Pub Date : 2022-12-26DOI: 10.30702/ujcvs/22.30(04)/oo055-8893
Y. Orel, H. Y. Orel, Yuriy Z. Khorkavyi, Oleg M. Slabyy
Despite the insigniϐicant prevalence, aneurysms of the splenicartery take a dominant share among all visceral aneurysms with a predominance of morbidity in women of childbearing age. Taking into account the mostly asymptomatic course and the high risk of mortality due to its rupture, timely diagnosis and correct treatment strategy remain extremely important. Questions regarding the choice of surgical treatment tactics for patients with this pathology remain debatable. The aim. Demonstration of a clinical case, improvement of diagnosis andsurgical treatment of patients with splenic artery aneurysms. Clinical case. Female patient G., 32 years old, with complaints of periodic pain in the left hypochondrium, signs of portal hypertension against the background of cavernous transformationof the portal vein, history of recurrent bleeding from the esophageal veins, hypersplenism admitted with a pre-diagnosed aneurysm of the splenic artery of giant dimensions (diameter 8x5 cm). The patient was qualified for open surgery and aneurysm resection with splenectomy and spleen autotransplantation by N. Roth. The postoperative period was complicated by the occurrence of reactive pancreatitis on day 7, which was successfully treated conservatively. In the future, the course was unremarkable. The remote follow-up lasted two years, and no recurrence of the aneurysm was detected. The performed immunogram showed normal results. Conclusion. The timely diagnosis makes it possible to establish the correct diagnosis, justify the treatment tactics and prevent fatal complications. Open surgical intervention in somecases remains the method of choice in the treatment of this pathology. Autotransplantation of the spleen has shown good long-term results and can be performed in patients of this category for the prevention of immunodeficiency states.
{"title":"Features of Surgical Treatment of Patients with Splenic Artery Aneurysms (Case Report and Literature Review)","authors":"Y. Orel, H. Y. Orel, Yuriy Z. Khorkavyi, Oleg M. Slabyy","doi":"10.30702/ujcvs/22.30(04)/oo055-8893","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(04)/oo055-8893","url":null,"abstract":"Despite the insigniϐicant prevalence, aneurysms of the splenicartery take a dominant share among all visceral aneurysms with a predominance of morbidity in women of childbearing age. Taking into account the mostly asymptomatic course and the high risk of mortality due to its rupture, timely diagnosis and correct treatment strategy remain extremely important. Questions regarding the choice of surgical treatment tactics for patients with this pathology remain debatable. \u0000The aim. Demonstration of a clinical case, improvement of diagnosis andsurgical treatment of patients with splenic artery aneurysms. \u0000Clinical case. Female patient G., 32 years old, with complaints of periodic pain in the left hypochondrium, signs of portal hypertension against the background of cavernous transformationof the portal vein, history of recurrent bleeding from the esophageal veins, hypersplenism admitted with a pre-diagnosed aneurysm of the splenic artery of giant dimensions (diameter 8x5 cm). The patient was qualified for open surgery and aneurysm resection with splenectomy and spleen autotransplantation by N. Roth. The postoperative period was complicated by the occurrence of reactive pancreatitis on day 7, which was successfully treated conservatively. In the future, the course was unremarkable. The remote follow-up lasted two years, and no recurrence of the aneurysm was detected. The performed immunogram showed normal results. \u0000Conclusion. The timely diagnosis makes it possible to establish the correct diagnosis, justify the treatment tactics and prevent fatal complications. Open surgical intervention in somecases remains the method of choice in the treatment of this pathology. Autotransplantation of the spleen has shown good long-term results and can be performed in patients of this category for the prevention of immunodeficiency states.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48841199","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 : 2022-12-26DOI: 10.30702/ujcvs/22.30(04)/km057-2025
M. Kucheriava, G. Mankovsky
The aim. To evaluate the results of incomplete myocardial revascularization with percutaneous coronary intervention (PCI) in patients with ischemic cardiomyopathy and heart failure with reduced left ventricular ejection fraction based on the residual SYNTAX Score (rSS) scale. Materials and methods. This prospective observational one-center study was conducted at the Ukrainian Children’s Cardiac Center, Clinic for Adults and included 192 patients whounderwent coronary angiography and myocardial re-vascularization using PCI. Baseline demographic and clinical parameters, including gender, age, presence of comorbid pathology were obtained from the medical history of each patient retrospectively. The results of revascularization were evaluated over a period of 2 years (from March 2020 to March 2022). To assess the completeness of revascularization, the rSS scale was used, and coronary angiography was repeated. Results and discussion. The most significant adverse events during 24 months of follow-up, associated with the severity of coronary artery damage according to the SYNTAX scale ≥23 points, were: death from any cause with odds ratio (OR) 6.9 (95% CI, p = 0.05); myocardial infarction (MI) with OR 5.5 (95% CI, p = 0.001); the combined endpoint was OR 2.4 (95% CI, p = 0.005). Over a 2-year follow-up period,results of myocardial revascularization according to the rSS scale were evaluated the effect of coronary artery stenting with minimal residual atherosclerotic narrowing (rSS ≤8) and significant arterial lesions (rSS ≥9) on indicators such as all-cause mortality, myocardial revascularization, re-hospitalization, recurrent acute MI and stroke were analyzed. Data analysis showed statistically significant difference in all indicators in favor of the group with a score of rSS ≤8 (р <0.05). Conclusions. The rSS scale in patients with coronary artery disease and heart failure with reduced left ventricular ejection fraction after PCI is a statistically significant criterion for the impact on the combined endpoint. In addition, an rSS score ≥9 was associated with a significantly higher riskof all-cause mortality, recurrent acute MI, and recurrent revascularization. A stratified rSS score ≥9 in ischemic cardiomyopathy with left ventricular ejection fraction ≤40% was more often observed in patients with existing comorbid pathology, such as hypertension, diabetes mellitus, stroke, peripheral artery disease.
