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Coronary physiology – the news from the last year 冠状动脉生理学——去年的新闻
Pub Date : 2023-07-27 DOI: 10.3897/icf.3.e108803
P. Gatzov
The myocardial blood supply changes, leading to myocardial ischemia deserve deep understanding. They could be on different levels: epicardial arteries, microcirculation or both. Along with the anatomical findings, the functional assessment of coronary vessels is a key moment in making the decision for the type of treatment and the need for coronary revascularization. Together with the established methods for functional assessment of coronary circulation, new technologies nowadays have been applied in the clinical practice. The trends for future development are methods not using myocardial hyperemia, an attempt for functional assessment on the basis of invasive on noninvasive imaging technics and stronger attention to the microcirculatory dysfunction. The new achievements in that direction are on the focus of the current review.
心肌血供的变化,导致心肌缺血值得深入认识。它们可能在不同的层面:心外膜动脉、微循环或两者都有。与解剖结果一样,冠状血管的功能评估是决定治疗类型和冠状动脉重建术需要的关键时刻。随着现有的冠状动脉循环功能评估方法的发展,新技术已被应用于临床。未来的发展趋势是不使用心肌充血的方法,尝试在有创或无创成像技术的基础上进行功能评估,加强对微循环功能障碍的关注。这方面的新成就是本次审查的重点。
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引用次数: 0
Коронарни интервенции 2021: обзор от списанията на националните дружества по кардиология към Европейското дружество по кардиология
Pub Date : 2023-04-03 DOI: 10.3897/icf.3.e104121
Jean-Jacques Monsuez, Пламен Гацов, Игнасио Ферейра-Гонзалес, Fernando Alfonso
Коронарни интервенции 2021: обзор от списанията на националните дружества по кардиология към Европейското дружество по кардиология
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引用次数: 0
Сърдечно-съдовата медицина през 2022 г.: най-добрите 10 статии за спешните състояния в кардиологията и исхемичната болест на сърцето
Pub Date : 2023-04-03 DOI: 10.3897/icf.3.e104187
Susanna Price, Juan Carlos Kaski, R. Al-Lamee, William Boden, Kurt Huber, Jason Katz, Konstantin Krychtiuk
Сърдечно-съдовата медицина през 2022 г.: най-добрите 10 статии за спешните състояния в кардиологията и исхемичната болест на сърцето
2022 年的心血管医学:心脏病学和缺血性心脏病急症方面的十大文章
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引用次数: 0
Eight-year single-center experience with transcatheter aortic valve implantation (TAVI) 8年单中心经导管主动脉瓣植入术经验
Pub Date : 2022-12-22 DOI: 10.3897/icf.2.e98590
I. Petrov, Z. Stankov, P. Polomski, D. Boychev
The first TAVI implantation was performed in 2002 by Cribier and colleagues. From then, we have seen significant progress in technology, with the appearance of new generations – lower-profile, longer-lasting and more stable during positioning TAVI prostheses. The present publication presents single-center results and experience with TAVI procedures over an eight-year period. During the period 2013 – November 2022 a total of 354 TAVI procedures were performed in Acibadem City Clinical Cardiovascular Center. Two operating strategies are used – standard and minimalist approach. From the first procedure in 2013 until mid-2018 the standard approach (surgical vascular access, general anesthesia, direct valve implantation where possible) was mostly used. Then, the minimalist approach (percutaneous access, no intubation anesthesia, mandatory valve predilation and use of rapid pacing) was introduced as a standard approach in the center.
2002年,Cribier和他的同事进行了第一次TAVI植入。从那时起,我们看到了技术上的重大进步,新一代的TAVI假体出现了——更低调,更持久,在定位时更稳定。本出版物介绍了单中心结果和八年期间TAVI手术的经验。2013年至2022年11月期间,阿奇巴登市临床心血管中心共进行了354例TAVI手术。采用两种操作策略:标准方法和极简方法。从2013年的第一次手术到2018年中期,标准方法(手术血管通路,全身麻醉,尽可能直接植入瓣膜)被广泛使用。然后,极简入路(经皮入路,无插管麻醉,强制瓣膜预扩张和使用快速起搏)被引入中心作为标准入路。
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引用次数: 0
Clinical case of Bow Hunter's Syndrome 弓亨特综合征临床1例
Pub Date : 2022-10-31 DOI: 10.3897/icf.2.e94644
N. Ivanov
Bow Hunter‘s Syndrome (BHS) is a mechanical compression of the vertebral artery during head rotation, leading to partial disruption or complete interruption of the blood flow of the affected artery, causing vertebrobasilar vascular insufficiency. There are no established precise diagnostic and therapeutic behavioral algorithms in patients with BHS. I present a case of an 80-year-old woman with syncopal symptoms, in which a dynamic stenosis of the dominant left vertebral artery was diagnosed, and the same artery originates from the aortic arch with a separate ostium.
