RESUMEN
Primary percutaneous coronary intervention (primary PCI) is the preferred immediate treatment for patients with acute ST elevation myocardial infarction. It is however, considerably more labour-intensive than the previous standard of care and requires an immediate response from consultant-led teams to deliver best outcomes. We describe the introduction of a comprehensive primary PCI service for Northern Ireland and suggest that the process by which it was designed, piloted, commissioned and benchmarked can serve as a prototype for other high-risk, time-sensitive clinical emergency services.
Asunto(s)
Intervención Coronaria Percutánea/tendencias , Infarto del Miocardio con Elevación del ST/terapia , Protocolos Clínicos , Electrocardiografía , Servicios Médicos de Urgencia/organización & administración , Administración de los Servicios de Salud , Humanos , Irlanda del Norte , Tiempo de TratamientoRESUMEN
An asymptomatic 35-year-old woman with history of coarctation repair underwent routine echo. This showed a bicuspid aortic valve with a significant gradient in the left ventricular outflow tract (LVOT). The anterior mitral valve leaflet appeared redundant. Transoesophageal echo showed thickened chordae tendineae from both mitral valve leaflets inserted into a single postero-medial papillary muscle-a parachute mitral valve. During systole, there was anterior motion of redundant mitral chordae into the LVOT producing significant obstruction. A diagnosis of partial Shone complex was made. She was referred for mitral (and possibly aortic) valve surgery. The combination of aortic coarctation with bicuspid aortic valve should stimulate a search for other levels of systemic obstruction-don't stop at two!