Kardiyak Trombüsü Olan Hastada Anestezi Yönetimi
Özet
İntraventriküler trombüs yaşamı tehdit eden potansiyel bir durumu temsil eder ve inme ve sistemik tromboembolizm riski nedeniyle önem arzeder. Sol ventrikül trombozunun en sık sebepleri endotel hasarı, kan akımının durması, miyokard enfarktüsü, kronik kalp yetmezliği, dilate kardiyomiyopati, artmış shear stres veya sistemik inflamasyon, kardiyomiyopati ve hiperkoagülopati durumudur. Ekokardiyografi noninvaziv yolla intrakardiyak trombüslerin tanısında kolay, hızlı uygulanabilir bir seçenektir. Kardiyak trombüs saptanan hastalarda öncelikli tedavi seçeneği antikoagülan tedavidir. Akut mezenterik iskemi (AMİ), yaşamı tehdit eden acil bir durumdur. Hastamız intraventriküler trombüsü olan ve acil akut mezenterik iskemi nedeniyle operasyon planlanan bir olguydu. Sistemik tromboembolizm riski nedeniyle hastamızın yönetimi önem arzetmektedir. Genel anestezi altında operasyon süresi 39 dakika sürdü. Peroperatif takiplerinde noradrenalin infüzyonu ile hemodinamik bozulma olmadı, emboli lehine akut bulgu görülmedi. Postoperatif 1. gününde noradrenalin ihtiyacı kalmayan ve sedasyonu kesilen hasta ekstübe edildi. Hastanın Glaskow Koma Skalası 15 olarak değerlendirildi. Hastada sistemik emboli düşündürecek klinik ve labaratuvar bulguya rastlanmadı. Hastamız postoperatif 3. gün genel cerrahi servisine devri sağlandı.
Intraventricular thrombus represents a potentially life-threatening condition and is important due to the risk of stroke and systemic thromboembolism. The most common causes of left ventricular thrombosis are endothelial damage, blood flow arrest, myocardial infarction, chronic heart failure, dilated cardiomyopathy, increased shear stress or systemic inflammation, cardiomyopathy and hypercoagulopathy. Echocardiography is an easy and rapidly applicable option for the noninvasive diagnosis of intracardiac thrombus. The primary treatment option in patients with cardiac thrombus is anticoagulant therapy. Acute mesenteric ischemia (AMI) is a life-threatening emergency. Our patient was a case with intraventricular thrombus and an operation was planned due to urgent acute mesenteric ischemia. Management of our patient is important due to the risk of systemic thromboembolism. The operation took 39 minutes under general anesthesia. During the perioperative follow-up, there was no hemodynamic deterioration due to noradrenaline infusion, and no acute findings in favor of embolism were observed. On the first postoperative day, the patient no longer required noradrenaline and sedation was discontinued and was extubated. The patient's Glasgow Coma Scale was evaluated as 15. There were no clinical or laboratory findings suggestive of systemic embolism in the patient. Our patient was transferred to the general surgery service on the 3rd postoperative day.
Referanslar
Choi UL, Park JH, Sun BJ,et al. Impaired left ventricular diastolic function is related to the formation of left ventricular apical thrombus in patients with acute anterior myocardial infarction. Heart Vessels; 2018;33 (5): 447-452.
Satish M, Vukka N, Apala D, Mahfood Haddad T, Gupta J. Left ventricular thrombus after acute decompensated heart failure in the setting of ıschemic cardiomyopathy. Cureus; 2019;11 (4): e4537.
Deniz O, Burhan Ö, Selmin K, Nihal D, Filiz Ş. Çocuklarda Kardiyak Trombüs: 10 Olguluk Seri Bulguları. İç Hastlıkları Dergisi; 1999;6: 299-302
Lee JM, Park JJ, Jung HW, et al. Left ventricular thrombus and subsequent thromboembolism, comparison of anticoagulation, surgical removal, and antiplatelet agents. J Atheroscler Thromb; 2013;20(1): 73-93.
