Izazovi u lečenju postinfarktnog septalnog defekta i srčane slabosti
Sažetak
Uvod. Stečeni ventrikularni septalni defekt (VSD) je retka ali ozbiljna mehanička komplikacija akutnog infarkta miokarda sa lošom prognozom i visokom stopom mortaliteta kod bolesnika lečenih hirurškim putem ili konzervativno. Prikaz bolesnika. U radu je prikazan bolesnik, star 58 godina, koji je primljen u našu instituciju šest dana nakon akutnog infarkta miokarda, komplikovanim rupturom inferoseptalnog dela septuma i znacima srčane insuficijencije. Koronarografija urađena u regionalnoj bolnici pokazala je trosudovnu koronarnu bolest sa proksimalno okludiranom, dominantnom, desnom koronarnom arterijom. Transtorakalnim ehokardiografskim pregledom ustanovljena je aneurizma vrlo istanjenog inferiornog septuma i bazalnog dela inferiornog zida leve komore, sa rupturom septuma. Jedna od dimenzija defekta bila je 15 mm, sa izračunatim Qp: Qs odnosom od 2 : 1. S obzirom na to da je bolesnik bio pod jako visokim rizikom od hirurške korekcije defekta, odlučeno je da se pristupi transkateterskom zatvaranju VSD, kao boljoj opciji za bolesnika. Pod kratkom intravenskom sedacijom, postavljen je Amplatzer okluder 24 mm, uz neprekidnu transezofagealnu ehokardiografiju. Postproceduralnim ehokardiografskim pregledom ustanovljeno je prisustvo malog rezidualnog šanta, ali uz značajno poboljšanje hemodinamskog statusa. Na bolesnikovom 24-časovnom Holter elektrokardiogramu nisu registrovani poremećaji srčanog ritma. Deset dana nakon intervencije, urađena je ponovna koronarografija i stentiranje cirkumflekne arterije i ramus intermedijusa. Ostijalna lezija na prednjoj descedentnoj arteriji ostavljena je za dalju funckionalnu dijagnostiku. Zaključak. Transkatetersko zatvaranje ventrikularnog septalnog defekta septalnim okluderom može biti definitivni način lečenja bolesnika sa anatomski pogodnim defektima, ali i poslužiti za premošćavanje do hirurškog lečenja.
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