Pub Date : 2023-03-27DOI: 10.30702/ujcvs/23.31(01)/tp003-5359
O. M. Trembovetska, Olha V. Pantas, V. Kravchenko, Ivan M. Kravchenko, I. Osadovska
The aim. To evaluate the rate of long-term complications on ascending aorta after bicuspid aortic valve (BAV) replacement depending on the type of defect (stenosis or insufficiency) and to determine the indications to certain type of surgery in this category of patients. Materials and methods. One hundred five patients underwent BAV replacement between 2007 and 2014. The patients were divided into two groups. Group 1 included 63 patients with stenosis prevalence, group 2 included 42 patients with insufficiency. Aortic diameter at the level of the sinuses of Valsalva and at the level of the ascending aorta was assessed preoperatively and in the long-term postoperative period. Results. Long-term results were studied in 86 (81.9%) patients during 6.8 ± 2.2 years at the average. Sixteen (18.6%) patients developed aortic complications: 6 (6.9%) of them had progressive dilatation (10% from initial diameter), aneurysm formation was detected in 8 cases (9.3%) with 6 cases (6.9%) of dissection, 1 patient (1.3%) had aortic rupture. Freedom from ascending aorta dilatation within 13 years after BAV replacement was 95.1% in group 1 and 62.3% in group 2. Freedom from aortic dissection within 13 years after BAV replacement was 90.1% at the average (97% in group 1 and 80.6% in group 2). Conclusion. The tactics of aortic aneurysm correction in BAV depends on its diameter and, to a lesser extent, on the presence of stenosis or insufficiency of the valve. With existing stenosis and a diameter of the ascending aorta up to 4.5 cm, it is possible to consider correction without intervention on the ascending aorta. The presence of valve insufficiency in such a situation often requires additional manipulations on the ascending aorta.
{"title":"Surgical Treatment of Patients with a Bicuspid Aortic Valve and Concomitant Expansion of the Ascending Aorta","authors":"O. M. Trembovetska, Olha V. Pantas, V. Kravchenko, Ivan M. Kravchenko, I. Osadovska","doi":"10.30702/ujcvs/23.31(01)/tp003-5359","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(01)/tp003-5359","url":null,"abstract":"The aim. To evaluate the rate of long-term complications on ascending aorta after bicuspid aortic valve (BAV) replacement depending on the type of defect (stenosis or insufficiency) and to determine the indications to certain type of surgery in this category of patients. \u0000Materials and methods. One hundred five patients underwent BAV replacement between 2007 and 2014. The patients were divided into two groups. Group 1 included 63 patients with stenosis prevalence, group 2 included 42 patients with insufficiency. Aortic diameter at the level of the sinuses of Valsalva and at the level of the ascending aorta was assessed preoperatively and in the long-term postoperative period. \u0000Results. Long-term results were studied in 86 (81.9%) patients during 6.8 ± 2.2 years at the average. Sixteen (18.6%) patients developed aortic complications: 6 (6.9%) of them had progressive dilatation (10% from initial diameter), aneurysm formation was detected in 8 cases (9.3%) with 6 cases (6.9%) of dissection, 1 patient (1.3%) had aortic rupture. Freedom from ascending aorta dilatation within 13 years after BAV replacement was 95.1% in group 1 and 62.3% in group 2. Freedom from aortic dissection within 13 years after BAV replacement was 90.1% at the average (97% in group 1 and 80.6% in group 2). \u0000Conclusion. The tactics of aortic aneurysm correction in BAV depends on its diameter and, to a lesser extent, on the presence of stenosis or insufficiency of the valve. With existing stenosis and a diameter of the ascending aorta up to 4.5 cm, it is possible to consider correction without intervention on the ascending aorta. The presence of valve insufficiency in such a situation often requires additional manipulations on the ascending aorta.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45819352","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 : 2023-03-27DOI: 10.30702/ujcvs/23.31(01)/zhs014-4552
I. Zhekov, Oleh I. Sarhosh, Andrii V. Grytsiuk, Andrii I. Perepeliuk, A. Rudenko
The aim. To determine the effectiveness of myocardial protection in various variants of administration of cardioplegic solution in patients with aortic aneurysms combined with coronary artery lesions. Materials and methods. We analyzed 111 operations for aortic aneurysms combined with lesions of the coronary arteries, which were performed from 2011 to 2020 at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. The subjects were divided into four groups: group 1 where all three methods of cardioplegic solution administration (antegradely, retrogradely and into alloshunts) were used (60 [54.1%] patients), group 2 with administration of cardioplegic solution retrogradely and into alloshunts (48 [43.2%] patients), group 3 with antegrade and retrograde administration (2 [1.8%] patients), and group 4 with only retrograde administration of cardioplegic solution (1 [0.9%] patient). Of these operations, 19 (17.1%) were performed for acute type A aortic dissection, 4 (53.6%) for chronic type A aortic dissection, 88 (79.3%) for aortic aneurysm without dissection. The most common surgical interventions performed were: Robicsek procedure (41 [36.9%] interventions), Bentall – de Bono procedure (40 [36.0%] interventions), supracoronary ascending aortic replacement (22 [19.8%] operations), Wheat procedure (7 [6.3%] interventions). Results. According to our results, the aortic cross-clamp time was longer in group 2 (p < 0.05). The average time of extubation in groups 1 and 2 did not differ significantly (p > 0.05). At the same time, the average time of stay of patients in the intensive care unit differed significantly (p < 0.05) in patients of groups 1 (168.92 ± 121.54 h) and 2 (199.35 ± 214.42 h), which indicates faster recovery of patients of group 1. We diagnosed a total of 34 (30.6%) complications in 111 operated patients. A significant number of complications, namely 20 (33.3%) cases, were observed in group 1. The most frequent complications in this group were atrial fibrillation which occurred in 4 (6.7%) cases and hemorrhagic complications which were observed in 3 (5.0%) cases; of these, 1 (1.7%) case was with hemothorax and hemopericardium (this patient underwent rethoracotomy), 1 (1.7%) with hemopericardium and tamponade, and 1 (1.7%) with hemothorax. Of the 111 operations analyzed, 5 (4.5%) cases turned out to be fatal. Conclusions. The most effective method of introducing a cardioplegic solution in surgical interventions for aortic aneurysms combined with coronary artery lesions is the administration of cardioplegic solution antegradely, retrogradely and into alloshunts, after anastomosing thereof. This technique allows for the most effective protection of the myocardium by reducing the period of ischemia. In other cases, when it is impossible to introduce a cardioplegic solution antegradely (due to dissection of coronary arteries) or retrogradely (due to the presence of a persistent left
