Pub Date : 2022-09-26DOI: 10.30702/ujcvs/22.30(03)/km042-4449
M. Kucheriava, G. Mankovsky
The aim. To evaluate the short-term and long-term outcomes of myocardial revascularization – percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) – in patients with coronary artery disease (CAD) and heart failure (HF) with reduced left ventricular ejection fraction. Materials and methods. This one-center prospective study was conducted on the basis of the Ukrainian Children’s Cardiac Center, Clinic for Adults, Kyiv, Ukraine. Analysis included 194 patients with CAD and HF with reduced left ventricular ejection fraction. The studied cohort of patients underwent myocardial revascularization: 99 (51.1%) patients through PCI and 95 (48.9%) patients through CABG during 24 months (between January 2020 and January 2022). Results and discussion. PCI and CAD were associated with a similar risk of all-cause mortality during 30-day follow-up (HR 0,95; [95% CI], 0.135-6.796; p=0.96). When analyzing the long-term results of myocardial revascularization in terms of the effect on all-cause mortality, PCI and CABG had identical results, no significant difference was observed (HR 1.05; [95% CI], 0.448-2.481; p = 0.903). However, PCI was associated with an increased risk of repeated myocardial revascularization (HR 3.00; [95% CI], 1.251-7.221; p=0.025) compared with CABG. Patients who underwent CABG had a significant difference in the number of re-hospitalizations due to HF progression compared to those after PCI (HR 0.33; [95% CI], 0.170-0.652; p=0.002). The rehabilitation period was 2±4 days in patients after PCI, and 7±4 days in patients after CABG, which corresponded to a statistically significant difference (HR 3.48; [95% CI], 2.489-4.891; p <0.001). The visual analog scale scores of pain intensity were 3±1 in patients after PCI and 7±2 in those after CABG, the difference is statistically significant (HR 3.16; [95% CI], 2.283-4.382; p <0.001). Conclusions. Results of myocardial revascularization with PCI and CABG had identical short-term and long-term all-cause mortality rates. However, PCI was associated with a higher risk of repeated myocardial revascularization over a 2-year follow-up period. CABG, in turn, was associated with more frequent HF readmissions than PCI. The rehabilitation period was statistically shorter in patients after PCI. According to the visual analog scale, the pain in patients after CABG was more pronounced.
{"title":"Myocardial Revascularization in Patients with Coronary Artery Disease and Reduced Left Ventricular Ejection Fraction","authors":"M. Kucheriava, G. Mankovsky","doi":"10.30702/ujcvs/22.30(03)/km042-4449","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(03)/km042-4449","url":null,"abstract":"The aim. To evaluate the short-term and long-term outcomes of myocardial revascularization – percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) – in patients with coronary artery disease (CAD) and heart failure (HF) with reduced left ventricular ejection fraction. \u0000Materials and methods. This one-center prospective study was conducted on the basis of the Ukrainian Children’s Cardiac Center, Clinic for Adults, Kyiv, Ukraine. Analysis included 194 patients with CAD and HF with reduced left ventricular ejection fraction. The studied cohort of patients underwent myocardial revascularization: 99 (51.1%) patients through PCI and 95 (48.9%) patients through CABG during 24 months (between January 2020 and January 2022). \u0000Results and discussion. PCI and CAD were associated with a similar risk of all-cause mortality during 30-day follow-up (HR 0,95; [95% CI], 0.135-6.796; p=0.96). When analyzing the long-term results of myocardial revascularization in terms of the effect on all-cause mortality, PCI and CABG had identical results, no significant difference was observed (HR 1.05; [95% CI], 0.448-2.481; p = 0.903). However, PCI was associated with an increased risk of repeated myocardial revascularization (HR 3.00; [95% CI], 1.251-7.221; p=0.025) compared with CABG. Patients who underwent CABG had a significant difference in the number of re-hospitalizations due to HF progression compared to those after PCI (HR 0.33; [95% CI], 0.170-0.652; p=0.002). The rehabilitation period was 2±4 days in patients after PCI, and 7±4 days in patients after CABG, which corresponded to a statistically significant difference (HR 3.48; [95% CI], 2.489-4.891; p <0.001). The visual analog scale scores of pain intensity were 3±1 in patients after PCI and 7±2 in those after CABG, the difference is statistically significant (HR 3.16; [95% CI], 2.283-4.382; p <0.001). \u0000Conclusions. Results of myocardial revascularization with PCI and CABG had identical short-term and long-term all-cause mortality rates. However, PCI was associated with a higher risk of repeated myocardial revascularization over a 2-year follow-up period. CABG, in turn, was associated with more frequent HF readmissions than PCI. The rehabilitation period was statistically shorter in patients after PCI. According to the visual analog scale, the pain in patients after CABG was more pronounced.","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":"46425150","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)/al035-1521
Ramil A. Aliyev, Y. Lebedieva, M. Grusha, Mykyta M. Brianskyi
The article is dedicated to topical issues of the tactics of surgical treatment of postinfarction ventricular septum rupture (PIVSR). Based on the study of the peculiarities of surgical treatment of ventricular septal defect in patients with different deadlines for surgical intervention after the development of acute myocardial infarction (AMI), the most appropriate approach to the correction of PIVSR in such patients was determined. In particular, taking into account mortality risk (42 %), the most reasonable is the use of wait-and-see tactics in the management of patients with PIVSR at the early stages after the development of AMI. At the same time, the decision on the timing of surgical intervention should be made individually, taking into account the clinical condition of the patient and the course of the postinfarction heart remodeling. Special attention is paid to the analysis of the effectiveness of the use of intra-aortic balloon counterpulsation and the time intervals of surgical intervention from the moment of hospitalization in patients with PIVSR. It was found that clinical course of coronary heart disease complicated by PIVSR can be extremely unpredictable not only in the early postinfarction period, but also up to 2 months after the development of AMI. In addition, when planning the amount of surgical intervention, it is necessary to take into account the presence of multivessel atherosclerotic lesions of the coronary arteries in patients with PIVSR, regardless of the timing after the development of AMI.
