cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2024.10.n2659cardio-2659Research ArticleКЛИНИЧЕСКИЙ СЛУЧАЙCLINICAL CASE REPORTПериоперационный инфаркт миокарда и успешная реваскуляризация у пациента с первичным метасинхронным раком прямой кишки, желудка и мочевого пузыряPerioperative Myocardial Infarction and Successful Revascularization in Patient With Primary Metasynchronic Rectal, Gastric and Bladder CancerПотиевскаяВ. И.PotievskayaV. I.

д.м.н., заведующая научной группой кардиоонкологии, МНИОИ им. П.А.Герцена - филиала ФГБУ «НМИЦ радиологии» Минздрава РФ, Москва, Россия, профессор кафедры кардиологии, Академия последипломного образования ФНКЦ ФМБА России

Москва, Россия

MD, PhD, head of Scientific Cardiooncology group, P.A. Hertsen Moscow oncology research institute - branch of FSBI “National Medical Research Radiological Center” of the Ministry of Health of the Russian Federation, Moscow, Russia, professor

Moscow, Russia

ХороненкоВ. Э.ChoronenkoV. E.

д.м.н., профессор, начальник отдела анестезиологии и реанимации, МНИОИ им. П.А.Герцена - филиала ФГБУ «НМИЦ радиологии» Минздрава РФ, 

Москва, Россия

 MD, PhD, professor, head of Anesthesiology and Reanimatology Department, P.A. Hertsen Moscow oncology research institute - branch of FSBI “National Medical Research Radiological Center” of the Ministry of Health of the Russian Federation

Moscow, Russia

ЛоенкоВ. Б.LoenkoV. B.

д.м.н., заведующий отделением рентгенологии и рентгеноэндоваскулярных методов диагностики и лечения, НИИ урологии и интервенционной радиологии им. Н.А. Лопаткина – филиал ФГБУ «НМИЦ радиологии» Минздрава РФ

Москва, Россия

MD, PhD, head of Department of Radiology and X-ray Endovascular Diagnostic and Treatment Methods, N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology (SRIUIR) branch of FSBI “National Medical Research Radiological Center” of the Ministry of Health of the Russian Federation

Moscow, Russia

РербергА. Г.RerbergA. G.

к.м.н., заведующий отделением рентгенохирургических методов диагностики и лечения, МНИОИ им. П.А.Герцена - филиала ФГБУ «НМИЦ радиологии» Минздрава РФ

Москва, Россия

 PhD, head of Department of Radiology and X-ray Endovascular Diagnostic and Treatment Methods, P.A. Hertsen Moscow oncology research institute - branch of FSBI “National Medical Research Radiological Center” of the Ministry of Health of the Russian Federation

Moscow, Russia

https://orcid.org/0009-0007-4047-0129БагиянЕ. Р.BagiyanE. R.

врач по рентгенэндоваскулярным диагностике и лечению

Москва, Россия

physician of Department of Radiology and X-ray Endovascular Diagnostic and Treatment Methods, P.A. Hertsen Moscow oncology research institute - branch of FSBI “National Medical Research Radiological Center” of the Ministry of Health of the Russian Federation

Moscow, Russia

ellenbagiyan@gmail.comМНИОИ им. П.А.Герцена – филиал ФГБУ «НМИЦ радиологии» Минздрава РФ; Академия постдипломного образования ФГБУ ФНКЦ ФМБА РоссииРоссияHertsen Moscow Oncology Research Institute, Branch of the National Medical Research Radiological Center; Academy of Postgraduate Education of the Federal Research and Clinical CenterRussian FederationМНИОИ им. П.А.Герцена – филиал ФГБУ «НМИЦ радиологии» Минздрава РФРоссияHertsen Moscow Oncology Research Institute, Branch of the National Medical Research Radiological CenterRussian FederationНИИ урологии и интервенционной радиологии им. Н.А. Лопаткина – филиал ФГБУ «НМИЦ радиологии» Минздрава РФРоссияLopatkin Research Institute of Urology and Interventional Radiology, Branch of the National Medical Research Radiological CenterRussian Federation20243110202464106873Copyright © Kardiomag, 20242024KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/2659

Представлен клинический случай периоперационного инфаркта миокарда без подъема сегмента ST у пациента с первичным метасинхронным раком прямой кишки, желудка и мочевого пузыря, развившегося во время симультанного хирургического вмешательства в объеме проксимальной резекции желудка и брюшно-промежностной экстирпации прямой кишки. Колебания артериального давления и дисбаланс в системе гемостаза на этапах анестезии и операции у пациента с выраженным системным атеросклерозом стали причиной развития ишемии миокарда в зоне значимого стеноза коронарных артерий. При экстренной коронароангиографии был выявлен субтотальный стеноз передней нисходящей артерии, выполнено стентирование пораженного участка коронарной артерии. Контроль гемодинамических параметров и изменений системы гемостаза на фоне оптимальной антиангинальной терапии позволили вывести пациента из критического состояния и выписать на 18‑е сутки из стационара.

The article presents a clinical case of perioperative non-ST-segment elevation myocardial infarction in a patient with primary metasynchronous cancer of the rectum, stomach and bladder, which developed during simultaneous surgical intervention in the volume of proximal gastrectomy and abdominoperineal extirpation of the rectum. Fluctuations in blood pressure and imbalance in the hemostasis system at the stages of anesthesia and surgery in a patient with severe systemic atherosclerosis caused the development of myocardial ischemia in the area of significant coronary stenosis. Emergency coronary angiography detected subtotal stenosis of the anterior descending artery; stenting of the affected area of the coronary artery was performed. Monitoring of hemodynamic parameters and changes in the hemostasis system during the optimal antianginal therapy allowed to bring the patient out of critical condition and discharge him from the hospital on the 18th day.

 

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