Pub Date : 2022-03-23DOI: 10.30702/ujcvs/22.30(01)/s008-1520
P. M. Semeniv
The aim. To determinate the influence of the duration of artificial circulation and ischemic time on the structure of complications with one-time combined correction of lesions of two or three heart valves and myocardial revascularization and the possibility of their avoidance. Materials and methods. The work is based on a comparative analysis of the results of one-step multivalvular correction combined with coronary artery bypass grafting (CABG) in 93 patients, which was performed at the National Amosov Institute of Cardiovascular Surgery from 2014 to 2021. Depending on the tactical approaches and the sequence of surgical manipulations, the patients were divided into three groups. Group I included patients who underwent heart valve correction first and then CABG with the use of cardioplegia (n = 42), group II patients underwent CABG first and then valve correction with the use of cardioplegia (n = 36), and group III patients underwent off-pump CABG first and then correction of the heart valves (n = 15). The groups differed significantly in terms of ischemic time and artificial circulation. Results. The use of different approaches to achieve high-quality protection of the myocardium during ischemia and to minimize the impact of artificial circulation on the body by improving conditions and reducing ischemic time in the correction of multivalvular lesions and CABG showed significant advantages of the method of off-pump bypass. Conclusions. Correction of combined valvular and coronary pathology in patients with cardioplegic arrest increases the ischemic time above the critical point, which affects the occurrence of specific complications, especially acute heart failure, which significantly worsens the immediate results of surgery. Complications that occurred in the postoperative period in patients with the correction of valvular defects combined with CABG were due to prolonged cardiovascular failure. The technique proposed in the study group with off-pump bypass surgery was more effective than in groups where bypass was performed with the use of cardioplegic cardiac arrest. This technique requires more time to perform and is more technically complex, but can significantly reduce myocardial ischemic time, which, in turn, significantly reduces the incidence of heart failure and postoperative complications.
{"title":"The Influence of Operation Duration and Ischemic Time of Artificial Circulation on the Structure of Postoperative Complications in Patients after Surgical Treatment of Multivalvular Defects Combined with Coronary Pathology","authors":"P. M. Semeniv","doi":"10.30702/ujcvs/22.30(01)/s008-1520","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(01)/s008-1520","url":null,"abstract":"The aim. To determinate the influence of the duration of artificial circulation and ischemic time on the structure of complications with one-time combined correction of lesions of two or three heart valves and myocardial revascularization and the possibility of their avoidance. \u0000Materials and methods. The work is based on a comparative analysis of the results of one-step multivalvular correction combined with coronary artery bypass grafting (CABG) in 93 patients, which was performed at the National Amosov Institute of Cardiovascular Surgery from 2014 to 2021. Depending on the tactical approaches and the sequence of surgical manipulations, the patients were divided into three groups. Group I included patients who underwent heart valve correction first and then CABG with the use of cardioplegia (n = 42), group II patients underwent CABG first and then valve correction with the use of cardioplegia (n = 36), and group III patients underwent off-pump CABG first and then correction of the heart valves (n = 15). The groups differed significantly in terms of ischemic time and artificial circulation. \u0000Results. The use of different approaches to achieve high-quality protection of the myocardium during ischemia and to minimize the impact of artificial circulation on the body by improving conditions and reducing ischemic time in the correction of multivalvular lesions and CABG showed significant advantages of the method of off-pump bypass. \u0000Conclusions. Correction of combined valvular and coronary pathology in patients with cardioplegic arrest increases the ischemic time above the critical point, which affects the occurrence of specific complications, especially acute heart failure, which significantly worsens the immediate results of surgery. Complications that occurred in the postoperative period in patients with the correction of valvular defects combined with CABG were due to prolonged cardiovascular failure. The technique proposed in the study group with off-pump bypass surgery was more effective than in groups where bypass was performed with the use of cardioplegic cardiac arrest. This technique requires more time to perform and is more technically complex, but can significantly reduce myocardial ischemic time, which, in turn, significantly reduces the incidence of heart failure and postoperative complications.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47631849","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}
Pub Date : 2022-03-23DOI: 10.30702/jcvs/22.30(01)/gr019-7176
O. Gogayeva, Mykola L. Rudenko, N. O. Ioffe
In the first year of the COVID-19 pandemic, there was a significant reduction in the number of cardiac surgeries, but recently, with the vaccination campaign, the former surgical activity is gradually recovering. Among cardiac surgery patients, many have had COVID-19. The effects of SARS-CoV-2 on the human body in general and vascular endothelium in particular cause multisystem damage, which is associated with a high risk of pulmonary, cardiac, neurological and thrombotic complications not only in the acute period but also in the long term. The issue of the timing of operations in cardiac surgery patients after COVID-19, among whom patients with complicated forms of coronary artery disease are the most severe, is very acute. Case description. Patient H., 42 y.o, was hospitalized to the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with thrombosed postinfarction aneurysm of the left ventricle, polymorbidity, severe COVID-19 with 60% lung damage 2 months ago. According to the results of diagnostic study, the on-pump surgical intervention was indicated: coronary artery bypass grafting, left ventricular aneurysm resection with thrombectomy. The predicted mortality risk was 11.5% by the EuroSCORE II scale and 8.08% by the Society of Thoracic Surgery Score (STS). The heart team decided to perform the life-saving surgery. After stabilization of the condition and compensation of concomitant diseases, the patient was successfully operated and discharged from the Institute without complications on the 9th day after surgery. Conclusions. High-risk patients with complicated coronary artery disease require careful preparation for cardiac surgery and compensation of comorbidity. Preoperative risk stratification allows the heart team to make decisions, predict perioperative complications and take measures to prevent them, as well as plan the volume of operation. Polysegmental bilateral COVID-19-associated pneumonia within the last 2 months is not a contraindication to cardiac surgery in the conditions of artificial circulation, provided adequate training, stability of the radiological picture. An important point of the positive result of cardiac surgery is intraoperative reduction of ischemic time with the performance of the main stage of the operation in conditions of parallel perfusion.