{"title":"Tactics of Surgical Treatment of Postinfarction Ventricular Septum Rupture Depending on the Time after the Development of an Acute Myocardial Infarction","authors":"Ramil A. Aliyev, Y. Lebedieva, M. Grusha, Mykyta M. Brianskyi","doi":"10.30702/ujcvs/22.30(03)/al035-1521","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(03)/al035-1521","url":null,"abstract":"The article is dedicated to topical issues of the tactics of surgical treatment of postinfarction ventricular septum rupture (PIVSR). Based on the study of the peculiarities of surgical treatment of ventricular septal defect in patients with different deadlines for surgical intervention after the development of acute myocardial infarction (AMI), the most appropriate approach to the correction of PIVSR in such patients was determined. In particular, taking into account mortality risk (42 %), the most reasonable is the use of wait-and-see tactics in the management of patients with PIVSR at the early stages after the development of AMI. At the same time, the decision on the timing of surgical intervention should be made individually, taking into account the clinical condition of the patient and the course of the postinfarction heart remodeling. Special attention is paid to the analysis of the effectiveness of the use of intra-aortic balloon counterpulsation and the time intervals of surgical intervention from the moment of hospitalization in patients with PIVSR. It was found that clinical course of coronary heart disease complicated by PIVSR can be extremely unpredictable not only in the early postinfarction period, but also up to 2 months after the development of AMI. In addition, when planning the amount of surgical intervention, it is necessary to take into account the presence of multivessel atherosclerotic lesions of the coronary arteries in patients with PIVSR, regardless of the timing after the development of AMI.","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":"43856984","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)/pb033-104108
V. Popov, V. Boukarim, O. Bolshak, Olena V. Khoroshkovata, O. Yuvchyk
Implementation of the principles of medical preparation, comprehensive reconstruction of the left heart in patients with atriomegaly and ventriculomegaly and combined mitral-tricuspid valve diseases leads to improvement of myocardial function and morphometric parameters of the left atrium (LA) and left ventricle (LV). Case description. Patient R., male, 67 years old, underwent examination and treatment from April 22 to May 25, 2021 at the department of surgical treatment of acquired heart diseases of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with the diagnosis of stage IV mitral regurgitation, stage IV tricuspid insufficiency, high grade pulmonary hypertension, permanent atrial fibrillation (lasting 10 years since 2011), IIB heart failure with reduced left ventricular ejection fraction (LVEF), secondary hypothyroidism (state of drug subcompensation). Upon admission, the patient was in a state of circulatory decompensation, which required long-term medical preparation for the operation. After his condition was improved, the patient underwent surgery: mitral valve replacement with complete preservation of the valve apparatus, triangular plasty of LA, tricuspid valve plasty with the imposition of a support ring and resection of the right atrium. There were no complications during the intraoperative period. The postoperative period was characterized by symptoms of hyperbilirubinemia, increased exudation from drainages on the first day after surgery. After appropriate treatment, the patient’s condition was stabilized. The patient was discharged on the 13th day after surgery with improvement. Conclusion. Given the initial severe condition of the patient with advanced heart disease with reduced LVEF, left atriomegaly 9.5x12.3 cm, high grade pulmonary hypertension (peak systolic pressure = 70 mm Hg) and comorbidities, comprehensive reconstruction of the left heart with atriomegaly and ventriculomegaly leads to improvement of functional state of the myocardium and morphometric parameters of LA and LV.
心房和心室肿大合并二尖瓣和三尖瓣合并病变患者实施医学准备、左心全面重建原则，使心肌功能和左心房、左心室形态学参数得到改善。案例描述。患者R，男，67岁，于2021年4月22日至5月25日在乌克兰国家医学科学院国立阿莫索夫心血管外科研究所获得性心脏病外科治疗科接受检查和治疗，诊断为IV期二尖瓣反流，IV期三尖瓣不全，重度肺动脉高压，永久性房颤(2011年至今，持续10年)。IIB心力衰竭伴左室射血分数(LVEF)降低，继发性甲状腺功能减退(药物亚代偿状态)。入院时，患者处于循环失代偿状态，需要为手术做长期的医疗准备。在病情好转后，患者接受了手术:二尖瓣置换术，完全保留瓣膜装置，LA三角形成形术，三尖瓣成形术，施加支撑环并切除右心房。术中无并发症发生。术后以高胆红素血症症状为特征，术后第一天引流液渗出物增多。经适当治疗，患者病情稳定。患者术后13天出院，病情好转。结论。考虑到晚期心脏病患者初始病情严重，LVEF降低，左心房扩大9.5x12.3 cm，高级别肺动脉高压(收缩压峰值= 70 mm Hg)及合并症，综合重建左心并心房和心室扩大，可改善心肌功能状态及左室、左室形态学参数。
{"title":"Complete Reconstruction of the Left Heart with Atriomegaly and Ventriculomegaly: Clinical Case","authors":"V. Popov, V. Boukarim, O. Bolshak, Olena V. Khoroshkovata, O. Yuvchyk","doi":"10.30702/ujcvs/22.30(03)/pb033-104108","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(03)/pb033-104108","url":null,"abstract":"Implementation of the principles of medical preparation, comprehensive reconstruction of the left heart in patients with atriomegaly and ventriculomegaly and combined mitral-tricuspid valve diseases leads to improvement of myocardial function and morphometric parameters of the left atrium (LA) and left ventricle (LV). \u0000Case description. Patient R., male, 67 years old, underwent examination and treatment from April 22 to May 25, 2021 at the department of surgical treatment of acquired heart diseases of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with the diagnosis of stage IV mitral regurgitation, stage IV tricuspid insufficiency, high grade pulmonary hypertension, permanent atrial fibrillation (lasting 10 years since 2011), IIB heart failure with reduced left ventricular ejection fraction (LVEF), secondary hypothyroidism (state of drug subcompensation). Upon admission, the patient was in a state of circulatory decompensation, which required long-term medical preparation for the operation. After his condition was improved, the patient underwent surgery: mitral valve replacement with complete preservation of the valve apparatus, triangular plasty of LA, tricuspid valve plasty with the imposition of a support ring and resection of the right atrium. There were no complications during the intraoperative period. The postoperative period was characterized by symptoms of hyperbilirubinemia, increased exudation from drainages on the first day after surgery. After appropriate treatment, the patient’s condition was stabilized. The patient was discharged on the 13th day after surgery with improvement. \u0000Conclusion. Given the initial severe condition of the patient with advanced heart disease with reduced LVEF, left atriomegaly 9.5x12.3 cm, high grade pulmonary hypertension (peak systolic pressure = 70 mm Hg) and comorbidities, comprehensive reconstruction of the left heart with atriomegaly and ventriculomegaly leads to improvement of functional state of the myocardium and morphometric parameters of LA and LV.","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":"45219890","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)/dm031-3543
