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Aortic valve replacement using a polytetrafluoroethylene leaflet valve in patients with a history of the Bentall–De Bono procedure: a case series 有Bentall-De Bono手术史的患者使用聚四氟乙烯小叶瓣膜置换主动脉瓣:病例系列
Q4 Medicine Pub Date : 2023-03-30 DOI: 10.21688/1681-3472-2023-1-54-59
V. Bazylev, A. B. Voevodin, I. D. Potopalskiy, V. A. Karnakhin, M. Patel, A. A. Kuznetsova
Objective: To analyze outcomes of 4 transcatheter aortic valve replacements using a polytetrafluoroethylene leaflet valve in patients with a history of the Bentall–De Bono procedure.Methods: We retrospectively analyzed a series of 4 cases. From February 2019 to March 2022 in Federal Center for Cardiovascular Surgery (Penza, Russia), patients with a history of the Bentall–De Bono procedure underwent transaortic aortic valve implantation of the MedLAB-CT balloon-expandable valve under cardiopulmonary bypass and cardioplegia. Valve No. 25 was implanted in 3 patients, and 1 patient received valve No. 23.Results: According to echocardiography, valve hemodynamic performance improved in the postoperative period: mean and peak pressure gradients were 11.5 and 24 mm Hg, respectively; the median value of effective orifice area was 1.9 cm2, while mitral regurgitation in all cases did not exceed grade 1. Median cardiopulmonary bypass and myocardial ischemia times were 59 and 31 minutes, respectively. There was no immediate and remote mortality. No complications were reported in the postoperative period.Conclusion: The proposed replacement of the valved conduit’s compromised part after the Bentall–De Bono procedure can significantly reduce the extent of surgery, cardiopulmonary bypass and myocardial ischemia times, as well as simplify the procedure.Received 1 December 2022. Revised 10 February 2023. Accepted 16 February 2023.Informed consent: The patient’s informed consent to use the records for medical purposes is obtained.Funding: The study did not have sponsorship.Conflict of interests: The authors declare no conflict of interest.Contribution of the authorsLiterature review: V.A. Karnakhin, I.D. PotopalskiyDrafting the article: V.V. Bazylev, A.B. Voevodin, I.D. Potopalskiy, V.A. KarnakhinCritical revision of the article: A.A. Kuznetsova, M.P. PatelSurgical treatment: V.V. Bazylev, A.B. VoevodinFinal approval of the version to be published: V.V. Bazylev, A.B. Voevodin, I.D. Potopalskiy, V.A. Karnakhin, M.P. Patel, A.A. Kuznetsova
目的:分析有本特尔-德博诺手术史的4例经导管主动脉瓣置换术的结果。方法:对4例患者进行回顾性分析。2019年2月至2022年3月,在俄罗斯奔萨联邦心血管外科中心(Federal Center for Cardiovascular Surgery, Penza, Russia),有Bentall-De Bono手术史的患者在体外循环和心脏停跳下接受了MedLAB-CT球囊扩张瓣膜经主动脉瓣植入术。25号瓣膜植入3例,23号瓣膜植入1例。结果:超声心动图显示,术后瓣膜血流动力学性能有所改善:平均压力梯度11.5 mm Hg,峰值压力梯度24 mm Hg;有效孔面积中位数为1.9 cm2,所有病例二尖瓣返流均未超过1级。中位体外循环时间59分钟,心肌缺血时间31分钟。没有立即死亡和长期死亡。术后无并发症发生。结论:本特尔-德博诺手术后瓣膜导管受损部分的置换可显著减少手术面积、体外循环及心肌缺血次数,简化手术流程。收到2022年12月1日。2023年2月10日修订。2023年2月16日接受。知情同意:已取得患者知情同意将病历用于医疗目的。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。作者贡献文献综述:V.V. Karnakhin, I.D. Potopalskiy文章起草:V.V. Bazylev, A.B. Voevodin, I.D. Potopalskiy, V.A. karnakhin文章关键修改:A.A. Kuznetsova, M.P. Patel手术治疗:V.V. Bazylev, A.B. Voevodin最终批准出版版本:V.V. Bazylev, A.B. Voevodin, I.D. Potopalskiy, V.A. Karnakhin, M.P. Patel, A.A. Kuznetsova
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引用次数: 0
Preoperative and intraoperative risk factors of surgical wound infection in cardiac surgery: a retrospective study 心脏手术中外科伤口感染的术前及术中危险因素:回顾性研究
Q4 Medicine Pub Date : 2023-03-30 DOI: 10.21688/1681-3472-2023-1-30-37
A. V. Stepin
Objective: To assess the significance of preoperative and intraoperative risk factors of surgical wound infection in cardiac surgery.Methods: The retrospective study included data obtained from 1,992 medical records of patients after cardiac surgery. All patients were divided into two groups: with (n=97, 4.9%) or without (n=1,895, 95.1%) infectious complications in the postoperative period. The rate of risk factors in both groups was compared and their impact on the surgical wound infection was assessed. Risk factors were analyzed in the groups of patients with superficial and deep forms of infection.Results: In the group of patients with surgical wound infection, males are more common than among the patients without it (82.5% vs. 70.95%). Patients with infection were more likely to have an obesity (43.3% vs. 30.3% without surgical wound infection) and chronic obstructive pulmonary disease (24.7% vs. 13.3%, respectively). In the patients with surgical wound infection, two internal mammary arteries were used more often (29.9% vs. 17.3% without surgical wound infection), the crossover variant of using two internal mammary arteries — 55.2% vs. 34.1% without surgical wound infection. According to the results, male gender and chronic obstructive pulmonary disease increase the risk of surgical wound infection twice as much, with obesity increasing this risk by 1.76 times. Using one of the internal mammary arteries may increase the chances of surgical wound infection by 1.7 times, while using two arteries — by 3.27 times. Increasing the number of factors in one patient may increase the chances of complications by 1.31 times.Conclusion: In cardiac surgery one should assess risk factors of surgical wound infection, plan the surgery (with or without internal mammary arteries), and evaluate the probability of infection complications with personalized approach.Received 2 February 2022. Revised 20 January 2023. Accepted 16 February 2023.Funding: The study had no sponsorship.Conflict of interest: The author declares no conflict of interest.