{"title":"Reasonable Incomplete Myocardial Revascularization in Patients with Chronic Heart Failure and Reduced Left Ventricular Ejection Fraction","authors":"M. Kucheriava, G. Mankovsky","doi":"10.30702/ujcvs/22.30(04)/km057-2025","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(04)/km057-2025","url":null,"abstract":"The aim. To evaluate the results of incomplete myocardial revascularization with percutaneous coronary intervention (PCI) in patients with ischemic cardiomyopathy and heart failure with reduced left ventricular ejection fraction based on the residual SYNTAX Score (rSS) scale. \u0000Materials and methods. This prospective observational one-center study was conducted at the Ukrainian Children’s Cardiac Center, Clinic for Adults and included 192 patients whounderwent coronary angiography and myocardial re-vascularization using PCI. Baseline demographic and clinical parameters, including gender, age, presence of comorbid pathology were obtained from the medical history of each patient retrospectively. The results of revascularization were evaluated over a period of 2 years (from March 2020 to March 2022). To assess the completeness of revascularization, the rSS scale was used, and coronary angiography was repeated. \u0000Results and discussion. The most significant adverse events during 24 months of follow-up, associated with the severity of coronary artery damage according to the SYNTAX scale ≥23 points, were: death from any cause with odds ratio (OR) 6.9 (95% CI, p = 0.05); myocardial infarction (MI) with OR 5.5 (95% CI, p = 0.001); the combined endpoint was OR 2.4 (95% CI, p = 0.005). Over a 2-year follow-up period,results of myocardial revascularization according to the rSS scale were evaluated the effect of coronary artery stenting with minimal residual atherosclerotic narrowing (rSS ≤8) and significant arterial lesions (rSS ≥9) on indicators such as all-cause mortality, myocardial revascularization, re-hospitalization, recurrent acute MI and stroke were analyzed. Data analysis showed statistically significant difference in all indicators in favor of the group with a score of rSS ≤8 (р <0.05). \u0000Conclusions. The rSS scale in patients with coronary artery disease and heart failure with reduced left ventricular ejection fraction after PCI is a statistically significant criterion for the impact on the combined endpoint. In addition, an rSS score ≥9 was associated with a significantly higher riskof all-cause mortality, recurrent acute MI, and recurrent revascularization. A stratified rSS score ≥9 in ischemic cardiomyopathy with left ventricular ejection fraction ≤40% was more often observed in patients with existing comorbid pathology, such as hypertension, diabetes mellitus, stroke, peripheral artery disease.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42054539","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 : 2022-12-26DOI: 10.30702/ujcvs/22.30(04)/ht050-128132
Bohdan I. Hulitskyi, Tammo Raad, Hanna E. Morkovkina, Alyona V. Sydorova, A. Maksymenko, Olena V. Stohova, R. Sekelyk, Tetiana A. Yalynska
Anatomically corrected malposition of the great arteries (ACMGA) is a rare form of congenital heart disease. This abnormality belongs to conotruncal anomalies. ACMGA is an anomaly in which aorta arises from the left ventricle and pulmonary artery arises from the right ventricle but great arteries are located in parallel relationships. Therefore, diagnosis of this disease is complicated due to frequent diagnostic errors. The aim. To share our experience of late diagnosis of ACMGA in a patientwho was previously mistakenly diagnosed with congenitally corrected transposition of great arteries (CC-TGA). Case report. We present a case of late diagnosis of ACMGA. An 11-day-old newborn was admitted to the Ukrainian Children’s Cardiac Center in 2007. After clinical examination, which included ultrasound examination, the diagnosis of CC-TGA, pulmonary stenosis, ventricular septal defect and atrial septal defect was conϐirmed. The patient was in a stable condition and there were no signs of heart failure. That is whythe patient was discharged. In 2017, cardiac catheterization was performed, and there were doubts about the diagnosis because of untypical anatomical features. In 2022, we performed computed tomography and magnetic resonance imaging. The diagnosis of ACMGA was made. Conclusions. ACMGA is an unusual form of congenital heart disease. The diagnosis of ACMGA is challenging, because its anatomical features are similar to those of CC-TGA. The difference of both these diagnoses is normal anatomy and hemodynamics but abnormal relationship in ACMGA, in contrast to abnormal anatomy in CC-TGA.