Ya.Yu. Dzhun, Y. Marushko, Ya.A. Saienko, N. Rudenko, B. Mankovsky
Nowadays treatment of patients with coronary artery disease (CAD) and concomitant type 2 diabetes mellitus (DM) needs further study. The aim. Evaluation of the clinical effect and glycemic variability of dapagliflozin in patients with angiographically confirmed CAD and concomitant type 2 DM. Materials and methods. The study involved 47 patients with angiographically confirmed CAD. The patients underwent laboratory blood tests, electrocardiography, echocardiography, continuous glucose monitoring and percutaneous coronary intervention (PCI). Depending on the usage of dapagliflozin 10 mg, the patients were divided into 2 groups: group I (+SGLT2i, n = 24) and group II (–SGLT2i, n = 23). The average follow-up period was 16 months. Results. Distribution of the examined patients by age, anthropometric characteristics, duration of DM, functional state of the heart and kidneys, smoking, the presence of acute cardiovascular events and previous PCI showed no statistically significant difference. In patients of group I, on the background of taking SGLT2i, a decrease in body mass index and improved glycemic profile were revealed. Patients in group II were more likely to have complaints of angina (4 [17.3%] vs 1 [4.3%], p>0.05); repeated coronary angiography in this group was significantly more likely to reveal progression to atherosclerotic CAD (4 [17.3%], p<0.05) which required re-revascularization. No fatalities were detected during the follow-up. Conclusion. Dapagliflozin has improved glycemic and lipid profile of the blood and long-term prognosis after PCI. Adding this drug to the treatment reduces the clinical progression of CAD, the need for re-hospitalization and cardiac revascularization.
目前，冠状动脉疾病(CAD)合并2型糖尿病(DM)的治疗方法有待进一步研究。的目标。评价达格列净对冠心病合并2型糖尿病患者的临床疗效和血糖变异性。材料和方法。该研究纳入了47例经血管造影证实的冠心病患者。患者接受了实验室血液检查、心电图、超声心动图、连续血糖监测和经皮冠状动脉介入治疗(PCI)。根据达格列净10mg的使用情况，将患者分为2组:I组(+SGLT2i, n = 24)和II组(-SGLT2i, n = 23)。平均随访时间为16个月。结果。年龄、人体测量特征、糖尿病病程、心肾功能状态、吸烟情况、有无急性心血管事件及既往PCI的分布差异无统计学意义。在I组患者中，在服用SGLT2i的背景下，体重指数下降，血糖谱改善。II组患者出现心绞痛主诉的可能性更大(4例[17.3%]vs 1例[4.3%]，p < 0.05);该组反复冠状动脉造影更有可能显示动脉粥样硬化性CAD进展(4例[17.3%]，p<0.05)，需要再血运重建。随访期间未发现死亡病例。结论。达格列净改善了PCI术后的血糖和血脂状况和长期预后。在治疗中加入该药可减少CAD的临床进展、再次住院和心脏血运重建术的需要。
{"title":"The Clinical Effect of Dapagliflozin in Patients with Angiographically Confirmed Coronary Artery Disease and Concomitant Type 2 Diabetes Mellitus","authors":"Ya.Yu. Dzhun, Y. Marushko, Ya.A. Saienko, N. Rudenko, B. Mankovsky","doi":"10.30702/ujcvs/22.30(03)/dm031-3543","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(03)/dm031-3543","url":null,"abstract":"Nowadays treatment of patients with coronary artery disease (CAD) and concomitant type 2 diabetes mellitus (DM) needs further study. \u0000The aim. Evaluation of the clinical effect and glycemic variability of dapagliflozin in patients with angiographically confirmed CAD and concomitant type 2 DM. \u0000Materials and methods. The study involved 47 patients with angiographically confirmed CAD. The patients underwent laboratory blood tests, electrocardiography, echocardiography, continuous glucose monitoring and percutaneous coronary intervention (PCI). Depending on the usage of dapagliflozin 10 mg, the patients were divided into 2 groups: group I (+SGLT2i, n = 24) and group II (–SGLT2i, n = 23). The average follow-up period was 16 months. \u0000Results. Distribution of the examined patients by age, anthropometric characteristics, duration of DM, functional state of the heart and kidneys, smoking, the presence of acute cardiovascular events and previous PCI showed no statistically significant difference. In patients of group I, on the background of taking SGLT2i, a decrease in body mass index and improved glycemic profile were revealed. Patients in group II were more likely to have complaints of angina (4 [17.3%] vs 1 [4.3%], p>0.05); repeated coronary angiography in this group was significantly more likely to reveal progression to atherosclerotic CAD (4 [17.3%], p<0.05) which required re-revascularization. No fatalities were detected during the follow-up. \u0000Conclusion. Dapagliflozin has improved glycemic and lipid profile of the blood and long-term prognosis after PCI. Adding this drug to the treatment reduces the clinical progression of CAD, the need for re-hospitalization and cardiac revascularization.","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":"44301707","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)/dt044-6875
I. Dziuryi, I. Truba, Vasyl V. Fylypchuk, I. Perepeka, V. Lazoryshynets