目的:探讨心脏外科手术切口感染术前及术中危险因素的意义。方法:回顾性分析1992例心脏手术患者的病历资料。所有患者分为两组:术后感染并发症组(n=97, 4.9%)和无感染并发症组(n= 1895, 95.1%)。比较两组危险因素发生率,并评估其对手术创面感染的影响。分析浅表和深部感染患者组的危险因素。结果:手术创面感染患者中男性多于非手术创面感染患者(82.5% vs. 70.95%)。感染患者更容易发生肥胖(43.3% vs. 30.3%,未发生手术伤口感染)和慢性阻塞性肺疾病(24.7% vs. 13.3%)。在手术伤口感染的患者中,使用两条乳内动脉的频率更高(29.9%比17.3%,未发生手术伤口感染的患者),使用两条乳内动脉的交叉变异- 55.2%比34.1%,未发生手术伤口感染的患者。结果显示,男性和慢性阻塞性肺疾病使手术伤口感染的风险增加了两倍,肥胖使这种风险增加了1.76倍。使用一条乳腺内动脉可能会使手术伤口感染的几率增加1.7倍,而使用两条动脉则会增加3.27倍。在一个患者中增加因素的数量可能会使并发症的几率增加1.31倍。结论:在心脏外科手术中应评估手术伤口感染的危险因素,计划手术(有无乳腺内动脉),并评估感染并发症的可能性,采用个性化的入路。2022年2月2日收到。2023年1月20日修订。2023年2月16日接受。资助:本研究没有赞助。利益冲突:作者声明无利益冲突。
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引用次数: 0
Type III endoleaks after endovascular aneurysm repair for abdominal aortic aneurysm: a case series 腹主动脉瘤腔内修复术后III型腔内渗漏一例
Q4 Medicine Pub Date : 2023-03-30 DOI: 10.21688/1681-3472-2023-1-67-73
E. Kalmykov, I. Suchkov, R. Dammrau
Background: Owing to the increased number of endovascular aneurysm repairs (EVAR) for abdominal aortic aneurysms (AAA), the number of patients requiring reinterventions for type III endoleaks is also growing.Objective: To analyze our experience in treatment of type IIIa and IIIb endoleaks after EVAR.Methods: Of 457 patients treated by EVAR between 2010 and 2019, type IIIa and IIIb endoleaks were detected in 5 (1.1%) patients: 4 men and 1 woman. Their mean age was 67.2 years.Results: Type IIIa and IIIb endoleaks were found in an average of 77.4 months after EVAR. The incidence of type III endoleaks was 1.1%. Type IIIb and IIIa endoleaks were observed in 1 and 4 cases, respectively. In one case, type IIIa endoleak resulted in a ruptured AAA. The main treatment methods were relining (n = 1), stent graft implantation (n = 4), implantation of a bifurcated stent graft into a stent graft. No intraoperative complications or perioperative mortality were reported. 100% of the interventions were successful. In the long-term follow-up period, 2 patients had reinterventions. One patient required an intervention for type IIIa endoleak on the contralateral side, and the other patient was diagnosed with type Ia endoleak after type IIIb endoleak treatment. In the long-term follow-up period, no ruptured aneurysms or deaths were reported.Conclusion: Type III endoleaks are associated with a risk of AAA rupture and require treatment. Endovascular treatment of endoleaks demonstrated good immediate results; however, due to the high risk of endoleaks requiring reintervention, further long-term follow-up is needed.Received 18 November 2022. Revised 15 December 2022. Accepted 19 December 2022.Informed consent: The patient’s informed consent to use the records for medical purposes is obtained.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.Contribution of the authors: The authors contributed equally to this article.
背景:由于腹主动脉瘤(AAA)的血管内动脉瘤修复(EVAR)数量的增加,III型内漏需要再干预的患者数量也在增加。目的:分析我们治疗EVAR后IIIa型和IIIb型内漏的经验。方法:2010年至2019年接受EVAR治疗的457例患者中,有5例(1.1%)患者检测到IIIa型和IIIb型内漏,其中男性4例,女性1例。他们的平均年龄为67.2岁。结果:在EVAR后平均77.4个月出现IIIa型和IIIb型内漏。III型渗漏发生率为1.1%。IIIb型和IIIa型肠漏分别为1例和4例。1例IIIa型内漏导致AAA破裂。主要治疗方法为复衬里(n = 1)、支架植入术(n = 4)、将分岔支架植入支架内。无术中并发症和围手术期死亡报告。干预措施100%成功。长期随访期间,2例患者再干预。1例患者因对侧IIIa型内漏需要干预,另1例患者经IIIb型内漏治疗后诊断为Ia型内漏。在长期随访期间,没有动脉瘤破裂或死亡的报道。结论:III型内漏与AAA破裂风险相关,需要治疗。血管内治疗渗漏表现出良好的立竿见影的效果;然而,由于需要再次干预的内漏风险较高,需要进一步的长期随访。2022年11月18日收到。2022年12月15日修订。接受日期为2022年12月19日。知情同意:已取得患者知情同意将病历用于医疗目的。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。作者的贡献:作者对本文的贡献相同。
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引用次数: 0
Safety of intracoronary iopromide solution for experimental pharmaco-cold ex vivo preservation of donor heart 异丙咪唑冠脉内液用于供体心脏实验药冷离体保存的安全性
Q4 Medicine Pub Date : 2022-12-29 DOI: 10.21688/1681-3472-2022-4-42-51
M. Zhulkov, D. Sirota, I. Zykov, A. Sabetov, H. Agaeva, A. G. Makaev, D. Osintsev, A.E. Kalendarev, A. P. Nadeev, V. Kliver, A. Tarkova, M. A. Ovchinnikova, A. Fomichev, N. A. Karmadonova, D.V. Khomushku
Objective: To evaluate the effect of intracoronary iopromide (Ultravist®, Bayer, AG, Leverkusen, Germany) during pharmaco-cold ex vivo preservation of a donor heart on the restoration of heart pumping function and cardiomyocyte metabolism in the early post-transplant period.Methods: Black-and-white calves aged 3 months were used as an experimental model. In the control group, pharmaco-cold preservation of the donor heart was performed by injecting 2 liters of custodiol (Custodiol®, Dr. Franz Köhler Chemie GmbH, Bensheim, Germany) into the aortic root. The hearts were then stored in an appropriate solution at 0 to 1°C for 2 hours. In the experimental group (n = 6), a solution of iopromide and custodiol were injected into the aortic root at a ratio of 50:50 under a pressure of 70-80 