Embólia koronárnych artérií je menej častou príčinou akútneho infarktu myokardu. Predstavujeme kazuistiku 22-ročnej pacientky s dvojvtokovou ľavou komorou, defektom komorového septa a pulmonálnou stenózou po Fontanovej operácii s akútnym spodným STEMI na embolickom podklade. Okrem známych rizík vedúcich k trombotickým komplikáciám spojeným s Fontanovskou cirkuláciou, medzi potenciálne predisponujúce faktory trombembolizmu u tejto pacientky patrili vytvorenie trombu v dolnej dutej žile a nedostatočná antikoagulačná liečba. Táto kazuistika predstavuje jednu z prvých dokumentovaných embolických príčin STEMI u pacienta s Fontanovskou cirkuláciou. Doteraz nie je vytvorený konsenzus, že antikoagulačná terapia warfarínom je u pacientov s Fontanovskou cirkuláciou superiórna voči aspirínu v primárnej prevencii trombembolických príhod.
Coronary artery embolism is an uncommon cause of acute myocardial infarction. We present a case of a 22-year-old patient with double inlet left ventricle (DILV), ventricular septal defect and pulmonary stenosis after Fontan repair with an acute embolic inferior ST-segment elevation myocardial infarction (STEMI). Apart from already known risk factors of thrombotic complications associated with Fontan circulation, additional predispositions in this patient included thrombus formation located in the inferior vena cava and the lack of anticoagulation therapy. This is one of the first reported embolic causes of STEMI in a patient with a Fontan circulation. Up to date, there is no consensus that anticoagulation therapy with warfarin is superior to aspirin in primary prevention of thromboembolism in patients with Fontan circulation.
- MeSH
- antikoagulancia terapeutické užití MeSH
- Fontanova operace MeSH
- infarkt myokardu * diagnóza etiologie terapie MeSH
- lidé MeSH
- mladý dospělý MeSH
- pooperační komplikace MeSH
- tromboembolie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: Cryoballoon ablation for the treatment of patients with atrial fibrillation (AF) has been utilized in Europe for >15 years. OBJECTIVES: Report patient and procedural characteristics that influence the safety of cryoablation for the treatment of AF. METHODS: Patients enrolled in the prospective, multicenter Cryo AF Global Registry were treated at 38 European centers. Freedom from a ≥30s episode of AF/atrial flutter (AFL)/atrial tachycardia (AT) at 12-months and serious complications were analyzed. Univariate and multivariable models identified baseline patient and procedural characteristics that predicted a procedure-related complication. RESULTS: Of the 1418 subjects who completed an index procedure, the cohort was 62 ± 11 years of age, 37.7% female, and 72.2% paroxysmal AF (PAF). The mean procedure, left atrial dwell, and fluoroscopy times were 81 ± 34, 54 ± 25, and 14 ± 13 min, respectively. Among the 766 patients with 12-month follow-up, freedom from a ≥30 s AF/AFL/AT recurrence was 83.3% (95% CI: 79.8%-86.3%) and 71.6% (95% CI: 64.6%-77.4%) in patients with PAF and persistent AF. The serious procedure- and device-related adverse event rates were 4.7% and 2.0%. No baseline patient characteristic independently predicted a procedure-related adverse event; however, prolonged procedure duration (OR = 1.01 [95% CI: 1.00-1.01]), use of general anesthesia (OR = 1.71 [95% CI: 1.01-2.92]), and delivery of a cavotricuspid isthmus line (OR = 3.04 [95% CI: 1.01-9.20]) were each independently associated with the occurrence of a serious procedural safety event (all p < .05). CONCLUSIONS: Cryoballoon ablation is safe and effective in real-world use across a broad cohort of patients with AF.
- MeSH
- fibrilace síní chirurgie MeSH
- fluoroskopie MeSH
- kryochirurgie metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- recidiva MeSH
- registrace MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Evropa MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