{"title":"Comparative Analysis of the Effectiveness of Different Options for the Administration of Cardioplegic Solution during Surgical Correction of an Aortic Aneurysm Combined with Coronary Artery Lesions","authors":"I. Zhekov, Oleh I. Sarhosh, Andrii V. Grytsiuk, Andrii I. Perepeliuk, A. Rudenko","doi":"10.30702/ujcvs/23.31(01)/zhs014-4552","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(01)/zhs014-4552","url":null,"abstract":"The aim. To determine the effectiveness of myocardial protection in various variants of administration of cardioplegic solution in patients with aortic aneurysms combined with coronary artery lesions. \u0000Materials and methods. We analyzed 111 operations for aortic aneurysms combined with lesions of the coronary arteries, which were performed from 2011 to 2020 at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. The subjects were divided into four groups: group 1 where all three methods of cardioplegic solution administration (antegradely, retrogradely and into alloshunts) were used (60 [54.1%] patients), group 2 with administration of cardioplegic solution retrogradely and into alloshunts (48 [43.2%] patients), group 3 with antegrade and retrograde administration (2 [1.8%] patients), and group 4 with only retrograde administration of cardioplegic solution (1 [0.9%] patient). Of these operations, 19 (17.1%) were performed for acute type A aortic dissection, 4 (53.6%) for chronic type A aortic dissection, 88 (79.3%) for aortic aneurysm without dissection. The most common surgical interventions performed were: Robicsek procedure (41 [36.9%] interventions), Bentall – de Bono procedure (40 [36.0%] interventions), supracoronary ascending aortic replacement (22 [19.8%] operations), Wheat procedure (7 [6.3%] interventions). \u0000Results. According to our results, the aortic cross-clamp time was longer in group 2 (p < 0.05). The average time of extubation in groups 1 and 2 did not differ significantly (p > 0.05). At the same time, the average time of stay of patients in the intensive care unit differed significantly (p < 0.05) in patients of groups 1 (168.92 ± 121.54 h) and 2 (199.35 ± 214.42 h), which indicates faster recovery of patients of group 1. We diagnosed a total of 34 (30.6%) complications in 111 operated patients. A significant number of complications, namely 20 (33.3%) cases, were observed in group 1. The most frequent complications in this group were atrial fibrillation which occurred in 4 (6.7%) cases and hemorrhagic complications which were observed in 3 (5.0%) cases; of these, 1 (1.7%) case was with hemothorax and hemopericardium (this patient underwent rethoracotomy), 1 (1.7%) with hemopericardium and tamponade, and 1 (1.7%) with hemothorax. Of the 111 operations analyzed, 5 (4.5%) cases turned out to be fatal. \u0000Conclusions. The most effective method of introducing a cardioplegic solution in surgical interventions for aortic aneurysms combined with coronary artery lesions is the administration of cardioplegic solution antegradely, retrogradely and into alloshunts, after anastomosing thereof. This technique allows for the most effective protection of the myocardium by reducing the period of ischemia. \u0000In other cases, when it is impossible to introduce a cardioplegic solution antegradely (due to dissection of coronary arteries) or retrogradely (due to the presence of a persistent left ","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48215625","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 : 2023-03-27DOI: 10.30702/ujcvs/23.31(01)/ko001-6065
I. Kobza, Y. Orel, H. Y. Orel, Y. Mota, T. Kobza, Yuriy Z. Khorkavyi
Introduction. Isolated superior mesenteric artery dissection (ISMAD) is a rare disease with high variability of clinical manifestations: from incidental findings to the development of acute or chronic mesenteric ischemia and the formation of aneurysms with the probability of their rupture. Despite significant world experience, surgical and conservative treatment of patients with ISMAD remains debatable. The aim. Improvement of the diagnosis and surgical treatment of patients with ISMAD. Clinical cases. In the first clinical observation, a 78-year-old patient with chronic visceral ischemia was diagnosed with an aneurysm of the upper mesenteric artery with signs of dissection and malperfusion. Previous unsuccessful attempts of endovascular treatment at another hospital caused the need for open surgical intervention – resection of the aneurysm and upper mesenteric artery reconstruction. In the second clinical case, a 61-year-old patient had acute abdominal pain syndrome, and based on clinical examination, laboratory and instrumental examination, the diagnosis of acute mesenteric ischemia with signs of dissection of the superior mesenteric artery was confirmed, which determined immediate indications for surgical treatment – resection of the affected segment of superior mesenteric artery and aorta-superior mesenteric bypass. The surgical interventions contributed to complete regression of clinical symptoms. Follow-up of the patients showed promising long-term results. Conclusion. Computed tomography angiography is the method of choice in the diagnosis of ISMAD and makes it possible to provide prompt diagnosis, determine treatment tactics and prevent the development of fatal complications. Open surgical intervention in some cases remains the method of choice in the treatment of ISMAD.