{"title":"Surgical Treatment of Postinfarction Thrombosed Left Ventricular Aneurysm after Bilateral Polysegmental COVID-19-Associated Pneumonia. Case Report","authors":"O. Gogayeva, Mykola L. Rudenko, N. O. Ioffe","doi":"10.30702/jcvs/22.30(01)/gr019-7176","DOIUrl":"https://doi.org/10.30702/jcvs/22.30(01)/gr019-7176","url":null,"abstract":"In the first year of the COVID-19 pandemic, there was a significant reduction in the number of cardiac surgeries, but recently, with the vaccination campaign, the former surgical activity is gradually recovering. Among cardiac surgery patients, many have had COVID-19. The effects of SARS-CoV-2 on the human body in general and vascular endothelium in particular cause multisystem damage, which is associated with a high risk of pulmonary, cardiac, neurological and thrombotic complications not only in the acute period but also in the long term. The issue of the timing of operations in cardiac surgery patients after COVID-19, among whom patients with complicated forms of coronary artery disease are the most severe, is very acute. \u0000Case description. Patient H., 42 y.o, was hospitalized to the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with thrombosed postinfarction aneurysm of the left ventricle, polymorbidity, severe COVID-19 with 60% lung damage 2 months ago. According to the results of diagnostic study, the on-pump surgical intervention was indicated: coronary artery bypass grafting, left ventricular aneurysm resection with thrombectomy. The predicted mortality risk was 11.5% by the EuroSCORE II scale and 8.08% by the Society of Thoracic Surgery Score (STS). The heart team decided to perform the life-saving surgery. After stabilization of the condition and compensation of concomitant diseases, the patient was successfully operated and discharged from the Institute without complications on the 9th day after surgery. \u0000Conclusions. High-risk patients with complicated coronary artery disease require careful preparation for cardiac surgery and compensation of comorbidity. Preoperative risk stratification allows the heart team to make decisions, predict perioperative complications and take measures to prevent them, as well as plan the volume of operation. Polysegmental bilateral COVID-19-associated pneumonia within the last 2 months is not a contraindication to cardiac surgery in the conditions of artificial circulation, provided adequate training, stability of the radiological picture. An important point of the positive result of cardiac surgery is intraoperative reduction of ischemic time with the performance of the main stage of the operation in conditions of parallel perfusion.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42499851","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}
Pub Date : 2022-03-23DOI: 10.30702/ujcvs/22.30(01)/pk016-8993
E. O. Perepeka, B. Kravchuk, Oksana M. Paratsii, L. Hrubyak, Volodymyr L. Leonchuk, M. Sychyk
Background. Implementation of conduction system permanent pacing methods in patients with cardiac bradyarrhythmias allows to maintain the physiological sequence of excitation and contraction of the ventricles and to avoid the development of heart failure due to electrical and mechanical dyssynchrony in patients with high rates of ventricular pacing. Case description. A 61-year-old female patient was examined and treated at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from January 25 to January 27, 2022 at the department of surgical treatment of complex cardiac arrhythmias with a diagnosis of proximal complete atrioventricular block. A two-chamber pacemaker (Vitatron Q50A2) with a ventricular lead to stimulate the His bundle region (Medtronic 3830, 69 cm) was implanted to the patient with a special delivery system (C315HIS). At an X-ray operating room, 12 ECG leads from the electrophysiological station LabSystem Pro (Bard, USA) were connected to the patient to analyze the criteria for capturing the conduction system on stimulation during ventricular lead placement, and a diagnostic quadripolar electrode was inserted into the right ventricle to record the potential of the His bundle as an X-ray reference point. During placement of the ventricular lead in the area of the His bundle due to high pacing thresholds the decision was made to implement an alternative method of conduction system pacing – left bundle branch pacing through the interventricular septum. After gradual passage of the electrode through the septum, capture of the conduction system of the heart was achieved, although no clear potential of the left bundle was registered. The interval from stimulus to peak R wave in lead V6 was 68 ms, and the interval from stimulus to peak R wave in lead V1 was 110 ms. The difference between intervals was 42 ms, which indicated the criteria of nonselective capture of the left bundle branch, with stimulation thresholds below 1 V at a pulse length of 0.5 ms. In the postoperative period, the patient was evaluated for global longitudinal deformity of the left ventricle on constant ventricular stimulation, which was carried out according to standard methods using speckle-tracking echocardiography; no signs of dyssynchrony were found. Also, the location of the endocardial electrode in the middle segments of the interventricular septum on the right ventricular side was visualized and confirmed by performing B-mode transthoracic echocardiography with subcostal access. Conclusions. Left bundle branch pacing, like His bundle pacing, maintains electrical and mechanical synchrony of the left ventricle at lower pacing thresholds, greater amplitude of the sensitivity signal and lower risks of lead dislocation.