{"title":"A Case of Late Diagnosis of Anatomically Corrected Malposition of the Great Arteries","authors":"Bohdan I. Hulitskyi, Tammo Raad, Hanna E. Morkovkina, Alyona V. Sydorova, A. Maksymenko, Olena V. Stohova, R. Sekelyk, Tetiana A. Yalynska","doi":"10.30702/ujcvs/22.30(04)/ht050-128132","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(04)/ht050-128132","url":null,"abstract":"Anatomically corrected malposition of the great arteries (ACMGA) is a rare form of congenital heart disease. This abnormality belongs to conotruncal anomalies. ACMGA is an anomaly in which aorta arises from the left ventricle and pulmonary artery arises from the right ventricle but great arteries are located in parallel relationships. Therefore, diagnosis of this disease is complicated due to frequent diagnostic errors. \u0000The aim. To share our experience of late diagnosis of ACMGA in a patientwho was previously mistakenly diagnosed with congenitally corrected transposition of great arteries (CC-TGA). \u0000Case report. We present a case of late diagnosis of ACMGA. An 11-day-old newborn was admitted to the Ukrainian Children’s Cardiac Center in 2007. After clinical examination, which included ultrasound examination, the diagnosis of CC-TGA, pulmonary stenosis, ventricular septal defect and atrial septal defect was conϐirmed. The patient was in a stable condition and there were no signs of heart failure. That is whythe patient was discharged. In 2017, cardiac catheterization was performed, and there were doubts about the diagnosis because of untypical anatomical features. \u0000In 2022, we performed computed tomography and magnetic resonance imaging. The diagnosis of ACMGA was made. \u0000Conclusions. ACMGA is an unusual form of congenital heart disease. The diagnosis of ACMGA is challenging, because its anatomical features are similar to those of CC-TGA. The difference of both these diagnoses is normal anatomy and hemodynamics but abnormal relationship in ACMGA, in contrast to abnormal anatomy in CC-TGA.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46099071","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 : 2022-12-26DOI: 10.30702/ujcvs/22.30(04)/sd063-104110
S. O. Siromakha, I. Davydova, B. Kravchuk, Valerii P. Zalevskiy, Nataliia Nakonechna, V. Lazoryshynets
Arrhythmia is the main cause of pregnancy-related hospitalizations. Potential risk of arrhythmias during pregnancy is associated with hypercoagulation and increased risk of thromboembolism. The aim. To increase patients’ safety and to improve maternal and perinatal outcomes by choosing the optimal medical strategy. Methods. We present the experience of multidisciplinary care for 54 pregnant and parturient women (32 with tachy-, 20 with bradyarrhythmia and 2 with ventricular asynchrony) who were admitted to the cardiac surgery facility from December 2013 to February 2022. Pacemakers were implanted in 15 cases of complete atrioventricular block radiofrequency ablation was performed in 12 cases. Results. There were no near misses and maternal losses in our group of patients. Two programmed perinatal losses were provided in patients with rhythm disorders and complex congenital heart defects. Type and place of delivery were chosen by the multidisciplinary team. There were nine childbirths at a specialized cardiac surgery clinic. There were no perinatal losses among patients who underwent rhythm interventions. In our group of patients, electrical cardioversion was performed in three cases, the pregnancies ended successfully with the birth of healthy newborns. Conclusions. Arrhythmias in all trimesters of pregnancy and the postpartum period are a common reason for seeking medical attention and hospitalization during pregnancy.Most of the arrhythmias are hemodynamically insignificant and don’t require hospitalization. Maternal risk stratification of major cardiac events during pregnancy, childbirth and the postpartum period is the cornerstone for choosing a strategy of medical care for pregnant women with arrhythmias. Patients with hemodynamic manifestations of tachy- and bradyarrhythmias, as well as patients with life-threatening types of rhythm disturbances are in the focus of attention of pregnancy heart team. Preconceptional management of patients with life threating arrhythmias is the best type of care in these patients. Pregnancy and delivery in high-risk class patients should be managed in an experienced center with on-site interventional electrophysiology techniques. Rhythm interventions have extremely limited indications and can be conducted when less invasive treatment strategy is unsuccessful.
{"title":"Arrhythmias in Pregnancy. Experience of the Multidisciplinary Team","authors":"S. O. Siromakha, I. Davydova, B. Kravchuk, Valerii P. Zalevskiy, Nataliia Nakonechna, V. Lazoryshynets","doi":"10.30702/ujcvs/22.30(04)/sd063-104110","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(04)/sd063-104110","url":null,"abstract":"Arrhythmia is the main cause of pregnancy-related hospitalizations. Potential risk of arrhythmias during pregnancy is associated with hypercoagulation and increased risk of thromboembolism. \u0000The aim. To increase patients’ safety and to improve maternal and perinatal outcomes by choosing the optimal medical strategy. \u0000Methods. We present the experience of multidisciplinary care for 54 pregnant and parturient women (32 with tachy-, 20 with bradyarrhythmia and 2 with ventricular asynchrony) who were admitted to the cardiac surgery facility from December 2013 to February 2022. Pacemakers were implanted in 15 cases of complete atrioventricular block radiofrequency ablation was performed in 12 cases. \u0000Results. There were no near misses and maternal losses in our group of patients. Two programmed perinatal losses were provided in patients with rhythm disorders and complex congenital heart defects. Type and place of delivery were chosen by the multidisciplinary team. There were nine childbirths at a specialized cardiac surgery clinic. There were no perinatal losses among patients who underwent rhythm interventions. In our group of patients, electrical cardioversion was performed in three cases, the pregnancies ended successfully with the birth of healthy newborns. \u0000Conclusions. Arrhythmias in all trimesters of pregnancy and the postpartum period are a common reason for seeking medical attention and hospitalization during pregnancy.Most of the arrhythmias are hemodynamically insignificant and don’t require hospitalization. Maternal risk stratification of major cardiac events during pregnancy, childbirth and the postpartum period is the cornerstone for choosing a strategy of medical care for pregnant women with arrhythmias. Patients with hemodynamic manifestations of tachy- and bradyarrhythmias, as well as patients with life-threatening types of rhythm disturbances are in the focus of attention of pregnancy heart team. Preconceptional management of patients with life threating arrhythmias is the best type of care in these patients. Pregnancy and delivery in high-risk class patients should be managed in an experienced center with on-site interventional electrophysiology techniques. Rhythm interventions have extremely limited indications and can be conducted when less invasive treatment strategy is unsuccessful.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49192605","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 : 2022-12-26DOI: 10.30702/ujcvs/22.30(04)/pk064-94103