{"title":"Features of Surgical Treatment of Symptomatic Patients with Isolated Superior Mesenteric Artery Dissection (Clinical Cases and Literature Review)","authors":"I. Kobza, Y. Orel, H. Y. Orel, Y. Mota, T. Kobza, Yuriy Z. Khorkavyi","doi":"10.30702/ujcvs/23.31(01)/ko001-6065","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(01)/ko001-6065","url":null,"abstract":"Introduction. Isolated superior mesenteric artery dissection (ISMAD) is a rare disease with high variability of clinical manifestations: from incidental findings to the development of acute or chronic mesenteric ischemia and the formation of aneurysms with the probability of their rupture. Despite significant world experience, surgical and conservative treatment of patients with ISMAD remains debatable. \u0000The aim. Improvement of the diagnosis and surgical treatment of patients with ISMAD. \u0000Clinical cases. \u0000In the first clinical observation, a 78-year-old patient with chronic visceral ischemia was diagnosed with an aneurysm of the upper mesenteric artery with signs of dissection and malperfusion. Previous unsuccessful attempts of endovascular treatment at another hospital caused the need for open surgical intervention – resection of the aneurysm and upper mesenteric artery reconstruction. \u0000 \u0000In the second clinical case, a 61-year-old patient had acute abdominal pain syndrome, and based on clinical examination, laboratory and instrumental examination, the diagnosis of acute mesenteric ischemia with signs of dissection of the superior mesenteric artery was confirmed, which determined immediate indications for surgical treatment – resection of the affected segment of superior mesenteric artery and aorta-superior mesenteric bypass. \u0000 \u0000The surgical interventions contributed to complete regression of clinical symptoms. Follow-up of the patients showed promising long-term results. \u0000 \u0000Conclusion. Computed tomography angiography is the method of choice in the diagnosis of ISMAD and makes it possible to provide prompt diagnosis, determine treatment tactics and prevent the development of fatal complications. Open surgical intervention in some cases remains the method of choice in the treatment of ISMAD.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48743310","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 : 2023-03-27DOI: 10.30702/ujcvs/23.31(01)/k013-2935
H. B. Koltunova
Background. Management of patients with infective endocarditis (IE) has changed rapidly in recent years with improvements in diagnostic procedures and early aggressive surgical treatment. The annual incidence of IE in high-income countries has reached 9 cases per 100,000 population. Approximately half of patients with IE require surgical treatment due to severe complications, the most common of which is acute heart failure (AHF), which occurs in 40–60% of cases. Clinical scenarios of IE are often complex, requiring rapid diagnostic measures and early appointment of surgical intervention. The aim. To determine the preoperative algorithm of diagnostic and therapeutic measures in the presence of signs of AHF in patients with IE. Materials and methods. The basis of this study is the clinical data of 311 patients with active IE who underwent examination and treatment at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medi- cal Sciences of Ukraine from 01/01/2019 to 10/22/2021. The diagnosis of IE was established in accordance with Duke Endocarditis Service criteria proposed in 1994. The average age of the studied patients was 47.9 ± 3.83 (19 to 77) years. Results. In order to determine the degree of AHF at the preoperative stage, all the patients were divided into 4 groups according to the New York Heart Association functional classification. Preoperative clinical data of IE patients with signs of AHF comprised the basis for functional class IV (59 [18.9%] cases) and formed the studied group. For preoperative diagnosis of AHF, cardiohemodynamic data was obtained based on the results of echocardiographic parameters and level of N-terminal pro-B-type natriuretic peptide (NTproBNP). In order to improve the diagnosis of AHF, tactics of preoperative examination of patients with IE were developed. In our study, the following echocardiographic examination results were indicative in the diagnosis of IE complicated by heart failure: detection of vegetations on the leaflets of the left heart valves, end-diastolic index >94.3 ml/m2, end-systolic index >40.8 ml/m2, pulmonary artery pressure >50 mm Hg. The main biochemical marker of AHF in the group of patients with IE was the threshold level of NTproBNP greater than 7473.7 pg/ml. Identified changes in cardiohemodynamic and biochemical indicators became independent indications for hospitalization in the intensive care unit and emergency preoperative preparation. Conclusions. During hospitalization of patients with IE to the cardiosurgical center, the basis of the effectiveness of the provided care is the timely diagnosis of complications of the underlying disease. Based on the results of the work, the protocol for preoperative AHF diagnosis was developed. Critical levels of biochemical and hemodynamic indicators in patients with IE became an independent indication for hospitalization to the intensive care unit and emergency preoperative management. The early start of in
背景。近年来，随着诊断方法的改进和早期积极的手术治疗，感染性心内膜炎(IE)患者的管理发生了迅速变化。在高收入国家，IE的年发病率已达到每10万人9例。由于严重的并发症，大约一半的IE患者需要手术治疗，其中最常见的是急性心力衰竭(AHF)，发生在40-60%的病例中。IE的临床情况往往是复杂的，需要快速诊断措施和早期预约手术干预。的目标。确定IE患者存在AHF体征时的诊断和治疗措施的术前算法。材料和方法。本研究的基础是311例活动性IE患者的临床数据，这些患者于2019年1月1日至2021年10月22日在乌克兰国家医学科学院国家阿莫索夫心血管外科研究所接受了检查和治疗。IE的诊断是根据1994年提出的Duke心内膜炎服务标准建立的。患者平均年龄为47.9±3.83(19 ~ 77)岁。结果。为了确定术前AHF的程度，所有患者按照纽约心脏协会功能分类分为4组。伴有AHF体征的IE患者的术前临床资料构成功能级IV(59例[18.9%])的基础，构成研究组。术前诊断AHF时，根据超声心动图参数和n端前b型利钠肽(NTproBNP)水平获得血流动力学数据。为了提高AHF的诊断水平，提出了IE患者的术前检查策略。在我们的研究中，超声心动图检查结果对IE合并心衰的诊断具有指示性:左心瓣膜小叶植被、舒张末期指数>94.3 ml/m2、收缩末期指数>40.8 ml/m2、肺动脉压>50 mm Hg。IE患者AHF的主要生化指标为NTproBNP阈值水平大于7473.7 pg/ml。确定的心血管动力学和生化指标的变化成为重症监护病房住院和急诊术前准备的独立指征。结论。在IE患者到心外科中心住院期间，所提供护理的有效性的基础是及时诊断潜在疾病的并发症。根据工作结果，制定了AHF术前诊断方案。IE患者的生化和血流动力学指标的临界水平成为重症监护病房住院和急诊术前管理的独立指征。IE中AHF的早期重症监护是可能影响治疗策略选择的一个基本因素。
