rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2011-7-6-739-743rpcardio-988Research ArticleNOTES FROM PRACTICEКЛИНИЧЕСКИЙ ОПЫТCORONARY EMBOLISM WITH FRAGMENTED THROMBUS FROM THE LEFT VENTRICLE IN PATIENT WITH POSTINFARCTION ANEURYSMЭМБОЛИЯ КОРОНАРНЫХ АРТЕРИЙ ФРАГМЕНТИРОВАННЫМИ ТРОМБАМИ ИЗ ЛЕВОГО ЖЕЛУДОЧКА У ПАЦИЕНТА С ПОСТИНФАРКТНОЙ АНЕВРИЗМОЙСалаховаЮ. Ф.SalakhovaYu. F.

врач-кардиолог

ГарькинаС. В.Gar'kinaS. V.

к.м.н., врач-кардиолог

КислухинТ. В.KislukhinT. V.

зав. отделением рентгенохирургических методов лечения

ДупляковД. В.DuplyakovD. V.

д.м.н., зам. главного врача; доцент кафедры кардиологии и кардиохирургии Института последипломного образования

duplyakov@yahoo.comИвановВ. С.IvanovV. S.

к.м.н., зав. кардиологическим отделением

ПеруноваЕ. Р.PerunovaE. R.

к.м.н., врач

БаженоваЭ. И.BazhenovaE. I.

врач-кардиолог

БурназянС. Е.BurnazyanS. E.

врач-кардиолог

ХохлуновС. М.KhokhlunovS. M.

д.м.н., главный врач; зав. кафедрой кардиологии и кардиохирургии Института последипломного образования Самарского государственного медицинского университета

Самарский областной клинический кардиологический диспансерРоссияSamara Regional Сlinical Сardiology СentreRussian Federation20112301201676739743Copyright © Salakhova Y.F., Gar'kina S.V., Kislukhin T.V., Duplyakov D.V., Ivanov V.S., Perunova E.R., Bazhenova E.I., Burnazyan S.E., Khokhlunov S.M., 20162016Салахова Ю.Ф., Гарькина С.В., Кислухин Т.В., Дупляков Д.В., Иванов В.С., Перунова Е.Р., Баженова Э.И., Бурназян С.Е., Хохлунов С.М.Salakhova Y.F., Gar'kina S.V., Kislukhin T.V., Duplyakov D.V., Ivanov V.S., Perunova E.R., Bazhenova E.I., Burnazyan S.E., Khokhlunov S.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/988

The thrombus formation in the left ventricle (LV) cavity is a frequent complication of myocardial infarction (MI) as well as a risk factor for peripheral arterial embolism. Probability of intraventricular thrombus depends on MI location and its therapy. A case of coronary embolism in a patient with anterior MI and thrombus in the LV aneurysm is considered in details. Successful percutaneous coronary intervention (PCI) in the first 90 minutes after admission was performed. Decision to appoint a three-component antithrombotic therapy (acetylsalicylic acid, clopidogrel, warfarin) was made on the 4th day of disease onset taking into account the combination of MI, stent placement in the anterior interventricular artery and the presence of left ventricular aneurysm with parietal thrombus. Recurrence of MI developed on the 9th day of disease onset. Aspiration thromboembolectomy was performed taking into account thrombosis of two coronary arteries. Warfarin therapy was discontinued in connection with subsequent clot lysis and development of not intensive nosebleed. Subsequent MI course was uneventful. In conclusion, even in spite of the timely achievement of PCI and early reperfusion, MI course can be complicated by thrombosis of the left ventricle and subsequent development of thromboembolic complications.

Формирование тромба в полости левого желудочка (ЛЖ) — нередкое осложнение инфаркта миокарда (ИМ) и является фактором риска эмболии периферических артерий. Вероятность образования внутрижелудочкового тромба напрямую зависит от локализации ИМ и проводимой терапии. Подробно рассматривают случай эмболии коронарных артерий у пациента с передним ИМ и тромбом в полости аневризмы ЛЖ. Больному было проведено успешное чрескожное коронарное вмешательство (ЧКВ) в первые 90 мин после госпитализации. Учитывая сочетание ИМ, выполненного стентирования передней межжелудочковой артерии, а так-же наличие аневризмы ЛЖ с пристеночным тромбом на 4-й день от начала заболевания было принято решение о проведении трехкомпонентной антитромботической терапии(ацетилсалициловая кислота, клопидогрел и варфарин). На 9-й день от начала заболевания у пациента возник рецидив ИМ. С учетом признаков тромбоза двух коронарных артерий пациенту была выполнена аспирационная тромбоэмболэктомия. В связи с последующим лизисом тромба и развитием немассивного носового кровотечения терапия варфарином была отменена. В последующем динамика ИМ протекала без особенностей. Продемонстрировано, что, даже несмотря на своевременное проведение ЧКВ и раннее достижение реперфузии, течение ИМ может осложняться тромбозом ЛЖ и развитием последующих тромбоэмболических осложнений.

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The authors declare that there are no conflicts of interest present.