{"title":"Transventricular Left Bundle Branch Pacing","authors":"E. O. Perepeka, B. Kravchuk, Oksana M. Paratsii, L. Hrubyak, Volodymyr L. Leonchuk, M. Sychyk","doi":"10.30702/ujcvs/22.30(01)/pk016-8993","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(01)/pk016-8993","url":null,"abstract":"Background. Implementation of conduction system permanent pacing methods in patients with cardiac bradyarrhythmias allows to maintain the physiological sequence of excitation and contraction of the ventricles and to avoid the development of heart failure due to electrical and mechanical dyssynchrony in patients with high rates of ventricular pacing. \u0000Case description. A 61-year-old female patient was examined and treated at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from January 25 to January 27, 2022 at the department of surgical treatment of complex cardiac arrhythmias with a diagnosis of proximal complete atrioventricular block. A two-chamber pacemaker (Vitatron Q50A2) with a ventricular lead to stimulate the His bundle region (Medtronic 3830, 69 cm) was implanted to the patient with a special delivery system (C315HIS). At an X-ray operating room, 12 ECG leads from the electrophysiological station LabSystem Pro (Bard, USA) were connected to the patient to analyze the criteria for capturing the conduction system on stimulation during ventricular lead placement, and a diagnostic quadripolar electrode was inserted into the right ventricle to record the potential of the His bundle as an X-ray reference point. During placement of the ventricular lead in the area of the His bundle due to high pacing thresholds the decision was made to implement an alternative method of conduction system pacing – left bundle branch pacing through the interventricular septum. After gradual passage of the electrode through the septum, capture of the conduction system of the heart was achieved, although no clear potential of the left bundle was registered. The interval from stimulus to peak R wave in lead V6 was 68 ms, and the interval from stimulus to peak R wave in lead V1 was 110 ms. The difference between intervals was 42 ms, which indicated the criteria of nonselective capture of the left bundle branch, with stimulation thresholds below 1 V at a pulse length of 0.5 ms. In the postoperative period, the patient was evaluated for global longitudinal deformity of the left ventricle on constant ventricular stimulation, which was carried out according to standard methods using speckle-tracking echocardiography; no signs of dyssynchrony were found. Also, the location of the endocardial electrode in the middle segments of the interventricular septum on the right ventricular side was visualized and confirmed by performing B-mode transthoracic echocardiography with subcostal access. \u0000Conclusions. Left bundle branch pacing, like His bundle pacing, maintains electrical and mechanical synchrony of the left ventricle at lower pacing thresholds, greater amplitude of the sensitivity signal and lower risks of lead dislocation.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44328474","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}
Pub Date : 2022-03-23DOI: 10.30702/ujcvs/22.30(01)/zhk007-2731
I. Zhekov, V. Kravchenko, Oleh I. Sarhosh, Olena B. Larionova, A. Rudenko
The aim. To determine the degree of increased operative risk in the group of patients with a combination of aortic aneurysms and coronary artery disease compared with those with isolated aortic aneurysms. Materials and methods. In the period from January 1, 2010 to October 1, 2021 at the National Amosov Institute of Cardiovascular Surgery, 820 patients with aortic aneurysm, including 172 (20.9%) patients with concomitant aortic and coronary artery disease, underwent surgical treatment. Diagnosis was based on standard examination methods such as electrocardiography, transthoracic echocardiography, coronary angiography, and computed tomography without coronary angiography in cases of aortic dissection. In patients with aortic dissection and coronary artery disease, the extent of the lesion was examined mainly by CT diagnosis and Coronary Artery Disease Reporting and Data System (CAD-RADS) scale due to contraindications to coronary angiography. Results.Thetotalnumberofcomplicationswas26(15.1%)cases.Cerebrovasculardisorderswereobservedin4(2.3%) cases, 3 of which regressed in the postoperative period; in all 4 (2.3%) cases there was a history of acute cerebrovascular disorders. Spinal cord ischemia was observed in 2 (1.2%) cases. Multiple organ failure occurred in the postoperative period in 6 (3.5%) patients, renal failure in 4 (2.3%) patients. Respiratory failure was found in 3 (1.7%) patients. Septic shock occurred in 1 (0.6%) patient. Increased exudation was present in 6 (3.5%) cases requiring rethoracotomy. There were 7 (4.0%) in-hospital deaths, 3 (9.3%) in the acute dissection group and 4 (2.9%) in the aortic aneurysm group without stratification. The distribution of patients by lethal complications was as follows: 1 (14.3%) patient had acute cerebrovascular accident, 1 (14.3%) had septic shock and 1 (14.3%) had acute renal failure. In more than 50% of cases, the cause of death was multiple organ failure (4 [57%] patients). Conclusions. Concomitant lesions of arteries with aortic aneurysms are associated with higher rates of postoperative complications and mortality. In the group of patients with aortic dissection combined with coronary artery disease, there was longer duration of surgery, duration of artificial circulation and aortic compression due to the high initial severity of condition in such patients and greater complexity and volume of surgery. Hospital mortality in the group of aortic aneurysms combined with coronary artery lesions was almost 3 times higher than that in the group of isolated aortic aneurysms (4% and 1.5%, respectively).
{"title":"Results of Treatment of Patients with Concomitant Aortic Lesions and Coronary Heart Disease","authors":"I. Zhekov, V. Kravchenko, Oleh I. Sarhosh, Olena B. Larionova, A. Rudenko","doi":"10.30702/ujcvs/22.30(01)/zhk007-2731","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(01)/zhk007-2731","url":null,"abstract":"The aim. To determine the degree of increased operative risk in the group of patients with a combination of aortic aneurysms and coronary artery disease compared with those with isolated aortic aneurysms. \u0000Materials and methods. In the period from January 1, 2010 to October 1, 2021 at the National Amosov Institute of Cardiovascular Surgery, 820 patients with aortic aneurysm, including 172 (20.9%) patients with concomitant aortic and coronary artery disease, underwent surgical treatment. Diagnosis was based on standard examination methods such as electrocardiography, transthoracic echocardiography, coronary angiography, and computed tomography without coronary angiography in cases of aortic dissection. In patients with aortic dissection and coronary artery disease, the extent of the lesion was examined mainly by CT diagnosis and Coronary Artery Disease Reporting and Data System (CAD-RADS) scale due to contraindications to coronary angiography. \u0000Results.Thetotalnumberofcomplicationswas26(15.1%)cases.Cerebrovasculardisorderswereobservedin4(2.3%) cases, 3 of which regressed in the postoperative period; in all 4 (2.3%) cases there was a history of acute cerebrovascular disorders. Spinal cord ischemia was observed in 2 (1.2%) cases. Multiple organ failure occurred in the postoperative period in 6 (3.5%) patients, renal failure in 4 (2.3%) patients. Respiratory failure was found in 3 (1.7%) patients. Septic shock occurred in 1 (0.6%) patient. Increased exudation was present in 6 (3.5%) cases requiring rethoracotomy. There were 7 (4.0%) in-hospital deaths, 3 (9.3%) in the acute dissection group and 4 (2.9%) in the aortic aneurysm group without stratification. The distribution of patients by lethal complications was as follows: 1 (14.3%) patient had acute cerebrovascular accident, 1 (14.3%) had septic shock and 1 (14.3%) had acute renal failure. In more than 50% of cases, the cause of death was multiple organ failure (4 [57%] patients). \u0000Conclusions. Concomitant lesions of arteries with aortic aneurysms are associated with higher rates of postoperative complications and mortality. In the group of patients with aortic dissection combined with coronary artery disease, there was longer duration of surgery, duration of artificial circulation and aortic compression due to the high initial severity of condition in such patients and greater complexity and volume of surgery. Hospital mortality in the group of aortic aneurysms combined with coronary artery lesions was almost 3 times higher than that in the group of isolated aortic aneurysms (4% and 1.5%, respectively).","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46514943","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}