{"title":"Tactics of Preoperative Examination of Patients with Infective Endocarditis Complicated by Acute Heart Failure","authors":"H. B. Koltunova","doi":"10.30702/ujcvs/23.31(01)/k013-2935","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(01)/k013-2935","url":null,"abstract":"Background. Management of patients with infective endocarditis (IE) has changed rapidly in recent years with improvements in diagnostic procedures and early aggressive surgical treatment. The annual incidence of IE in high-income countries has reached 9 cases per 100,000 population. Approximately half of patients with IE require surgical treatment due to severe complications, the most common of which is acute heart failure (AHF), which occurs in 40–60% of cases. Clinical scenarios of IE are often complex, requiring rapid diagnostic measures and early appointment of surgical intervention. The aim. To determine the preoperative algorithm of diagnostic and therapeutic measures in the presence of signs of AHF in patients with IE. Materials and methods. The basis of this study is the clinical data of 311 patients with active IE who underwent examination and treatment at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medi- cal Sciences of Ukraine from 01/01/2019 to 10/22/2021. The diagnosis of IE was established in accordance with Duke Endocarditis Service criteria proposed in 1994. The average age of the studied patients was 47.9 ± 3.83 (19 to 77) years. Results. In order to determine the degree of AHF at the preoperative stage, all the patients were divided into 4 groups according to the New York Heart Association functional classification. Preoperative clinical data of IE patients with signs of AHF comprised the basis for functional class IV (59 [18.9%] cases) and formed the studied group. For preoperative diagnosis of AHF, cardiohemodynamic data was obtained based on the results of echocardiographic parameters and level of N-terminal pro-B-type natriuretic peptide (NTproBNP). In order to improve the diagnosis of AHF, tactics of preoperative examination of patients with IE were developed. In our study, the following echocardiographic examination results were indicative in the diagnosis of IE complicated by heart failure: detection of vegetations on the leaflets of the left heart valves, end-diastolic index >94.3 ml/m2, end-systolic index >40.8 ml/m2, pulmonary artery pressure >50 mm Hg. The main biochemical marker of AHF in the group of patients with IE was the threshold level of NTproBNP greater than 7473.7 pg/ml. Identified changes in cardiohemodynamic and biochemical indicators became independent indications for hospitalization in the intensive care unit and emergency preoperative preparation. Conclusions. During hospitalization of patients with IE to the cardiosurgical center, the basis of the effectiveness of the provided care is the timely diagnosis of complications of the underlying disease. Based on the results of the work, the protocol for preoperative AHF diagnosis was developed. Critical levels of biochemical and hemodynamic indicators in patients with IE became an independent indication for hospitalization to the intensive care unit and emergency preoperative management. The early start of in","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46812735","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 : 2023-03-27DOI: 10.30702/ujcvs/23.31(01)/pk002-6673
Y. Popovich, Vyacheslav V. Korsak, P. Boldizhar, Orest P. Laver
The aim. To evaluate the effectiveness of surgical methods of prevention of venous thromboembolic complications in transfascial thrombosis of the lower extremities. Materials and methods. The paper analyzes the results of examination and surgical or conservative treatment of 417 patients with transfascial thrombosis treated at the Vascular Surgery Department of the Zakarpattia Regional Clinical Hospital named after A. Novak from 1995 to March 2020 and at the Surgical Department of the Central City Clinical Hospital of Uzhhorod from September 2020 to September 2022. The main (I) group consisted of 349 (83.7%) patients who were operated for transfascial thrombosis. The control (II) group consisted of 68 (16.3%) patients with transfascial thrombosis who received conservative treatment. Results. In case of acute varicothrombophlebitis complicated by transfascial thrombosis, the scope of surgery should be expanded in order to surgically prevent thromboembolism of the pulmonary artery. All the patients with transfascial thrombosis were treated as for deep vein thrombosis. The approach to the removal of the small saphenous vein should be differentiated depending on the extent of thrombotic occlusion and the confluence of the sural veins. Surgical treatment of patients with transfascial thrombosis made it possible to prevent recurrence of the thrombotic process in the superficial and deep veins of the lower extremities, thromboembolism of the pulmonary artery, while with conservative treatment their frequency was 5.1%, 3.4% and 3.4%, respectively. Active surgical tactics in patients of the I group made it possible to reduce the frequency of manifestations of decompensated chronic venous insufficiency from 27.1% to 7.0%, and manifestations of postthrombotic syndrome in the deep veins of the lower extremities from 100% to 3.7%. Conclusions. Implementation of operative treatment of acute varicothrombophlebitis complicated by transfascial thrombosis allows to effectively prevent venous thromboembolic complications, eliminate manifestations of chronic venous insufficiency and prevent the development of post-thrombotic changes in superficial and deep veins.
