Dissecção espontânea de coronária em gestante
relato de caso
DOI:
https://doi.org/10.61695/rcs.v2i2.44Palabras clave:
Coronariopatia, dissecção, cirurgia cardiovascular, gestaçãoResumen
A Dissecção Espontânea de Artéria Coronária (DEAC) é uma condição rara, está frequentemente associada à gravidez e apresenta alta taxa de morbimortalidade. As opções terapêuticas variam, desde tratamento medicamentoso, intervenção coronariana percutânea e cirurgia de revascularização do miocárdio. Descrevemos um caso de uma mulher de 38 anos, que apresentou DEAC na 36ª semana gestacional. Descrição do Caso: Paciente sem comorbidades, admitida no Pronto-Socorro com dor torácica, irradiada para o dorso e para membro superior esquerdo, sendo diagnosticada com IAM com supra de ST em parede anterior. Angiografia coronariana evidenciou dissecção em tronco de coronária esquerda e disfunção moderada de ventrículo esquerdo. Evoluiu com instabilidade hemodinâmica, sendo encaminhada para o centro cirúrgico, onde foi realizado parto cesariano de emergencial, seguido de toracotomia mediana para revascularização do miocárdio. Implantado dispositivo de contra-pulsação aórtica (balão intra-aórtico) antes da indução anestésica. Após a esternotomia, apresentou PCR. Estabelecida a circulação extracorpórea (CEC), foi realizada a revascularização miocárdica utilizando apenas enxertos venosos. Ao tentar sair de CEC, observou-se disfunção biventricular severa com necessidade de aminas vasoativas (noradrenalina e dobutamina). Paciente levada à UTI em choque cardiogênico, onde evoluiu com melhora hemodinâmica progressiva. Extubada no 6º DPO, alta da UTI no 9º DPO e alta hospitalar no 18º DPO. Conclusão: No caso apresentado, a opção pelo tratamento cirúrgico para revascularização miocárdica com cesariana de emergência foi exitosa, e possibilitou o tratamento da dissecção espontânea da TCE e da disfunção momentânea do ventrículo esquerdo.
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Derechos de autor 2024 Helmgton Souza, Marcus Vinícius dos Santos, Glauco Kalil Pina, Leonardo Jadyr Silva Rodrigues Alves, Beatriz Estrella Souza, Ricardo Barros Corso
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
