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Issue. Articles

1(29) // 2010





Flaking aneurisms of thoracic aorta: variants of progression and results of surgery

L.L. Sytar, I.. Kravchenko, V.I. Kravchenko, V.A. Lytvynenko, O.A. Tretiak, V.Ye. Dupliakina, O.V. Rybakova, O.B. Larionova, O.V. Pantas, Yu.N. Tarasenko

The aim – to analyze the variants of clinical manifestations of thoracic aorta flaking aneurisms, short- and long-term consequences of surgical interventions at considerable number of patients who were successively operated on at a cardiosurgery center during the period of 30 years.

Materials and methods. 371 patients with thoracic aorta flaking aneurisms were axamined. 330 of them had type A flaking (215 – in the acute stage, 115 – in the chronic); 41 patients had type B flaking. We operated on all the 330 patients with type A flaking and 15 (36.6 %) – with type ; 26 (63.4 %) patients with type flaking were not operated on for different reasons.

Results and discussion. The total hospital lethality was 18.8 %. Hospital lethality during the surgical treatment of type A flaking in acute stage was 22.8 %, in chronic stage – 11.3 %, during the surgical treatment of type B flaking – 33.3 %. The long-term results (within the period from 6 months to 18 years) were studied in 261 (93.9 %) patients discharged from the hospital. Good long-term surgery results were fixed in 170 (65.1 %) patients, satisfactory – in 40 (15.3 %), unsatisfactory – in 20 (7.7 %) patients. 31 (11.9 %) patients died in the long date.

Conclusions. Hospital lethality of patients with type A aorta flaking was substantially higher among those who were operated on in the acute stage than among those who were operated on at a later date (22.8 vs 11.3 %). High hospital post-operative lethality among patients with type B aorta flaking suggests the advantages of conservative treatment in cases when urgent surgery is not indicated. The patients need life-long prophylactic supervision to obtain the early diagnosis and timely surgical treatment of the specific long-term complications.

Keywords: flaking aorta aneurisms, type A, acute and chronic flaking.



Influence of duration of newly diagnosed I type flutter on the morphofunctional condition of the myocardium and efficiency of transesophageal pacing

Yu.V. Zinchenko

The aim – to estimate the influence of duration of newly diagnosed isolated I type flutter of atriums (FA) on the morphofunctional condition of the myocardium and the efficiency of transesophageal pacing (TEP).

Materials and methods.We performed 116 TEP aimed at the restoration of the sinus rhythm in case of newly diagnosed I type FA in 104 patients, including 94 (90.4 %) men and 10 (9.6 %) women aged 18–75 years (mean 56.6 ± 1 years) with different cardiac pathologies: ischemic heart disease – in 68 (65.4 %) and myocardiofibrosis – in 36 (34.6 %). Arterial hypertension was revealed in 58 (55.8 %) patients. Chronic heart failure (HF) which did not exceed IIA stage was diagnosed in all patients and systolic dysfunction (left ventricle ejection fraction < 45 %) – in 16 (15.4 %) patients. The duration of FA was from 9 days to 3 years (mean 108.3 ± 13.7 days). All the patients were divided into four groups: in I group (n = 25) the duration of FA was 9–30 days (22.2 ± 1.1 days), in II group (n = 40) – 31–90 days (56.9 ± 2.6 days), in III group (n = 23) – 91–180 days (124.6 ± 4.7 days) and in IV group (n = 16) – over 180 days (365.3 ± 60 days). Before the cardioversion all the patients underwent echocardiography: characteristics of the left and right atriums (LA and RA) and ventricles (LV and RV) were estimated in a two-dimension regime: end-systolic and end-diastolic size and volume (ESS, EDS, ESV, EDV) and the area (S) of atriums during the systole and the diastole; EF and LV index and mass were also calculated. TEP was started with frequency exceeding that of FA by 25–30 %. Then, the frequency was increased until the sinus rhythm was restored or stable atrium flutter achieved. The power of currency was 15–30 m, the impulse duration – 10 ms, stimulation – 1–5 s, interpolar intervals – 10–20 mm.