{"title":"Surgical Prevention of Thromboembolic Complications in Transfascial Thrombosis","authors":"Y. Popovich, Vyacheslav V. Korsak, P. Boldizhar, Orest P. Laver","doi":"10.30702/ujcvs/23.31(01)/pk002-6673","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(01)/pk002-6673","url":null,"abstract":"The aim. To evaluate the effectiveness of surgical methods of prevention of venous thromboembolic complications in transfascial thrombosis of the lower extremities. \u0000Materials and methods. The paper analyzes the results of examination and surgical or conservative treatment of 417 patients with transfascial thrombosis treated at the Vascular Surgery Department of the Zakarpattia Regional Clinical Hospital named after A. Novak from 1995 to March 2020 and at the Surgical Department of the Central City Clinical Hospital of Uzhhorod from September 2020 to September 2022. The main (I) group consisted of 349 (83.7%) patients who were operated for transfascial thrombosis. The control (II) group consisted of 68 (16.3%) patients with transfascial thrombosis who received conservative treatment. \u0000Results. In case of acute varicothrombophlebitis complicated by transfascial thrombosis, the scope of surgery should be expanded in order to surgically prevent thromboembolism of the pulmonary artery. All the patients with transfascial thrombosis were treated as for deep vein thrombosis. The approach to the removal of the small saphenous vein should be differentiated depending on the extent of thrombotic occlusion and the confluence of the sural veins. Surgical treatment of patients with transfascial thrombosis made it possible to prevent recurrence of the thrombotic process in the superficial and deep veins of the lower extremities, thromboembolism of the pulmonary artery, while with conservative treatment their frequency was 5.1%, 3.4% and 3.4%, respectively. Active surgical tactics in patients of the I group made it possible to reduce the frequency of manifestations of decompensated chronic venous insufficiency from 27.1% to 7.0%, and manifestations of postthrombotic syndrome in the deep veins of the lower extremities from 100% to 3.7%. \u0000Conclusions. Implementation of operative treatment of acute varicothrombophlebitis complicated by transfascial thrombosis allows to effectively prevent venous thromboembolic complications, eliminate manifestations of chronic venous insufficiency and prevent the development of post-thrombotic changes in superficial and deep veins.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48105180","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 : 2023-03-27DOI: 10.30702/ujcvs/23.31(01)/g005-1018
O. Gogayeva
The aim. To analyze the effectiveness of the developed algorithms for the perioperative management of high-risk cardiac surgery patients with coronary artery disease (CAD) and polymorbidity. Materials and methods. We analyzed perioperative management of 354 high-risk cardiac surgery patients with CAD with EuroSCORE II predicted mortality >5%, among which 194 (54.8%) underwent isolated coronary artery bypass grafting, and 160 (45.2%) had surgical myocardial revascularization with accompanying valvular pathology correction or left ventricular postinfarction aneurysm resection. All the patients were discharged after cardiac surgery performed at the Department of Surgical Treatment of CAD of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine in the period from 2009 to 2019. As part of the study, general clinical examinations, electrocardiography, echocardiography, coronary angiography, cardiosurgical treatment were provided, and perioperative patient management protocols were developed and implemented. Results. Based on the conducted detailed analysis, it was established that the success of surgical revascularization of the myocardium depends not only on cardiac factors, but also on the compensation of concomitant diseases, the work of an experienced cardiac team consisting of a cardiologist, an interventionist, an anesthesiologist, a cardiac surgeon, and an intensivist. Treatment and prevention measures should be personalized and aimed at timely response to changes in laboratory and hemodynamic indicators of patients at all stages of their management, as well as stabilization of concomitant diseases. An important point in the preoperative preparation of cardiac surgery patients is verification of concomitant diseases with the aim of their timely compensation. The implemented algorithm for searching for comorbid conditions made it possible to improve the diagnosis of initial disorders of glucose metabolism, abnormal uric acid levels and cerebrovascular disease. Lowering the glucose level according to the developed algorithm of management of patients with impaired glucose metabolism in the perioperative period made it possible to reduce the number of postoperative wound infections by 3.4% and arrhythmological complications by 19.4%. Correction of drug therapy taking into account the glomerular filtration rate made it possible to avoid postoperative hemodialysis. Preventive prescription of therapeutic doses of proton pump inhibitors against the background of dual antiplatelet therapy, according to the developed protocol, led to a decrease in postoperative gastroduodenal complications from 5.1% to 0.3%. Conclusions. Implementation of the system of personalized treatment and preventive management of patients in the perioperative period made it possible to reduce postoperative complications from 16.7% to 4% (p=0.0190).