mm Hg for 5 minutes after 120 minutes of preservation. Then the coronary bed was washed with 1 liter of custodiol at a pressure of 40 mm Hg and orthotopic heart transplantation was performed. In the post-transplant period, the parameters of central hemodynamics, myocardial oxygen consumption, and the levels of myocardial ischemia markers (troponin I, creatine phosphokinase-MB, lactate dehydrogenase) were assessed.Results: Twelve orthotopic heart transplantations were performed during the study. In 120 minutes after the restoration of spontaneous cardiac activity, the level of cardiac output was 5.11 [4.99; 5.41] L/min and 5.77 [4.97; 6.62] L/min (p = 0.0009) in the control and experimental groups, respectively. Changes in the concentration of lactate dehydrogenase, troponin I and lactate in the blood flowing from the coronary sinus were significantly higher in the early reperfusion period. However, no statistically significant difference was observed between the groups (p > 0.05). Myocardial oxygen consumption was significantly reduced at reperfusion. However, the initial values were restored by reperfusion minute 60 without any significant intergroup difference (p > 0.05).Conclusion: We established the safety of intracoronary iopromide administration for pharmaco-cold ex vivo preservation of the donor heart. Intracoronary administration of iopromide solution does not affect the restoration of the pumping function of the heart or metabolism in cardiomyocytes in the early post-transplant period.Received 6 May 2022. Revised 14 June 2022. Accepted 11 July 2022.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authorsConception and study design: M.O. Zhulkov, D.A. Sirota, I.S. ZykovData collection and analysis: M.O. Zhulkov, I.S. Zykov, A.K. Sabetov, H.A. Agaeva, A.G. Makaev, D.M. Osintsev, A.E. Kalendarev, A.P. Nadeev, V.E. Kliver, A.R. Tarkova, M.A. Ovchinnikova, N.A. Karmadonova, D.V. KhomushkuStatistical analysis: M.O. Zhulkov, A.G. MakaevDrafting the article: M.O. ZhulkovCritical revision of the article: M.O. Zhulkov, D.A. Sirota, I.S. Zykov, A.V. FomichevFinal approval of the version to be
目的:评价体外药冷保存供体心脏时冠脉内应用碘丙胺(Ultravist®,Bayer, AG, Leverkusen, Germany)对移植后早期心脏泵血功能和心肌细胞代谢恢复的影响。方法:以3月龄黑白犊牛为实验模型。在对照组中,通过向主动脉根部注射2升custodiol (custodiol®,Dr. Franz Köhler Chemie GmbH, Bensheim, Germany)来进行供体心脏的药物冷保存。然后将心脏保存在合适的溶液中,在0 ~ 1°C下保存2小时。实验组(n = 6),保存120分钟后,在70-80 mm Hg的压力下,按50:50的比例将碘丙胺和固二醇溶液注入主动脉根部,保存5分钟。然后在40 mm Hg的压力下,用1升的custodiol冲洗冠状动脉床,进行原位心脏移植。在移植后,评估中心血流动力学参数、心肌耗氧量和心肌缺血标志物(肌钙蛋白I、肌酸磷酸激酶- mb、乳酸脱氢酶)水平。结果:本研究共进行原位心脏移植12例。心脏自发活动恢复后120分钟,心排血量为5.11 [4.99;5.41] L/min和5.77 [4.97;6.62] L/min (p = 0.0009)。冠状窦血流中乳酸脱氢酶、肌钙蛋白I和乳酸浓度的变化在再灌注早期明显升高。但两组间差异无统计学意义(p < 0.05)。再灌注时心肌耗氧量明显降低。再灌注60min后恢复初始值,组间差异无统计学意义(p < 0.05)。结论:在体外药冷保存供体心脏时,冠状动脉内给予碘丙胺是安全的。在移植后早期,冠状动脉内给予碘丙胺溶液不影响心脏泵血功能的恢复或心肌细胞的代谢。收到2022年5月6日。2022年6月14日修订。2022年7月11日接受。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。研究构思与设计:M.O. Zhulkov, d.a Sirota, I.S. Zykov, A.K. Sabetov, H.A. Agaeva, A.G. Makaev, D.M. Osintsev, A.E. Kalendarev, A.P. Nadeev, V.E. Kliver, A.R. Tarkova, M.A. Ovchinnikova, N.A. Karmadonova, D.V. khomushkuu统计分析:M.O. Zhulkov, A.G. Makaev文章撰写:M.O. Zhulkov文章关键修改:最终批准出版的版本:M.O.朱尔科夫,d.a Sirota, I.S. Zykov, A.K. Sabetov, H.A. Agaeva, A.G. Makaev, D.M. Osintsev, A.E. Kalendarev, A.P. Nadeev, V.E. Kliver, A.R. Tarkova, M.A. Ovchinnikova, A.V. Fomichev, N.A. kaladonova, D.V. Khomushku
{"title":"Safety of intracoronary iopromide solution for experimental pharmaco-cold ex vivo preservation of donor heart","authors":"M. Zhulkov, D. Sirota, I. Zykov, A. Sabetov, H. Agaeva, A. G. Makaev, D. Osintsev, A.E. Kalendarev, A. P. Nadeev, V. Kliver, A. Tarkova, M. A. Ovchinnikova, A. Fomichev, N. A. Karmadonova, D.V. Khomushku","doi":"10.21688/1681-3472-2022-4-42-51","DOIUrl":"https://doi.org/10.21688/1681-3472-2022-4-42-51","url":null,"abstract":"Objective: To evaluate the effect of intracoronary iopromide (Ultravist®, Bayer, AG, Leverkusen, Germany) during pharmaco-cold ex vivo preservation of a donor heart on the restoration of heart pumping function and cardiomyocyte metabolism in the early post-transplant period.Methods: Black-and-white calves aged 3 months were used as an experimental model. In the control group, pharmaco-cold preservation of the donor heart was performed by injecting 2 liters of custodiol (Custodiol®, Dr. Franz Köhler Chemie GmbH, Bensheim, Germany) into the aortic root. The hearts were then stored in an appropriate solution at 0 to 1°C for 2 hours. In the experimental group (n = 6), a solution of iopromide and custodiol were injected into the aortic root at a ratio of 50:50 under a pressure of 70-80 mm Hg for 5 minutes after 120 minutes of preservation. Then