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Issue. Articles

1(25) // 2009





Aneurysmotomy and plasty of the left ventricle in patients with gigantic posterobasal heart aneurisms

V.I. Ursulenko

The aim of the research was to evaluate the efficiency of the method of aneurysmotomy and plasty of the left ventricle (LV) defect after the resection of gigantic posterobasal heart aneurisms (PB ALV).

Materials and methods. 1943 patients with ischemic heart disease were operated on at M.M. Amosov National Institute of Cardio-vascular Surgery within the period from January 2006 to October 2008. In 293 (15.1 %) of them, the ischemic heart disease was combined with ALV. Gigantic PB ALV was revealed in 7 (2.4 %) patients. We have developed a more rational and simple method of the resection of these forms of heart aneurisms. The originality of the method is based on cutting off the sac of aneurism from inside: commissures are separated only at a small part of anterolateral wall of the aneurism sac as wide as 23 cm from its base above the healthy myocardium as long as 1/3 of the perimeter of its upper circle. Then, a longitudinal incision of 4 5 cm is made and a TF like incision of the aneurism wall is achieved. The edges of the incision are moved apart by Alice clamp and, then, trombi are removed in the region of the neck of the aneurism sack by special scoops, gripping forceps and curettes. The sack of the aneurism is cut off after the removal of trombi from inside at the distance of 2 cm from the base of aneurism neck.

Results and discussion. Initial highly elevated values of the end diastolic volume in all patients decreased by 2040 %, which was accompanied by the decrease of the end systolic volume and the increase of the ejection fraction that, in all the patients, was less than 45 % that is, by 2025 %. All the patients before the operation demonstrated the increased end diastolic pressure in the LV, systolic and diastolic pressure in the pulmonary artery, the values of these indices in dynamics decreased by 4547 % in all the 3 patients. Control roentgen-contrast ventriculography proved a good effect in terms of the restoration of LV geometry.

Conclusions. The method that we have developed for cutting off PB ALV from inside and plasty of the LV defect with further airtight suturing of the aneurism bag edges is characterized by simplicity and provides good effect in terms of LV geometry restoration and the improvement of its systolic function.

Keywords: ischemic heart disease, gigantic posterobasal aneurisms of the left ventricle, aneurysmotomy, plasty of the left ventricle



Surgical treatment of postinfarction heart aneurysms. The choice of left ventricle plasty method after aneurysmectomy

V.I. Ursulenko

The aim — to study the immediate results of the left ventricle (LV) plasty conducted by means of suturing the margins of the wide base of an aneurysm neck by the two-storey stitches with simultaneous interventricular septum plication in order to eliminate this part of the dome of an aneurysm head.

Materials and methods. The clinical material consists of 283 patients with ischemic heart disease (IHD) complicated by the aneurysm of the left ventricle, who were consecutively operated on within the period from 01.01.2006 to 31.01.2007. The patients were divided into three groups. The first group (n = 129) consisted of patients with the small sizes of an aneurysm. In this group a linear LV plasty was used. Depending on the kind operation, this group was divided into 2 subgroups. Coronary artery bypass grafting (CABG) and LV plasty with the use of heart-lung bypass and cardioplegia was performed in 76 patients, and off pump CABG and LV plasty fulfilled on the fibrillating heart – in 53 patients. The 2nd and 3rd groups were composed of patients with big or middle sizes of LV aneurysms. The patients of the 2nd group composed the research group (n = 124), who underwent LV plasty using the method of a two-storey stitch with the simultaneous manoeuvre of interventricular septum placation; the 3rd (comparison group, n = 23) included the patients, who underwent LV plasty with the use of a patch according to Dor method. The evaluation of the end diastolic volume (EDV), end systolic volume (ESV), ejection faction (EF), end diastolic pressure in left ventricle (EDPLV), pulmonary artery (PA) systolic pressure was performed by methods of EchoCG and by heart catheterization.