Surgical treatment of complex congenital heart defects (CHD) in patients who cannot undergo radical correction due to pronounced hypoplasia or dysfunction of the right ventricle (RV) remains one of the most urgent problems in pediatric cardiac surgery. In 1989, Billingsley et al. first reported the addition of bidirectional cavopulmonary anastomosis to definitive biventricular repair in patients with RV hypoplasia, pulmonary artery atresia, and intact interventricular septum in four patients, and introduced the term one and half ventricle repair (1.5VR). The method of 1.5VR consists of bidirectional cavopulmonary anastomosis, which reduces the volume load on the RV, in addition to the complete repair of other CHDs. The aim. To assess perioperative characteristics of patients, immediate and long-term results after surgical correction of complex CHD through the method of 1.5VR. Materials and methods. In the period from 1996 to 2022, surgical correction was performed in 33 patients with complex CHD combined with hypoplasia and/or dysfunction of the RV at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. There were 21 male patients (64%) and 12 female patients (36%). The mean age of the patients at the time of surgery was 57.9 months. Me = 34 [3.5; 312] months. The main method of diagnosis in determining the defect and assessing the immediate and long-term results was echocardiographic examination and probing of the heart cavities, which made it possible to assess the morphology, kinetics of the heart structures, and hemodynamic state. Depending on the selected tactics of surgical treatment, all the patients were divided into two groups: group І (n=21) with patients operated through the method of 1.5VR, and group ІІ (n = 12) including those operated through the single ventricle pathway. Results. In the early postoperative period, there were 3 (9%) deaths in both groups: one (4.7%) death in group I, and 2 (16%) deaths among patients of group II. In all the deceased patients, the cause of death was acute heart failure, which subsequently led to multiple organ failure. In one patient of the group II, in addition to heart failure, acute cerebrovascular accident occurred. In the group I, the average indicator of systemic saturation (92±6.2%) at discharge from the hospital was higher, than that in group II (87±4.7%). Average duration of mechanical ventilation (10±7.3 vs. 15±7.8 hours), total exudation (65±34 vs. 88.8±39.9 hours), total duration of sympathomimetic support (71±27.5 vs. 108±75.5 hours) and its doses (4.8±2 vs. 6.5±3.8 μkg/kg/hour) were significantly lower in the group I, therefore, the patients of the group II stayed almost twice as long in the intensive care department (146±56 vs. 96±49.8 hours), although the total length of hospital stay did not differ significantly (25±3.8 vs. 26±12.3 days). An uncomplicated course of the early postoperative period was observed in 15 (46%) pa
{"title":"Comparison of the Methods of Surgical Treatment of Complex Congenital Heart Defects Combined with Right Ventricular Hypoplasia","authors":"I. Dziuryi, I. Truba, Vasyl V. Fylypchuk, I. Perepeka, V. Lazoryshynets","doi":"10.30702/ujcvs/22.30(03)/dt044-6875","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(03)/dt044-6875","url":null,"abstract":"Surgical treatment of complex congenital heart defects (CHD) in patients who cannot undergo radical correction due to pronounced hypoplasia or dysfunction of the right ventricle (RV) remains one of the most urgent problems in pediatric cardiac surgery. In 1989, Billingsley et al. first reported the addition of bidirectional cavopulmonary anastomosis to definitive biventricular repair in patients with RV hypoplasia, pulmonary artery atresia, and intact interventricular septum in four patients, and introduced the term one and half ventricle repair (1.5VR). The method of 1.5VR consists of bidirectional cavopulmonary anastomosis, which reduces the volume load on the RV, in addition to the complete repair of other CHDs. \u0000The aim. To assess perioperative characteristics of patients, immediate and long-term results after surgical correction of complex CHD through the method of 1.5VR. \u0000Materials and methods. In the period from 1996 to 2022, surgical correction was performed in 33 patients with complex CHD combined with hypoplasia and/or dysfunction of the RV at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. There were 21 male patients (64%) and 12 female patients (36%). The mean age of the patients at the time of surgery was 57.9 months. Me = 34 [3.5; 312] months. The main method of diagnosis in determining the defect and assessing the immediate and long-term results was echocardiographic examination and probing of the heart cavities, which made it possible to assess the morphology, kinetics of the heart structures, and hemodynamic state. Depending on the selected tactics of surgical treatment, all the patients were divided into two groups: group І (n=21) with patients operated through the method of 1.5VR, and group ІІ (n = 12) including those operated through the single ventricle pathway. \u0000Results. In the early postoperative period, there were 3 (9%) deaths in both groups: one (4.7%) death in group I, and 2 (16%) deaths among patients of group II. In all the deceased patients, the cause of death was acute heart failure, which subsequently led to multiple organ failure. In one patient of the group II, in addition to heart failure, acute cerebrovascular accident occurred. In the group I, the average indicator of systemic saturation (92±6.2%) at discharge from the hospital was higher, than that in group II (87±4.7%). Average duration of mechanical ventilation (10±7.3 vs. 15±7.8 hours), total exudation (65±34 vs. 88.8±39.9 hours), total duration of sympathomimetic support (71±27.5 vs. 108±75.5 hours) and its doses (4.8±2 vs. 6.5±3.8 μkg/kg/hour) were significantly lower in the group I, therefore, the patients of the group II stayed almost twice as long in the intensive care department (146±56 vs. 96±49.8 hours), although the total length of hospital stay did not differ significantly (25±3.8 vs. 26±12.3 days). An uncomplicated course of the early postoperative period was observed in 15 (46%) pa","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":"46545912","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)/zhk038-9397
I. Zhekov, V. Kravchenko, Oleh I. Sarhosh, Genadii A. Zinchenko, A. Rudenko
