Pub Date : 2022-12-26DOI: 10.30702/ujcvs/22.30(04)/sa048-111114
O. S. Stychynskyi, P. O. Almiz
Since the introduction of catheter ablation of atrial fibrillation (AF), it developed from a specialized experimental procedure into a common treatment option to prevent recurrent AF. In recent years substantial improvement has been made in the equipment and techniques used in catheter ablation of AF. The volume of procedures expanded year after year. Naturally, this has been reflected on indications for catheter ablation. The aim. To study the changes in indications for catheter ablations of AF which has occurred during the last decade, according to European and American literature. Materials and methods. We reviewed four documents related to the management of AF: 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation ofatrial fibrillation; 2017 HRS/EHRA/ECAS/APHRS/SOLEACE expert consensus statement on catheter and surgical ablation of atrial fibrillation; 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS; 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Results. During the analyzed period there have been a lot of changes inindications for catheter ablation of AF. Recent years guidelines pointed out that a decision on AF catheter ablation should be based on the patient’s preferences. It is recommended to take into consideration the procedural risks andmajor risk factors of arrhythmia recurrence. All this should be discussed with patient. Today antiarrhythmic drugs still remain a first-line rhythm control therapy. Catheter ablation is recommended after drug therapy failure in patients with all clinical forms of AF. In AF patients with heart failure, when tachycardia-induced cardiomyopathy is highly probable, catheter ablation is recommended as a first-line therapy. Conclusion. Catheter ablation is effective in maintaining sinus rhythm in patients with paroxysmal and persistent AF. Its role as a method of rhythm control has increased during thelast decade.
{"title":"The Indications for Catheter Ablation of Atrial Fibrillation","authors":"O. S. Stychynskyi, P. O. Almiz","doi":"10.30702/ujcvs/22.30(04)/sa048-111114","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(04)/sa048-111114","url":null,"abstract":"Since the introduction of catheter ablation of atrial fibrillation (AF), it developed from a specialized experimental procedure into a common treatment option to prevent recurrent AF. In recent years substantial improvement has been made in the equipment and techniques used in catheter ablation of AF. The volume of procedures expanded year after year. Naturally, this has been reflected on indications for catheter ablation. \u0000The aim. To study the changes in indications for catheter ablations of AF which has occurred during the last decade, according to European and American literature. \u0000Materials and methods. We reviewed four documents related to the management of AF: 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation ofatrial fibrillation; 2017 HRS/EHRA/ECAS/APHRS/SOLEACE expert consensus statement on catheter and surgical ablation of atrial fibrillation; 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS; 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). \u0000Results. During the analyzed period there have been a lot of changes inindications for catheter ablation of AF. Recent years guidelines pointed out that a decision on AF catheter ablation should be based on the patient’s preferences. It is recommended to take into consideration the procedural risks andmajor risk factors of arrhythmia recurrence. All this should be discussed with patient. Today antiarrhythmic drugs still remain a first-line rhythm control therapy. Catheter ablation is recommended after drug therapy failure in patients with all clinical forms of AF. In AF patients with heart failure, when tachycardia-induced cardiomyopathy is highly probable, catheter ablation is recommended as a first-line therapy. \u0000Conclusion. Catheter ablation is effective in maintaining sinus rhythm in patients with paroxysmal and persistent AF. Its role as a method of rhythm control has increased during thelast decade.","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":"48540088","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)/ss051-1219
S. V. Salo, Valentyn O. Shumakov, A. Y. Gavrylyshyn, O. Levchyshyna, S. S. Shpak
Intracoronary administration of drugs allows to achieve the fastest possible effect in interventional cardiology. This allows to avoid all the biological filters of the body and achieve the required concentration of the active substance at the injection site. Also, given the local action, systemic side effects are nearly absent. The aim. To study the literature data of the leading countries of the world in the field of intracoronary drug administration. To analyze the experience of different centers on the use of various medications in the treatment of the phenomenon of distal microembolization. Results. One of the first drugs administered intracoronary was streptokinase for the treatment of acute myocardial infarction. After that, it became clear that this method of delivering drugs is possible and can be used. With the beginning of the treatment of acute coronary syndromes by stenting, one of the possible complications arose in the form of no-reflow. At the same time, realizing that this is a local problem, they began to use the possibility of intracoronary administration of drugs to treat this phenomenon. The main advantage of this method is quick response to drug administration. Today, the drugs of choice in the treatment of no-reflow are verapamil, adenosine, nitroprusside, adrenaline. On the other hand, probably the most common drug that is administered intracoronary is nitroglycerin. It is used as a vasodilator in the event of spasm of the coronary arteries. Subsequently, it has been recommended to deliver drugs via a microcatheter or aspiration catheter to achieve even more selective effect in the area of the affected vessel, and this also minimizes drug loss due to coronary reflux into the aortic sinuses while usinga guiding catheter. Work is also underway on the use of intracoronary insulin in acute coronary syndrome in order to reduce the area of damage in myocardial infarction. It is also very promising to study the introduction of stem cells directlyinto the myocardium through a microcatheter in order to regenerate the myocardium after a heart attack. Conclusions. Intracoronary administration of drugs allows to achieve the maximum effect in the shortest possible time. Today, many drugs can be used in this way, starting from the treatment of the phenomenon of distal microembolization and ending with myocardial regeneration after myocardial infarction.