the coronary bed was washed with 1 liter of custodiol at a pressure of 40 mm Hg and orthotopic heart transplantation was performed. In the post-transplant period, the parameters of central hemodynamics, myocardial oxygen consumption, and the levels of myocardial ischemia markers (troponin I, creatine phosphokinase-MB, lactate dehydrogenase) were assessed.Results: Twelve orthotopic heart transplantations were performed during the study. In 120 minutes after the restoration of spontaneous cardiac activity, the level of cardiac output was 5.11 [4.99; 5.41] L/min and 5.77 [4.97; 6.62] L/min (p = 0.0009) in the control and experimental groups, respectively. Changes in the concentration of lactate dehydrogenase, troponin I and lactate in the blood flowing from the coronary sinus were significantly higher in the early reperfusion period. However, no statistically significant difference was observed between the groups (p > 0.05). Myocardial oxygen consumption was significantly reduced at reperfusion. However, the initial values were restored by reperfusion minute 60 without any significant intergroup difference (p > 0.05).Conclusion: We established the safety of intracoronary iopromide administration for pharmaco-cold ex vivo preservation of the donor heart. Intracoronary administration of iopromide solution does not affect the restoration of the pumping function of the heart or metabolism in cardiomyocytes in the early post-transplant period.\u0000Received 6 May 2022. Revised 14 June 2022. Accepted 11 July 2022.\u0000Funding: The study did not have sponsorship.\u0000Conflict of interest: Authors declare no conflict of interest.\u0000Contribution of the authorsConception and study design: M.O. Zhulkov, D.A. Sirota, I.S. ZykovData collection and analysis: M.O. Zhulkov, I.S. Zykov, A.K. Sabetov, H.A. Agaeva, A.G. Makaev, D.M. Osintsev, A.E. Kalendarev, A.P. Nadeev, V.E. Kliver, A.R. Tarkova, M.A. Ovchinnikova, N.A. Karmadonova, D.V. KhomushkuStatistical analysis: M.O. Zhulkov, A.G. MakaevDrafting the article: M.O. ZhulkovCritical revision of the article: M.O. Zhulkov, D.A. Sirota, I.S. Zykov, A.V. FomichevFinal approval of the version to be","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"105 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73985094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Gas detection in the portal vein after aortobifemoral bypass: a case report 主动脉股静脉旁路术后门静脉气体检测1例
Q4 Medicine Pub Date : 2022-12-29 DOI: 10.21688/1681-3472-2022-4-73-79
M. Zozulya, A. Lenkin, K. M. Lebedinskii
We present a case report of early surgical treatment of abdominal compartment syndrome after aortobifemoral bypass. A 73-year-old man was admitted to the I.I. Mechnikov North-Western State Medical University with critical lower limb ischemia. Aortobifemoral bypass with a synthetic prosthesis was performed via laparotomy. The postoperative period was complicated by the dynamic bowel obstruction. The patient's condition worsened (hypovolemic and septic shock, respiratory failure due to severe pneumonia). Initial tactics was conservative. Signs of bowel ischemia (pneumatosis of the intestinal wall, gas in the portal vein) were identified using “point of care” ultrasound, which led to a change in the treatment tactics. On the same day, decompression relaparotomy was performed and the intestinal decompression tube was inserted. The postoperative period proceeded with positive dynamics: early extubation with acceptable parameters of gas exchange, minimal dosages of vasopressor support. Bowel function improved and stool appeared on the 2nd day after surgery.Gas in the portal vein is an ultrasound phenomenon, which in 70 % of cases suggests necrosis of the intestinal wall. The detection of such a symptom in patients after the abdominal aorta surgery may indicate bowel ischemia, since mesenteric circulation disorders primarily develop in the inferior mesenteric artery. This condition requires urgent surgical intervention, but its differential diagnosis with postoperative paralytic ileus is not always possible, especially in the early stages. We demonstrate a case of early gas detection in the portal vein and the emergency intervention that allowed preventing irreversible ischemic damage of the bowel. “Point of care” ultrasound can help suspect this condition and determine the indications for early surgical intervention, which can positively influence the outcome.Received 19 April 2022. Revised 29 May 2022. Accepted 1 June 2022.Informed consent: The patient’s informed consent to use the records for medical purposes is obtained.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors: The authors contributed equally to this article.