Results and discussion. The analysis of the LV plasty by different methods showed that in small aneurysms and a linear plasty with a 2-storey stitch (sometimes with a partial plication of interventricular septum) LV EDV significantly diminished as soon as on the 5–7 postoperative day (from 183.4 ml to 150.7 ml (p < 0.05) in the 1st subgroup and from 173.8 ml to 132.7 ml (p < 0.05) in the 2nd subgroup). EF in the 1st subgroup did not change (47.1 % ± 7.4 and 44.0 % ± 8.1, p > 0.05); in the 2nd subgroup it increased from (42.6 ± 7.3) to (47.8 ± 6.8) %, (p < 0.05). In 66.0 % cases in this subgroup there was no need in dopmin after the operation, in 33.9 % cases – positive ECG dynamics was noted, and only in 5.6 % cases it was negative. 43.4 % post-operative patients were delivered to the intensive care unit on their own breathing. Comparative analysis of the cardio-hemodynamic indices in the 2nd and in the 3rd groups showed a significant decrease of the LV ESV (by 19.4 % and by 28.8 %, correspondingly, in both groups), however EF in the 2nd group increased from (37.8 % ± 6.2) to (47.4 % ± 3.8) (p < 0.05), while in the 3rd group it practically did not change. In 51.7 % cases in the 2nd group there was no necessity in dopmin immediately after the operation. 40.6 % of operated patients of this group were delivered to the intensive care unit on their own breathing and only 1 (4.3 %) such patient – from the 3rd group. The second heart catheterization showed a significant decrease of LV EDP from (21.2 ± 4.8) to (12.3 ± 2.1) mm Hg (p < 0.05) and of PA pressure – from (57.3 ± 10.5) to (36.3 ± 5.4) mm Hg (p < 0.05). The mean pasoperative stay in hospital in the 3rd group of patients was (12.1 ± 2.5) days, this index in the 2nd group was (7.5 ± 1.5) days (p < 0.05), which was less by (4.6 ± 2).

Conclusions. The method of LV plasty using a 2-storey stitch with simultaneous elimination of a septal part of the aneurismal head dome by means of its goffering with a lower storey stitch is an effective method of LV plasty after the resection of middle and big LV aneurysms. The method permits improving the indices of the LV contractile function during the hospital period after the operation, which is evidenced by the increase of EF, the decrease of LV end diastolic pressure and of the pressure in PA, the significant decrease of LV volumes. Control ventriculography data revealed the efficiency and reliability of the method in restoration of the geometry of LV cavity in many variants of LV.

Keywords: ischemic heart disease, left ventricle aneurysm, aneurysmectomy, left ventricle plasty



Quality of life predictors in NYHA III chronic heart failure patients

L.G. Voronkov, L.P. Parashchenyuk, G.V. Yanovsky, O.I. Semenenko, N.A. Tkach, A.V. Lyashenko

The aim – on the ground of routine general clinical and clinical-instrumental study results, to determine the quality of life (QL) predictors in a group with similar clinical and functional condition of patients with chronic heart failure (CHF).

Materials and methods. Standardized questionnaire «Minnesota Living with Heart Failure» was used to interrogate 554 patients with CHF of NYHA III functional class (FC). 33 main clinical, instrumental and laboratory variables obtained in the course of examination of patients were analyzed according to the standard protocol specified by the current guidelines on diagnosis and treatment of CHF. After dividing the patients into groups, according to the values of QL indexes based on the results of the questionnaire, independent QL predictors in CHF patients were singled out by means of multiple logistic regression.

Results and discussion. Independent predictors of unsatisfactory QL in patients with CHF of NYHA III FC were: age > 60 years, female gender, ischemic etiology of CHF, previous myocardial infarction, angina, 6-minute walk distance ≤ 220 m, low serum cholesterol, hyperuricemia (≥ 600 mkmol/l), lymphocytopenia (lymphocyte level ≤ 20 %), anemia (hemoglobin level < 120 g/l), creatinine clearance ≤ 60 ml/min, and rest heart rate ≥ 80 beats per min.

Conclusions. Consideration of potentially modifiable predictors of QL in CHF patients – such as concomitant arterial hypertension (OR = 1.57), tachycardia (OR = 1.61), angina (OR = 1.66), anemia (OR = 1.80), high plasma uric acid (OR = 2.29) – may be important during their long-term management.

Keywords: chronic heart failure, quality of life, predictors



Diagnostic value of modern heart visualization methods in patients with postinfarction left ventricle aneurism

M.N. Dolzhenko, .V. Rudenko, S.V. Potashev, N.N. Nosenko, S.A. Rudenko, O.A. Sharayevskiy, I.L. Sarbash

The aim to compare the efficacy of modern methods of heart left chambers visualization in patients with postinfarction cardiosclerosis (PIC) and left ventricle (LV) aneurism before coronary artery bypass grafting (CABG) combined with LV aneurismectomy (CABG + AE) for LV global contractility evaluation and reliability of LV an eurism and its thrombosis diagnosis.

Materials and methods. 116 patients at the age of (43.8 10.2) with PIC and heart failure (HF) of I- NYHA functional class (FC) (LV ejection fraction (EF) = 37.1 12.4 %) underwent coronary ventriculography (CVG), multispiral computed tomography (MSCT) and Doppler echocardiography (EchoCG) before planned surgical LV revascularization aimed at evaluation of the LV global contractility and LV aneurism and its thrombosis diagnosis.

