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2020, vol. 77, br. 11, str. 1226-1230
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Infarkt miokarda izazvan koronarnom embolijom nakon operacije srčanih zalistaka
Coronary embolism causing myocardial infarction after heart valve surgery
Univerzitet u Novom Sadu, Medicinski fakultet + Univerzitet u Novom Sadu, Medicinski fakultet, Institut za kardiovaskularne bolesti
e-adresa: andrej.preveden@mf.uns.ac.rs
Sažetak
Uvod. Koronarna embolija je redak uzrok infarkta miokarda. Najčešće se povezuje sa atrijalnom fibrilacijom, dilatativnom kardiomiopatijom, bakterijskim endokarditisom i hiperkoagulabilnim stanjem, kao i sa operacijom srca. Prikaz bolesnika. Prikazan je slučaj bolesnika sa teškom mitralnom i trikuspidnom regurgitacijom, bez postojeće koronarne bolesti. Urađena je operacija srčanih zalistaka, a neposredni postoperativni tok je protekao uredno. Pet dana posle operacije došlo je srčanog zastoja koji je bio praćen uspešnim reanimacionim postupkom. Elektrokardiografski je registrovana atrijalna fibrilacija sa značajnom elevacijom ST segmenta u inferiornim odvodima. Urgentna koronarna angiografija je pokazala totalnu okluziju desne koronarne arterije, te se pristupilo perkutanoj koronarnoj intervenciji kojom je uspešno uspostavljen ponovni protok kroz arteriju. Bolesnik je otpušten 20. postoperativnog dana, sa trojnom antitrombotskom terapijom. Zaključak. Operacija srca može biti praćena neočekivanim i potencijalno fatalnim komplikacijama, među kojima je i koronarna embolija. Brza i adekvatna reakcija medicinskog tima ključna je za preživljavanje i oporavak bolesnika.
Abstract
Introduction. Coronary embolism can rarely be a cause of myocardial infarction. It is usually associated with atrial fibrillation, dilated cardiomyopathy, bacterial endocarditis and underlying hypercoagulable state, as well as heart surgery. Case report. We reported a case of a patient with severe mitral and tricuspid regurgitation, with no underlying coronary artery disease. The patient underwent heart valve surgery, and the immediate postoperative course was uneventful. Five days after the operation, the patient sustained cardiac arrest, which was followed by a successful cardiopulmonary resuscitation. Electrocardiography showed atrial fibrillation with a significant ST segment elevation in the inferior leads. Urgent coronary angiography revealed a total occlusion of the right coronary artery, thus percutaneous coronary intervention was performed, after which flow restoration through the artery was achieved. The patient was discharged with triple antithrombotic therapy on the 20th postoperative day. Conclusion. Heart surgery could be followed by unexpected and potentially fatal complications, coronary embolism being one of them. In such case, the prompt and adequate reaction by the whole medical team is crucial for a patient's survival and recovery.
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