E. O. Perepeka, B. Kravchuk
Chronic right ventricular myocardial pacing causes an asynchronous pattern of left ventricular activation, reduces left ventricular ejection fraction (LVEF), and may be associated with worsening of clinical outcomes in the long term. Although with the emergence of algorithms that minimize ventricular pacing it became possible to reduce the percentage of paced complexes in patients with sinus node dysfunction, permanent ventricular pacing is still inevitable in patients with high-degree atrioventricular (AV) block. The use of permanent conduction system pacing is a promising method for preserving the physiological activation of the ventricular myocardium and preventing the development of heart failure due to ventricular dyssynchrony. The aim. To analyze the immediate and long-term results of the use of conduction system pacing in patients with indications for permanent ventricular pacing. Materials and methods. This study included 18 patients with indications for permanentventricular pacing who were operated at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine in the period from 01/01/2013 to 12/31/2022, in whom permanent conduction system pacing was used. There were 17 patients with bradyarrhythmias, of these 16 (88%) suffered from high-degree AV block (including 1 patient with Frederick’s syndrome and 1 (5%) patient with atrial ϐibrillation with slow ventricular response) and 1 (5%) patient with ischemic cardiomyopathy with left bundle branch block and ϐirstdegree AV block with indications for cardiac resynchronization therapy. The mean age of the patients was 55 ± 16 years (8 men, 10 women), LVEF at the time of the intervention was 56.42 ± 9.13 %, end diastolic volume 130.2 ± 23.8 ml, end systolic volume 55.1 ± 17.7 ml, diameter of the left atrium 4.01 ± 0.6 cm. The average QRS width before implantation was 116.5 ± 27.7 ms. In 6 (33%) patients, a special delivery system (С304-L69, Medtronic in 1 patient [5%], C315HIS in 5 [27%] patients) and 4.1F active ϐixation lead Medtronic 3830 Select Secure (69 or 74 cm) were used; in other cases (66%) standard 6F leads with active ϐixation and a lumen for a stylet without a delivery system were used. Results. The average follow-up period after implantation of pacemaker was 36.35 ± 29.65 months. During the observation period, LVEF was 57.07 ± 5.38 %, end diastolic volume111.5 ± 18.09 ml, end systolic volume 49.5 ± 13.4 ml, diameter of the left ventricle 3.9 ± 0.5 cm. The mean duration of paced QRS was 119.1 ± 10.09 ms. In 6 patients (33%), it was possible to demonstrate a change in the QRS width when the amplitude of ventricular stimulation was reduced, with 2 variants of transitions: 1) 4 (22%) patients with a transition from non-selective His bundle pacing (NSHBP) to selective His bundle pacing (SHBP), in 2 (11%) of these patients with a transition from SHBP with correction of right bundle branch block (RBBB) to SHBP without correction of RB
{"title":"Results of Using Various Conduction System Pacing Options in Patients with Bradyarrhythmia","authors":"E. O. Perepeka, B. Kravchuk","doi":"10.30702/ujcvs/22.30(04)/pk064-94103","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(04)/pk064-94103","url":null,"abstract":"Chronic right ventricular myocardial pacing causes an asynchronous pattern of left ventricular activation, reduces left ventricular ejection fraction (LVEF), and may be associated with worsening of clinical outcomes in the long term. Although with the emergence of algorithms that minimize ventricular pacing it became possible to reduce the percentage of paced complexes in patients with sinus node dysfunction, permanent ventricular pacing is still inevitable in patients with high-degree atrioventricular (AV) block. The use of permanent conduction system pacing is a promising method for preserving the physiological activation of the ventricular myocardium and preventing the development of heart failure due to ventricular dyssynchrony. \u0000The aim. To analyze the immediate and long-term results of the use of conduction system pacing in patients with indications for permanent ventricular pacing. \u0000Materials and methods. This study included 18 patients with indications for permanentventricular pacing who were operated at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine in the period from 01/01/2013 to 12/31/2022, in whom permanent conduction system pacing was used. There were 17 patients with bradyarrhythmias, of these 16 (88%) suffered from high-degree AV block (including 1 patient with Frederick’s syndrome and 1 (5%) patient with atrial ϐibrillation with slow ventricular response) and 1 (5%) patient with ischemic cardiomyopathy with left bundle branch block and ϐirstdegree AV block with indications for cardiac resynchronization therapy. The mean age of the patients was 55 ± 16 years (8 men, 10 women), LVEF at the time of the intervention was 56.42 ± 9.13 %, end diastolic volume 130.2 ± 23.8 ml, end systolic volume 55.1 ± 17.7 ml, diameter of the left atrium 4.01 ± 0.6 cm. The average QRS width before implantation was 116.5 ± 27.7 ms. In 6 (33%) patients, a special delivery system (С304-L69, Medtronic in 1 patient [5%], C315HIS in 5 [27%] patients) and 4.1F active ϐixation lead Medtronic 3830 Select Secure (69 or 74 cm) were used; in other cases (66%) standard 6F leads with active ϐixation and a lumen for a stylet without a delivery system were used. \u0000Results. The average follow-up period after implantation of pacemaker was 36.35 ± 29.65 months. During the observation period, LVEF was 57.07 ± 5.38 %, end diastolic volume111.5 ± 18.09 ml, end systolic volume 49.5 ± 13.4 ml, diameter of the left ventricle 3.9 ± 0.5 cm. The mean duration of paced QRS was 119.1 ± 10.09 ms. In 6 patients (33%), it was possible to demonstrate a change in the QRS width when the amplitude of ventricular stimulation was reduced, with 2 variants of transitions: 1) 4 (22%) patients with a transition from non-selective His bundle pacing (NSHBP) to selective His bundle pacing (SHBP), in 2 (11%) of these patients with a transition from SHBP with correction of right bundle branch block (RBBB) to SHBP without correction of RB","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43351243","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 : 2022-12-26DOI: 10.30702/ujcvs/22.30(04)/rp049-3338