我们报告一例主动脉股动脉绕道术后早期手术治疗腹膜间室综合征的病例。一名73岁男子因严重下肢缺血住进梅奇尼科夫西北州立医科大学。经剖腹手术行人工主动脉股动脉搭桥术。术后出现动力性肠梗阻。患者病情恶化(低血容量性和感染性休克,严重肺炎引起的呼吸衰竭)。最初的策略是保守的。肠缺血的迹象(肠壁肺肿,门静脉气体)是通过“护理点”超声确定的,这导致了治疗策略的改变。同日行减压再开腹术,置入肠减压管。术后期间进行积极动态:早期拔管,可接受的气体交换参数,最小剂量的血管加压剂支持。术后第2天肠功能改善,出现大便。门静脉内气体是一种超声现象,70%的病例提示肠壁坏死。由于肠系膜循环障碍主要发生在肠系膜下动脉,因此在腹主动脉手术后发现这种症状可能表明肠缺血。这种情况需要紧急手术干预,但其与术后麻痹性肠梗阻的鉴别诊断并不总是可能的,特别是在早期阶段。我们展示了一个门静脉早期气体检测和紧急干预的病例,可以防止肠的不可逆缺血性损伤。“护理点”超声可以帮助怀疑这种情况,并确定早期手术干预的适应症,这对结果有积极的影响。2022年4月19日收到。2022年5月29日修订。接受日期为2022年6月1日。知情同意:已取得患者知情同意将病历用于医疗目的。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。作者的贡献:作者对本文的贡献相同。
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引用次数: 0
Long-term outcomes of drug-eluting balloons for treatment of side branches in patients with true coronary bifurcation lesions 药物洗脱球囊治疗真冠状动脉分叉病变患者侧支的长期疗效
Q4 Medicine Pub Date : 2022-12-29 DOI: 10.21688/1681-3472-2022-4-7-18
T. K. Eraliev, D. Khelimskii, A. Badoian, O. Krestyaninov, A. A. Baranov, A. Gorgulko
Background: Bifurcation treatments make up ca. 15–20% of coronary interventions. Despite the use of drug-eluting stents, the management of bifurcation lesions, especially with side branches involved, remains a challenge.Objective: To evaluate long-term clinical and angiographic outcomes after using a paclitaxel-coated balloon for the treatment of side branches in patients with true bifurcation lesions.Methods: Eighty patients with coronary artery disease were enrolled after true bifurcation lesion stenting. All patients were randomized at the 1:1 ratio to the group of main branches stenting followed by the dilatation of side branches with drug-eluting balloons and provisional stenting group.Results: Long-term results were analyzed after 12 months. The most common bifurcation lesion involved the left anterior descending artery and diagonal branch (57.5%). Late lumen loss in the side branch (0.51 ± 0.22 vs 0.33 ± 0.24 mm) and in both the bifurcation branches (main branch + side branch) (1.06 ± 0.29 vs 0.79 ± 0.27 mm) was significantly higher in the patients after provisional stenting.Overall postoperative incidence of major adverse cardiovascular events was 17.5% and 7.5% (p = 0.31) in the provisional stenting and drug coated balloon groups, respectively. Patients with drug-eluting balloons for the treatment of side branches had a more pronounced decrease in angina symptoms after 12 months. Multivariate analysis showed that diabetes mellitus (OR: 10.9) and glomerular filtration rate (OR: 0.95) were independent predictors of major adverse cardiovascular events in bifurcation interventions.Conclusion: Drug-eluting balloons for the dilatation of side branches after the stenting of main branches are superior to provisional stenting in terms of the late lumen loss.Received 31 August 2022. Revised 17 November 2022. Accepted 18 November 2022.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.Contribution of the authorsConception and study design: T.K. Eraliev, D.A. Khelimskii, A.G. Badoian, O.V. KrestyaninovData collection and analysis: T.K. Eraliev, D.A. Khelimskii, A.G. Badoian, O.V. Krestyaninov, A.A. Baranov, A.P. GorgulkoStatistical analysis: T.K. Eraliev, D.A. Khelimskii, A.G. BadoianDrafting the article: T.K. Eraliev, D.A. Khelimskii, A.G. Badoian, O.V. Krestyaninov, A.A. Baranov, A.P. GorgulkoCritical revision of the article: T.K. Eraliev, D.A. Khelimskii, A.G. Badoian, O.V. KrestyaninovFinal approval of the version to be published: T.K. Eraliev, D.A. Khelimskii, A.G. Badoian, O.V. Krestyaninov, A.A. Baranov, A.P. Gorgulko
背景:冠状动脉分叉治疗约占冠脉介入治疗的15-20%。尽管使用药物洗脱支架,分叉病变的管理,特别是涉及侧分支,仍然是一个挑战。目的:评价紫杉醇包被球囊治疗真正分叉病变患者侧支的长期临床和血管造影结果。方法:80例冠状动脉病变真分叉支架植入术患者。所有患者按1:1的比例随机分为主支支架术组、药物洗脱球囊扩张侧支组和临时支架术组。结果:12个月后分析远期结果。最常见的分叉病变包括左前降支和斜支(57.5%)。临时支架植入术后,侧支晚期管腔损失(0.51±0.22 vs 0.33±0.24 mm)和两支分支(主支+侧支)(1.06±0.29 vs 0.79±0.27 mm)显著增加。临时支架组和药物包覆球囊组术后主要心血管不良事件的总发生率分别为17.5%和7.5% (p = 0.31)。使用药物洗脱球囊治疗侧支的患者在12个月后心绞痛症状明显减轻。多因素分析显示,糖尿病(OR: 10.9)和肾小球滤过率(OR: 0.95)是分叉干预中主要不良心血管事件的独立预测因子。结论:药物洗脱球囊在主支支架术后用于侧支扩张在后期管腔损失方面优于临时支架术。收到2022年8月31日。2022年11月17日修订。接受日期为2022年11月18日。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。作者贡献概念与研究设计:T.K. Eraliev, D.A. Khelimskii, A.G. Badoian, O.V. Krestyaninov, A.A. Khelimskii, A.G. Badoian, a.v. Krestyaninov, A.A. Baranov, a.v. gorgulko数据收集与分析:T.K. Eraliev, A.A. Khelimskii, A.G. Badoian, O.V. Krestyaninov, A.A. Baranov, A.P. gorgulko文章撰写:T.K. Eraliev, D.A. Khelimskii, A.G. Badoian, O.V. Krestyaninov, A.A. Baranov, A.P. gorgulko文章的关键修改:最终批准出版的版本:T.K. Eraliev, D.A. khelimski, A.G. Badoian, O.V. Krestyaninov, A.A. Baranov, A.P. Gorgulko