The aim. To compare the effectiveness of methods of protecting the brain and visceral organs during operations for aortic aneurysms combined with coronary artery lesions. Materials and methods. In the period from 2012 to 2020, 23 patients with Stanford type A and non-A non-B aortic dissection with damage to the coronary arteries were operated at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine using the brain protection techniques. Out of 23 surgical interventions, 16 were performed for Stanford type A acute aortic dissection, 3 for Stanford type A chronic aortic dissection, 1 for Stanford type A subacute aortic dissection, and 3 for Stanford non-A non-B aortic dissection. The main causes of aortic dissection were hypertension (16 patients), Marfan syndrome (3 patients), bicuspid aortic valve (4 patients). Results. The most threatening postoperative complication in this group of patients is neurological damage, which was observed in 4 (17%) patients after surgery, with gradual recovery of brain function. Also, the complications observed were respiratory failure in 3 (13%) patients, which required long-term artificial ventilation (more than 72 hours), and multiple organ failure in 1 (4.3%) patient, which caused a fatal outcome.Complications such as kidney and liver failure were not observed (most likely due to the small sample size). Heart failure was not noted as well. Hospital mortality was 4.3% (1 fatal case). In our study, among the entire group of operated patients, symptoms of neurological damage occurred in 4 (17.4%) patients, hemorrhagic stroke was present in 1 (4.3%) patient with a complicated medical history, 2 (8.6%) patients had hemiparesis and in 1 case (4.3%) there were cognitive disorders. Conclusions. Comparing brain protection techniques, taking into account the prolongation of aortic clamping time due to coronary artery shunting compared to isolated aortic dissection, it can be concluded that longer duration of selective brain perfusion (retrograde or antegrade) or duration of circulatory arrest more often lead to postoperative complications, namely neurological lesions. On the other hand, the small number of observations does not make it possible to fully assess the impact of each of the techniques. Further follow-up with a larger sample will provide opportunities for a more complete evaluation of brain protection techniques in operations for dissecting aortic aneurysms and coronary artery lesions.
{"title":"Brain Protection in Patients with Aortic Dissection and Coronary Artery Disease","authors":"I. Zhekov, V. Kravchenko, Oleh I. Sarhosh, Genadii A. Zinchenko, A. Rudenko","doi":"10.30702/ujcvs/22.30(03)/zhk038-9397","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(03)/zhk038-9397","url":null,"abstract":"The aim. To compare the effectiveness of methods of protecting the brain and visceral organs during operations for aortic aneurysms combined with coronary artery lesions. \u0000Materials and methods. In the period from 2012 to 2020, 23 patients with Stanford type A and non-A non-B aortic dissection with damage to the coronary arteries were operated at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine using the brain protection techniques. Out of 23 surgical interventions, 16 were performed for Stanford type A acute aortic dissection, 3 for Stanford type A chronic aortic dissection, 1 for Stanford type A subacute aortic dissection, and 3 for Stanford non-A non-B aortic dissection. The main causes of aortic dissection were hypertension (16 patients), Marfan syndrome (3 patients), bicuspid aortic valve (4 patients). \u0000Results. The most threatening postoperative complication in this group of patients is neurological damage, which was observed in 4 (17%) patients after surgery, with gradual recovery of brain function. Also, the complications observed were respiratory failure in 3 (13%) patients, which required long-term artificial ventilation (more than 72 hours), and multiple organ failure in 1 (4.3%) patient, which caused a fatal outcome.Complications such as kidney and liver failure were not observed (most likely due to the small sample size). Heart failure was not noted as well. Hospital mortality was 4.3% (1 fatal case). In our study, among the entire group of operated patients, symptoms of neurological damage occurred in 4 (17.4%) patients, hemorrhagic stroke was present in 1 (4.3%) patient with a complicated medical history, 2 (8.6%) patients had hemiparesis and in 1 case (4.3%) there were cognitive disorders. \u0000Conclusions. Comparing brain protection techniques, taking into account the prolongation of aortic clamping time due to coronary artery shunting compared to isolated aortic dissection, it can be concluded that longer duration of selective brain perfusion (retrograde or antegrade) or duration of circulatory arrest more often lead to postoperative complications, namely neurological lesions. \u0000On the other hand, the small number of observations does not make it possible to fully assess the impact of each of the techniques. Further follow-up with a larger sample will provide opportunities for a more complete evaluation of brain protection techniques in operations for dissecting aortic aneurysms and coronary artery lesions.","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":"42971751","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)/gd037-98103
V. Galagan, Y. Dudierina, A. Pavlova
A clinical case of microduplication of chromosome 22q11.21 in a fetus with a malformation of the cardiovascular system (vascular ring) is presented. This anatomical variant of the vascular ring is extremely rare and is formed by the pathological circumflex retroesophageal left-sided cervical aortic arch with the left arterial ductus arteriosus. The anatomical features of the circumflex cervical aortic arch are the left-sided pathological curved aortic arch in combination with the right-sided descending aorta. This vascular pathology can cause compression of the trachea and esophagus. This variant of the vascular ring is extremely unfavorable for surgical correction. Chromosome 22q11.21 microduplication syndrome is associated with the clinical presentation of “cat eye syndrome”. The clinical case description shows unique data from instrumental and genetic studies. All stages of examination of a pregnant woman from primary to tertiary medical care are described. The features and importance of a multidisciplinary approach are also presented. Every case of congenital heart defect in fetus, confirmed by echocardiographic method in a specialized institution, requires medical and genetic counseling. Using of the highly sensitive specific molecular cytogenetic method, comparative genomic hybridization, in prenatal diagnosis allows for timely diagnosis of microstructural disorders of chromosomes in fetus. Follow-up of a pregnant woman with congenital heart defect in the fetus requires a multidisciplinary approach not only to improve diagnosis and treatment, but also to calculate genetic risk.
