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Medicinski pregled
2007, vol. 60, br. 5-6, str. 287-291
jezik rada: srpski
vrsta rada: prikaz slučaja
doi:10.2298/MPNS0706287I


Značaj koronarne kolateralne cirkulacije u očuvanju funkcije miokarda
Univerzitet u Novom Sadu, Medicinski fakultet, Institut za kardiovaskularne bolesti

Sažetak

Nakon okluzije ili subokluzije krvnog suda, perfuzija miokarda može da se odvija putem kolateralnih krvnih sudova. Oni nastaju na dva načina. Arteriogeneza je transformacija postojećih kolaterala u razvijene. Drugi način, angiogeneza, podrazumeva razvoj novih krvnih sudova od već postojećih. Kolateralni krvni sudovi imaju veliki broj funkcionalnih uloga. Adekvatno razvijeni, mogu zaštiti miokard kod okluzije krvnog suda. Čak i kod totalne okluzije koronarnog krvnog suda, regionalna pokretljivost leve komore bolja je u segmentima koji imaju adekvatno razvijenu kolateralnu cirkulaciju. Često pacijenti sa razvijenom kolateralnom cirkulacijom imaju okluziju koronarne arterije bez evidentnog infarkta u području distribucije okludirane arterije. Razvijenost kolateralnog protoka je jedna od determinanti veličine infarkta. Dobro razvijene kolaterale smanjuju rizik nestabilnih kardijalnih događaja. Prikazan je slučaj okluzije desne koronarne arterije sa dobrom kolateralnom cirkulacijom i očuvanom pokretljivošću miokarda leve komore. Nakon implantacije koronarnog stenta nestale su tegobe, maksimalni stres - test za ishemiju miokarda je negativan. Uprkos okluziji koronarnog krvnog suda, kolateralni protok krvi je očuvao funkcije pumpe miokarda leve komore.

Ključne reči

kolateralna cirkulacija; koronarna cirkulacija; miokard; bolesti miokarda; infartk miokarda

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