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Herz

, Volume 24, Issue 5, pp 398–402 | Cite as

Spontandissektion der Koronararterien: Eine seltene kardiologische Diagnose

  • Peter Lemke
  • Matthias Schwab
  • Barnabas Urbanyi
  • Klaus Hellberg
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Zusammenfassung

Bei einer 50jährigen Patientin, die wegen akuter thorakaler Schmerzen notfallmäßig aufgenommen wurde, bestätigte sich ein anteroseptaler Myokardinfarkt. Bei der vier Wochen nach dem Akutereignis durchgeführten Koronarangiographie fand sich neben einer Stenosierung des linken Hauptstamms und des proximalen Ramus circumflexus der Zufallsbefund einer längerstreckigen Dissektion des Ramus interventricularis anterior (RIVA). In der Folge wurde die Patientin kardiochirurgisch versorgt und erhielt einen autologen Venenbypass auf den RIVA mit zusätzlicher Readaptation der dissezierten Wandschichten und einer proximalen Ligatur des RIVA oberhalb der Anastomose sowie einen Venenbypass auf den Ramus marginalis des Ramus circumflexus.

Anhand dieses Fallbeispiels wird das derzeitige unterschiedliche therapeutische Vorgehen bei einer spontanen Koronardissektion — konservativ-kardiologisch versus kardiochirurgisch — diskutiert.

Schlüsselwörter

Spontane Koronararteriendissektion Myokardinfarkt Koronare Herzkrankheit 

Spontaneous coronary artery dissection: Rare cardial diagnosis

Abstract

A 55-year-old woman who was admitted to hospital with acute chest pain as a case of emergency suffered from an acute anteroseptal myocardial infarction. Four weeks later coronary angiography revealed a long dissection of the left anterior descending artery (LAD) as well as a significant stenosis of the left main and the proximal circumflex. Cardiovascular surgery was done subsequently. In addition to myocardial revascularization using coronary artery bypass grafts a readaptation of the dissecting artery walls and a proximal ligation of the LAD before anastomosis were performed. Clinical data, pathogenesis, and indications for medical and surgical treatment of spontaneous artery dissection are presented.

Key Words

Spontaneous coronary artery dissection Myocardial infarction Coronary heart disease 

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Copyright information

© Urban & Vogel 1999

Authors and Affiliations

  • Peter Lemke
    • 1
  • Matthias Schwab
    • 2
  • Barnabas Urbanyi
    • 1
  • Klaus Hellberg
    • 1
  1. 1.Abteilung für Herz- und GefäßchirurgieRobert-Bosch-KrankenhausStuttgart
  2. 2.Dr.-Margarete-Fischer-Bosch-Institut für Klinische PharmakologieStuttgart

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