title: Interdisciplinary Approach in a Complex Case of STEMI.
abstract: We reported the case of a young man with ST-Segment Elevation Myocardial Infarction (STEMI), with ventricular fibrillation on debut and cardiogenic shock, who needed a complex interdisciplinary approach for a favourable long term outcome. A 43-year-old man was admitted with inferior STEMI and cardiogenic shock. First coronary angiography revealed total chronic occlusion of left anterior descending artery (LAD) and tight stenosis with thrombus on right coronary artery (RCA). Thrombus aspiration and stent implantation on RCA was performed with good results. LAD couldn't be opened. Intraaortic balloon pump was implanted. Forty-eight hours later, we try again to open LAD, without success. After a lot of complications, all solved with difficulty, patient was discharged cachectic and with progressive exertion on mild exercise. Two months later an implantable cardioverter-defibrillator (ICD) was decided for persistent ventricular tachycardia and after one year he was referred to a cardiac surgery centre abroad for aneurismectomy with left ventricle (LV) reconstruction and mitral valve repair. The patient is currently asymptomatic with a normal social and professional life. In conclusion, high performance cardiac surgery, after a complete interventional treatment, can improve quality of life and long-term outcome to a patient with severe cardiovascular disease. Team work between clinical cardiologists, interventional cardiologists, electrophisyologists, intensi-vists and cardiac surgeons is the key to success.
authors.affiliation: Department of Cardiology, Emergency University Hospital, Bucharest, Romania.
authors.forename: Cristian A
authors.initials: CA
authors.lastname: Udroiu
authors.affiliation: Department of Cardiology, Emergency University Hospital, Bucharest, Romania.
authors.forename: Alexandru
authors.initials: A
authors.lastname: Cotoban
authors.affiliation: Department of Cardiovascular Surgery, Klinik fur Herz und GefaBchirurgie "Robert Bosch Krankenhaus", Stuttgart, Germany.
authors.forename: Adrian
authors.initials: A
authors.lastname: Ursulescu
authors.affiliation: Emergency University Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Calin
authors.initials: C
authors.lastname: Siliste
authors.affiliation: Emergency University Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Dragos
authors.initials: D
authors.lastname: Vinereanu
keywords: ICD in secondary prevention; aneurismectomy; primary PCI