弓亨特综合征(Bow Hunter 's Syndrome, BHS)是头部旋转时椎动脉受到机械压迫,导致受累动脉血流部分中断或完全中断,导致椎基底动脉血管功能不全。在BHS患者中,没有建立精确的诊断和治疗行为算法。我报告一例有晕厥症状的80岁妇女,其中诊断为左侧主要椎动脉动态狭窄,同一动脉起源于主动脉弓并有单独的开口。
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引用次数: 0
Complete estamation of patient with myocardial ischemia 心肌缺血患者的完全评估
Pub Date : 2022-10-26 DOI: 10.3897/icf.2.e95002
P. Gatzov
To solve any problem, first of all we need to know it in details. The entity of myocardial ischemia is a deep deterioration in metabolic processes and function of cardiomyocytes, because of lack of oxygen supply. The diagnostic process of patients with chronic coronary syndrome includes myocardial ischemia provocation with stress tests. Next steps are the ischemic myocardium amount estimation, the exact cause оf ischemia revealing: the epicardial coronary arteries, micro vessels or both. The last step is the decision of method of treatment and its implementation. The realization of all that steps takes time and efforts, but is absolutely obligatory for exact assessment of patient with myocardial ischemia. The description and details of every one of those steps are the aims of this review.
要解决任何问题,首先我们需要详细地了解它。心肌缺血是由于缺氧引起的心肌细胞代谢过程和功能的严重恶化。慢性冠状动脉综合征的诊断过程包括心肌缺血刺激和应激试验。下一步是缺血心肌数量的估计,揭示缺血的确切原因:心外膜冠状动脉、微血管或两者兼而有之。最后一步是治疗方法的确定及其实施。所有这些步骤的实现都需要时间和精力,但对于准确评估心肌缺血患者是绝对必要的。这篇综述的目的是描述和详细说明每一个步骤。
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引用次数: 0
Compression of the left main coronary artery by a pulmonary artery aneurysm – treated with endovascular approach 肺动脉动脉瘤压迫左冠状动脉主动脉-血管内入路治疗
Pub Date : 2022-08-23 DOI: 10.3897/icf.2.e89266
Z. Stankov, S. Vasilev, I. Petrov
Pulmonary artery aneurysms (PAAs) are rare with non-specific clinical presentation but may lead to serious complications such as pulmonary artery dissection, rupture and compression of the left main coronary artery (LMCA). Their complications and PAA association with pulmonary hypertension lead to significant morbidity and mortality. The standard treatment strategy is surgical correction of the aneurysm, however percutaneous coronary intervention in patients with clinically significant compression of the LMCA, due to PAA should be considered as a possible treatment approach. In this article, we present a case report of a 73-year-old with polymorbidity, presenting with an acute coronary syndrome, caused by extrinsic compression of the LMCA by PAA. Due to the high surgical risk, we adopted an endovascular approach with stenting of the compressed LMCA with successful restoration of the blood flow and clinical stabilization. In this case, a percutaneous coronary intervention proved to be a safe and effective treatment option for selected patients, who are at high operative risk. 