{"title":"Prenatal Diagnosis of Chromosome 22q11.21 Microduplication Syndrome in a Fetus with Congenital Malformation of the Cardiovascular System: Case Report","authors":"V. Galagan, Y. Dudierina, A. Pavlova","doi":"10.30702/ujcvs/22.30(03)/gd037-98103","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(03)/gd037-98103","url":null,"abstract":"A clinical case of microduplication of chromosome 22q11.21 in a fetus with a malformation of the cardiovascular system (vascular ring) is presented. This anatomical variant of the vascular ring is extremely rare and is formed by the pathological circumflex retroesophageal left-sided cervical aortic arch with the left arterial ductus arteriosus. The anatomical features of the circumflex cervical aortic arch are the left-sided pathological curved aortic arch in combination with the right-sided descending aorta. This vascular pathology can cause compression of the trachea and esophagus. This variant of the vascular ring is extremely unfavorable for surgical correction. Chromosome 22q11.21 microduplication syndrome is associated with the clinical presentation of “cat eye syndrome”. The clinical case description shows unique data from instrumental and genetic studies. All stages of examination of a pregnant woman from primary to tertiary medical care are described. The features and importance of a multidisciplinary approach are also presented. \u0000Every case of congenital heart defect in fetus, confirmed by echocardiographic method in a specialized institution, requires medical and genetic counseling. Using of the highly sensitive specific molecular cytogenetic method, comparative genomic hybridization, in prenatal diagnosis allows for timely diagnosis of microstructural disorders of chromosomes in fetus. Follow-up of a pregnant woman with congenital heart defect in the fetus requires a multidisciplinary approach not only to improve diagnosis and treatment, but also to calculate genetic risk.","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":"44959650","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)/mt041-5059
O. Mitchenko, K. Timokhova, N. Chulaievska
The aim. To optimize the diagnostic algorithm for patients with true “possible” familial hypercholesterolemia (FH) and differential diagnosis with hypercholesterolemia on the background of comorbid endocrinopathies for selection of optimal hypolipidemic therapy. Materials and methods. We examined 130 patients with hypercholesterolemia and comorbid pathology (type 2 diabetes mellitus, hypothyroidism, obesity grade II-III). In each group, subgroups with low-density lipoproteins (LDL) ≥5 mmol/l were selected and followed up on the background of maximum tolerated doses of statins in combination with therapy aimed to compensate comorbid pathology. The control group consisted of 20 patients with verified FH. Results and discussion. Combined dyslipidemia was detected in groups 1 and 3, pure hypercholesterolemia in group 2. Direct correlations between lipid profile and comorbid pathology characteristics were revealed. Patients of the subgroups with “possible” FH had higher atherogenicity of the lipid profile associated with comorbid pathology destabilization and high percentage of atherosclerosis of carotid and coronary arteries. According to the results of the follow-up, it was established that statin therapy and comorbid pathology compensation led to the achievement of target levels of LDL (group 3) or a reduction of LDL by 50% (group 1, 2). In patients of the control group, statin therapy with maximally tolerated doses did not show such results. Conclusions. The cohort of patients defined as having “possible” FH is heterogeneous and may include patients with secondary dyslipidemia on the background of comorbid pathology destabilization, timely verification and treatment of which contributes to achieving the goals of lipid-lowering therapy. Taking into account that only obese patients reached the target level of LDL <1.8 mmol/l, combined lipid-lowering therapy is recommended for patients with hypothyroidism and diabetes. Refractoriness to statin therapy in patients with verified “possible” FH emphasizes the need for combined lipid-lowering therapy (ezetimibe, PCSK9 inhibitors).