N. Rudenko, O.Yu. Pukas
The use of total arterial myocardial revascularization in patients with multivessel lesions of the coronary arteries has a number of advantages, namely the duration of functioning or patency of the grafts. The level of total arterial myocardial revascularization implementation in developed and developing countries remains quite low. The aim. Based on the analysis of our own experience, to determine the influence of the technique of total arterial revascularization on the frequency of complications in the early postoperative period. Materials and methods. From February 22, 2016 to December 24, 2020, 390 consecutive patients were operated at the Ukrainian Children’s Cardiac Center. The patients were divided into two groups: participants of the group I underwent total arterial myocardial revascularization, and those includedin the group II underwent conventional coronary artery bypass grafting (CABG). The inclusion criteria were: ischemic heart disease, stable angina or exertional angina, multivascular coronary artery disease, absence of valvular pathology. Results. There was zero 30-day mortality in both groups. The frequency of postoperative bleeding was higher in group II and amounted to 1.6%. Surgical wound complications (infection) were also more common in the group II: 1.2% versus 0.69% (p=0.906) in the group I. Similarly, laboratory parameters such as the level of creatine kinase-MB were almost identical. Conclusions. Total arterial myocardial revascularization is a safe method with good immediate results. The frequency of complications in total arterial myocardial revascularizationdoes not differ from that in conventional CABG. For a wider application of the total arterial myocardial revascularization,it is necessary to continue toconduct studies of the remote postoperative period.
{"title":"Comparative Analysis of Early Postoperative Period in Patients with Total Arterial Revascularization and Conventional Coronary Artery Bypass Grafting","authors":"N. Rudenko, O.Yu. Pukas","doi":"10.30702/ujcvs/22.30(04)/rp049-3338","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(04)/rp049-3338","url":null,"abstract":"The use of total arterial myocardial revascularization in patients with multivessel lesions of the coronary arteries has a number of advantages, namely the duration of functioning or patency of the grafts. The level of total arterial myocardial revascularization implementation in developed and developing countries remains quite low. \u0000The aim. Based on the analysis of our own experience, to determine the influence of the technique of total arterial revascularization on the frequency of complications in the early postoperative period. \u0000Materials and methods. From February 22, 2016 to December 24, 2020, 390 consecutive patients were operated at the Ukrainian Children’s Cardiac Center. The patients were divided into two groups: participants of the group I underwent total arterial myocardial revascularization, and those includedin the group II underwent conventional coronary artery bypass grafting (CABG). The inclusion criteria were: ischemic heart disease, stable angina or exertional angina, multivascular coronary artery disease, absence of valvular pathology. \u0000Results. There was zero 30-day mortality in both groups. The frequency of postoperative bleeding was higher in group II and amounted to 1.6%. Surgical wound complications (infection) were also more common in the group II: 1.2% versus 0.69% (p=0.906) in the group I. Similarly, laboratory parameters such as the level of creatine kinase-MB were almost identical. \u0000Conclusions. Total arterial myocardial revascularization is a safe method with good immediate results. The frequency of complications in total arterial myocardial revascularizationdoes not differ from that in conventional CABG. For a wider application of the total arterial myocardial revascularization,it is necessary to continue toconduct studies of the remote postoperative period.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42589875","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 : 2022-12-26DOI: 10.30702/ujcvs/22.30(04)/nr046-2632
O. Nishkumay, O. Rokyta, Illia A. Kordubailo, Aza A. Kovalenko, Artem O. Govorov, I. Gorda, Svitlana M. Dubynska, Marta Yu. Vibla, Nataliia O. Pidmurniak
Coronary artery disease (CAD) remains a top cause of morbidity and mortality nowadays. Current guidelines are used to deϐine timely diagnostic and management strategies for a patient with new angina symptom. According to the guidelines, the main purpose is assessment of the pretest probability of obstructive CAD. Exercise electrocardiography is the most accessible methodwith 85-90% speciϐicity and 45-50% sensitivity. Cardiopulmonary exercise testing (CPET) with concomitant monitoring of electrocardiogram, heart rate and blood pressure, expired gas analysis has become widespread among different exercise tests. CPET is an important clinical tool to estimate exercise capacity. In most cases it allowsto determine the causes of limited physical activity, evaluate both the blood supply (pulmonary, cardiovascular, haematopoietic systems) and tissue oxygen metabolism (skeletal muscle system) in response to physical exercise.The indications for invasive coronary angiography include: high clinical risk of CAD, symptoms which are refractory to medical therapy, low tolerance to exercise or if revascularization is considered for improvement of prognosis. The aim. To highlight the need for a combination of non-invasive stresstesting (CPET, stress echocardiography) and invasive testing (such as coronary angiography) to develop proper tactics of treating patients with established CAD. Conclusion. Described clinical case demonstrates preferences of combined different functional non-invasive tests (CPET, stress echocardiography) in a patient with confirmed CAD, who received prognosis modifying therapy and had high exercise tolerance due to regular cardio training. This gave the reason for postponing the repeated ICA to determine the dynamics of the progression of coronary atherosclerosis. However, when an anginal attack occurred and repeated urgent ICA was performed, it became necessary to perform coronary artery bypass grafting and, later, due to the continuation of anginal attacks and the presence of areas of ischemia, stenting of the trunk of the left coronary artery.
