Merkely Béla

Pericardialis tamponáddal, ST-szakasz-elevációval szövodött akut "a" típusú aortadissectio sikeresen operált esetének ismertetése

Az akut „A” tipusu aortadissectio sikeres kezelesenek kulcsa a gyors diagnosztika es a kesedelem nelkuli műtet. A gyors diagnozis felallitasat szamos szovődmeny (myocardialis ischaemia, akut aortainsufficientia, szervperfuzios zavarok, pericardialis tamponad) es az azokhoz kapcsolodo, a klinikai kepet olykor uralo tunetek nehezithetik. A szerzők egy 72 eves nőbeteg kortortenetet ismertetik, aki ujraelesztes utan kerult intezetukbe ST-elevacios myocardialis infarctus EKG-jeleivel. A kateterasztalon keszitett echokardiografias vizsgalat akut „A” tipusu dissectiot es pericardialis tamponadot igazolt. Akut műtet soran aortaascendens-reszekcio, gyokrekonstrukcio tortent. A beteg korhazba erkezesetől a műtet vegeig 6 ora telt el. A kontrollvizsgalat jo balkamra-funkcio mellett kompetens aortabillentyűt mutatott. A beteg jelenleg jo altalanos allapotban, panaszmentesen, a rehabilitacios kezeles utan, otthonaban tartozkodik. A szerzők feltetelezik, hogy a diagnosztikus es terapias lehetősegek fejlődesevel a jovőb...Successful treatment of type A acute aortic dissection depends on the promptness of diagnostic evaluation and therapy. Fast diagnosis can be challenged by numerous complications such as myocardial ischemia, acute aortic insufficiency, and disturbances in organ perfusion and pericardial tamponade. The authors report the case history of a 72-year-old woman, who was admitted after resuscitation with ST segment elevation. Echocardiography revealed acute type A aortic dissection with signs of pericardial tamponade. An emergency operation consisting of the resection of the ascending aorta and the reconstruction of the aortic root was performed, which took six hours from admission until the end of the operation. Follow-up examinations demonstrated good left ventricular function and competent aortic valve. The authors propose that with the development of diagnostic and therapeutic options, faster and less invasive interventions will be introduced in near future for the treatment of acute aortic dissection, which may reduce the morbidity and mortality rates of this lethal illness.

Idiopathiás fascicularis kamrai tachycardia ablatiója

Idiopathic fascicular ventricular tachycardia is an important and not very rare cardiac arrhythmia with specific electrocardiographic features and therapeutic options. Ventricular tachycardia is characterized by relatively narrow QRS complex and right bundle branch block pattern. The QRS axis depends on which fascicle is involved in the re-entry. Left axis deviation is noted with left posterior fascicular tachycardia and right axis deviation with left anterior fascicular tachycardia. A left septal fascicular tachycardia with normal QRS axis is also possible. Idiopathic fascicular tachycardia is usually seen in individuals without structural heart disease. Response to verapamil is an important feature of fascicular tachycardia. In some cases intravenous adenosine may also terminate the arrhythmia. During electrophysiology study, presystolic or diastolic potentials precede the QRS, presumed to originate from the Purkinje fibers. The potentials can be recorded during sinus rhythm and ventricular tachycardia in many patients with fascicular tachycardia. This potential (so-called Purkinje potential) has been used as a guide to catheter ablation. Correct diagnosis of fascicular tachycardia is very important because catheter ablation is very effective in the treatment of this type of ventricular tachycardia. In this review, we describe three patients with idiopathic ventricular tachycardia and their successful catheter ablation, and summarize the actual knowledge of the diagnosis and management of this special ventricular tachycardia.Az idiopathias fascicularis kamrai tachycardia fontos es nem nagyon ritka szivritmuszavar specifi kus EKG-jelekkel es terapias lehetősegekkel. A kamrai tachycardia EKG-kepe relative keskeny QRS-morfologiat mutat a jobb-Tawara-szar-blokk morfologia javal. A QRS-tengelyallas attol fugg, hogy melyik fasciculus resze a reentry kornek. Baltengely-deviacio van jelen bal posterior fascicularis tachycardia, jobbtengely-deviacio bal anterior fascicularis tachycardia eseten. Bal septalis fascicularis tachycardia egyutt jarhat normalis tengelyallassal is. A fascicularis tachycardiak altalaban strukturalis szivbetegseg nelkul alakulnak ki. A fascicularis tachycardiak egyik fontos ismerve, hogy verapamilkezelesre jol reagalnak. Nehany esetben intravenas adenozin is hatekony lehet a ritmuszavar terminalasaban. A fascicularis tachycardiaban szenvedő betegek nagy reszeben sinusrhythmusban es a kamrai tachycardia alatt is a QRS-t megelőző preszisztoles vagy diasztoles potencial regisztralhato, amely feltehetően a Purkinje-rostokbol ered. Ez az ugynevezett P-potencial szolgal segitsegul a leghatekonyabb terapia, a kateterablatio soran. A ritmuszavar azonnali felismerese es megfelelő helyre tortenő iranyitasa azert fontos, mert a ritmuszavar kitűnően ablalhato, es az ablatio kurativ. Attekintesunkben harom fi atal idiopathias fascicularis tachycardiaban szenvedő betegunk kortortenetet es sikeres ablatiojat irjuk le, es az esetek kapcsan foglaljuk ossze a specialis ritmuszavarral kapcsolatos jelenlegi ismereteinket. Kulcsszavak: fascicularis tachycardia, ablatio, ritmuszavar Ablation of idiopathic fascicular ventricular tachycardia Idiopathic fascicular ventricular tachycardia is an important and not very rare cardiac arrhythmia with specifi c electrocardiographic features and therapeutic options. Ventricular tachycardia is characterized by relatively narrow QRS complex and right bundle branch block pattern. The QRS axis depends on which fascicle is involved in the re-entry. Left axis deviation is noted with left posterior fascicular tachycardia and right axis deviation with left anterior fascicular tachycardia. A left septal fascicular tachycardia with normal QRS axis is also possible. Idiopathic fascicular tachycardia is usually seen in individuals without structural heart disease. Response to verapamil is an important feature of fascicular tachycardia. In some cases intravenous adenosine may also terminate the arrhythmia. During electrophysiology study, presystolic or diastolic potentials precede the QRS, presumed to originate from the Purkinje fi bers. The potentials can be recorded during sinus rhythm and ventricular tachycardia in many patients with fascicular tachycardia. This potential (so-called Purkinje potential) has been used as a guide to catheter ablation. Correct diagnosis of fascicular tachycardia is very important because catheter ablation is very effective in the treatment of this type of ventricular tachycardia. In this review, we describe three patients with idiopathic ventricular tachycardia and their successful catheter ablation, and summarize the actual knowledge of the diagnosis and management of this special ventricular tachycardia.