{"title":"Diagnostic Features and Selection of Hypolipidemic Therapy in Patients with Coronary Artery Disease with “Possible” Familial Hypercholesterolemia","authors":"O. Mitchenko, K. Timokhova, N. Chulaievska","doi":"10.30702/ujcvs/22.30(03)/mt041-5059","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(03)/mt041-5059","url":null,"abstract":"The aim. To optimize the diagnostic algorithm for patients with true “possible” familial hypercholesterolemia (FH) and differential diagnosis with hypercholesterolemia on the background of comorbid endocrinopathies for selection of optimal hypolipidemic therapy. \u0000Materials and methods. We examined 130 patients with hypercholesterolemia and comorbid pathology (type 2 diabetes mellitus, hypothyroidism, obesity grade II-III). In each group, subgroups with low-density lipoproteins (LDL) ≥5 mmol/l were selected and followed up on the background of maximum tolerated doses of statins in combination with therapy aimed to compensate comorbid pathology. The control group consisted of 20 patients with verified FH. \u0000Results and discussion. Combined dyslipidemia was detected in groups 1 and 3, pure hypercholesterolemia in group 2. Direct correlations between lipid profile and comorbid pathology characteristics were revealed. Patients of the subgroups with “possible” FH had higher atherogenicity of the lipid profile associated with comorbid pathology destabilization and high percentage of atherosclerosis of carotid and coronary arteries. According to the results of the follow-up, it was established that statin therapy and comorbid pathology compensation led to the achievement of target levels of LDL (group 3) or a reduction of LDL by 50% (group 1, 2). In patients of the control group, statin therapy with maximally tolerated doses did not show such results. \u0000Conclusions. The cohort of patients defined as having “possible” FH is heterogeneous and may include patients with secondary dyslipidemia on the background of comorbid pathology destabilization, timely verification and treatment of which contributes to achieving the goals of lipid-lowering therapy. Taking into account that only obese patients reached the target level of LDL <1.8 mmol/l, combined lipid-lowering therapy is recommended for patients with hypothyroidism and diabetes. Refractoriness to statin therapy in patients with verified “possible” FH emphasizes the need for combined lipid-lowering therapy (ezetimibe, PCSK9 inhibitors).","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":"46833775","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)/ks034-0914
Yurii V. Kashchenko, Dmytro P. Sakevych, Stamatella-Ahapi S. Arvanitaki, S. A. Rudenko
Coronary artery bypass grafting (CABG) is a complex, high-tech surgical intervention. Its success depends not only on the skill and experience of the surgeon but equally on the coherence of work and professionalism of all services involved in the operation. Severe left ventricular (LV) dysfunction after heart surgery is one of the main causes of cardiogenic shock, which is characterized by a local transient reduction of myocardial contractility (“stunned” myocardium) and/or significant cell damage caused by ischemia. In this state, systemic metabolic disorders often occur: increased concentration of free fatty acids, lactic acidosis, hypoxemia, and increased catecholamine content. General approaches to determining the risk of CABG surgery have not been definitively established. In addition, the data concerning the choice of optimal tactics in patients with a reduced ejection fraction (EF) are still limited. Relatively high early operative mortality in patients with reduced left ventricular EF requires further serious study. The aim. To determine the dominant complications and causes of fatal cases in patients with reduced LV contractility after CABG surgery. Materials and methods. The study included 210 patients with EF of 35% or less, who underwent CABG at the National Amosov Institute of Cardiovascular Surgery in the period from 01/01/2015 to 12/31/2021. Among them were 190 men (90.5%) and 20 women (9.5%). The age of the patients ranged from 29 to 83 years (61.1±8.9). Most patients underwent revascularization of three or more arteries. Results and discussion. In the group of patients with EF 35-30% in the postoperative period, acute heart failure (HF) occurred in 5 (3.8%) cases, respiratory failure (RF) was observed in 3 (2.3%) cases, renal failure in 3 (2.3%) cases, central nervous system (CNS) complications in 5 (3.8%). At the same time, along with the decrease in EF, the frequency of postoperative complications increased. In patients with EF below 24%, the frequency of postoperative complications increased significantly: acute HF was noted in 3 (15%) cases, RF in 5 (25%) cases, renal failure in 2 (10%) cases, CNS complications were noted in 0 (0%) cases. The duration of artificial lung ventilation increased significantly to 24.9±27.7 hours, the length of stay in the intensive care unit increased to 12.8±8 days, and the total length of stay of the patient in the hospital to 20.2±11.7 days. Conclusion. Based on the data we received, we concluded that: in patients with reduced LV myocardial contractility, such complications as HF, RF and renal failure, CNS complications most often occur; in addition, their frequency is higher than that in patients with preserved EF and increases with its decrease; one of the most frequent and life-threatening complications in this group of patients was acute HF; the use of intra-aortic balloon pump allows to avoid or improve treatment of HF and, at the same time, to increase survival in patients with reduce
{"title":"Complications and Mortality after CABG Surgery in Patients with Reduced Ejection Fraction","authors":"Yurii V. Kashchenko, Dmytro P. Sakevych, Stamatella-Ahapi S. Arvanitaki, S. A. Rudenko","doi":"10.30702/ujcvs/22.30(03)/ks034-0914","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(03)/ks034-0914","url":null,"abstract":"Coronary artery bypass grafting (CABG) is a complex, high-tech surgical intervention. Its success depends not only on the skill and experience of the surgeon but equally on the coherence of work and professionalism of all services involved in the operation. Severe left ventricular (LV) dysfunction after heart surgery is one of the main causes of cardiogenic shock, which is characterized by a local transient reduction of myocardial contractility (“stunned” myocardium) and/or significant cell damage caused by ischemia. In this state, systemic metabolic disorders often occur: increased concentration of free fatty acids, lactic acidosis, hypoxemia, and increased catecholamine content. General approaches to determining the risk of CABG surgery have not been definitively established. In addition, the data concerning the choice of optimal tactics in patients with a reduced ejection fraction (EF) are still limited. Relatively high early operative mortality in patients with reduced left ventricular EF requires further serious study. \u0000The aim. To determine the dominant complications and causes of fatal cases in patients with reduced LV contractility after CABG surgery. \u0000Materials and methods. The study included 210 patients with EF of 35% or less, who underwent CABG at the National Amosov Institute of Cardiovascular Surgery in the period from 