{"title":"Risk Stratification in Patients with Coronary Artery Disease: Timeliness of Invasive Interventions","authors":"O. Nishkumay, O. Rokyta, Illia A. Kordubailo, Aza A. Kovalenko, Artem O. Govorov, I. Gorda, Svitlana M. Dubynska, Marta Yu. Vibla, Nataliia O. Pidmurniak","doi":"10.30702/ujcvs/22.30(04)/nr046-2632","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(04)/nr046-2632","url":null,"abstract":"Coronary artery disease (CAD) remains a top cause of morbidity and mortality nowadays. Current guidelines are used to deϐine timely diagnostic and management strategies for a patient with new angina symptom. According to the guidelines, the main purpose is assessment of the pretest probability of obstructive CAD. Exercise electrocardiography is the most accessible methodwith 85-90% speciϐicity and 45-50% sensitivity. Cardiopulmonary exercise testing (CPET) with concomitant monitoring of electrocardiogram, heart rate and blood pressure, expired gas analysis has become widespread among different exercise tests. CPET is an important clinical tool to estimate exercise capacity. In most cases it allowsto determine the causes of limited physical activity, evaluate both the blood supply (pulmonary, cardiovascular, haematopoietic systems) and tissue oxygen metabolism (skeletal muscle system) in response to physical exercise.The indications for invasive coronary angiography include: high clinical risk of CAD, symptoms which are refractory to medical therapy, low tolerance to exercise or if revascularization is considered for improvement of prognosis. \u0000The aim. To highlight the need for a combination of non-invasive stresstesting (CPET, stress echocardiography) and invasive testing (such as coronary angiography) to develop proper tactics of treating patients with established CAD. \u0000Conclusion. Described clinical case demonstrates preferences of combined different functional non-invasive tests (CPET, stress echocardiography) in a patient with confirmed CAD, who received prognosis modifying therapy and had high exercise tolerance due to regular cardio training. This gave the reason for postponing the repeated ICA to determine the dynamics of the progression of coronary atherosclerosis. However, when an anginal attack occurred and repeated urgent ICA was performed, it became necessary to perform coronary artery bypass grafting and, later, due to the continuation of anginal attacks and the presence of areas of ischemia, stenting of the trunk of the left coronary artery.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48582609","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 : 2022-12-26DOI: 10.30702/ujcvs/22.30(04)/rn047-7380
Kostiantyn V. Rudenko, L. Nevmerzhytska, O. M. Unitska, P. Danchenko, Nadiia S. Leiko
Fabry disease (FD) is an X-linked lysosomal storage disease caused by a mutation in the gene encoding α-galactosidase A and leads to reduced activity or complete absence of this enzyme, which causes the accumulation of globotriaosylceramide (Gb3) and its deacylated form (lyso-Gb3) in cells of the whole body. FD can occur both with multisystem manifestations, including damage to the nervous system, kidneys, and skin, and can affect only the heart. Cardiac involvement is a major cause of poor quality of life and death in patients with FD and an underrecognized cause of heart failure with preserved ejection fraction and ventricular arrhythmias in men over 30 years of age and women over 40 years of age. Cardiac damage begins at an early age, progresses subclinically until the appearance of significant symptoms, and usually manifests as leftventricular hypertrophy, mimicking hypertrophic cardiomyopathy. After the introduction of enzyme replacement therapy, early recognition of FD and differential diagnosis with other causes of leftventricular hypertrophy have become crucial to limit the progression of the disease. Recent advances in the understanding of cardiac pathophysiology and imaging have improved diagnostic and therapeutic approaches to the cardiac manifestations of this pathology. Modern achievements in the study of cardiac manifestations of FD have made it possible to significantly improve diagnostic and therapeutic approaches, in particular, in relation to the identification of pathogenetic mechanisms of organ damage and early disruption of their function. A better understanding of secondary pathogenic pathways, such as myocardial inflammation, may influence future therapeutic strategies and timely diagnosis of FD. Delay in diagnosis and untimely initiation of treatment remain critical problems for many patients with FD, especially for patients with late-onset cardiovascular manifestations, in whom treatment effects may be more limited and ineffective. Cooperation between specialists in genetic diseases and cardiologists remains important to identify patients before the appearance of cardiac symptoms in order to obtain maximum therapeutic effects.
