RANA DIJAGNOZA I LEČERNJE ANOMALNOG ISHODIŠTA LEVE KORONARNE ARTERIJE
DOI:
https://doi.org/10.46793/PP180321014PKljučne reči:
Anomalno ishodište leve koronarne arterije, ALCAPA, kardiomiopatija, ishemija, odojčeApstrakt
Anomalno ishodište leve koronarne arterije iz plućne arterije (ALCAPA) predstavlja retku kongenitalnu anomaliju, koja se javlja sa učestalošću od 1:300.000 živorođene dece i kod koje ishemija miokarda nastaje usled fenomena »koronarne krađe«.
Dvomesečno odojče je hospitalizovano sa znacima teške kongestivne srčane insuficijencije, koja je bila praćena metaboličkom acidozom, povišenim koncentracijama kardiospecifičnih enzima i proteina, radiografskim uvećanjem srčane senke i elektrokardiografskim znacima ishemije miokarda. Ehokardiografski je registrovana značajna dilatacija i hipokontraktilnost leve komore uzrokovani anomalnim ishodištem leve koronarne arterije iz plućne arterije i prisutnim fenomenom «koronarne krađe». Dijagnoza je potvrđena angiografijom koronarnih krvnih sudova. U uzrastu od tri i po meseca učinjena je kardiohirurška intervencija po tipu transfera leve koronarne arterije sa urednim operativnim i dugoročnim postoperativnim tokom. Kontrolni nalazi, tokom dvogodišnjeg praćenja bolesnika, su ukazali na kompletni oporavak.
Kod nelečenih bolesnika sa ALCAPA smrtnost u prvoj godini iznosi 90%. Međutim, prognoza oboljenja je značajno poboljšana kao rezultat mogućnosti rane ehokardiografske dijagnoze i poboljšanja hirurške tehnike.
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