{"title":"Intracoronary Administration of Drugs in Clinical Practice","authors":"S. V. Salo, Valentyn O. Shumakov, A. Y. Gavrylyshyn, O. Levchyshyna, S. S. Shpak","doi":"10.30702/ujcvs/22.30(04)/ss051-1219","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(04)/ss051-1219","url":null,"abstract":"Intracoronary administration of drugs allows to achieve the fastest possible effect in interventional cardiology. This allows to avoid all the biological filters of the body and achieve the required concentration of the active substance at the injection site. Also, given the local action, systemic side effects are nearly absent. \u0000The aim. To study the literature data of the leading countries of the world in the field of intracoronary drug administration. To analyze the experience of different centers on the use of various medications in the treatment of the phenomenon of distal microembolization. \u0000Results. One of the first drugs administered intracoronary was streptokinase for the treatment of acute myocardial infarction. After that, it became clear that this method of delivering drugs is possible and can be used. With the beginning of the treatment of acute coronary syndromes by stenting, one of the possible complications arose in the form of no-reflow. At the same time, realizing that this is a local problem, they began to use the possibility of intracoronary administration of drugs to treat this phenomenon. The main advantage of this method is quick response to drug administration. Today, the drugs of choice in the treatment of no-reflow are verapamil, adenosine, nitroprusside, adrenaline. On the other hand, probably the most common drug that is administered intracoronary is nitroglycerin. It is used as a vasodilator in the event of spasm of the coronary arteries. Subsequently, it has been recommended to deliver drugs via a microcatheter or aspiration catheter to achieve even more selective effect in the area of the affected vessel, and this also minimizes drug loss due to coronary reflux into the aortic sinuses while usinga guiding catheter. Work is also underway on the use of intracoronary insulin in acute coronary syndrome in order to reduce the area of damage in myocardial infarction. It is also very promising to study the introduction of stem cells directlyinto the myocardium through a microcatheter in order to regenerate the myocardium after a heart attack. \u0000Conclusions. Intracoronary administration of drugs allows to achieve the maximum effect in the shortest possible time. Today, many drugs can be used in this way, starting from the treatment of the phenomenon of distal microembolization and ending with myocardial regeneration after myocardial infarction.","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":"46146116","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)/gr058-115121
O. Gogayeva, Mykola L. Rudenko, O. Nudchenko
An important point in the provision of highly specialized cardiac surgical care for combat trauma is determination of the optimal time, method and volume of surgical intervention, taking into account the persisting threat of infection with the SARS-COV-2 virus and associated thrombotic complications. The aim. To investigate the mechanism of development and methods of prevention of thrombotic complications resulting from combat trauma against the background of the COVID-19 pandemic. Materials and methods. We analyzed clinical case of patient R., a 37-year-old soldier with a postinfarction thrombosed aneurysm of the left ventricle. The patient underwent standard clinical and laboratory tests, electrocardiography, echocardiography, coronary angiography, computed tomography of the chest, duplex scanning of carotid arteries, arteries and veins of the upper and lower extremities. It was established that 4 months ago, during a combat mission, the service-man received a mine-explosive injury, shrapnel wounds of lower extremities, multifragmentary fracture of the right ϐibula and a gunshot wound to the right chest. The causes of post-traumatic myocardial infarction are mine-explosive injury, intramural course of the left anterior descending artery, youngage, poorly developed collaterals of coronary arteries, long-term transportation during the stages of medical evacuation and post-traumatic stress disorder. A month ago, the patient was diagnosed with COVID-19, thromboembolism of the right main branch of the pulmonary artery, for which thrombolytic therapy was performed. Follow-up computed tomography showed the signs of thromboembolism of the pulmonary arteries. Ultrasound examination revealed thromboses of upper and lower limbs. Thrombotic complications against the background of combat polytrauma are the result of hypercoagulation, acute inϐlammation with the release of proinϐlammatory cytokines and damage of the endothelium. SARS-COV-2 infection triggers a state of hypercoagulation and creates additional conditions for the occurrence of arterial and venous thrombosis. Considering the nature of the thrombotic lesions, was made a decision to postpone the cardiosurgical intervention for 3 months. Conclusions. Thrombotic complications are an urgent problem after combat trauma. COVID-19 is an additional risk factor for hypercoagulation and a reason for delaying elective cardiac surgery. Conducting an electrocardiography to the wounded, regardless of age, is crucial for timely diagnosis andtreatment of acute coronary events. It is important to initiate anticoagulant therapy after eliminating all possible sources of bleeding due to the high risk of thrombotic complications against the background of chest trauma and limb fractures.