Pub Date : 2022-03-23DOI: 10.30702/ujcvs/22.30(01)/gr009-0914
O. Gogayeva, A. Rudenko, V. Lazoryshynets, S. A. Rudenko, T. A. Andrushchenko
The aim. To analyze the features of the perioperative period in high-risk cardiac surgery patients with coronary artery disease (CAD) and thyroid disease. Materials and methods. Retrospective analysis of data of 354 high-risk patients with CAD who were operated and discharged from the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine from 2009 to 2019. All the patients underwent standard clinical and laboratory tests, ECG, echocardiography, coronary angiography and surgical myocardial revascularization with correction of concomitant cardiac pathology. Ultrasound screening of thyroid disease and thyroid hormone levels was not performed in all patients, however, patients with severe symptoms were referred for follow-up. Results. Thyroid disease was diagnosed in 37 (10.4%) patients, of whom 11 (3.1%) had hypothyroidism and were receiving hormone replacement therapy, and 1 (0.28%) had hyperthyroidism on tyrosol therapy. Ultrasound signs of thyroiditis were detected in 7 (1.9%) patients, nodular goiter in 29 (8.1%), and retrosternal goiter in 1 (0.28%) patient. Dependingonthecardiacsurgicalpathology,theprevalenceofhypothyroidismdidnotdifferinpatientswithuncomplicated and complicated forms of CAD (7 [3.6%] and 4 [2.5%] patients, respectively, p = 0.5498). Patients with hypothyroidism received hormone replacement therapy with levothyroxine in a dosage prescribed by an endocrinologist. The day before the surgery, thyroid-stimulating hormone control was performed to confirm the achievement of compensation. When comparing the course of the operative period in compensated hypothyroidism and clinical euthyroidism, no significant differences were found, and the postoperative period didn’t differ in the occurrence of atrial fibrillation (p = 0.0801), hydrothorax (p = 0.5280), but a decrease in the estimated glomerular filtration rate at discharge was found in patients with hypothyroidism (59.5 ± 16.8 vs. 71.3 ± 19.6 ml/min/1.73 m2, p = 0.0493). Conclusions. Timely detection of thyroid dysfunction allows to compensate the condition and avoid postoperative complications. Analysis of the perioperative period in patients with hypothyroidism showed no effect of compensated hypothyroidism on the operative and postoperative periods in high-risk patients with CAD. Decreased glomerular filtration rate after surgery in patients with hypothyroidism requires further study and adherence to the strategy of nephroprotection in polymorbid patients.
{"title":"Thyroid Pathology in High-Risk Cardiac Surgery Patients with Coronary Artery Disease","authors":"O. Gogayeva, A. Rudenko, V. Lazoryshynets, S. A. Rudenko, T. A. Andrushchenko","doi":"10.30702/ujcvs/22.30(01)/gr009-0914","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(01)/gr009-0914","url":null,"abstract":"The aim. To analyze the features of the perioperative period in high-risk cardiac surgery patients with coronary artery disease (CAD) and thyroid disease. \u0000Materials and methods. Retrospective analysis of data of 354 high-risk patients with CAD who were operated and discharged from the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine from 2009 to 2019. All the patients underwent standard clinical and laboratory tests, ECG, echocardiography, coronary angiography and surgical myocardial revascularization with correction of concomitant cardiac pathology. Ultrasound screening of thyroid disease and thyroid hormone levels was not performed in all patients, however, patients with severe symptoms were referred for follow-up. \u0000Results. Thyroid disease was diagnosed in 37 (10.4%) patients, of whom 11 (3.1%) had hypothyroidism and were receiving hormone replacement therapy, and 1 (0.28%) had hyperthyroidism on tyrosol therapy. Ultrasound signs of thyroiditis were detected in 7 (1.9%) patients, nodular goiter in 29 (8.1%), and retrosternal goiter in 1 (0.28%) patient. Dependingonthecardiacsurgicalpathology,theprevalenceofhypothyroidismdidnotdifferinpatientswithuncomplicated and complicated forms of CAD (7 [3.6%] and 4 [2.5%] patients, respectively, p = 0.5498). Patients with hypothyroidism received hormone replacement therapy with levothyroxine in a dosage prescribed by an endocrinologist. The day before the surgery, thyroid-stimulating hormone control was performed to confirm the achievement of compensation. When comparing the course of the operative period in compensated hypothyroidism and clinical euthyroidism, no significant differences were found, and the postoperative period didn’t differ in the occurrence of atrial fibrillation (p = 0.0801), hydrothorax (p = 0.5280), but a decrease in the estimated glomerular filtration rate at discharge was found in patients with hypothyroidism (59.5 ± 16.8 vs. 71.3 ± 19.6 ml/min/1.73 m2, p = 0.0493). \u0000Conclusions. Timely detection of thyroid dysfunction allows to compensate the condition and avoid postoperative complications. Analysis of the perioperative period in patients with hypothyroidism showed no effect of compensated hypothyroidism on the operative and postoperative periods in high-risk patients with CAD. Decreased glomerular filtration rate after surgery in patients with hypothyroidism requires further study and adherence to the strategy of nephroprotection in polymorbid patients.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47095485","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}
Pub Date : 2022-03-23DOI: 10.30702/ujcvs/22.30(01)/sa001-5963
O. S. Stychynskyi, P. O. Almiz, A. Topchii
Pulmonary vein isolation is a standard for catheter treatment of atrial fibrillation (AF). As for the need for additional impact on the arrhythmogenic substrate in the atria, there is no consensus or unified technique. The aim. To study the efficiency of AF induction by frequent atrial pacing as a prognostic criterium for arrhythmia recurrence in the long term after catheter treatment. Materials and methods. We analyzed 55 catheter procedures of AF ablation in 55 patients (27 women, mean age 52 ± 6.8 years) without structural heart disease. There were 28 patients and 27 patients with paroxysmal and persistent arrhythmia, respectively. Concomitant diseases (coronary heart disease, hypertension, diabetes) were reported in 30 (54.5%) cases. The technique of the procedure was as follows. At first, the pulmonary veins were isolated. After that frequent stimulation was carried out from two sites with a cycle of 300 ms for 10 seconds, with a phased shortening by 20 ms, until atrial refractoriness was achieved. Arrhythmia was considered induced if its episode lasted more than 30 seconds. In case of induction of AF and absence of its spontaneous termination within the pre-specified time, the search and ablation of the areas with fragmented activity were performed. There were no additional effects on the substrate in the atria. Recurrence of AF was defined as the occurrence of AF within 3 months after ablation. Results. Atrial fibrillation was induced in 9 (16.4%) of 55 patients. During the follow-up period lasting 12 to 26 months, recurrent arrhythmia occurred in 11 (20%) of 55 patients, including 3 (33.3%) of 9 with induced AF, and 8 (17.4 %) of 46 in whom it was not induced (relative risk 1.9; odds ratio 2.4; 95% confidence interval 16.5-23.5). Comparison of the recurrence rate depending on the form of arrhythmia did not reveal significant differences: the relative risk was 2.2 for persistent form and 1.5 for paroxysmal form (P > 0.05). Conclusions. Our results indicate that in cases where AF was induced after pulmonary vein isolation, the likelihood of its subsequent recurrence was twice as high as in cases when it was not induced. This trend was observed both in paroxysmal and persistent forms of arrhythmia.
