Avtor/Urednik		Tretjak, Martin
Naslov		Miokardna kontrastna ehokardiografija pri akutnem miokardnem infarktu z dvignjeno veznico ST
Prevedeni naslov		Myocardial contrast echocardiography in acute ST elevation myocardial infarction
Tip		članek
Vir		Zdrav Vestn
Vol. in št.		Letnik 73, št. 7-8
Leto izdaje		2004
Obseg		str. 585-8
Jezik		slo
Abstrakt		Background. Tissue myocardial perfusion is an important prognostic factor in patients after acute ST elevation myocardial infarction (STEMI) and early reperfusion treatment. Simple clinical methods for tissue perfusion assessment are unreliable. Myocardial contrast echocardiography (MCE) was developed recently as an upgrade of standard ultrasound examination of the heart. By using gas microbubbles as a contrast agent, it enables a direct visualization of myocardial microvascular integrity and tissue perfusion. Methods. Two case reports of MCE use in patients with STEMI are presented. The first patient was treated with systemic thrombolysis, MCE study was performed four hours after it has been finished. The second patient was treated with primary percutaneous transluminal coronary angioplasty (PTCA) in Clinical centre. MCE was performed on the second day, after the patient had been transferred to our hospital. Results. In both patients MCE showed abnormal tissue perfusion that was conclusive with incomplete reperfusion. In the first patient subacute rupture of free left ventricular wall with cardiac tamponade and death occurred on the next day. The location of the rupture could have been the area of myocardium with unsuccessful reperfusion. In the second patient the area of incomplete reperfusion was connected with a permanent functional damage. Conclusions. MCE is a non-invasive method for assessing tissue myocardial perfusion. In clinical practice it can be used in patients with STEMI treated with systemic thrombolysis or PTCA. MCE offers an excellent tool for judging reperfusion success and has important implications on future treatment of those patients.
Izvleček		Izhodišča. Prekrvitev srčne mišice na tkivni ravni je zelo pomemben napovedni dejavnik pri bolnikih po akutnem miokardnem infarktu z dvignjeno veznico ST (AMI), ki jih zdravimo z zgodnjim poskusom ponovne prekrvitve. Enostavne klinične metode za ugotavljanje tkivne prekrvitve niso dovolj zanesljive. Vzadnjem času se je kot nadgradnja standardne ultrazvočne preiskave srca razvila miokardna kontrastna ehokardiografija (MCE). MCE kot kontrast uporablja mikroskopske plinske mehurčke. Ti omogočajo prikaz celovitosti kapilarne mreže v srčni mišici in s tem tkivne prekrvitve. Metode. Prikazujem dva klinična primera uporabe MCE pri bolnikih z AMI. Prva bolnica je bila zdravljena s sistemsko farmakološko trombolizo. MCE smo opravili štiri ure po končani trombolizi. Drugi bolnik je bil zdravljen s primarno perkutano transluminalno koronarno angioplastiko (PTCA) v Kliničnem centru. MCE je bil opravljen drugi dan po posegu, ko je bil bolnik premeščen v našo bolnišnico. Rezultati. Pri obeh bolnikih smo z MCE ugotovili motnjo tkivne prekrvitve srčne mišice, torej nepopolno ponovno vzpostavitev prekrvitve. Pri prvi bolnici je v nadaljnjem poteku prišlo do subakutne rupture proste stene levega prekata, srčne tamponade in smrti. Mesto rupture je bilo najverjetneje v področju, kjer do ponovne vzpostavitve prekrvitve ni prišlo. Pri drugem bolniku je bilo območje nepopolne tkivne prekrvitve povezano s trajno funkcijsko okvaro srčne mišice. Zaključki. MCE je neinvazivna slikovna metoda za ugotavljanje prekrvitve srčne mišice na tkivni ravni. Trenutno jo lahko v klinični praksi uporabljamo pri bolnikih z AMI, ki jih zdravimo s sistemsko farmakološko trombolizo ali perkutanim revaskularizacijskim posegom. Z MCE ocenimo uspešnost ponovne vzpostavitve pretoka na tkivni ravni, kar lahko pomembno vpliva na nadaljnje zdravljenje teh bolnikov.
Deskriptorji		MYOCARDIAL INFARCTION ECHOCARDIOGRAPHY THROMBOLYTIC THERAPY ANGIOPLASTY, TRANSLUMINAL, PERCUTANEOUS CORONARY HEART RUPTURE, POST-INFARCTION