Successful primary percutaneous coronary interventions in a patient with two consecutive ST-segment elevation myocardial infarctions and dual left anterior descending artery (type IV)

Marijan Spasić; Boris Džudović; Siniša Rusović; Zoran Jović; Predrag Djurić; Radoslav Romanović; Nemanja Djenić; Radomir Matunović; Slobodan Obradović

doi:10.2298/7016

Marijan Spasić Clinic for Cardiology, Military Medical Academy, Belgrade, Serbia
Boris Džudović Klinika za Urgentnu internu medicinu, Vojnomedicinska akademija, Beograd, Srbija
Siniša Rusović Institute of Radiology, Military Medical Academy, Belgrade, Serbia
Zoran Jović Clinic for Cardiology, Military Medical Academy, Belgrade, Serbia
Predrag Djurić Clinic for Cardiology, Military Medical Academy, Belgrade, Serbia
Radoslav Romanović Clinic for Emergency and Internal Medicine, Military Medical Academy, Belgrade, Serbia
Nemanja Djenić Clinic for Emergency and Internal Medicine, Military Medical Academy, Belgrade, Serbia
Radomir Matunović Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
Slobodan Obradović Clinic for Emergency and Internal Medicine, Military Medical Academy, Belgrade, Serbia

DOI: https://doi.org/10.2298/7016

Ključne reči: coronary vessels||, ||aa. coronariae, congenital abnormalities||, ||anomalije, myocardial infarction||, ||infarkt miokarda, stents||, ||stentovi, reoperation||, ||reoperacija, electrocardiography||, ||elektrokardiografija,

Sažetak

Uvod. Dvostruka prednja descedentna arterija (PDA) je veoma retka urođena anomalija i može biti otkrivena slučajno tokom primarne perkutane koronarne intervencije (pPKI) što može stvoriti poteškoće u određivanju i lečenju infarktne lezije. Prikaz bolesnika. Prikazali smo muškarca, starog 52 godine, sa infarktom miokarda sa ST-elevacijom (STEMI) donjeg zida, kod koga je tokom pPKI otkrivena dvostruka PDA. Kratka PDA je imala ishodište iz levog glavnog koronarnog stabla, a dugačka PDA iz proksimalnog dela desne koronarne arterije (DKA). Na mestu infarktne lezije u DKA uspešno je implantiran metalni stent i postignuta rezolucija ST-segmenta u EKG-u. Nakon dva sata, bolesnik je vraćen u angiosalu zbog novog STEMI anteroseptalne lokalizacije. Drugi metalni stent implantiran je na mestu nove infarktne lezije, ovog puta u proksimalnom delu kratke PDA. Zaključak. Pravilna interpretacija EKG-a od velike je pomoći u detekciji i lečenju infarktne lezije kod retke anomalne dvostruke PDA.

Reference

Spindola-Franco H, Grose R, Solomon N. Dual left anterior de-scending coronary artery: angiographic description of im-portant variants and surgical implications. Am Heart J 1983; 105(3): 445−55.

Manchanda A, Qureshi A, Brofferio A, Go D, Shirani J. Novel var-iant of dual left anterior descending coronary artery. J Cardio-vasc Comput Tomogr 2010; 4(2): 139−41.

Maroney J, Klein LW. Report of a new anomaly of the left ante-rior descending artery: type VI dual LAD. Cathet Cardiovasc Interv 2012; 80(4): 626−9.

Dogan SM, Gursurer M, Aydin M, Gocer H, Cabuk M, Dursun A. Myocardial ischemia caused by a coronary anomaly left anteri-or descending coronary artery arising from right sinus of Valsalva. Int J Cardiol 2006; 112(3): e57−9.

Roynard JL, Cattan S, Artigou JY, Desoutter P. Anomalous course of the left anterior descending coronary artery between the aorta and pulmonary trunk: a rare cause of myocardial ischae-mia at rest. Heart 1994; 72(4): 397−9.

Kheirkhah J, Sadeghipour P, Kouchaki A. An Anomalous Origin of Left Anterior Descending Coronary Artery from Right Coronary Artery in a Patient with Acute Coronary Syndrome. J Teh Univ Heart Ctr 2011; 6(4): 217−9.

Lee Y, Lim Y, Shin J, Kim K. A case report of type VI dual left anterior descending coronary artery anomaly presenting with non-ST-segment elevation myocardial infarction. BMC Cardi-ovasc Disord 2012; 12(1): 101.

Matsumoto M, Yokoyama K, Yahagi T, Kikushima K, Watanabe K, Tani S, et al. Double left anterior descending artery arising from right and left sinus of Valsalva in patient with acute cor-onary syndrome. Int J Cardiol 2011; 149(1): e40-2.

van der Wal AC, Becker AE. Atherosclerotic plaque rupture--pathologic basis of plaque stability and instability. Cardiovasc Res 1999; 41(2): 334−44.

Chen F, Eriksson P, Kimura T, Herzfeld I, Valen G. Apoptosis and angiogenesis are induced in the unstable coronary athero-sclerotic plaque. Coron Artery Dis 2005; 16(3): 191−7.

Ross M, Reul MD, Denton A, Cooley MD, Grady L, Hallman MD, et al. Surgical Treatment of Coronary Artery Anomalies. Tex Heart Inst J 2002; 29(4): 299−307.

Uspešne primarne perkutane intervencije kod bolesnika sa dva uzastopna infarkta miokarda sa elevacijom ST-segmenta i dvostrukom prednjom descedentnom arterijom (tip IV)

Sažetak

Reference