{"title":"Long-term outcomes of drug-eluting balloons for treatment of side branches in patients with true coronary bifurcation lesions","authors":"T. K. Eraliev, D. Khelimskii, A. Badoian, O. Krestyaninov, A. A. Baranov, A. Gorgulko","doi":"10.21688/1681-3472-2022-4-7-18","DOIUrl":"https://doi.org/10.21688/1681-3472-2022-4-7-18","url":null,"abstract":"Background: Bifurcation treatments make up ca. 15–20% of coronary interventions. Despite the use of drug-eluting stents, the management of bifurcation lesions, especially with side branches involved, remains a challenge.Objective: To evaluate long-term clinical and angiographic outcomes after using a paclitaxel-coated balloon for the treatment of side branches in patients with true bifurcation lesions.Methods: Eighty patients with coronary artery disease were enrolled after true bifurcation lesion stenting. All patients were randomized at the 1:1 ratio to the group of main branches stenting followed by the dilatation of side branches with drug-eluting balloons and provisional stenting group.Results: Long-term results were analyzed after 12 months. The most common bifurcation lesion involved the left anterior descending artery and diagonal branch (57.5%). Late lumen loss in the side branch (0.51 ± 0.22 vs 0.33 ± 0.24 mm) and in both the bifurcation branches (main branch + side branch) (1.06 ± 0.29 vs 0.79 ± 0.27 mm) was significantly higher in the patients after provisional stenting.Overall postoperative incidence of major adverse cardiovascular events was 17.5% and 7.5% (p = 0.31) in the provisional stenting and drug coated balloon groups, respectively. Patients with drug-eluting balloons for the treatment of side branches had a more pronounced decrease in angina symptoms after 12 months. Multivariate analysis showed that diabetes mellitus (OR: 10.9) and glomerular filtration rate (OR: 0.95) were independent predictors of major adverse cardiovascular events in bifurcation interventions.Conclusion: Drug-eluting balloons for the dilatation of side branches after the stenting of main branches are superior to provisional stenting in terms of the late lumen loss.\u0000Received 31 August 2022. Revised 17 November 2022. Accepted 18 November 2022.\u0000Funding: The study did not have sponsorship.\u0000Conflict of interest: The authors declare no conflict of interest.\u0000Contribution of the authorsConception and study design: T.K. Eraliev, D.A. Khelimskii, A.G. Badoian, O.V. KrestyaninovData collection and analysis: T.K. Eraliev, D.A. Khelimskii, A.G. Badoian, O.V. Krestyaninov, A.A. Baranov, A.P. GorgulkoStatistical analysis: T.K. Eraliev, D.A. Khelimskii, A.G. BadoianDrafting the article: T.K. Eraliev, D.A. Khelimskii, A.G. Badoian, O.V. Krestyaninov, A.A. Baranov, A.P. GorgulkoCritical revision of the article: T.K. Eraliev, D.A. Khelimskii, A.G. Badoian, O.V. KrestyaninovFinal approval of the version to be published: T.K. Eraliev, D.A. Khelimskii, A.G. Badoian, O.V. Krestyaninov, A.A. Baranov, A.P. Gorgulko","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85704541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Surgical treatment of distal aneurysms on superior cerebellar artery: two case reports 小脑上动脉远端动脉瘤的外科治疗:附2例报告
Q4 Medicine Pub Date : 2022-12-29 DOI: 10.21688/1681-3472-2022-4-67-72
A. Somova, I. Senko, K. Orlov
Distal aneurysms of the superior cerebellar arteries (SCA) present a rare subgroup of intracranial aneurysms. Only few case reports describe this condition. Therefore, the surgical approach to treating distal SCA aneurysms remains controversial.We are demonstrating surgical treatments of previously unavailable, distal SCA aneurysms as a number of multimodal case reports.We describe two different ways to treat two patients with distal SCA aneurysms and provide a literature review. First, a 38-year-old patient presented with an acute subarachnoid ventricular hemorrhage due to distal SCA aneurysm rupture. Microsurgical clipping of the aneurysm was performed. Then the aneurysm ruptured intraoperatively, which required temporary clipping of the SCA trunk. The postoperative period was complicated by a progressive and eventually lethal cerebral angiospasm. Another, 36-year-old female patient was admitted in acute condition after recurrent ruptures of a distal SCA aneurysm associated with subarachnoid parenchymal hemorrhage. The patient underwent endovascular SCA deconstruction at the aneurysm level. No complications or neurological symptoms were observed postoperatively. The patient was discharged for outpatient treatment on day 4.Endovascular surgery should be considered as a method of choice for ruptured distal SCA aneurysms. Microsurgical intervention may be an option when endovascular repair is impossible and when other surgical procedures such as removal of hematoma and prevention of occlusive hydrocephalus are required.Received 31 August 2022. Revised 14 November 2022. Accepted 18 November 2022.Informed consent: The patient’s informed consent to use the records for medical purposes is obtained.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors: The authors contributed equally to this article.