01/01/2015 to 12/31/2021. Among them were 190 men (90.5%) and 20 women (9.5%). The age of the patients ranged from 29 to 83 years (61.1±8.9). Most patients underwent revascularization of three or more arteries. \u0000Results and discussion. In the group of patients with EF 35-30% in the postoperative period, acute heart failure (HF) occurred in 5 (3.8%) cases, respiratory failure (RF) was observed in 3 (2.3%) cases, renal failure in 3 (2.3%) cases, central nervous system (CNS) complications in 5 (3.8%). At the same time, along with the decrease in EF, the frequency of postoperative complications increased. In patients with EF below 24%, the frequency of postoperative complications increased significantly: acute HF was noted in 3 (15%) cases, RF in 5 (25%) cases, renal failure in 2 (10%) cases, CNS complications were noted in 0 (0%) cases. The duration of artificial lung ventilation increased significantly to 24.9±27.7 hours, the length of stay in the intensive care unit increased to 12.8±8 days, and the total length of stay of the patient in the hospital to 20.2±11.7 days. \u0000Conclusion. Based on the data we received, we concluded that: in patients with reduced LV myocardial contractility, such complications as HF, RF and renal failure, CNS complications most often occur; in addition, their frequency is higher than that in patients with preserved EF and increases with its decrease; one of the most frequent and life-threatening complications in this group of patients was acute HF; the use of intra-aortic balloon pump allows to avoid or improve treatment of HF and, at the same time, to increase survival in patients with reduce","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":"41342181","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)/kht036-109114
Y. Khrebtiy, D. V. Tsyhalko, Mykola O. Melnychuk
The aim. In the treatment of venous thromboembolism, a special place is occupied by patients with congenital anomalies of the development of the inferior vena cava (IVC). To date, only single cases of treatment of this pathology have been described in the literature. Studying the experience of treating patients with congenital anomalies of the IVC will allow to improve the results of treatment of this category of patients. Materials and methods. Patient B., a 36-year-old man, applied to the vascular surgery clinic of the Vinnytsia Regional Pyrohov Clinical Hospital in July 2010 with complaints of pain, swelling, cyanosis of both lower extremities, which bothered the patient for about 10 days. The patient had no history of venous insufficiency of both lower extremities. An objective examination revealed cyanosis and swelling of both lower extremities. A duplex scan of both lower extremities revealed hyperechoic iliofemoral thrombosis of both lower extremities. Aplasia of the IVC was diagnosed. The common iliac veins on both sides formed a collateral that flowed into the left renal vein. The infrarenal segment of the inferior vena cava was absent. Thrombosis spread from tibial to popliteal, femoral, iliac veins with venous collateral thrombosis up to the level of the left renal vein. The patient received enoxaparin at a dose of 1 mg per kg of body weight twice a day for 7 days with subsequent transition to warfarin under the control of international normalized ratio. Warfarin was prescribed from a starting dose of 5 mg with subsequent control of international normalized ratio in the range of 2.0-3.0. Venotonic and anti-inflammatory drugs were also prescribed. In combination with drug therapy, class 2 elastic compression stockings were recommended. After the treatment, the patient’s condition improved, swelling and cyanosis of both lower extremities regressed. Repeated duplex scanning at the discharge of the patient from the hospital after 7 days showed signs of initial recanalization of the affected venous segments and no progression of thrombosis. Conclusions. Thus, this clinical case showed that the use of anticoagulant therapy allows to obtain satisfactory results in the treatment of patients with congenital anomalies of the development of IVC, to avoid the development of pulmonary embolism and other life-threatening conditions. At the same time, such patients need regular follow-up examinations in order to adjust the treatment and prevent the development of IVC syndrome.
{"title":"Treatment of Bilateral Venous Thrombosis in a Patient with Aplasia of the Inferior Vena Cava","authors":"Y. Khrebtiy, D. V. Tsyhalko, Mykola O. Melnychuk","doi":"10.30702/ujcvs/22.30(03)/kht036-109114","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(03)/kht036-109114","url":null,"abstract":"The aim. In the treatment of venous thromboembolism, a special place is occupied by patients with congenital anomalies of the development of the inferior vena cava (IVC). To date, only single cases of treatment of this pathology have been described in the literature. Studying the experience of treating patients with congenital anomalies of the IVC will allow to improve the results of treatment of this category of patients. \u0000Materials and methods. Patient B., a 36-year-old man, applied to the vascular surgery clinic of the Vinnytsia Regional Pyrohov Clinical Hospital in July 2010 with complaints of pain, swelling, cyanosis of both lower extremities, which bothered the patient for about 10 days. The patient had no history of venous insufficiency of both lower extremities. \u0000An objective examination revealed cyanosis and swelling of both lower extremities. \u0000A duplex scan of both lower extremities revealed hyperechoic iliofemoral thrombosis of both lower extremities. Aplasia of the IVC was diagnosed. The common iliac veins on both sides formed a collateral that flowed into the left renal vein. The infrarenal segment of the inferior vena cava was absent. Thrombosis spread from tibial to popliteal, femoral, iliac veins with venous collateral thrombosis up to the level of the left renal vein. \u0000The patient received enoxaparin at a dose of 1 mg per kg of body weight twice a day for 7 days with subsequent transition to warfarin under the control of international normalized ratio. Warfarin was prescribed from a starting dose of 5 mg with subsequent control of international normalized ratio in the range of 2.0-3.0. Venotonic and anti-inflammatory drugs were also prescribed. In combination with drug therapy, class 2 elastic compression stockings were recommended. \u0000After the treatment, the patient’s condition improved, swelling and cyanosis of both lower extremities regressed. Repeated duplex scanning at the discharge of the patient from the hospital after 7 days showed signs of initial recanalization of the affected venous segments and no progression of thrombosis. \u0000Conclusions. Thus, this clinical case showed that the use of anticoagulant therapy allows to obtain satisfactory results in the treatment of patients with congenital anomalies of the development of IVC, to avoid the development of pulmonary embolism and other life-threatening conditions. At the same time, such patients need regular follow-up examinations in order to adjust the treatment and prevent the development of IVC syndrome.","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":"45114036","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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