{"title":"Fabry Disease, a Rare Disorder with Cardiac Manifestations. The Problem of Diagnosis and Treatment: a Literature Review","authors":"Kostiantyn V. Rudenko, L. Nevmerzhytska, O. M. Unitska, P. Danchenko, Nadiia S. Leiko","doi":"10.30702/ujcvs/22.30(04)/rn047-7380","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(04)/rn047-7380","url":null,"abstract":"Fabry disease (FD) is an X-linked lysosomal storage disease caused by a mutation in the gene encoding α-galactosidase A and leads to reduced activity or complete absence of this enzyme, which causes the accumulation of globotriaosylceramide (Gb3) and its deacylated form (lyso-Gb3) in cells of the whole body. FD can occur both with multisystem manifestations, including damage to the nervous system, kidneys, and skin, and can affect only the heart. Cardiac involvement is a major cause of poor quality of life and death in patients with FD and an underrecognized cause of heart failure with preserved ejection fraction and ventricular arrhythmias in men over 30 years of age and women over 40 years of age. Cardiac damage begins at an early age, progresses subclinically until the appearance of significant symptoms, and usually manifests as leftventricular hypertrophy, mimicking hypertrophic cardiomyopathy. \u0000After the introduction of enzyme replacement therapy, early recognition of FD and differential diagnosis with other causes of leftventricular hypertrophy have become crucial to limit the progression of the disease. Recent advances in the understanding of cardiac pathophysiology and imaging have improved diagnostic and therapeutic approaches to the cardiac manifestations of this pathology. \u0000Modern achievements in the study of cardiac manifestations of FD have made it possible to significantly improve diagnostic and therapeutic approaches, in particular, in relation to the identification of pathogenetic mechanisms of organ damage and early disruption of their function. A better understanding of secondary pathogenic pathways, such as myocardial inflammation, may influence future therapeutic strategies and timely diagnosis of FD. \u0000Delay in diagnosis and untimely initiation of treatment remain critical problems for many patients with FD, especially for patients with late-onset cardiovascular manifestations, in whom treatment effects may be more limited and ineffective. \u0000Cooperation between specialists in genetic diseases and cardiologists remains important to identify patients before the appearance of cardiac symptoms in order to obtain maximum therapeutic effects.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49275125","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 : 2022-12-26DOI: 10.30702/ujcvs/22.30(04)/dv061-5358
I. Ditkivskyy, Denys L. Voloshyn, Y. V. Yermolovych, I. Perepeka, V. Lazoryshynets
The aim. To assess the effectiveness and safety of transcatheter closure of a secondary atrial septal defect (ASD) using an occluder in symptomatic children weighing ≤10 kg. Materials and methods. In the period from November 2014 to June 2021, on the basis of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, closure of secondary ASD using an occluder was performed in 18 patients, among them 13 women (72.2%) and 5 men (27.8%). Th e mean age of the patients was 18.94±9.44 months (the youngest patient was 12 months, the oldest was 4 years). The mean weight was 9.294±1.170 kg (6.4 kg to 10 kg), the mean Z-score was -1.7±1.5 (-4.6 to 0.46), the mean height was 80 cm (71 cm to 88 cm). According to the measurements by transesophageal echocardiography (TEE), the average size of the defects was 13.7 mm±3.6mm (the largest 18.0 mm, the smallest 6.0 mm). Results and discussion. In our publication, the effectiveness of the method was 100% (18/18), while the world statistics show 94-95%. Th e frequency of complications was 5.6% (n=1). We suggest that this is associated with the use of a sizing balloon and careful selection of the device. When choosing treatment tactics for symptomatic children weighing ≤10 kg, the decisive factor was the determination of the presence of edges and the size of the defect. Defects were considered suitable for closure, according to TEE data, when all margins of the defect were ≥4 mm, except for the aortic margin. Although the total length of the interatrial membrane was taken into account, it was not of decisive importance, since for most occluders with the presence of all edges, the fields of the implant could not interfere with the work of the anatomical structures of the heart. To determine the real size of the defect, we recommend a measuring balloon under TEE control. The following devices were used to close the defect: MemoPart ASD occluder, Amplatzer Septal Occluder, LifeTech HeartR Occluder, LifeTech HeartR Multi-Fenestrated Atrial Septal Defect (MF-ASD) Occluder. Conclusion. After the study, we are convinced that the endovascular method of closing a hemodynamically significant secondary ASD for the treatment of children with a body weight of ≤10 kg has proven to be an effective method, with successful implantation of the occluder in 100% of cases.