{"title":"The Occurrence of Thrombotic Complications Due to Combat Trauma Against the Background of the COVID-19 Pandemic","authors":"O. Gogayeva, Mykola L. Rudenko, O. Nudchenko","doi":"10.30702/ujcvs/22.30(04)/gr058-115121","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(04)/gr058-115121","url":null,"abstract":"An important point in the provision of highly specialized cardiac surgical care for combat trauma is determination of the optimal time, method and volume of surgical intervention, taking into account the persisting threat of infection with the SARS-COV-2 virus and associated thrombotic complications. \u0000The aim. To investigate the mechanism of development and methods of prevention of thrombotic complications resulting from combat trauma against the background of the COVID-19 pandemic. \u0000Materials and methods. We analyzed clinical case of patient R., a 37-year-old soldier with a postinfarction thrombosed aneurysm of the left ventricle. The patient underwent standard clinical and laboratory tests, electrocardiography, echocardiography, coronary angiography, computed tomography of the chest, duplex scanning of carotid arteries, arteries and veins of the upper and lower extremities. It was established that 4 months ago, during a combat mission, the service-man received a mine-explosive injury, shrapnel wounds of lower extremities, multifragmentary fracture of the right ϐibula and a gunshot wound to the right chest. The causes of post-traumatic myocardial infarction are mine-explosive injury, intramural course of the left anterior descending artery, youngage, poorly developed collaterals of coronary arteries, long-term transportation during the stages of medical evacuation and post-traumatic stress disorder. A month ago, the patient was diagnosed with COVID-19, thromboembolism of the right main branch of the pulmonary artery, for which thrombolytic therapy was performed. Follow-up computed tomography showed the signs of thromboembolism of the pulmonary arteries. Ultrasound examination revealed thromboses of upper and lower limbs. Thrombotic complications against the background of combat polytrauma are the result of hypercoagulation, acute inϐlammation with the release of proinϐlammatory cytokines and damage of the endothelium. SARS-COV-2 infection triggers a state of hypercoagulation and creates additional conditions for the occurrence of arterial and venous thrombosis. Considering the nature of the thrombotic lesions, was made a decision to postpone the cardiosurgical intervention for 3 months. \u0000Conclusions. Thrombotic complications are an urgent problem after combat trauma. COVID-19 is an additional risk factor for hypercoagulation and a reason for delaying elective cardiac surgery. Conducting an electrocardiography to the wounded, regardless of age, is crucial for timely diagnosis andtreatment of acute coronary events. It is important to initiate anticoagulant therapy after eliminating all possible sources of bleeding due to the high risk of thrombotic complications against the background of chest trauma and limb fractures.","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":"46496737","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)/ld054-133139
Y. Lebedieva, S. Y. Denysov, Mykyta M. Brianskyi, Marchelina S. Gergi, Ramil A. Aliyev
The article is dedicated to topical issues of diagnosis and surgical treatment of postinfarction left ventricular (LV) myocardial rupture. Postinfarction LV rupture is one of the most life-threatening complications of acute myocardial infarction (AMI). Given the low prevalence, this complication almost always leads to a fatal outcome. At the same time, a large proportion of patients (over 60%) die before the diagnosis is verified, suddenly, without specific clinical precursors. The aim. To draw the attention of doctors to the problem of diagnosis and surgical treatment of LV myocardial rupture as a complication of AMI. The article describes a clinical case of diagnosis of pseudoaneurysm of the LV free wall after coronary stenting. The peculiarity of this case was absence of a typical pain syndrome, electrocardiographic and echocardiographic signs, suggesting the presenceof such a mechanical complication of AMI. Special attention is paid to the analysis of factors enabling to assess the risk of developing this complication in patients with AMI. The given clinical case demonstrates the importance of early hospitalization and myocardial revascularization by stenting in order to prevent mechanical complications of AMI. Timely diagnosis and urgent surgical treatment of LV myocardial ruptures can reduce mortality due to mechanical complications of AMI. Conclusions. Timely hospitalization and revascularization of the myocardium in AMI patients reduce the risk of LV rupture in the affected area. The use of echocardiography makesit possible to detect severe complications of AMI with sufficient sensitivity. The only effective treatment method forLV rupture is urgent surgical intervention. Postinfarction myocardial rupture repair is a difficult task considering the initial severity of the patient’s clinical condition, the significant volume and technical complexity of the surgical intervention.