{"title":"Clinical Significance of Induction of Atrial Fibrillation after Pulmonary Vein Isolation","authors":"O. S. Stychynskyi, P. O. Almiz, A. Topchii","doi":"10.30702/ujcvs/22.30(01)/sa001-5963","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(01)/sa001-5963","url":null,"abstract":"Pulmonary vein isolation is a standard for catheter treatment of atrial fibrillation (AF). As for the need for additional impact on the arrhythmogenic substrate in the atria, there is no consensus or unified technique. \u0000The aim. To study the efficiency of AF induction by frequent atrial pacing as a prognostic criterium for arrhythmia recurrence in the long term after catheter treatment. \u0000Materials and methods. We analyzed 55 catheter procedures of AF ablation in 55 patients (27 women, mean age 52 ± 6.8 years) without structural heart disease. There were 28 patients and 27 patients with paroxysmal and persistent arrhythmia, respectively. Concomitant diseases (coronary heart disease, hypertension, diabetes) were reported in 30 (54.5%) cases. The technique of the procedure was as follows. At first, the pulmonary veins were isolated. After that frequent stimulation was carried out from two sites with a cycle of 300 ms for 10 seconds, with a phased shortening by 20 ms, until atrial refractoriness was achieved. Arrhythmia was considered induced if its episode lasted more than 30 seconds. In case of induction of AF and absence of its spontaneous termination within the pre-specified time, the search and ablation of the areas with fragmented activity were performed. There were no additional effects on the substrate in the atria. Recurrence of AF was defined as the occurrence of AF within 3 months after ablation. \u0000Results. Atrial fibrillation was induced in 9 (16.4%) of 55 patients. During the follow-up period lasting 12 to 26 months, recurrent arrhythmia occurred in 11 (20%) of 55 patients, including 3 (33.3%) of 9 with induced AF, and 8 (17.4 %) of 46 in whom it was not induced (relative risk 1.9; odds ratio 2.4; 95% confidence interval 16.5-23.5). Comparison of the recurrence rate depending on the form of arrhythmia did not reveal significant differences: the relative risk was 2.2 for persistent form and 1.5 for paroxysmal form (P > 0.05). \u0000Conclusions. Our results indicate that in cases where AF was induced after pulmonary vein isolation, the likelihood of its subsequent recurrence was twice as high as in cases when it was not induced. This trend was observed both in paroxysmal and persistent forms of arrhythmia.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49463455","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}
Pub Date : 2022-03-23DOI: 10.30702/ujcvs/22.30(01)/km013-7782
I. Kobza, Y. Mota, T. Kobza
Introduction. Reconstructive surgery of abdominal aortic aneurysms, despite significant international experience, remains one of the most complex issues of current vascular surgery, especially due to anatomical variability of arterial blood supply of the kidneys and abnormalities in their development, among which the most common is a horseshoe kidney. Features of vascularization, placement of the renal isthmus relative to the main vessels, the choice of the optimal method of abdominal aortic aneurysm reconstruction cause a high risk of surgery. The issues of open and endovascular aortic grafting, possibility of crossing the isthmus of the horseshoe kidney, feasibility of reconstruction of additional renal arteries still remain controversial. The aim. Improvement of the diagnosis and surgical treatment of abdominal aortic aneurysms with a horseshoe kidney. Case presentation. In our observation, in a 61-year-old patient, by clinical examination, laboratory and diagnostic imaging the diagnosis of two infrarenal abdominal aortic aneurysms with a horseshoe kidney was confirmed, that has become a direct indication for surgical intervention: exclusion of infrarenal aortic aneurysms from the blood flow, abdominal aortic prosthetic grafting with reimplantation of the renal isthmus arteries into the prosthetic graft. This clinical case confirms the advantages of open surgical technique, using transperitoneal approach, which not only provided sufficient exposure of the operating area, but also allowed to perform optimal reconstruction of the abdominal aorta without crossing the functioning isthmus of the horseshoe kidney with preservation of blood flow through additional renal arteries. Conclusion. Careful preoperative assessment of the peculiarities of the blood supply of the horseshoe kidney with coexistent abdominal aortic aneurysms allows to optimize the tactics of surgical treatment, prevent the development of severe complications and achieve complete recovery of the patient.