{"title":"Endovascular Closure of Secondary Septal Defect in Children with Low Body Weight","authors":"I. Ditkivskyy, Denys L. Voloshyn, Y. V. Yermolovych, I. Perepeka, V. Lazoryshynets","doi":"10.30702/ujcvs/22.30(04)/dv061-5358","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(04)/dv061-5358","url":null,"abstract":"The aim. To assess the effectiveness and safety of transcatheter closure of a secondary atrial septal defect (ASD) using an occluder in symptomatic children weighing ≤10 kg. \u0000Materials and methods. In the period from November 2014 to June 2021, on the basis of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, closure of secondary ASD using an occluder was performed in 18 patients, among them 13 women (72.2%) and 5 men (27.8%). Th e mean age of the patients was 18.94±9.44 months (the youngest patient was 12 months, the oldest was 4 years). The mean weight was 9.294±1.170 kg (6.4 kg to 10 kg), the mean Z-score was -1.7±1.5 (-4.6 to 0.46), the mean height was 80 cm (71 cm to 88 cm). According to the measurements by transesophageal echocardiography (TEE), the average size of the defects was 13.7 mm±3.6mm (the largest 18.0 mm, the smallest 6.0 mm). \u0000Results and discussion. In our publication, the effectiveness of the method was 100% (18/18), while the world statistics show 94-95%. Th e frequency of complications was 5.6% (n=1). We suggest that this is associated with the use of a sizing balloon and careful selection of the device. \u0000When choosing treatment tactics for symptomatic children weighing ≤10 kg, the decisive factor was the determination of the presence of edges and the size of the defect. Defects were considered suitable for closure, according to TEE data, when all margins of the defect were ≥4 mm, except for the aortic margin. Although the total length of the interatrial membrane was taken into account, it was not of decisive importance, since for most occluders with the presence of all edges, the fields of the implant could not interfere with the work of the anatomical structures of the heart. To determine the real size of the defect, we recommend a measuring balloon under TEE control. \u0000The following devices were used to close the defect: MemoPart ASD occluder, Amplatzer Septal Occluder, LifeTech HeartR Occluder, LifeTech HeartR Multi-Fenestrated Atrial Septal Defect (MF-ASD) Occluder. \u0000 \u0000Conclusion. After the study, we are convinced that the endovascular method of closing a hemodynamically significant secondary ASD for the treatment of children with a body weight of ≤10 kg has proven to be an effective method, with successful implantation of the occluder in 100% of cases.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49219036","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 : 2022-12-26DOI: 10.30702/ujcvs/22.30(04)/zk065-3946
V. P. Zakharova, Oleksii A. Krykunov, P. M. Semeniv, A. Balabai, Andrii A. Hulich
The aim. To study the morphological manifestations of the response of the myocardial capillaries to cardioplegia in patients with valvular defects and coronary heart disease. Materials and methods. Morphological research of operative and sectional material was carried out. Myocardium fragments for microscopical study were obtained from patients at different stages of an open-heart surgery and patients who died at the stage of conservative treatment without surgical intervention. Similar samples of the myocardium of a healthy young man who died from injuries incompatible with life were studied as a control. For electron microscopy study, samples of myocardium were taken from patients at the 185th minute of perfusion. Results. Histological preparations of the myocardium showed pronounced diffuse hypertrophy of cardiomyocytes (CMCs), sometimes at the stage of decompensation (perinuclear edema, loss of myofibrils, apoptosis). This transformation of CMCs was obviously related to their functional overload caused by combined defects of the mitral and aortic valves. Changes in muscle fibers were accompanied by interstitial and perinuclear fibrosis. In the pool of coronary arteries affected by atherosclerosis, signs of small focal coronary fibrosis were visible, as well as rough post-infarction scars in 3 patients. All the patients had signs of acute hypoxic damage to the myocardium in the form of CMCs shortening and interstitial edema. Conclusions. In patients with combined defects of the aortic and mitral valves of the heart with coronary artery disease, the phenomena of myocardial fibrosis prevail. Heart valve disease combined with coronary heart disease lead to the development of both alterative and compensatory-adaptiveprocesses in the vessels of the microcirculatory bed. The greatest loss of vital organelles in small vessels is observed at 185 min after administration of cardioplegic solution, irreversible changes develop 3 h after perfusion.
{"title":"The Reaction of Myocardial Capillaries to Crystalloid Cardioplegia of Different Durations in Patients with Valvular Pathology and Coronary Heart Disease","authors":"V. P. Zakharova, Oleksii A. Krykunov, P. M. Semeniv, A. Balabai, Andrii A. Hulich","doi":"10.30702/ujcvs/22.30(04)/zk065-3946","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(04)/zk065-3946","url":null,"abstract":"The aim. To study the morphological manifestations of the response of the myocardial capillaries to cardioplegia in patients with valvular defects and coronary heart disease. \u0000Materials and methods. Morphological research of operative and sectional material was carried out. Myocardium fragments for microscopical study were obtained from patients at different stages of an open-heart surgery and patients who died at the stage of conservative treatment without surgical intervention. Similar samples of the myocardium of a healthy young man who died from injuries incompatible with life were studied as a control. For electron microscopy study, samples of myocardium were taken from patients at the 185th minute of perfusion. \u0000Results. Histological preparations of the myocardium showed pronounced diffuse hypertrophy of cardiomyocytes (CMCs), sometimes at the stage of decompensation (perinuclear edema, loss of myofibrils, apoptosis). This transformation of CMCs was obviously related to their functional overload caused by combined defects of the mitral and aortic valves. Changes in muscle fibers were accompanied by interstitial and perinuclear fibrosis. In the pool of coronary arteries affected by atherosclerosis, signs of small focal coronary fibrosis were visible, as well as rough post-infarction scars in 3 patients. All the patients had signs of acute hypoxic damage to the myocardium in the form of CMCs shortening and interstitial edema. \u0000Conclusions. In patients with combined defects of the aortic and mitral valves of the heart with coronary artery disease, the phenomena of myocardial fibrosis prevail. Heart valve disease combined with coronary heart disease lead to the development of both alterative and compensatory-adaptiveprocesses in the vessels of the microcirculatory bed. The greatest loss of vital organelles in small vessels is observed at 185 min after administration of cardioplegic solution, irreversible changes develop 3 h after perfusion.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49017212","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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