{"title":"Diagnosis of Postinfarction Pseudoaneurysm of the Left Ventricular Free Wall after Coronary Stenting: Case Report","authors":"Y. Lebedieva, S. Y. Denysov, Mykyta M. Brianskyi, Marchelina S. Gergi, Ramil A. Aliyev","doi":"10.30702/ujcvs/22.30(04)/ld054-133139","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(04)/ld054-133139","url":null,"abstract":"The article is dedicated to topical issues of diagnosis and surgical treatment of postinfarction left ventricular (LV) myocardial rupture. Postinfarction LV rupture is one of the most life-threatening complications of acute myocardial infarction (AMI). Given the low prevalence, this complication almost always leads to a fatal outcome. At the same time, a large proportion of patients (over 60%) die before the diagnosis is verified, suddenly, without specific clinical precursors. \u0000The aim. To draw the attention of doctors to the problem of diagnosis and surgical treatment of LV myocardial rupture as a complication of AMI. \u0000The article describes a clinical case of diagnosis of pseudoaneurysm of the LV free wall after coronary stenting. The peculiarity of this case was absence of a typical pain syndrome, electrocardiographic and echocardiographic signs, suggesting the presenceof such a mechanical complication of AMI. Special attention is paid to the analysis of factors enabling to assess the risk of developing this complication in patients with AMI. The given clinical case demonstrates the importance of early hospitalization and myocardial revascularization by stenting in order to prevent mechanical complications of AMI. Timely diagnosis and urgent surgical treatment of LV myocardial ruptures can reduce mortality due to mechanical complications of AMI. \u0000Conclusions. Timely hospitalization and revascularization of the myocardium in AMI patients reduce the risk of LV rupture in the affected area. The use of echocardiography makesit possible to detect severe complications of AMI with sufficient sensitivity. The only effective treatment method forLV rupture is urgent surgical intervention. Postinfarction myocardial rupture repair is a difficult task considering the initial severity of the patient’s clinical condition, the significant volume and technical complexity of the surgical intervention.","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":"44297238","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)/tg056-5965
I. Truba, Oleksandr S. Golovenko, I. Dziuryi
The aim. This study aims to determine the reintervention rate in infantsundergoing aortic arch repair and to analyze risk factors and evaluate the results of reinterventions. Materials and methods. This retrospective study examines 445 infants with aortic arch hypoplasia who under-went aortic arch reconstruction between 2011 and 2019. The study included only patients with two-ventricle physiology and subsequent two-ventricle repair. Techniques for primary repair included extended end-to-end anastomosis (n = 348), end-to-side anastomosis (n = 611), autologous pericardial patch repair (n = 16). Results. The overall mortality in the entire study group was 3.3 %. Follow-up period ranged from 1 month to 9.4 years (mean 2.8 ± 2.5 years). Restenosis at the site of aortic arch repair was identiϐied in 47 (10.5 %) patients. Of these, 12 patients underwent surgical reconstruction of the aortic arch, 27 patients underwent balloon angioplasty, and in 8 patients both methods were used. Freedom from reintervention was 89.4 % at 1-year follow-up and 87.5 % at 4-year follow-up. The most determining factorsfor restenosis were related to hypoplastic proximal aortic arch and body weight less than 2.5 kg. Conclusions. Surgical treatment of aortic arch hypoplasia in newborns and infants is effective and shows good immediate and long-term results. Anatomical correction of reobstruction at the level of the aortic arch is safe with both endovacular and surgical methods with low mortality and incidence of repeated interventions. Identified risk factors for mortality and recurrent aortic arch interventions help to improve the treatment of aortic arch hypoplasia in patients under 1 year of age.
{"title":"Restenosis Rate and Reinterventions after Aortic Arch Repair in Infants","authors":"I. Truba, Oleksandr S. Golovenko, I. Dziuryi","doi":"10.30702/ujcvs/22.30(04)/tg056-5965","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(04)/tg056-5965","url":null,"abstract":"The aim. This study aims to determine the reintervention rate in infantsundergoing aortic arch repair and to analyze risk factors and evaluate the results of reinterventions. \u0000Materials and methods. This retrospective study examines 445 infants with aortic arch hypoplasia who under-went aortic arch reconstruction between 2011 and 2019. The study included only patients with two-ventricle physiology and subsequent two-ventricle repair. Techniques for primary repair included extended end-to-end anastomosis (n = 348), end-to-side anastomosis (n = 611), autologous pericardial patch repair (n = 16). \u0000Results. The overall mortality in the entire study group was 3.3 %. Follow-up period ranged from 1 month to 9.4 years (mean 2.8 ± 2.5 years). Restenosis at the site of aortic arch repair was identiϐied in 47 (10.5 %) patients. Of these, 12 patients underwent surgical reconstruction of the aortic arch, 27 patients underwent balloon angioplasty, and in 8 patients both methods were used. Freedom from reintervention was 89.4 % at 1-year follow-up and 87.5 % at 4-year follow-up. The most determining factorsfor restenosis were related to hypoplastic proximal aortic arch and body weight less than 2.5 kg. \u0000Conclusions. Surgical treatment of aortic arch hypoplasia in newborns and infants is effective and shows good immediate and long-term results. Anatomical correction of reobstruction at the level of the aortic arch is safe with both endovacular and surgical methods with low mortality and incidence of repeated interventions. Identified risk factors for mortality and recurrent aortic arch interventions help to improve the treatment of aortic arch hypoplasia in patients under 1 year of age.","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":"49299265","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)/km052-8187
I. Kobza, Y. Mota, T. Kobza
Extracranial carotid artery aneurysm (ECAA) is a rare vascularpathology with reported incidence of 0.2-5.0% of all carotid artery surgical interventions. Most of ECAAs remain clinically asymptomatic, however, they can manifest in neurological symptoms as transient ischemic attack or stroke. The presence of a pulsating formation, swallowing disorders, signs of compression of cranial nerves may beindicative of the aneurysm growth, which is associated with higher risk of thromboembolic complications and less oftenwith rupture. Surgical treatment is a method of choice in symptomatic patients or in cases of the aneurysm growth and includes resection with arterial reconstruction, ligation of the artery or endovascular intervention. The aim. To improve the results of surgical treatment of ECAAs. Materials and methods. The results of clinical examination, laboratory, instrumental, intraoperative observations were analyzed in 39 patients (35 [89.7%] men and 4 [10.3%] women) with 44 ECAAs, who were admitted to the Vascular Surgery Department of Lviv Regional Clinical Hospital for the period from 2003 to 2022. To conϐirm the diagnosis of ECAA, preoperative instrumental examination included duplex ultrasonography and multispiral computed tomography angiography. Results. Etiological causes of ECAAs included: atherosclerosis (79.5%),ϐibromuscular dysplasia (7.7%), trauma (5.1%), previous operations in the neck region (5.1%) and infection (2.6%). The justiϐication of the choice of surgical tactics depended on the localization of aneurysm, concomitant carotid occlusive disease or pathological deviation of carotid arteries. Early results of surgical treatment were evaluated up to 30 days of the postoperative period. The postoperative complications included: transient ischemic attack in 1 (2.6%), ischemic stroke in 2 (5.1%), cranial nerve damages in 4 (10.3%), thrombosis of arterial reconstruction in 2 (5.1%), hematoma of postoperative wound in 4 (10.3%), infection of postoperative wound in 1 (2.6%) cases. Postoperative mortality was 2.6%. Conclusion. ECAA is a rare clinical disease that requires an active surgical approach to reduce the risk of ischemic stroke. Reconstructive surgery of ECAAs is a highly effective method of treatment that allows to achieve satisfactory results and prevent the development of severe complications.