{"title":"Algorithms of Perioperative Management of High-Risk Cardiac Surgery Patients with Coronary Artery Disease and Polymorbidity","authors":"O. Gogayeva","doi":"10.30702/ujcvs/23.31(01)/g005-1018","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(01)/g005-1018","url":null,"abstract":"The aim. To analyze the effectiveness of the developed algorithms for the perioperative management of high-risk cardiac surgery patients with coronary artery disease (CAD) and polymorbidity. \u0000Materials and methods. We analyzed perioperative management of 354 high-risk cardiac surgery patients with CAD with EuroSCORE II predicted mortality >5%, among which 194 (54.8%) underwent isolated coronary artery bypass grafting, and 160 (45.2%) had surgical myocardial revascularization with accompanying valvular pathology correction or left ventricular postinfarction aneurysm resection. All the patients were discharged after cardiac surgery performed at the Department of Surgical Treatment of CAD of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine in the period from 2009 to 2019. As part of the study, general clinical examinations, electrocardiography, echocardiography, coronary angiography, cardiosurgical treatment were provided, and perioperative patient management protocols were developed and implemented. \u0000Results. Based on the conducted detailed analysis, it was established that the success of surgical revascularization of the myocardium depends not only on cardiac factors, but also on the compensation of concomitant diseases, the work of an experienced cardiac team consisting of a cardiologist, an interventionist, an anesthesiologist, a cardiac surgeon, and an intensivist. Treatment and prevention measures should be personalized and aimed at timely response to changes in laboratory and hemodynamic indicators of patients at all stages of their management, as well as stabilization of concomitant diseases. An important point in the preoperative preparation of cardiac surgery patients is verification of concomitant diseases with the aim of their timely compensation. The implemented algorithm for searching for comorbid conditions made it possible to improve the diagnosis of initial disorders of glucose metabolism, abnormal uric acid levels and cerebrovascular disease. Lowering the glucose level according to the developed algorithm of management of patients with impaired glucose metabolism in the perioperative period made it possible to reduce the number of postoperative wound infections by 3.4% and arrhythmological complications by 19.4%. Correction of drug therapy taking into account the glomerular filtration rate made it possible to avoid postoperative hemodialysis. Preventive prescription of therapeutic doses of proton pump inhibitors against the background of dual antiplatelet therapy, according to the developed protocol, led to a decrease in postoperative gastroduodenal complications from 5.1% to 0.3%. \u0000Conclusions. Implementation of the system of personalized treatment and preventive management of patients in the perioperative period made it possible to reduce postoperative complications from 16.7% to 4% (p=0.0190).","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44022629","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 : 2023-03-27DOI: 10.30702/ujcvs/23.31(01)/pb006-8085
V. Popov, O. Bolshak, V. Boukarim, Olena V. Khoroshkovata, O. M. Gurtovenko, K. Pukas
Background. Comprehensive reconstruction of the left and right parts of the heart in giant left atriomegaly, adequate tactics of mitral valve replacement in case of concomitant tricuspid insufficiency and dilation of the right atrium lead to an improvement in the functional state of the myocardium as early as at the hospital stage. Case description. Patient B., a 67-year-old woman, was examined and treated from July 12 to August 2, 2016 at the Department of Surgical Treatment of Acquired Heart Diseases of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with a diagnosis: stage IV mitral restenosis, condition after closed mitral commissurotomy in 2001, critically small cavity of the left ventricle, giant left atriomegaly, IV degree tricuspid insufficiency, right atriomegaly, high pulmonary hypertension, permanent form of atrial fibrillation for 15 years since 2001, NYHA class IV heart failure, IIB. The patient underwent surgical intervention: mitral valve replacement + W-shaped plastic surgery of the left atrium in combination with dosed resection of left atrium + tricuspid valve plasty with the imposition of a support ring + resection of the right atrium. Conclusion. Given the initial serious condition of the patient with advanced mitral restenosis, critically small left ventricular cavity, giant left atriomegaly of 169.4 × 115.8 mm (according to computed tomography) and high pulmonary hypertension (65 mm Hg), concomitant pathology of the right parts of the heart (tricuspid insufficiency and right atriomegaly), adequate tactics in mitral valve replacement and radical correction of the left atriomegaly lead to an improvement in the functional state of the heart as early as at the hospital stage.
背景在巨大的左心房中对心脏的左、右部分进行全面重建，在合并三尖瓣功能不全的情况下采用适当的二尖瓣置换策略，并扩大右心房，可以早在医院阶段改善心肌的功能状态。案例描述。患者B是一名67岁的女性，于2016年7月12日至8月2日在乌克兰国家医学科学院国家阿莫索夫心血管外科研究所获得性心脏病外科接受检查和治疗，诊断为：二尖瓣IV期再狭窄，2001年闭合性二尖瓣连合切开术后的情况，严重的左心室小腔，巨大的左心房肥大，IV度三尖瓣功能不全，右心房肥大，高肺动脉高压，自2001年以来15年的永久性心房颤动，NYHA IV级心力衰竭，IIB。患者接受了手术干预：二尖瓣置换术+左心房W形整形手术结合左心房剂量切除术+三尖瓣成形术加支撑环+右心房切除术。结论考虑到患者最初的严重情况，包括晚期二尖瓣再狭窄、左心室腔极小、169.4×115.8 mm的巨大左心房肥大（根据计算机断层扫描）和高肺动脉高压（65 mm Hg），以及心脏右侧部分的伴随病理学（三尖瓣功能不全和右心房肥大），二尖瓣置换术和左心房肥大根治术的适当策略可以在医院早期改善心脏的功能状态。
{"title":"Surgical Reconstruction of Mitral Restenosis Complicated by a Critically Small Left Ventricular Cavity and Giant Left and Right Atriomegaly (Clinical Case)","authors":"V. Popov, O. Bolshak, V. Boukarim, Olena V. Khoroshkovata, O. M. Gurtovenko, K. Pukas","doi":"10.30702/ujcvs/23.31(01)/pb006-8085","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(01)/pb006-8085","url":null,"abstract":"Background. Comprehensive reconstruction of the left and right parts of the heart in giant left atriomegaly, adequate tactics of mitral valve replacement in case of concomitant tricuspid insufficiency and dilation of the right atrium lead to an improvement in the functional state of the myocardium as early as at the hospital stage. \u0000Case description. Patient B., a 67-year-old woman, was examined and treated from July 12 to August 2, 2016 at the Department of Surgical Treatment of Acquired Heart Diseases of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with a diagnosis: stage IV mitral restenosis, condition after closed mitral commissurotomy in 2001, critically small cavity of the left ventricle, giant left atriomegaly, IV degree tricuspid insufficiency, right atriomegaly, high pulmonary hypertension, permanent form of atrial fibrillation for 15 years since 2001, NYHA class IV heart failure, IIB. \u0000The patient underwent surgical intervention: mitral valve replacement + W-shaped plastic surgery of the left atrium in combination with dosed resection of left atrium + tricuspid valve plasty with the imposition of a support ring + resection of the right atrium. \u0000Conclusion. Given the initial serious condition of the patient with advanced mitral restenosis, critically small left ventricular cavity, giant left atriomegaly of 169.4 × 115.8 mm (according to computed tomography) and high pulmonary hypertension (65 mm Hg), concomitant pathology of the right parts of the heart (tricuspid insufficiency and right atriomegaly), adequate tactics in mitral valve replacement and radical correction of the left atriomegaly lead to an improvement in the functional state of the heart as early as at the hospital stage.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49609475","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 : 2023-03-27DOI: 10.30702/ujcvs/23.31(01)/dp010-3644
