Dissecção espontânea de coronária em gestante
relato de caso
DOI:
https://doi.org/10.61695/rcs.v2i2.44Palavras-chave:
Coronariopatia, dissecção, cirurgia cardiovascular, gestaçãoResumo
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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Copyright (c) 2024 Helmgton Souza, Marcus Vinícius dos Santos, Glauco Kalil Pina, Leonardo Jadyr Silva Rodrigues Alves, Beatriz Estrella Souza, Ricardo Barros Corso
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