{"title":"Extracranial Carotid Artery Aneurysms: 20-Year Experience of Surgical Management","authors":"I. Kobza, Y. Mota, T. Kobza","doi":"10.30702/ujcvs/22.30(04)/km052-8187","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(04)/km052-8187","url":null,"abstract":"Extracranial carotid artery aneurysm (ECAA) is a rare vascularpathology with reported incidence of 0.2-5.0% of all carotid artery surgical interventions. Most of ECAAs remain clinically asymptomatic, however, they can manifest in neurological symptoms as transient ischemic attack or stroke. The presence of a pulsating formation, swallowing disorders, signs of compression of cranial nerves may beindicative of the aneurysm growth, which is associated with higher risk of thromboembolic complications and less oftenwith rupture. Surgical treatment is a method of choice in symptomatic patients or in cases of the aneurysm growth and includes resection with arterial reconstruction, ligation of the artery or endovascular intervention. \u0000The aim. To improve the results of surgical treatment of ECAAs. \u0000Materials and methods. The results of clinical examination, laboratory, instrumental, intraoperative observations were analyzed in 39 patients (35 [89.7%] men and 4 [10.3%] women) with 44 ECAAs, who were admitted to the Vascular Surgery Department of Lviv Regional Clinical Hospital for the period from 2003 to 2022. To conϐirm the diagnosis of ECAA, preoperative instrumental examination included duplex ultrasonography and multispiral computed tomography angiography. \u0000Results. Etiological causes of ECAAs included: atherosclerosis (79.5%),ϐibromuscular dysplasia (7.7%), trauma (5.1%), previous operations in the neck region (5.1%) and infection (2.6%). The justiϐication of the choice of surgical tactics depended on the localization of aneurysm, concomitant carotid occlusive disease or pathological deviation of carotid arteries. Early results of surgical treatment were evaluated up to 30 days of the postoperative period. The postoperative complications included: transient ischemic attack in 1 (2.6%), ischemic stroke in 2 (5.1%), cranial nerve damages in 4 (10.3%), thrombosis of arterial reconstruction in 2 (5.1%), hematoma of postoperative wound in 4 (10.3%), infection of postoperative wound in 1 (2.6%) cases. Postoperative mortality was 2.6%. \u0000Conclusion. ECAA is a rare clinical disease that requires an active surgical approach to reduce the risk of ischemic stroke. Reconstructive surgery of ECAAs is a highly effective method of treatment that allows to achieve satisfactory results and prevent the development of severe complications.","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":"48172555","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)/vi060-122127
R. M. Vitovskyi, V. Isaienko, Oleksandr A. Pishchurin, A. R. Vitovskyi, Maryna M. Serdiuk, Valentina P. Zakharova
With a mortality rate of 1 % to 5 %, surgical treatment of cardiac myxomas (CM) may be complicated by the development of intra- or postoperative bleeding, among other things. The aim. To present an unusual case of surgical treatment of left atrial myxoma with the occurrence of intraoperative bleeding, which was due to extremely rare features of the coronary circulation with a special blood supply to the base of the CM. Case report. Female patient R., 65 years old, case record No.3686, was admitted to the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with diagnosis of CM. Coronary angiography revealed unique features of coronary circulation: an arteriovenous malformation from the distal parts of the circumflex branch of the left coronary artery with discharge into the right parts of the heart was revealed. On 9/20/2022, urgent operation of resection of the myxoma of the left atrium (LA) was performed. After removal of the myxoma and sealing of the heart, accumulation of arterial blood was found in the area of the inferior vena cava (IVC) and the interatrialsulcus. Revision of the left atrium cavity was performed again:all intracardiac sutures in the area of the myxoma base were duplicated. After repeated resealing of the heart chambers, bleeding from the IVC region stopped after administration of protamine sulfate and tight tamponade of the space under the IVC. Tampons were removed from the pericardial cavity after 72 hours. Results. The source of the bleeding could be the site of the malformation of the coronary arteries, which is a tangle of small vessels located in the projection of the base of the myxoma below the point where the IVC meets the right atrium. During the histological examination of the myxoma, large full-blood vessels of the sinusoidal type were revealed, around which, due to damage to their thin walls, hematomas formed, giving the tumor a spotted appearance. The peculiarity of this tumor was the presence of a very large vascular plexus at its base; it had the appearance of a cluster of sections of numerous, different-sized, deformed and remodeled arteries. These data were confirmed by coronary angiography. Conclusions. Studying the data of coronary angiography with the analysis offeatures of localization of coronary arteries, as well as the presence of possible coronary malformations, can provide information that allows predicting the possibility of their damage, especially in the case of localization in the place of possible surgical manipulation. In the event of bleeding, one of the optimal methods of its elimination is the use of long-term tamponade.
