bolesnika, lečenog hirurškim putem, sa velikom aneurizmom glavnog stabla leve KA, koja se prezentovala akutnim koronarnim sindromom i srčanom insuficijencijom. Prikaz bolesnika. Bolesnica stara 66 godina primljena je u urgentni centar naše klinike zbog bolova u grudima i dispneje. Dijagnostikovan je akutni infarkt miokarda bez elevacije ST segmenta anterolateralne lokalizacije (maksimalne vrednosti kreatin kinaze 1 111 U/L, troponina T 3,754 ng/mL), komplikovan akutnom srčanom insuficijencijom. Kateterizacijom srca i koronarografijom otkrivena je ogromna (3,5 × 3,5 mm) sakularna aneurizma glavnog stable leve KA, puna tromba, koja je pritiskala proksimalne segmente leve prednje silazne i cirkumfleksne arterije. Zaključak. Ogromne aneurizme leve glavne KA su redak patološki nalaz i ne postoje utvrđeni principi lečenja. Mada je perkutani način lečenja sada dostupan u odabranim slučajevima, za te bolesnike je i dalje poželjan hirurški pristup.
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