肺动脉动脉瘤(PAAs)是一种罕见的非特异性临床表现,但可能导致严重的并发症,如肺动脉夹层,左主干冠状动脉(LMCA)破裂和压迫。它们的并发症和PAA与肺动脉高压的关联导致了显著的发病率和死亡率。标准的治疗策略是动脉瘤的手术矫正,然而,对于由于PAA导致LMCA有临床明显压迫的患者,应考虑经皮冠状动脉介入治疗作为一种可能的治疗方法。在这篇文章中,我们提出了一个73岁的病例报告,多病,表现为急性冠状动脉综合征,引起的外源性压迫LMCA由PAA。由于手术风险高,我们采用血管内入路对受压的LMCA进行支架置入,成功地恢复了血流和临床稳定。在本病例中,经皮冠状动脉介入治疗被证明是一种安全有效的治疗选择,适用于手术风险高的患者。
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引用次数: 0
Acute coronary syndrome and ischemic stroke in the course of COVID-19 infection COVID-19感染过程中的急性冠状动脉综合征和缺血性脑卒中
Pub Date : 2022-07-25 DOI: 10.3897/icf.2.e82491
I. Tasheva, S. Kafalieva
The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-Cov-2) pandemic has spread rapidly worldwide with 314 million infected and 5 million deceased worldwide (as of December 2021). SARS-Cov-2 has been shown to not only cause viral pneumonia, but also to lead to serious effects on the cardiovascular system. It has been proven that COVID-19 can be complicated by the Acute Coronary Syndrome through plaque rupture, vasospasm or microthrombi due to systemic inflammation or cytokine storm. An additional role is played by the hyperimmune response as well as the endothelial dysfunction, which contribute to the hypercoagulable state. Тhere is a strong possibility that the high inflammatory load is the cause of de novo coronary lesions. We present a clinical case of a 53-year-old man presenting with toxico-infectious syndrome, angina and dyspnea. Conducted paraclinical and clinical studies showed acut coronary syndrome without ST-elevation, left ventricular thrombosis, active SARS-CoV-2 infection and bilateral interstitial pneumonia. The patient was treated with percutaneous coronary intervention of LAD with drug-eluting stent, anticoagulant therapy, dual antiplatelet and anti-inflamatory therapy, beta blocker and ACE-inhibitor. On the 4th day of hospitalization the patient realized Left Middle Cerebral Artery Stroke. Our clinical case demonstrates unique prothromobotic properties of SARS-CoV-2, due to different mechanisms and complicated by thromboembolic events.
严重急性呼吸系统综合征冠状病毒-2 (SARS-Cov-2)大流行在全球迅速蔓延,全球有3.14亿人感染,500万人死亡(截至2021年12月)。SARS-Cov-2不仅会引起病毒性肺炎,还会对心血管系统造成严重影响。事实证明,新冠肺炎可通过全身炎症或细胞因子风暴引起的斑块破裂、血管痉挛或微血栓等方式并发急性冠状动脉综合征。高免疫反应和内皮功能障碍也起着额外的作用,它们有助于高凝状态。Тhere很有可能高炎症负荷是冠状动脉新发病变的原因。我们提出一个临床病例53岁的男子提出中毒感染综合征,心绞痛和呼吸困难。临床旁和临床研究显示急性冠状动脉综合征,无st段抬高、左心室血栓形成、活动性SARS-CoV-2感染和双侧间质性肺炎。患者接受经皮冠状动脉介入治疗药物洗脱支架,抗凝治疗,抗血小板抗炎双重治疗,受体阻滞剂和ace抑制剂。住院第4天患者发生左脑中动脉卒中。我们的临床病例显示了SARS-CoV-2独特的血栓形成原特性,这是由于不同的机制和血栓栓塞事件的复杂性。
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引用次数: 0
Kлиничен случай на преходна високостепенна митрална недостатъчност
Pub Date : 2022-06-20 DOI: 10.3897/icf.2.e85478
Пламен Гацов, В. Велчев, Б. Финков, Николай Стоянов
Представяме случай на 80-годишна жена с исхемична болест на сърцето, която в продължение на няколко седмици преминава от състояние на високостепенна митрална регургитация в състояние на практически липсваща такава и обратно, без ясна връзка с клиничните ѝ оплаквания. Обсъждат се възможните диференциални диагнози и избраният терапевтичен подход към пациентката.
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引用次数: 0
Анатомия, дизонтогенеза, патофизиология и патогенеза на болестите на вертебробазиларните артерии 解剖学,二聚体生成,病理生理学和病理发生在维捷罗基动脉上。
Pub Date : 2022-02-15 DOI: 10.3897/icf.2.e80540
Николай Иванов
Вертебро-базиларната система (ВБС) играе съществена роля в кръвоснабдяването на жизнено важни структури на нервната система. Като част от Вилизиевия кръг, тя допринася за големите компенсаторни възможности на мозъчната циркулация при някои хемодинамични нарушения. От друга страна, някои патологичните процеси, засягащи ВБС, могат да бъдат фатални или да доведат до тежки увреди и функционални дефицити при пациента. Множеството вариетети и аномалии на ВБС са честа причина за хемодинамични нарушения и съдово засягане от болестни процеси като атеросклерозата. Доброто познаване на вариететите, както и на анатомията ни позволяват да разберем патофизиологията и патогенезата на тези нарушения, което заедно с характерната клинична изява спомага за по-бързото и точно поставяне на диагнозата. Това стои в основата на започване на правилно лечение.
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引用次数: 0
期刊
Interventional Cardiology Forum
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