Akut Bakteriyel Myokardit Sonrası Gelişen Kardiyojenik Şokta Veno-Arteriyal ECMO Yardımı ile Tedavi
Özet
Miyokardit, klinik seyri oldukça değişken olan ve bazı hastalarda çok kısa sürede hayatı tehdit eden tablolara ilerleyebilen bir miyokard inflamasyonudur. Özellikle fulminan miyokardit olgularında hızlı gelişen ciddi sol ventrikül disfonksiyonu ve kardiyojenik şok, tanı ve tedavi sürecinde zamanla yarışılmasını gerektirir. Bu bölümde miyokarditin etyolojik nedenleri, klinik sınıflandırması, tanı yöntemleri ve güncel tedavi yaklaşımları ele alınmış; fulminan miyokardit yönetiminde mekanik dolaşım destek sistemlerinin önemi klinik ve literatür verileri ışığında değerlendirilmiştir. Sunulan olguda, akut bakteriyel miyokardit sonrası gelişen ve medikal tedaviye yanıt vermeyen kardiyojenik şok tablosunda erken dönemde veno-arteriyel ekstrakorporeal membran oksijenasyonu (VA-ECMO) uygulanmıştır. Leuconostoc mesenteroides’in etken olarak saptanması, literatürde oldukça nadir bildirilmesi olguyu dikkat çekici kılmaktadır. ECMO sürecinde gelişen vasküler komplikasyonların yönetimi, aksiller arter kanülasyonu gibi cerrahi stratejiler ve multidisipliner yaklaşım ayrıntılı olarak sunulmuştur. Bu olgu, fulminan miyokarditin uygun ve zamanında müdahale ile geri döndürülebilir bir klinik tablo olabileceğini göstermektedir. Mekanik dolaşım desteğinin gecikmeden devreye alınması prognoz üzerinde belirleyici olmaktadır. Bölümün amacı, fulminan miyokarditli hastalarda klinik karar verme sürecine katkı sağlamak ve ileri mekanik destek tedavilerinin uygun hasta seçimiyle etkin biçimde kullanılmasının önemini vurgulamaktır.
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