Results and discussions. During LV EF evaluation, the data of non-invasive methods of cardiac structure visualization highly correlated with CVG data (r = 0.80 for EchoCG and r = 0.71 for MSCT, = 0.11. Transthoracic EchoCG showed the same accuracy (86.2 %, = 0.97) in different localizations of LV aneurism diagnosis due to high sensitivity (89.5 %) and positive predictive value (90.7 %) of the method as compared to CVG. MSCT had the highest accuracy (100 %, < 0.0001) in the diagnosis of LV aneurism thrombosis due to high specificity (79.7 %) and negative predictive value (87.3 %) of the method as compared to CVG. Transthoracic EchoCG also had higher accuracy (94 %, = 0.0031) due to high specificity (76.8 %) and negative predictive value (84.1 %) of the method as compared to CVG. The data of MSCT and transthoracic EchoCG in diagnosing LV aneurism (r = 0.62 and r = 0.63, = 0.9, respectively) and its thrombosis (r = 0.52 and r = 0.36, = 0.14, respectively) were in significantly high correlation with the data of the golden standard of CVG; they also highly correlated with each other (r = 0.95, p < 0.0001, and r = 0.86, < 0.0001, respectively). No significant difference was found between the prognostic value of MSCT and transthoracic EchoCG for the diagnosis of post-infarction aneurism of LV and its thrombosis.

Conclusions. MSCT and transthoracic EchoCG are highly reliable and informative methods for LV global contractility evaluation and an adequate alternative to CVG for diagnosing LV chronic aneurism and its thrombosis in patients with PIC before planned surgical revascularization of myocardium combined with LV aneurismectomy.

Keywords: left ventricle aneurism, thrombosis, coronary ventriculography, multispiral computed tomography, echocardiography



The influence of statin treatment on the remote consequences of acute coronary syndrome without ST segment elevation

.N. Amosova, O.B. Yaremenko, D.L. Fedkov, I.S. Kovalyova, P.O. Lazarev, A.V. Sablin, N.V. Melnichenko

The aim — to define the influence of statin therapy in generally accepted doses on the remote consequences of acute coronary syndrome (ACS) without ST segment elevation (general mortality and frequency of recurring ACS) and the dependence of their effect on the initial total cholesterol (TC) level within one-centered retrospective observation research.

Material and methods. We analyzed the remote consequences (during one year) of ACS without ST segment elevation (death from any cause, recurrent hospitalization with ACS) by means of the telephone questioning of 1030 patients, who were discharged with that diagnosis from the Central City Clinical Hospital in the period from 01.01.2002 to 31.12.2004. 239 of them were prescribed statins within complex treatment (20 mg of simvastatin or 10 mg of atorvastatin) and they formed the basic group; 791 patients were not prescribed statins and they formed the control group. Both groups were comparable by age (63.5 ± 2.5 and 67.2 ± 2.7 years, accordingly), gender and the frequency of myocardial infarction (MI) without Q-wave in anamnesis. For the definition of the influence of TC level on the efficacy of statin treatment, all the patients were divided into 2 subgroups: the first one (n = 487) contained patients with initial TC level ≥ 5.0 mmol/l, including 164 of those who received statins and 323 of those who did not; the second subgroup (n = 209) contained patients with initial TC level < 5.0 mmol/l (44 patients from the basic group and 165 - from the control group, accordingly).

Results adn discussions. The total mortality of the basic group patients by the end of the first year was smaller than in the control group (2.9 % vs 10.0 %, accordingly, < 0.01). However, these patients had higher level of TC (on the average (6.15 ± 0.10) and (5.66 ± 0.06) mmol/l, < 0.05), higher frequency of surgical myocardial revascularization (7.5 % and 3.2 % accordingly), as well as of treatment with clopidogrel (15.9 % and 3.0 %) and b-blockers (by 9 %; all < 0.01). The treatment with aspirin, heparins and angiotensin converting enzyme inhibitors was the same. The frequency of recurrent hospitalization with ACS in both groups was 16.5 % and 18.1 % ( > 0.05). The TC level < 5.0 mmol/l in the patients, who did not take statins, was associated with higher level of mortality by the end of the first year as compared to the patient with TC ≥ 5.0 mmol/l – 10.1 % vs 5.5 %, accordingly, ( < 0.05). As compared to the controls, the patients of the basic group manifested more substantial decrease of total mortality in both subgroups - with TC ≥ 5.0 mmol/l (from 6.8 % to 3.0 %) and with TC < 5.0 mmol/l (from 12.1 % to 2.3 % all < 0.05). The frequency of recurrent ACS was the same in the both subgroups.

Conclusions. According to the retrospective analysis, the treatment of patients after ACS without ST segment elevation with statins in generally accepted doses starting from the 6th day of treatment in hospital promoted the decrease by 71 % of total mortality by the end of the first year in comparison with patients who were not treated with statins. However, it did not influence the frequency of recurrent hospitalizations with ACS. The expressiveness of the positive effect of statin therapy on the survival of patients after ACS without ST segment elevation by the end of the first year since the onset of the disease does not depend on the initial TC level (< 5.0 and ≥ 5.0 mmol/l).