小脑上动脉远端动脉瘤是一种罕见的颅内动脉瘤亚群。只有少数病例报告描述了这种情况。因此,手术方法治疗远端SCA动脉瘤仍然存在争议。我们正在展示手术治疗以前不可用的远端SCA动脉瘤作为一些多模式的病例报告。我们描述了两种不同的方法治疗两例远端SCA动脉瘤患者,并提供了文献综述。首先,一位38岁的患者因远端SCA动脉瘤破裂而出现急性蛛网膜下脑室出血。显微手术夹闭动脉瘤。然后术中动脉瘤破裂,这需要暂时切断SCA主干。术后并发进行性脑血管痉挛,最终致死性脑血管痉挛。另一名36岁女性患者因远端SCA动脉瘤复发破裂并蛛网膜下腔实质出血而入院。患者在动脉瘤水平行血管内SCA解构术。术后无并发症及神经系统症状。患者于第4天出院接受门诊治疗。血管内手术是治疗远端SCA动脉瘤破裂的首选方法。当血管内修复是不可能的,当其他外科手术,如去除血肿和预防闭塞性脑积水时,显微手术干预可能是一种选择。收到2022年8月31日。2022年11月14日修订。接受日期为2022年11月18日。知情同意:已取得患者知情同意将病历用于医疗目的。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。作者的贡献:作者对本文的贡献相同。
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引用次数: 0
Aortic stenting for aortic isthmus stenosis caused by the patent ductus arteriosus occluder: a case report 主动脉支架置入术治疗动脉导管未闭所致主动脉峡部狭窄1例
Q4 Medicine Pub Date : 2022-12-29 DOI: 10.21688/1681-3472-2022-4-60-66
R. Tarasov, A.Yu. Kolesnikov, I. Vereshchagin
We present a case report of stenting the aortic isthmus to manage a rare complication – stenosis caused by the patent ductus arteriosus occlude previously implanted to a child at the age of 7 months. After 7 years the patient was re-admitted to the cardiology hospital with the signs and symptoms of the aortic coarctation. The echocardiography revealed a peak pressure gradient of 40 mm Hg in the area of the aortic isthmus. The pressure gradient between the upper and lower extremities was 25-30 mm Hg. At the age of 8 the compromised blood flow in the aorta was completely resolved by stenting the aortic isthmus with covering of the implanted occluder. Andrastent XL (Andramed GmbH, Reutlingen, Germany) stent was implanted. Characteristics of this stent allow expanding it up to 14 mm. The pressure gradient in the area of the aortic isthmus was completely eliminated after the procedure. The effectiveness of the intervention was confirmed after 7 months with echocardiography. In conclusion, the aortic stenting using devices with the potential for further expansion as the child grows is justified due to its effectiveness, minimal invasiveness, and radical nature.Received 5 March 2022. Revised 10 July 2022. Accepted 11 July 2022.Informed consent: The patient’s informed consent to use the records for medical purposes is obtained.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors: The authors contributed equally to this article.
我们报告一个病例报告,在主动脉峡部置入支架,以处理一个罕见的并发症-先前植入7个月大的儿童动脉导管未闭闭塞引起的狭窄。7年后,患者因主动脉缩窄的体征和症状再次入住心脏病医院。超声心动图显示主动脉峡部压力梯度峰值为40 mm Hg。上肢和下肢之间的压力梯度为25-30 mm Hg。在8岁时,用植入的封堵器覆盖主动脉峡部支架完全解决了主动脉血流受损的问题。植入andra支架XL (Andramed GmbH, Reutlingen, Germany)支架。这种支架的特性允许将其扩展到14毫米。手术后主动脉峡区的压力梯度完全消除。7个月后超声心动图证实了干预的有效性。综上所述,由于其有效性、微创性和根治性,使用具有随着儿童生长进一步扩张潜力的设备进行主动脉支架置入术是合理的。2022年3月5日收。2022年7月10日修订。2022年7月11日接受。知情同意:已取得患者知情同意将病历用于医疗目的。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。作者的贡献:作者对本文的贡献相同。
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引用次数: 0
Endovascular treatment of multilevel brachiocephalic artery lesions in asymptomatic patients: a case series 无症状患者多节段头臂动脉病变的血管内治疗:一个病例系列
Q4 Medicine Pub Date : 2022-12-29 DOI: 10.21688/1681-3472-2022-4-52-59
A. Vanyurkin, A. Soboleva, N. Susanin, Yu. K. Belova, V. Soloviev, M. Chernyavskiy
Objective: To evaluate the outcomes of complete endovascular carotid revascularization in asymptomatic patients with tandem lesions of common carotid arteries (CCA) and internal carotid arteries (ICA) and to demonstrate the endovascular technique.Methods: Endovascular treatment of two-level brachiocephalic artery lesions was performed in 23 patients at the Almazov National Medical Research Centre from 2017 to 2022. The mean age of the patients was 71.3 years. The lesions were localized in the left CCA and ICA in 11 patients, in the right CCA and ICA in 7 patients, and in the brachiocephalic trunk and right ICA in 5 patients. All patients were asymptomatic on the affected side. Results: Completed with successful stent implantation, all the procedures were effective, with no complications at the access site (hematoma, dissection, bleeding) and no perioperative mortality or residual stenoses. Postoperative neurological disorders developed in two patients including ipsilateral neurological symptoms (NIHSS score 4, Rankin score 1) in one of them and moderate aphasia and dysarthria NIHSS score 2, Rankin score 1) in the other. Brain MSCT showed signs of ischemic stroke that did not require any additional surgical treatment in the second patient. Following the rehabilitation, the neurological symptoms regressed. The mean hospital stay was 4 days. Two years after the intervention two patients required reintervention, i.e. repeat angioplasty of the ICA stent, due to in-stent restenosis.Conclusion: The outcomes in a series of patients with tandem brachiocephalic artery lesions indicate the efficacy of complete endovascular intervention with good short-term results.Received 23 June 2022. Revised 31 July 2022. Accepted 23 August 2022Informed consent: The patient’s informed consent to use the records for medical purposes is obtained.Funding: The study did not have sponsorship.Conflict of interests: Authors declare no conflict of interest.Contribution of the authorsLiterature review: A.V. Soboleva, V.A. SolovievDrafting the article: A.G. Vanyurkin, Yu.K. BelovaCritical revision of the article: M.A. ChernyavskiySurgical treatment: M.A. Chernyavskiy, A.G. Vanyurkin, N.V. SusaninFinal approval of the version to be published: A.G. Vanyurkin, A.V. Soboleva, N.V. Susanin, Yu.K. Belova, V.A. Soloviev, M.A. Chernyavskiy