{"title":"Features of Diagnosis and Surgical Treatment of Abdominal Aortic Aneurysms with a Horseshoe Kidney","authors":"I. Kobza, Y. Mota, T. Kobza","doi":"10.30702/ujcvs/22.30(01)/km013-7782","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(01)/km013-7782","url":null,"abstract":"Introduction. Reconstructive surgery of abdominal aortic aneurysms, despite significant international experience, remains one of the most complex issues of current vascular surgery, especially due to anatomical variability of arterial blood supply of the kidneys and abnormalities in their development, among which the most common is a horseshoe kidney. Features of vascularization, placement of the renal isthmus relative to the main vessels, the choice of the optimal method of abdominal aortic aneurysm reconstruction cause a high risk of surgery. The issues of open and endovascular aortic grafting, possibility of crossing the isthmus of the horseshoe kidney, feasibility of reconstruction of additional renal arteries still remain controversial. \u0000The aim. Improvement of the diagnosis and surgical treatment of abdominal aortic aneurysms with a horseshoe kidney. \u0000Case presentation. In our observation, in a 61-year-old patient, by clinical examination, laboratory and diagnostic imaging the diagnosis of two infrarenal abdominal aortic aneurysms with a horseshoe kidney was confirmed, that has become a direct indication for surgical intervention: exclusion of infrarenal aortic aneurysms from the blood flow, abdominal aortic prosthetic grafting with reimplantation of the renal isthmus arteries into the prosthetic graft. This clinical case confirms the advantages of open surgical technique, using transperitoneal approach, which not only provided sufficient exposure of the operating area, but also allowed to perform optimal reconstruction of the abdominal aorta without crossing the functioning isthmus of the horseshoe kidney with preservation of blood flow through additional renal arteries. \u0000Conclusion. Careful preoperative assessment of the peculiarities of the blood supply of the horseshoe kidney with coexistent abdominal aortic aneurysms allows to optimize the tactics of surgical treatment, prevent the development of severe complications and achieve complete recovery of the patient.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46057163","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}
Pub Date : 2022-03-23DOI: 10.30702/ujcvs/22.30(01)/np010-6470
Andriy O. Nykonenko, Heorhii S. Podluzhniy, N. A. Koliada, Yuriy A. Levchak, Ye. Yu. Hardubey, I. Zubryk, O. O. Naumova, O. Nykonenko, F. Horlenko, Serhii O. Matvieiev, Olena V. Riabokon
In patients with COVID-19, histological examination of the pulmonary vessels shows serious disorders (local thrombosis and microangiopathy), significantly different to those in the control group composed of patients with influenza. Some studies have shown that coronavirus enters cells by binding angiotensin-converting enzyme 2 which is found mainly on the alveolar epithelium and endothelium. The increase in D-dimer levels is typical for patients with COVID-19. Although many inflammatory processes can affect D-dimer levels, an increase in D-dimer during COVID-19 is more likely to indicate thrombosis. The aim. To analyze the patients who have suffered from COVID-19 and to determine possible risk factors for the development of thrombotic complications and define the surgical or medical therapy tactics. Material and methods. The study was conducted from October 2020 to April 2021 in Ukraine (Zaporizhzhia, Uzhhorod, Kherson and Kyiv). We analyzed 121 patients aged 46.9± 15.3 years, 64 (52.8%) men and 57 (47.1%) women. All the patients had positive PCR test for COVID-19. The changes in D-dimer were analyzed. Results. Forty-one (33.9%) patients had thrombotic complications. Pulmonary embolism (PE) was diagnosed in 14 patients, deep vein thrombosis (DVT) in 17, acute stroke in 2 and peripheral artery thrombosis in 8 cases. An increase in D-dimer level was observed in most patients and was not associated with clinical manifestations of thrombosis. At a D-dimer level of 11,000-10,564 ng/ml the patients had clinical symptoms of thrombotic condition which was confirmed by computed tomography or ultrasound examination. At an increase over 725-7000 ng/ml, there were no clinical signs of thrombosis. We performed standard medical therapy in patients with PE and DVT. In case of arterial thrombosis open surgery was performed in 4 patients and direct catheter thrombolysis in 1 case. Conclusion. In our opinion, anticoagulants should be prescribed for patients with a D-dimer level of more than 700 ng/ml. Full anticoagulation is prescribed for severe forms of COVID-19 or confirmed thrombosis. We didn’t find any correlation between the development of thrombotic complications in patients with COVID-19 and comorbidities, body mass index and other factors. Medical therapy was successful in all cases of PE and DVT, anticoagulants were prescribed for 1 year. Femoral artery thrombectomy was successfully performed in 4 patients. After direct catheter thrombolysis we got peripheral pulse. In all cases of arterial thrombosis, we prescribed anticoagulants for 2 months after discharge and acetylsalicylic acid for a long time.