{"title":"Features of the Blood Supply of Cardiac Myxoma which Can Cause Bleeding","authors":"R. M. Vitovskyi, V. Isaienko, Oleksandr A. Pishchurin, A. R. Vitovskyi, Maryna M. Serdiuk, Valentina P. Zakharova","doi":"10.30702/ujcvs/22.30(04)/vi060-122127","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(04)/vi060-122127","url":null,"abstract":"With a mortality rate of 1 % to 5 %, surgical treatment of cardiac myxomas (CM) may be complicated by the development of intra- or postoperative bleeding, among other things. \u0000The aim. To present an unusual case of surgical treatment of left atrial myxoma with the occurrence of intraoperative bleeding, which was due to extremely rare features of the coronary circulation with a special blood supply to the base of the CM. \u0000Case report. Female patient R., 65 years old, case record No.3686, was admitted to the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with diagnosis of CM. Coronary angiography revealed unique features of coronary circulation: an arteriovenous malformation from the distal parts of the circumflex branch of the left coronary artery with discharge into the right parts of the heart was revealed. On 9/20/2022, urgent operation of resection of the myxoma of the left atrium (LA) was performed. After removal of the myxoma and sealing of the heart, accumulation of arterial blood was found in the area of the inferior vena cava (IVC) and the interatrialsulcus. Revision of the left atrium cavity was performed again:all intracardiac sutures in the area of the myxoma base were duplicated. After repeated resealing of the heart chambers, bleeding from the IVC region stopped after administration of protamine sulfate and tight tamponade of the space under the IVC. Tampons were removed from the pericardial cavity after 72 hours. \u0000Results. The source of the bleeding could be the site of the malformation of the coronary arteries, which is a tangle of small vessels located in the projection of the base of the myxoma below the point where the IVC meets the right atrium. During the histological examination of the myxoma, large full-blood vessels of the sinusoidal type were revealed, around which, due to damage to their thin walls, hematomas formed, giving the tumor a spotted appearance. The peculiarity of this tumor was the presence of a very large vascular plexus at its base; it had the appearance of a cluster of sections of numerous, different-sized, deformed and remodeled arteries. These data were confirmed by coronary angiography. \u0000Conclusions. Studying the data of coronary angiography with the analysis offeatures of localization of coronary arteries, as well as the presence of possible coronary malformations, can provide information that allows predicting the possibility of their damage, especially in the case of localization in the place of possible surgical manipulation. In the event of bleeding, one of the optimal methods of its elimination is the use of long-term tamponade.","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":"43032650","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)/cy062-6672
B. Cherpak, Nataliia S. Yaschuk, Y. V. Yermolovych, Oleksandr S. Golovenko, Yuri Panichkin
The aim. To determine the optimally necessary devices for endovascular stenting of coarctation of the aorta (CoA), considering the anatomical features of the defect and the age of the patient. Materials and methods. Examination and endovascular treatment of 189 patients aged 5 to 60 years with CoA of different anatomical and morphological variants was performed. Results and discussion. We presented the clinical features of different anatomical andmorphological variants of CoA. Endovascular treatment of CoA with stenting is considered the best method for adolescents and adults, due to the lower risk of aneurysm formation compared to balloon angioplasty. We were able to successfully reduce the invasive pressure gradient in patients of different ages and to establish dependence of the frequency of complications on the type of the stent used. There were no cases of in-hospital death. The effectiveness of the intervention was 99.4 %. All the patients were discharged from the hospital in good condition 3-7 days (3.3 ± 1.9 days) after the procedure. Currently, 95.7 % are being followed up. During the 5-year follow-up period, 1 patient died due to concomitant heart failure, heart rhythm disturbances (atrial fibrillation) and mitral insufficiency. There were 10.1 % patients (n = 19) with complications: 4.9 % (n = 4) with open-cell stents, 12.1 % (n = 13) with closed-cell stents, 2.2 % (n = 4) with stent-grafts, 7.9 % (n = 16) with uncovered stents. The frequency of reinterventions was 45.0 % in patients older than 25 years, 37.2 % in those aged 5-18 years and 17.6 % in those aged 19-25 years. Conclusions. The choice of optimally necessary devices for endovascular stenting of the aorta is recommended to be carried out considering the anatomical features of the defect and the age of the patient.