I. Ditkivskyy, Maksym S. Petrov, Denys L. Voloshyn, N. Yashchuk, V. Lazoryshynets
According to European guidelines, endovascular closure is the method of choice for defects with favorable anatomy. However, there are no clear criteria for determining favorable anatomy and this issue requires additional investigation. According to literature data, only 24.2% of secundum atrial septal defects (ASDII) have a central location, others have complicated anatomy. The aim. To analyze the experience of endovascular closure of ASDII with complex anatomy. Materials. In the period from 2003 to 2021, 1732 transesophageal echocardiographies and intracardiac echocardiographieswereperformedinpatientswithASDIIinitiallydiagnosedaccordingtotransthoracicechocardiography, and only 1408 (91.8%) were selected for endovascular closure. Mean age was 19.9±18 years, mean weight was 45±26.68 kg. Methods. The standard closure technique was primarily used in 100% of cases, and only when it was ineffective, we used modified techniques. Results. Modified techniques were used in 478 (33.9%) of 1408 patients and were effective in 460 (96.2%) patients with the complex anatomy. Based on previous statement, 460 (32.6%) of 1408 patients (one third of all) had modified techniques utilized and avoided open surgery. In 18 (1.3%) cases, it was impossible to close the defect. The overall technical success of transcatheter closure was 98.7% (1390 patients). Nineteen (1.3%) patients with poor visualization of inferior rim on transesophageal echocardiography had intracardiac echocardiography; in two of them inferior rim was present, others had open surgery. The rate of complications in immediate periprocedural period was 1.9% (27 patients). One death was recorded in the period of introduction of percutaneous interventions in our institution. Mean follow-up period was 5.41±3.28 years. In the follow-up period two complications were observed: 1 case of erosion, 17 (1.9%) cases of new-onset atrial fibrillation. Conclusion. The majority (90.6%) of ASDII can be closed percutaneously. Modified techniques improve the efficacy of the procedure enabling to close 32.6% of the defects. Safe procedure for the defects with complex anatomy is possible only with surgical and arrhythmological services back-up.
{"title":"Endovascular Closure of Secundum Atrial Septal Defects with Complex Anatomy","authors":"I. Ditkivskyy, Maksym S. Petrov, Denys L. Voloshyn, N. Yashchuk, V. Lazoryshynets","doi":"10.30702/ujcvs/23.31(01)/dp010-3644","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(01)/dp010-3644","url":null,"abstract":"According to European guidelines, endovascular closure is the method of choice for defects with favorable anatomy. However, there are no clear criteria for determining favorable anatomy and this issue requires additional investigation. According to literature data, only 24.2% of secundum atrial septal defects (ASDII) have a central location, others have complicated anatomy. \u0000The aim. To analyze the experience of endovascular closure of ASDII with complex anatomy. Materials. In the period from 2003 to 2021, 1732 transesophageal echocardiographies and intracardiac echocardiographieswereperformedinpatientswithASDIIinitiallydiagnosedaccordingtotransthoracicechocardiography, and only 1408 (91.8%) were selected for endovascular closure. Mean age was 19.9±18 years, mean weight was 45±26.68 kg. \u0000Methods. The standard closure technique was primarily used in 100% of cases, and only when it was ineffective, we used modified techniques. \u0000Results. Modified techniques were used in 478 (33.9%) of 1408 patients and were effective in 460 (96.2%) patients with the complex anatomy. Based on previous statement, 460 (32.6%) of 1408 patients (one third of all) had modified techniques utilized and avoided open surgery. In 18 (1.3%) cases, it was impossible to close the defect. The overall technical success of transcatheter closure was 98.7% (1390 patients). Nineteen (1.3%) patients with poor visualization of inferior rim on transesophageal echocardiography had intracardiac echocardiography; in two of them inferior rim was present, others had open surgery. The rate of complications in immediate periprocedural period was 1.9% (27 patients). One death was recorded in the period of introduction of percutaneous interventions in our institution. Mean follow-up period was 5.41±3.28 years. In the follow-up period two complications were observed: 1 case of erosion, 17 (1.9%) cases of new-onset atrial fibrillation. \u0000Conclusion. The majority (90.6%) of ASDII can be closed percutaneously. Modified techniques improve the efficacy of the procedure enabling to close 32.6% of the defects. Safe procedure for the defects with complex anatomy is possible only with surgical and arrhythmological services back-up.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47460575","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 : 2023-03-27DOI: 10.30702/ujcvs/23.31(01)/khch004-7479
Y. Khrebtiy, L. Chernukha, Oleh M. Skupyy, V. M. Maiko, H. Khrebtii
The aim. Treatment of venous thromboembolism continues to be one of the most controversial problems of modern angiology. This issue is especially relevant in the treatment of patients with traumatological pathology. Methods. Treatment of 1915 patients with fractures of lower extremities from 2017 to 2022 at the Vinnytsia Regional Pyrohov Clinical Hospital was analyzed. During the study period, 727 (38%) deep vein thromboses were diagnosed. Results. During the study period, 4 (0.2%) pulmonary embolisms were diagnosed, among which 3 (0.15%) were fatal. In 99.5% of patients with venous thrombosis and injuries, it was possible to achieve clinical improvement and regression of the thrombotic process. Conclusions. Treatment tactics for trauma patients with venous thromboembolism should be individualized and take into account the severity and localization of the injury, the need and urgency of trauma surgery, the risk of pulmonary embolism.