Lemaître AI, Picard F, Maurin V, et al. Clinical profile and midterm prognosis of left ventricular thrombus in heart failure. ESC Heart Fail; 2021. doi:10.1002/ ehf2.13211
Haugland JM, Asinger RW, Mikell FL, Elsperger J, Hodges M. Embolic potential of left ventricular thrombi detected by two-dimensional echocardiography. Circulation; 1984;70(4): 588-98
Lip GY. Intracardiac thrombus formation in cardiac impairment: the role of anticoagulant therapy. Postgrad Med J; 1996;72(854): 731-8.
Nowak-Göttl U, Junker R, Kreuz W, von Eckardstein A, Kosch A, Nohe N, et al. Risk of recurrent venous thrombosis in children with combined prothrombotic risk factors. Blood; 2001;97: 858-62
Kerzmann A, Haumann A, Boesmans E, Detry O, Defraigne JO. L’ischémie mésentérique aiguë [Acute mesenteric ischemia]. Rev Med Liege; 2018; 73(5-6): 300-3.
Lawson RM. Mesenteric Ischemia. Crit Care Nurs Clin North Am; 2018;30: 29-39.
Singh B, Kaur P. COVID-19 and acute mesenteric ischemia: A review of literature. Hematol Transfus Cell Ther; 2021;43(1): 112- 6.
Yang C, Hakenberg P, Weiß C, et al. Colon ischemia in patients with severe COVID-19: a single-center retrospective cohort study of 20 patients. Int J Colorectal Dis; 2021; 36(12): 2769-73.
Pirola L, Palermo A, Mulinacci G, et al. Acute mesenteric ischemia and small bowel imaging findings in COVID-19: A comprehensive review of the literature. World J Gastrointest Surg; 2021;13(7): 702-16.
Referanslar
Choi UL, Park JH, Sun BJ,et al. Impaired left ventricular diastolic function is related to the formation of left ventricular apical thrombus in patients with acute anterior myocardial infarction. Heart Vessels; 2018;33 (5): 447-452.
Satish M, Vukka N, Apala D, Mahfood Haddad T, Gupta J. Left ventricular thrombus after acute decompensated heart failure in the setting of ıschemic cardiomyopathy. Cureus; 2019;11 (4): e4537.
Deniz O, Burhan Ö, Selmin K, Nihal D, Filiz Ş. Çocuklarda Kardiyak Trombüs: 10 Olguluk Seri Bulguları. İç Hastlıkları Dergisi; 1999;6: 299-302
Lee JM, Park JJ, Jung HW, et al. Left ventricular thrombus and subsequent thromboembolism, comparison of anticoagulation, surgical removal, and antiplatelet agents. J Atheroscler Thromb; 2013;20(1): 73-93.
Lemaître AI, Picard F, Maurin V, et al. Clinical profile and midterm prognosis of left ventricular thrombus in heart failure. ESC Heart Fail; 2021. doi:10.1002/ ehf2.13211
Haugland JM, Asinger RW, Mikell FL, Elsperger J, Hodges M. Embolic potential of left ventricular thrombi detected by two-dimensional echocardiography. Circulation; 1984;70(4): 588-98
Lip GY. Intracardiac thrombus formation in cardiac impairment: the role of anticoagulant therapy. Postgrad Med J; 1996;72(854): 731-8.
Nowak-Göttl U, Junker R, Kreuz W, von Eckardstein A, Kosch A, Nohe N, et al. Risk of recurrent venous thrombosis in children with combined prothrombotic risk factors. Blood; 2001;97: 858-62
Kerzmann A, Haumann A, Boesmans E, Detry O, Defraigne JO. L’ischémie mésentérique aiguë [Acute mesenteric ischemia]. Rev Med Liege; 2018; 73(5-6): 300-3.
Lawson RM. Mesenteric Ischemia. Crit Care Nurs Clin North Am; 2018;30: 29-39.
Singh B, Kaur P. COVID-19 and acute mesenteric ischemia: A review of literature. Hematol Transfus Cell Ther; 2021;43(1): 112- 6.
Yang C, Hakenberg P, Weiß C, et al. Colon ischemia in patients with severe COVID-19: a single-center retrospective cohort study of 20 patients. Int J Colorectal Dis; 2021; 36(12): 2769-73.
Pirola L, Palermo A, Mulinacci G, et al. Acute mesenteric ischemia and small bowel imaging findings in COVID-19: A comprehensive review of the literature. World J Gastrointest Surg; 2021;13(7): 702-16.
