Author/Editor		Klokočovnik, Tomislav; Kržišnik-Zorman, Simona; Weiss, Miha
Title		Uspešno zdravljenje disekcije aorte tipa A z rekonstrukcijo aortne zaklopke po Tirone-Davidu pri bolniku z dvotirno antiagregacijsko zaščito. Prikaz primera
Translated title		Successful treatment of aortic dissection type A with reconstruction of aortic valve according to Tirone-David in patient who received two-tier antiplatelet therapy. Case report
Type		članek
Source		Slov Kardiol
Vol. and No.		Letnik 3, št. 1
Publication year		2007
Volume		str. 38-41
Language		slo
Abstract		The most efficient way of myocardial reperfusion in patients with ST-elevation myocardial infarction (STEMI) is percutaneous coronary intervention (PCI), where is in most cases necessary to stent the affected coronary artery. The guidelines dictates treatment with aspirin and clopidogrel for all patients prior to procedure for prevention of early stent thrombosis. Clinical features of acute myocardial infarction and electrocardiographic changes can also be seen in other emergency states, one of them is acute dissection of ascending aorta (type A). Treatment of this is always operative, most commonly mechanical aortic valve on vascular graft is inserted (Bentall operation), but is also possible to perform a native aortic valve-sparing operation (Tirone - David operation). A case of patient with acute type A dissection is presented, who because of the biased suspicion that he had STEMI, received a two-tier antiaggregate treatment preoperatively, which strongly complicated the course of treatment. Tirone - David procedure was performed, for this reason there was no need to initiate anticoagulant treatment. Despite the patient has survived, we suggest that clopidogrel should be administered only when clinical presentation and electrocardiographic changes are typical for STEMI and not till consultation about performing primary PCI with the specialist in the intervention centre.
Summary		Najučinkovitejši način reperfuzije srčne mišice pri bolnikih z akutnim srčnim infarktom z dvigom veznice ST (STEMI) je perkutani koronarni poseg (PCI), kjer je v večffni primerov obolele koronarne arterije potrebno oskrbeti z žilnimi opornicami. Smernice priporočajo preprečevanje zgodnjih tromboz v opornici s kombinacijo aspirina in klopidogrela pri vseh bolnikih že pred samim posegom. Klinično sliko akutnega srčnega infarkta in spremembe v elektrokardiogramu pa lahko opazimo tudi pri drugih nujnih stanjih, eno takšnih je akutna disekcija ascendentne aorte (tip A). Slednjo vedno zdravimo s kirurškim posegom, najpogosteje vstavimo žilni vsadek- konduit, na katerem je všita mehanska aortna zaklopka (operacija po Bentallu), lahko pa pri posegu ohranimo naravno aortno zaklopko (operacija po Tirone-Davidu). Prikazan je primer bolnika z akutno disekcijo aorte tip A, ki je zaradi podanega suma, da gre pri njem za STEMI, pred kirurškim posegom prejel dvotirno antiagregacijsko zaščito, kar je močno zapletlo potek zdravljenja. Napravljen je bil poseg po Tirone-Davidu, zaradi česar bolnik po posegu ni potreboval antikoagulacijskega zdravljenja. Kljub temu, da je bolnik preživel, pa svetujemo, da damo klopidogrel le ob jasni klinični sliki in elektrokardiografskih spremembah, ki so značilne za STEMI, in to šele po dogovoru o izvedbi primarne PCI s specialistom interventnega centra.
Descriptors		AORTIC ANEURYSM, THORACIC ANEURYSM, DISSECTING BLOOD VESSEL PROSTHESIS PLATELET AGGREGATION INHIBITORS MIDDLE AGE