{"title":"Thrombotic Conditions in Patients with COVID-19: Dynamics of D-Dimer and Tactics of Anticoagulant Therapy","authors":"Andriy O. Nykonenko, Heorhii S. Podluzhniy, N. A. Koliada, Yuriy A. Levchak, Ye. Yu. Hardubey, I. Zubryk, O. O. Naumova, O. Nykonenko, F. Horlenko, Serhii O. Matvieiev, Olena V. Riabokon","doi":"10.30702/ujcvs/22.30(01)/np010-6470","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(01)/np010-6470","url":null,"abstract":"In patients with COVID-19, histological examination of the pulmonary vessels shows serious disorders (local thrombosis and microangiopathy), significantly different to those in the control group composed of patients with influenza. Some studies have shown that coronavirus enters cells by binding angiotensin-converting enzyme 2 which is found mainly on the alveolar epithelium and endothelium. The increase in D-dimer levels is typical for patients with COVID-19. Although many inflammatory processes can affect D-dimer levels, an increase in D-dimer during COVID-19 is more likely to indicate thrombosis. \u0000The aim. To analyze the patients who have suffered from COVID-19 and to determine possible risk factors for the development of thrombotic complications and define the surgical or medical therapy tactics. \u0000Material and methods. The study was conducted from October 2020 to April 2021 in Ukraine (Zaporizhzhia, Uzhhorod, Kherson and Kyiv). We analyzed 121 patients aged 46.9± 15.3 years, 64 (52.8%) men and 57 (47.1%) women. All the patients had positive PCR test for COVID-19. The changes in D-dimer were analyzed. \u0000Results. Forty-one (33.9%) patients had thrombotic complications. Pulmonary embolism (PE) was diagnosed in 14 patients, deep vein thrombosis (DVT) in 17, acute stroke in 2 and peripheral artery thrombosis in 8 cases. \u0000An increase in D-dimer level was observed in most patients and was not associated with clinical manifestations of thrombosis. At a D-dimer level of 11,000-10,564 ng/ml the patients had clinical symptoms of thrombotic condition which was confirmed by computed tomography or ultrasound examination. At an increase over 725-7000 ng/ml, there were no clinical signs of thrombosis. \u0000We performed standard medical therapy in patients with PE and DVT. In case of arterial thrombosis open surgery was performed in 4 patients and direct catheter thrombolysis in 1 case. \u0000Conclusion. In our opinion, anticoagulants should be prescribed for patients with a D-dimer level of more than 700 ng/ml. Full anticoagulation is prescribed for severe forms of COVID-19 or confirmed thrombosis. We didn’t find any correlation between the development of thrombotic complications in patients with COVID-19 and comorbidities, body mass index and other factors. Medical therapy was successful in all cases of PE and DVT, anticoagulants were prescribed for 1 year. Femoral artery thrombectomy was successfully performed in 4 patients. After direct catheter thrombolysis we got peripheral pulse. In all cases of arterial thrombosis, we prescribed anticoagulants for 2 months after discharge and acetylsalicylic acid for a long time.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42317379","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}
Pub Date : 2022-03-23DOI: 10.30702/ujcvs/22.30(01)/pp005-4958
M. Petkanych, S. Potashev, N. Bankovska, V. V. Lazoryshynets
Background. Atrial fibrillation (AF) is the world’s most frequent arrhythmia associated with significant morbidity and mortality. Non-invasive multimodal imaging provides all necessary information for tactical decisions about radiofrequency catheter ablation and other methods of pharmacological and invasive AF treatment. Survival of patients with congenital heart diseases (CHDs) has grown over the past years. Still, there is a significant gap in evidence-based data regarding management of such patients with AF. Previously in Ukraine there were no studies of echocardiography parameters in patients with CHDs with paroxysmal or persistent AF, namely, those to find predictors for successful AF treatment before atrial septal defect (ASD) surgical or percutaneous closure. The aim. To evaluate ventricular myocardial function and central hemodynamics in patients with secondary ASD and paroxysmal or persistent AF compared to patients with paroxysmal or persistent AF without CHD. Methods. Weexamined54patients(36[66.7%]menand18[33.3%]women)aged61.4±9.8yearswithsecondaryASDand paroxysmal or persistent AF. Control group included 56 patients (38 [67.9%] men and 18 [32.1%] women) without CHD with non-valvular paroxysmal or persistent AF. All the patients underwent transthoracic and transesophageal echocardiography with tissue Doppler imaging and speckle-tracking echocardiography for longitudinal myocardial strain evaluation. Results. The patients in the study and control groups were comparable in terms of age and gender as well as comorbidities and cardiovascular risk factors. There were significant differences in the left heart remodeling indices and central hemodynamics alteration grades, for instance, the patients of the study group had significantly higher grade of left ventricular (LV) hypertrophy. Patients with ASD also had significantly more dilated LV and left atrium (LA) cavities and higher combined indices of LV filling pressure – E/E’ (14.9±4.2 vs. 9.6±5.3, p<0.0001) and E/Vp (2.84±0.44 vs. 2.25±0.61, p<0.0001), explaining more frequent AF in patients with ASD. The study group patients also had significantly higher systolic (sPAP) (52.4±2.8 vs. 44.6±3.2, p<0.0001) and mean (mPAP) (38.6±4.3 vs. 31.7±1.9, p<0.0001) pulmonary artery pressure compared to control group, as well as significantly worse all known indices of right ventricle (RV) myocardial function and right chambers overload. Global RV longitudinal strain strongly correlated with RV fractional area change (r = 0.75; p<0.0001), and especially highly with tricuspid annular plane systolic excursion (r = 0.97; p<0.0001) and tricuspid annular peak systolic velocity S’ (r = 0.98; p<0.0001) during tissue Doppler imaging, making it trustworthy and valuable predictor of RV myocardial dysfunction and its potential restoration after defect correction. Patients with ASD much more often had significant moderate-to-severe functional tricuspid regurgitation (92.6% vs. 53.4%, p<0.0001) with significantly
