Anormal Çıkışlı Sol Koroner Arter Vakası
Özet
Akut koroner sendrom ve kardiyojenik şok tablosuyla başvuran 72 yaşındaki bir kadın hastada nadir görülen anomalili sol koroner arter vakası sunulmaktadır. Göğüs ağrısı şikayetiyle akut lateral miyokard enfarktüsü öntanısı alan hastanın elektrokardiyografisinde ST elevasyonu ve ekokardiyografisinde sol ventrikül ejeksiyon fraksiyonunun %35 olduğu saptanmıştır. Kateter laboratuvarında sol sistemde damar izine rastlanamamış, pulmoner arter görüntüleme girişimi ise ventriküler taşikardi atakları nedeniyle tamamlanamamıştır. Yapılan detaylı incelemede, sağ koroner arterin hemen yanındaki bölgede kontrast doluşu fark edilerek sorumlu damar tespit edilmiştir. Balon dilatasyonunun ardından ilgili lezyonlara iki adet ilaç kaplı stent başarıyla implante edilmiştir. Ancak kollateral dolaşımın bulunmaması ve tüm kalbi etkileyen ağır iskemi nedeniyle, müdahalelere rağmen hasta işlemden yaklaşık iki saat sonra kardiyopulmoner arrest neticesinde hayatını kaybetmiştir. Koroner anjiyografi bu tür konjenital anomalilerin tanısında altın standart olmaya devam etmektedir. Sol koroner arterin normal anatomik yerinde izlenemediği durumlarda, klinisyenlerin sağ koroner bölgeyi ve pulmoner arteri çok dikkatli incelemesi hayati önem taşımaktadır.
A rare case of an anomalous left coronary artery is presented in a 72-year-old female patient presenting with acute coronary syndrome and cardiogenic shock. Admitted with chest pain under a preliminary diagnosis of acute lateral myocardial infarction, her electrocardiography showed ST elevation, and echocardiography revealed a left ventricular ejection fraction of 35%. In the catheterization laboratory, no vascular trace was found in the left system, and pulmonary artery imaging could not be completed due to sustained ventricular tachycardia attacks. Subsequent evaluation revealed contrast filling adjacent to the right coronary artery, leading to the identification of the culprit vessel. Following balloon dilatation, two drug-eluting stents were successfully implanted into the lesions. However, due to the absence of collateral circulation and severe global myocardial ischemia, the patient suffered cardiopulmonary arrest and passed away two hours post-procedure. Coronary angiography remains the gold standard for diagnosing such congenital anomalies. When the left coronary artery cannot be identified in its normal anatomical position, it is crucial for clinicians to meticulously examine the right coronary region and pulmonary artery.
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