Keywords: acute coronary syndrome, statins, remote consequences, total cholesterol level



Experience in endovascular closure of atrial septal defect with Amplatzer occluder

Yu.V. Panichkin, B.V. Cherpak, I.O. Dytkovskiy, S.M. Fanta, V.M. Beshliaga, O.A. Mazur, Ya.P. Truba, V.V. Lazoryshynetz

The aim to demonstrate that the transcutaneous correction of the secondary atrial septal defect is a safe and effective method of treatment of this anomaly.

Materials and methods. Within the period from June 2003 to December 2008, transcutaneous closure of secondary atrial septal defect was performed in 27 patients (19 women, 8 men) at the age of 754 (mean age 22.2 13.2 years). All the patients had been previously diagnosed by means of trans-thoracic EchoCG, in 12 cases (44 %) trans-alimentary Echo research was carried out. The number of defects, their diameter, the presence of defect edges and also the absence of aneurismal outpouching of atrial septum and the absence of other valvular defects were estimated. The ASD diameter in patients was 934 mm (mean 23.3 mm 7.6 mm). 2 ASDs (4 %) were revealed in one case. In 3 patients ASD was without the anterior (aortal) edge 99 (11 %). The size of Amplatzer Septal Occluder was from 10 t 36 mm (mean 24.9 mm 7.0 mm).

Results and discussion. All the patients in the post-operative period from 3 months to 5 years had no complaints. EchoCG displayed an adequate position of the occluder on the interatrial septum without any impairment of the function of atrioventricular valves, cardiac rhythm and residual bypasses.

Conclusions. Endovascular closure of the secondary ASD with the use of Amplatzer Occluder permits eliminating intracardiac bypassing of blood in 100 % patients with a relatively small frequency of serious complications (lesion of the left atrium wall with cardiac tamponade in 3,7 %).

Keywords: secondary atrial septal defect, transcutaneous closure, Amplatzer occluder



Perioperative period: cardivascular medications discontinuation problem Part

V.G. Mishalov, N.Yu. Litvinova

The aim to analyze problems and ways of their solution connected with abolishing and restoration of medication application, including cardiac medications, anticoagulants and disaggregates during perioperative period. In pre-operative period it's important to avoid medication application that can have negative interaction with anesthesia medications. In postoperative period it's necessary to prevent the abolishing syndrome developing and possible disease relapse.

Keywords: abolishing of medication application, perioperative period, cardiovascular diseases



Tetralogy of Fallot. Part V

V.B. Demyanchuk, .I. Tereshchenko, S.. Dykukha, V.V. Lazoryshynets

Historical and modern aspects of complex heart defect of tetralogy of Fallot are described in the manuscript. In the context of historical development, different methods of palliation were represented which are a definite stage of surgical treatment of this anomaly. Palliations allow patients with tetralogy stay alive during the natural history of the disease and come to complete repair safely. Advantages and risks of the palliations were demonstred.

Keywords: tetralogy of Fallot, surgical treatment, palliations



Sick Sinus Syndrome

N.T. Vatutin, N.V. Kalinkina, E.V. Mykhalchenko

Anatomy, etiology, pathogenesis, classification and epidemiology issues of sick sinus syndrome are covered in the article. Current state and perspectives of the development of diagnosis and treatment of the disease were analyzed. The data concerning their efficiency are presented.

Keywords: sick sinus syndrome, rhythm disturbances, syncope



The role of beta-blockers of ultra short-term effect in urgent cardiology

S.N. Tereschenko

The review presents the data about the beta-blocker (BB) of ultra shortFterm effect esmolol (preparation Breviblok of the company Baxter), specific features of its pharmacokinetics and pharmacodynamics, the results of its clinical use in acute myocardial infarction, hypertonic crisis and supraventricular arrhythmia. The preparation is also widely used in the perioperative period for reducing the risks of serious complications in the cardiovascular system without the danger of abstinence syndrome which is often observed after the withdrawal of oral BB of longFterm effect. Esmolol therapy has been proved efficient due to the possibility of its long-term (hours-long) introduction and individual titration of doses and also due to the quick (20 min) reverse of the effect.

Keywords: betaFblocker, esmolol, therapy, complication, safety

Current Issue Highlights

4(60) // 2017

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K. M. Amosova 1, I. I. Gorda 1, A. B. Bezrodnyi 1, G. V. Mostbauer 1, Yu. V. Rudenko 1, A. V. Sablin 2, N. V. Melnychenko 2, Yu. O. Sychenko 1, I. V. Prudkiy 1&a

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