{"title":"The Choice of Optimally Necessary Devices for Endovascular Treatment of Coarctation of the Aorta","authors":"B. Cherpak, Nataliia S. Yaschuk, Y. V. Yermolovych, Oleksandr S. Golovenko, Yuri Panichkin","doi":"10.30702/ujcvs/22.30(04)/cy062-6672","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(04)/cy062-6672","url":null,"abstract":"The aim. To determine the optimally necessary devices for endovascular stenting of coarctation of the aorta (CoA), considering the anatomical features of the defect and the age of the patient. \u0000Materials and methods. Examination and endovascular treatment of 189 patients aged 5 to 60 years with CoA of different anatomical and morphological variants was performed. \u0000Results and discussion. We presented the clinical features of different anatomical andmorphological variants of CoA. Endovascular treatment of CoA with stenting is considered the best method for adolescents and adults, due to the lower risk of aneurysm formation compared to balloon angioplasty. We were able to successfully reduce the invasive pressure gradient in patients of different ages and to establish dependence of the frequency of complications on the type of the stent used. There were no cases of in-hospital death. The effectiveness of the intervention was 99.4 %. All the patients were discharged from the hospital in good condition 3-7 days (3.3 ± 1.9 days) after the procedure. Currently, 95.7 % are being followed up. During the 5-year follow-up period, 1 patient died due to concomitant heart failure, heart rhythm disturbances (atrial fibrillation) and mitral insufficiency. There were 10.1 % patients (n = 19) with complications: 4.9 % (n = 4) with open-cell stents, 12.1 % (n = 13) with closed-cell stents, 2.2 % (n = 4) with stent-grafts, 7.9 % (n = 16) with uncovered stents. The frequency of reinterventions was 45.0 % in patients older than 25 years, 37.2 % in those aged 5-18 years and 17.6 % in those aged 19-25 years. \u0000Conclusions. The choice of optimally necessary devices for endovascular stenting of the aorta is recommended to be carried out considering the anatomical features of the defect and the age of the patient.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69577023","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)/pb059-4752
V. Popov, O. Bolshak, V. Boukarim, Olena V. Khoroshkovata, O. M. Gurtovenko
Case description. A 41-year-old male patient F. was admitted to the Department ofSurgical Treatment of Ac-quired Heart Diseases of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with a diagnosis: Dilated cardiomyopathy. Mitral-tricuspid insufϐiciency. Left atrial myxoma. Left atriomegaly. Pulmonary hypertension. The patient was operated with heart failure symptoms of NYHA functional class IV. After a week of medical preparation and additional examination,the patient was successfully operated on (remov-al of the left atrial myxoma, imposition of support rings on the left and right atrioventricular openings, paraanular plicacy of the left atrium). The postoperative period proceededwithout signiϐicant complications. On the 12th day after the operation, the patient was discharged in satisfactorycondition. In the remote period the patient died suddenly 3 years later. Conclusion. Taking into account the initial serious condition of a patient with advanced heart disease with a reduced left ventricular ejection fraction, left atriomegaly (7.8 cm), pulmonary hypertension (50 mm Hg) and comorbidities, complex reconstruction of the left heart in atriomegaly and ventriculomegaly leads to an improvement in the functional state of the myocardium and morphometric indicators of left atrium and left ventricular ejection fraction.
案例描述。41岁男性患者F.被乌克兰国家医学科学院国立阿莫索夫心血管外科研究所收治为急性心脏病外科治疗科，诊断为扩张性心肌病。Mitral-tricuspid insufϐ角度。左心房黏液瘤。左心房肥大。肺动脉高压。患者手术时心衰竭症状为NYHA功能四级。经过一周的医学准备和附加检查，患者成功手术(切除左心房黏液瘤，在左右房室开口上施加支撑环，左心房环旁并发症)。术后无signiϐicant并发症。术后第12天，患者出院，病情满意。在偏远地区，患者在3年后突然死亡。结论。考虑到晚期心脏病患者初始病情严重，左室射血分数降低，左心房增大(7.8 cm)，肺动脉高压(50 mm Hg)及合并症，左心复杂重建左心房和心室增大导致心肌功能状态及左心房和左心室射血分数形态学指标改善。
{"title":"Case of Dilated Cardiomyopathy in Combination with Left Atrial Myxoma and Left Atriomegaly (Rare Clinical Case)","authors":"V. Popov, O. Bolshak, V. Boukarim, Olena V. Khoroshkovata, O. M. Gurtovenko","doi":"10.30702/ujcvs/22.30(04)/pb059-4752","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(04)/pb059-4752","url":null,"abstract":"Case description. A 41-year-old male patient F. was admitted to the Department ofSurgical Treatment of Ac-quired Heart Diseases of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with a diagnosis: Dilated cardiomyopathy. Mitral-tricuspid insufϐiciency. Left atrial myxoma. Left atriomegaly. Pulmonary hypertension. The patient was operated with heart failure symptoms of NYHA functional class IV. \u0000After a week of medical preparation and additional examination,the patient was successfully operated on (remov-al of the left atrial myxoma, imposition of support rings on the left and right atrioventricular openings, paraanular plicacy of the left atrium). The postoperative period proceededwithout signiϐicant complications. On the 12th day after the operation, the patient was discharged in satisfactorycondition. In the remote period the patient died suddenly 3 years later. \u0000Conclusion. Taking into account the initial serious condition of a patient with advanced heart disease with a reduced left ventricular ejection fraction, left atriomegaly (7.8 cm), pulmonary hypertension (50 mm Hg) and comorbidities, complex reconstruction of the left heart in atriomegaly and ventriculomegaly leads to an improvement in the functional state of the myocardium and morphometric indicators of left atrium and left ventricular ejection fraction.","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":"45556425","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 : 2022-09-26DOI: 10.30702/ujcvs/22.30(03)/id040-7682
E. Imanov, I. Ditkivskyy, O. Plyska, O. Mazur, Artemiia O. Sloboda