{"title":"Treatment of Venous Thromboembolism in Trauma Patients: Features and Possibilities","authors":"Y. Khrebtiy, L. Chernukha, Oleh M. Skupyy, V. M. Maiko, H. Khrebtii","doi":"10.30702/ujcvs/23.31(01)/khch004-7479","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(01)/khch004-7479","url":null,"abstract":"The aim. Treatment of venous thromboembolism continues to be one of the most controversial problems of modern angiology. This issue is especially relevant in the treatment of patients with traumatological pathology. \u0000Methods. Treatment of 1915 patients with fractures of lower extremities from 2017 to 2022 at the Vinnytsia Regional Pyrohov Clinical Hospital was analyzed. During the study period, 727 (38%) deep vein thromboses were diagnosed. \u0000Results. During the study period, 4 (0.2%) pulmonary embolisms were diagnosed, among which 3 (0.15%) were fatal. \u0000In 99.5% of patients with venous thrombosis and injuries, it was possible to achieve clinical improvement and regression of the thrombotic process. \u0000Conclusions. Treatment tactics for trauma patients with venous thromboembolism should be individualized and take into account the severity and localization of the injury, the need and urgency of trauma surgery, the risk of pulmonary embolism.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42485448","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 : 2023-03-27DOI: 10.30702/ujcvs/23.31(01)/nm009-1928
V. Netiazhenko, Serhii E. Mostovyi, Olha M. Safonova
The aim. To study the impact of COVID-19 upon intracardiac hemodynamics and heart rate variability (HRV) in stable coronary artery disease (SCAD) patients. Materials and methods. In this cross-sectional study we analyzed clinical and instrumental data obtained from a sample of 80 patients. The patients were divided into three groups: group 1 included patients with SCAD without COVID-19 (n=30), group 2 included patients with SCAD and COVID-19 (n=25), and group 3 included patients with COVID-19 without SCAD (n=25). The control group included 30 relatively healthy volunteers. Results. The changes in intracardiac hemodynamics and HRV in group 2 were characterized by the impaired left ventricular systolic and diastolic function, dilation of both ventricles and elevated systolic pulmonary artery pressure. Left ventricular end-diastolic volume was higher in group 2 (205±21 ml) than that in group 1 (176±33 ml; р<0.001) and group 3 (130±21 ml; р<0.001). Patients in the groups 1–3, compared to controls, presented with the decrease in the overall HRV (by standard deviation [SD] of all NN intervals [SDNN]; SD of the averages of NN intervals in all 5 min segments of the entire recording; and mean of the SDs of all NN intervals for all 5 min segments of the entire recording) and parasympathetic activity (root-mean-square difference of successive NN intervals; the proportion derived by dividing the number of interval differences of successive NN intervals greater than 50 ms [NN50] by the total number of NN intervals [pNN50], and high frequency spectral component), along with QT interval prolongation and increase in its variability. Group 2 demonstrated the most advanced changes in HRV (by SDNN and pNN50) and both QT interval characteristics. Conclusions. The patients with SCAD and concomitant COVID-19, along with both ventricles dilation and intracardiac hemodynamics impairment, presented with the sings of autonomic dysfunction, QT interval prolongation and increase in its variability. The heart rate variability and QT interval characteristics should be additionally considered in the management of such patients.
{"title":"The Impact of COVID-19 upon Intracardiac Hemodynamics and Heart Rate Variability in Stable Coronary Artery Disease Patients","authors":"V. Netiazhenko, Serhii E. Mostovyi, Olha M. Safonova","doi":"10.30702/ujcvs/23.31(01)/nm009-1928","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(01)/nm009-1928","url":null,"abstract":"The aim. To study the impact of COVID-19 upon intracardiac hemodynamics and heart rate variability (HRV) in stable coronary artery disease (SCAD) patients. \u0000Materials and methods. In this cross-sectional study we analyzed clinical and instrumental data obtained from a sample of 80 patients. The patients were divided into three groups: group 1 included patients with SCAD without COVID-19 (n=30), group 2 included patients with SCAD and COVID-19 (n=25), and group 3 included patients with COVID-19 without SCAD (n=25). The control group included 30 relatively healthy volunteers. \u0000Results. The changes in intracardiac hemodynamics and HRV in group 2 were characterized by the impaired left ventricular systolic and diastolic function, dilation of both ventricles and elevated systolic pulmonary artery pressure. Left ventricular end-diastolic volume was higher in group 2 (205±21 ml) than that in group 1 (176±33 ml; р<0.001) and group 3 (130±21 ml; р<0.001). Patients in the groups 1–3, compared to controls, presented with the decrease in the overall HRV (by standard deviation [SD] of all NN intervals [SDNN]; SD of the averages of NN intervals in all 5 min segments of the entire recording; and mean of the SDs of all NN intervals for all 5 min segments of the entire recording) and parasympathetic activity (root-mean-square difference of successive NN intervals; the proportion derived by dividing the number of interval differences of successive NN intervals greater than 50 ms [NN50] by the total number of NN intervals [pNN50], and high frequency spectral component), along with QT interval prolongation and increase in its variability. Group 2 demonstrated the most advanced changes in HRV (by SDNN and pNN50) and both QT interval characteristics. \u0000Conclusions. The patients with SCAD and concomitant COVID-19, along with both ventricles dilation and intracardiac hemodynamics impairment, presented with the sings of autonomic dysfunction, QT interval prolongation and increase in its variability. The heart rate variability and QT interval characteristics should be additionally considered in the management of such patients.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48020367","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}
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