背景。心房颤动(AF)是世界上最常见的心律失常，具有显著的发病率和死亡率。非侵入性多模态成像为射频导管消融以及其他药物和侵入性房颤治疗方法的战术决策提供了所有必要的信息。先天性心脏病(CHDs)患者的生存率在过去几年有所增长。尽管如此，关于此类房颤患者的管理，循证数据仍存在显著差距。此前在乌克兰，没有对伴有阵发性或持续性房颤的冠心病患者的超声心动图参数进行研究，即在房间隔缺损(ASD)手术或经皮缝合前发现房颤成功治疗的预测因素。的目标。评价继发性ASD合并阵发性或持续性房颤患者与无冠心病的阵发性或持续性房颤患者的心室心肌功能和中央血流动力学。方法。54例继发性和阵发性或持续性房颤患者(男性36例[66.7%]，女性18例[33.3%])，年龄61.4±9.8岁。对照组56例(男性38例[67.9%]，女性18例[32.1%])无冠心病，非瓣膜性阵发性或持续性房颤。所有患者均行经胸和经食管超声心动图，组织多普勒成像和斑点跟踪超声心动图进行纵向心肌应变评估。结果。实验组和对照组的患者在年龄、性别、合并症和心血管危险因素方面具有可比性。两组左心重构指标和中央血流动力学改变等级有显著性差异，如研究组患者左室肥厚等级明显增高。ASD患者的左室和左心房(LA)腔也明显扩大，左室充盈压E/E′(14.9±4.2比9.6±5.3,p<0.0001)和E/Vp(2.84±0.44比2.25±0.61,p<0.0001)的综合指数也更高，说明ASD患者更容易发生房颤。研究组患者的收缩压(sPAP)(52.4±2.8 vs. 44.6±3.2,p<0.0001)和平均肺动脉压(mPAP)(38.6±4.3 vs. 31.7±1.9,p<0.0001)明显高于对照组，右心室(RV)心肌功能和右室负荷的所有已知指标均明显差于对照组。RV整体纵向应变与RV分数面积变化呈强相关(r = 0.75;P <0.0001)，尤其是三尖瓣环状平面收缩偏移(r = 0.97;p<0.0001)和三尖瓣环状峰值收缩速度S ' (r = 0.98;p<0.0001)，使其成为可靠和有价值的预测右心室心肌功能障碍及其缺损修复后的潜在恢复。ASD患者更常出现中重度功能性三尖瓣反流(92.6%比53.4%，p<0.0001)，中心静脉压指数(16.4±2.4比10.2±2.5,p<0.0001)明显升高，下腔静脉(IVC)明显变宽(1.89±0.31比1.43±0.42,p<0.0001)，吸气性塌陷更高。下腔静脉内径与左心室整体充盈压力(即右房压)指数E/E′呈强相关(r = 0.98;p < 0.0001)。研究组的LA附件血栓发生率明显高于对照组(40.7% vs. 21.4%， p=0.029)，自发造影剂现象明显高于对照组，LA附件排出率明显低于对照组(26.7±5.1 vs. 34.3±7.2,p<0.0001)。结论。对ASD合并阵发性或持续性房颤的患者进行射频消融分层，需要进行全面的超声心动图检查，并有针对性地评估某些指标，以便早期干预，以便对该特定患者群体进行早期诊断和有创或手术治疗，即左室肥厚等级、左室扩张伴左室整体收缩功能评价、根据sPAP和mPAP评估的肺动脉高压等级。包括斑点跟踪超声心动图在内的各种方法检测右心室超载等级指标，包括右心室心肌功能。
{"title":"Ventricular Myocardial Function and Central Hemodynamics in Patients with Secondary Atrial Septal Defect and Persistent or Paroxysmal Atrial Fibrillation","authors":"M. Petkanych, S. Potashev, N. Bankovska, V. V. Lazoryshynets","doi":"10.30702/ujcvs/22.30(01)/pp005-4958","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(01)/pp005-4958","url":null,"abstract":"Background. Atrial fibrillation (AF) is the world’s most frequent arrhythmia associated with significant morbidity and mortality. Non-invasive multimodal imaging provides all necessary information for tactical decisions about radiofrequency catheter ablation and other methods of pharmacological and invasive AF treatment. Survival of patients with congenital heart diseases (CHDs) has grown over the past years. Still, there is a significant gap in evidence-based data regarding management of such patients with AF. Previously in Ukraine there were no studies of echocardiography parameters in patients with CHDs with paroxysmal or persistent AF, namely, those to find predictors for successful AF treatment before atrial septal defect (ASD) surgical or percutaneous closure. \u0000The aim. To evaluate ventricular myocardial function and central hemodynamics in patients with secondary ASD and paroxysmal or persistent AF compared to patients with paroxysmal or persistent AF without CHD. \u0000Methods. Weexamined54patients(36[66.7%]menand18[33.3%]women)aged61.4±9.8yearswithsecondaryASDand paroxysmal or persistent AF. Control group included 56 patients (38 [67.9%] men and 18 [32.1%] women) without CHD with non-valvular paroxysmal or persistent AF. All the patients underwent transthoracic and transesophageal echocardiography with tissue Doppler imaging and speckle-tracking echocardiography for longitudinal myocardial strain evaluation. \u0000Results. The patients in the study and control groups were comparable in terms of age and gender as well as comorbidities and cardiovascular risk factors. There were significant differences in the left heart remodeling indices and central hemodynamics alteration grades, for instance, the patients of the study group had significantly higher grade of left ventricular (LV) hypertrophy. Patients with ASD also had significantly more dilated LV and left atrium (LA) cavities and higher combined indices of LV filling pressure – E/E’ (14.9±4.2 vs. 9.6±5.3, p<0.0001) and E/Vp (2.84±0.44 vs. 2.25±0.61, p<0.0001), explaining more frequent AF in patients with ASD. The study group patients also had significantly higher systolic (sPAP) (52.4±2.8 vs. 44.6±3.2, p<0.0001) and mean (mPAP) (38.6±4.3 vs. 31.7±1.9, p<0.0001) pulmonary artery pressure compared to control group, as well as significantly worse all known indices of right ventricle (RV) myocardial function and right chambers overload. Global RV longitudinal strain strongly correlated with RV fractional area change (r = 0.75; p<0.0001), and especially highly with tricuspid annular plane systolic excursion (r = 0.97; p<0.0001) and tricuspid annular peak systolic velocity S’ (r = 0.98; p<0.0001) during tissue Doppler imaging, making it trustworthy and valuable predictor of RV myocardial dysfunction and its potential restoration after defect correction. Patients with ASD much more often had significant moderate-to-severe functional tricuspid regurgitation (92.6% vs. 53.4%, p<0.0001) with significantly","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47562720","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}
Pub Date : 2022-03-23DOI: 10.30702/ujcvs/22.30(01)/md011-8388
Georgy B. Mankovsky, Ya.Yu. Dzhun, Y. Marushko, Ya.A. Saienko, N. Rudenko, B. Mankovsky
We present a clinical case of continuous monitoring in a patient with coronary artery disease and concomitant type 2 diabetes mellitus. A 75-year-old patient with a history of coronary artery bypass graft surgery more than 10 years ago was admitted to the Ukrainian Children’s Cardiac Center, Clinic for Adults with complaints of angina pectoris. The patient had progressive atherosclerotic lesions of the coronary arteries despite of controlled risk factors (normal weight, regular monitoring of blood pressure, lipid profile, blood glucose and glycated hemoglobin [HbA1c], active lifestyle). The heart team decided to perform percutaneous coronary intervention which resulted in thrombolysis in myocardial infarction (TIMI) 3 flow. During continuous glycemic monitoring in the patient we detected nocturnal asymptomatic episodes of hypoglycemia. Together with endocrinologist we performed adjustment of drug treatment: the hypoglycemic drug sulfonylurea was changed to a sodium-glucose cotransporter 2 inhibitor. Three months later we repeated monitoring of glycemia and no episodes of hypoglycemia were detected, HbA1c was 6.4%. Conclusions. This case report shows that continuous glucose monitoring is an optimal method for diagnosing silent episodes of hypoglycemia and should be considered along with the control of the HbA1c level as an important auxiliary method for controlling type 2 diabetes mellitus in patients with cardiovascular diseases. Because glucose-lowering drugs such as sulfonylureas are risk factors for hypoglycemic episodes in patients with coronary artery disease, they should be changed to more effective and safer medications if possible.
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