The aim. To analyze the results of the use of endovascular treatments for pulmonary artery atresia (PAA). Materials and methods. Treatment of this heart defect at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine with application of endovascular methods began in 2006. Since then, 138 patients were operated, 57 of them female (41.3%) and 81 (58.6%) were male. Endovascular methods were used in 23 patients, and 115 patients underwent open-heart surgery. The mean length of hospital stay was 25±16.3 days. Of 115 patients who underwent open-heart surgery, 62 (54%) were male and 53 (46%) were female. On the day of surgery, the mean age of these patients was 607.8±1023.7 days, mean weight was 8.8±8.1 kg. The average length of hospital stay was 26±18.6 (maximum 215, minimum 5). Of 23 patients who underwent endovascular surgery, 18 (77%) were male and 5 (23%) were female. The mean age on the day of surgery was 220.5±650.2 days, mean weight was 5.0±4.4 kg. The mean length of hospital stay was 22±5.7 days (maximum 34, minimum 4). In the treatment of PAA, a stepwise procedure is used, correcting part of the defect at each stage and thereby reducing the traumaticity of the operation. In our case, correction of the defect was performed on the open heart and using endovascular methods of treatment. After endovascular interventions, no fatal effects were observed. Open-heart surgery was performed in case if endovascular interventions could not be performed. The condition of such patients was usually more severe. It should also be noted that the open-heart surgery itself is a serious trauma to the body. Due to the above, postoperative period in this group of patients more often proceeded with complications. Due to more severe preoperative condition of the patients and surgical trauma, in some cases of open-heart interventions, some patients did not recover after surgery. As a result, the total mortality in the group of patients who underwent open-heart surgery was 13.0%. In addition, in 7 cases, such surgery was supplemented by the Rashkind procedure. In case of recurrent surgery after 6 months, stenting of patent ductus arteriosus was performed. Repeated surgical interventions were accompanied by the improvement of the condition and the patients were discharged from the clinic in satisfactory condition. Conclusions. PAA is one of the most complex congenital pathologies of the heart and main vessels, and therefore preservation of such a newborn depends on the preservation of patent ductus arteriosus. Endovascular surgery for PAA is the operation of choice that allows to prepare the patient for the next stage of treatment, including open-heart surgery. Endovascular interventions in PAA are minimally invasive, which increases the chances of patients with complicated anatomy to survive despite their serious condition on admission to the hospital.
{"title":"Experience of Endovascular Treatment of Pulmonary Artery Atresia","authors":"E. Imanov, I. Ditkivskyy, O. Plyska, O. Mazur, Artemiia O. Sloboda","doi":"10.30702/ujcvs/22.30(03)/id040-7682","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(03)/id040-7682","url":null,"abstract":"The aim. To analyze the results of the use of endovascular treatments for pulmonary artery atresia (PAA). \u0000Materials and methods. Treatment of this heart defect at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine with application of endovascular methods began in 2006. Since then, 138 patients were operated, 57 of them female (41.3%) and 81 (58.6%) were male. Endovascular methods were used in 23 patients, and 115 patients underwent open-heart surgery. The mean length of hospital stay was 25±16.3 days. \u0000Of 115 patients who underwent open-heart surgery, 62 (54%) were male and 53 (46%) were female. On the day of surgery, the mean age of these patients was 607.8±1023.7 days, mean weight was 8.8±8.1 kg. The average length of hospital stay was 26±18.6 (maximum 215, minimum 5). Of 23 patients who underwent endovascular surgery, 18 (77%) were male and 5 (23%) were female. The mean age on the day of surgery was 220.5±650.2 days, mean weight was 5.0±4.4 kg. The mean length of hospital stay was 22±5.7 days (maximum 34, minimum 4). \u0000In the treatment of PAA, a stepwise procedure is used, correcting part of the defect at each stage and thereby reducing the traumaticity of the operation. In our case, correction of the defect was performed on the open heart and using endovascular methods of treatment. After endovascular interventions, no fatal effects were observed. Open-heart surgery was performed in case if endovascular interventions could not be performed. The condition of such patients was usually more severe. It should also be noted that the open-heart surgery itself is a serious trauma to the body. Due to the above, postoperative period in this group of patients more often proceeded with complications. Due to more severe preoperative condition of the patients and surgical trauma, in some cases of open-heart interventions, some patients did not recover after surgery. As a result, the total mortality in the group of patients who underwent open-heart surgery was 13.0%. In addition, in 7 cases, such surgery was supplemented by the Rashkind procedure. In case of recurrent surgery after 6 months, stenting of patent ductus arteriosus was performed. Repeated surgical interventions were accompanied by the improvement of the condition and the patients were discharged from the clinic in satisfactory condition. \u0000Conclusions. PAA is one of the most complex congenital pathologies of the heart and main vessels, and therefore preservation of such a newborn depends on the preservation of patent ductus arteriosus. Endovascular surgery for PAA is the operation of choice that allows to prepare the patient for the next stage of treatment, including open-heart surgery. Endovascular interventions in PAA are minimally invasive, which increases the chances of patients with complicated anatomy to survive despite their serious condition on admission to the hospital.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42875751","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：