目的:评价颈总动脉(CCA)和颈内动脉(ICA)串联病变无症状患者血管内颈动脉完全血运重建术的效果,并论证血管内技术的应用价值。方法:2017 - 2022年,在阿尔马佐夫国家医学研究中心对23例患者进行了两段头臂动脉病变的血管内治疗。患者平均年龄71.3岁。病变定位于左侧CCA和ICA 11例,右侧CCA和ICA 7例,头臂干和右侧ICA 5例。所有患者患侧均无症状。结果:支架置入术顺利完成,所有手术均有效,无通路部位并发症(血肿、夹层、出血),无围手术期死亡或残留狭窄。2例患者术后出现神经功能障碍,其中1例患者出现同侧神经症状(NIHSS评分4分,Rankin评分1分),另1例患者出现中度失语和构音障碍(NIHSS评分2分,Rankin评分1分)。脑MSCT显示缺血性中风的迹象,不需要任何额外的手术治疗。康复后,神经症状消退。平均住院时间为4天。干预2年后,2例患者因支架内再狭窄需要再次干预,即重复ICA支架血管成形术。结论:连续头臂动脉病变患者的预后表明完全血管内介入治疗是有效的,短期效果良好。2022年6月23日收到。2022年7月31日修订。知情同意:已获得患者将病历用于医疗目的的知情同意。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。作者贡献文献综述:A.V. Soboleva, V.A. soloviv文章撰写:A.G. Vanyurkin, uk。下一篇文章的关键性修改:M.A. Chernyavskiy外科治疗:M.A. Chernyavskiy, A.G. Vanyurkin, N.V. Susanin最终批准发表的版本:A.G. Vanyurkin, A.V. Soboleva, N.V. Susanin, ukBelova, V.A. Soloviev, M.A. Chernyavskiy
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引用次数: 1
Combined method of renal denervation in an animal model 动物模型肾去神经联合方法
Q4 Medicine Pub Date : 2022-12-29 DOI: 10.21688/1681-3472-2022-4-33-41
D. Bashta, L. I. Vilenskiy, Y. Krivosheev, A. Simonyan, A. Romanov
Background: Currently, intra-arterial radiofrequency renal denervation is an only interventional treatment for resistant hypertension. However, available data are controversial since this method does not provide the long-term hypotensive effect.Objective: To compare the safety and efficacy of laparoscopic mechanical renal denervation and laparoscopic combined renal denervation using a radiofrequency clamp.Methods: Thirty sheep weighing 93.00 ± 3.72 kg were divided into two groups for mechanical laparoscopic renal denervation (group I, n = 15) and combined laparoscopic renal denervation with a radiofrequency clamp (group II, n = 15). The observation period lasted for six months. We assessed the following parameters: blood pressure (BP) in response to high-frequency electric stimulation from the lumen of the vessel, creatinine and uric acid levels, iatrogenic damage to the renal arteries based on angiography findings, and destruction of nerve fibers based on histological findings.Results: All the animals survived throughout the observation period. Creatinine and uric acid levels were within the normal ranges. Renal angiography did not reveal any iatrogenic stenosis. After six months, we found some BP response (elevated systolic BP ∆66.73 ± 6.63 mm Hg [p < 0.001], elevated diastolic BP ∆47.27 ± 5.98 mm Hg [p < 0.001]) to high-frequency electric stimulation in group I and no hypertensive response in group II. After six months, the animals were withdrawn for further histological assessment. Histology revealed complete destruction of the nerve fiber (demyelination) in group II and vacuolized swollen nerve fibers without any signs of demyelination in group I.Conclusion: Laparoscopic combined renal denervation is a safe and efficacious method with a stable hypotensive effect after six months in an animal model as compared to laparoscopic mechanical renal denervation.Received 30 March 2022. Revised 5 December 2022. Accepted 9 December 2022.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authorsConception and study design: D.I. Bashta, L.I. Vilenskiy, A.B. RomanovData collection and analysis: D.I. Bashta, Yu.S. Krivosheev, A.A. SimonyanStatistical analysis: D.I. Bashta, Yu.S. KrivosheevDrafting the article: D.I. Bashta, Yu.S. Krivosheev Critical revision of the article: L.I. Vilenskiy, Yu.S. Krivosheev, A.B. Romanov Final approval of the version to be published: D.I. Bashta, L.I. Vilenskiy, Yu.S. Krivosheev, A.A. Simonyan, A.B. Romanov
背景:目前,动脉内射频肾去神经是治疗顽固性高血压的唯一介入治疗方法。然而,现有的数据是有争议的,因为这种方法不提供长期的降压效果。目的:比较腹腔镜下机械肾去神经和腹腔镜下射频钳联合肾去神经的安全性和有效性。方法:选取体重93.00±3.72 kg的绵羊30只,分为机械腹腔镜肾去神经组(I组,n = 15)和射频钳联合腹腔镜肾去神经组(II组,n = 15)。观察期为6个月。我们评估了以下参数:血管腔高频电刺激下的血压(BP)、肌酐和尿酸水平、基于血管造影结果的肾动脉医源性损伤,以及基于组织学结果的神经纤维破坏。结果:观察期内所有动物均存活。肌酐和尿酸水平在正常范围内。肾血管造影未发现任何医源性狭窄。6个月后,我们发现高频电刺激组有血压反应(收缩压升高∆66.73±6.63 mm Hg [p < 0.001],舒张压升高∆47.27±5.98 mm Hg [p < 0.001]), II组无高血压反应。6个月后,取出动物进行进一步的组织学评估。组织学显示II组神经纤维完全破坏(脱髓鞘),i组神经纤维空泡肿胀,无脱髓鞘迹象。结论:与腹腔镜机械肾去神经相比,腹腔镜联合肾去神经是一种安全有效的方法,动物模型6个月后降压效果稳定。2022年3月30日收。2022年12月5日修订。接受日期为2022年12月9日。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。作者贡献。研究构思与设计:D.I. Bashta, L.I. Vilenskiy, A.B. romanov数据收集与分析:D.I. Bashta,美国。统计分析:D.I. Bashta,美国。本文起草人:D.I. Bashta,美国。Krivosheev文章的批判性修订:L.I. Vilenskiy,美国。Krivosheev, A.B. Romanov最终批准出版的版本:D.I. Bashta, L.I. Vilenskiy,美国。Krivosheev, A.A. Simonyan, A.B.罗曼诺夫
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Patologiya krovoobrashcheniya i kardiokhirurgiya
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