Results and discussion. The groups were matched by age, gender, FA etiology, HF intensity, anti-arrhythmic therapy preceding TEP (p > 0.05). Electrophysiological parameters and the stimulation protocol did not differ, either. The results of echocardiography showed significantly thicker walls of the LV in I group as compared to the other groups, and significantly bigger mass of the LV myocardium (276.9 ± 14 g) and its index (133.3 ± 6.7) as compared to II group (234.1 ± 11.4 g and 112.1 ± 5.3; p < 0.05). The patients of all the groups had no significant differences in LV EDV (146.7 ± 10, 153.7 ± 7.7, 157.7 ± 6.1, 141.8 ± 8.1 ml), LV EF (50.7 ± 2.9, 52.6 ± 1.3, 51.2 ± 1.5, 55.5 ± 3 %), RV EDS (29.3 ± 2.1, 31 ± 1, 30.9 ± 1.1, 29 ± 0.8 mm), LA S (27.8 ± 2.4, 26.9 ± 1.3, 27.9 ± 1.2, 26 ± 0.8 cm2) and RA S (26.8 ± 1.5, 25.5 ± 1.4, 26.3 ± 1.4, 26.8 ± 1.1 cm2). The efficiency of the sinus rhythm restoration in the groups was (96, 97.5, 95.7 and 87.5 %; p > 0.05), FA recurrence was fixed in 8, 10, 8.7 and 18.8 % patients (p > 0.05).

Conclusions. The morphofunctional condition of atriums and ventricles of patients with long-lasting (from 180 days to 3 years) development of newly diagnosed I type FA at the background of an organic cardiac pathology and HF not exceeding IIA stage does not differ from that of patients with less duration of arrhythmia. TEP is an effective method of cardioversion in case of newly diagnosed FA, which makes it possible to restore the sinus rhythm in more than 90 % patients irrespective of arrhythmia duration (from 9 days to 3 years).

Keywords: flutter of atriums, restoration of rhythm, transesophageal pacing, electrophysiological remodeling.



Mini-invasive procedures in vascular surgery ten years of implementation experience

Yu.S. Spirin, I.V. Arbuzov, R.V. Ivashko, V.I. Arbuzov, I.I. Bolianovsky

The aim – to analyze the experience of modern mini-invasive technology implementation into the practice of a Vascular Surgery Department.

Materials and methods. 147 mini-invasive procedures were performed in patients with obliterate diseases of peripheral vessels: thoracoscopic sympathectomy (68 cases), mini-invasive lumbar sympathectomy (35), mini-invasive reconstructions of aorta-iliac segment (22), combined (open and endovascular) procedures (22 cases). The following clinical sings were estimated: conversion rate, early postoperative complication rate, immediate results, mortality, in-hospital mean time. The analysis of factors which hamper the wide implementation of these procedures was undertaken.

Results and discussion. Immediate positive results were obtained in 137 cases (93.19 %). Early morbidity rate was 2.72 % (4 cases). General post-operative mortality was 1.36 %. In 6 cases (4.08 %) intra-operative complications were observed or unexpected technical difficulties made the mini-invasive procedures impossible. In all these cases open surgery was performed. The mean in-hospital time was (5.9 ± 0.84) days.

Conclusions. Mini-invasive procedures in patients with obliterating disease of the abdominal aorta and peripheral arteries are characterized with a high rate of positive immediate results (93.2 %), low morbidity (2.72 %) and mortality (1.4 %) rates. The wide implementation of mini-invasive vascular procedures is only possible if vascular surgeons master laparoscopic and catheter techniques.

Keywords: mini-invasive procedures, obliterating atherosclerosis.



The influence of lipid-lowering simvastatin therapy on albumin excretion rate in patients with diabetes mellitus

B.M. Mankovsky, O.V. Malinovska

The aim – to determine the influence of lipid-lowering simvastatin therapy on microalbuminuria level (MAL) in patients with diabetes mellitus (DM).

Materials and methods.We studied 24 patients with DM and MAL: 8 of them – with type 1 (I group) and 16 – with type 2 DM (II group). The patients of both groups were matched by age, gender, occurrence of concomitant ischemic heart disease and hypertensive disease, arterial pressure level, antihypertensive therapy, lipid spectrum index value before treatment. Only the cholesterol (CS) level of high-density lipoproteins (HDLP) and apolipoproteins A1 were substantially lower in patients of the II group (p < 0.05). Simvastatin was prescribed to all patients in the dose of 20 mg a day for 3 months. Plasma level of total CS, triglycerides, CS of low-density lipoproteins (LDLP), CS of HDLP, apolipoproteins A1 and B (using the photometric method), MAL level in the daily urine (using the photometric method) were determined before and after treatment. The criterion of exclusion from the study was liver dysfunction (alanine-aminotransferase and aspartate aminotransferase > 40 u/l) or kidney dysfunction (serum creatinine > 115 μmole/l).

Results and discussion. Simvastatin therapy contributed to the substantial decrease of MAL which was (130.2 ± 9.9) and (55.1 ± 2.1) μg/ml in type 1 diabetic patients and (172.6 ± 7.1) and (113.1 ± 5.2) μg/ml in type 2 diabetic subjects, before and after treatment with simvastatin, respectively ( < 0.05). CS level of LDLP was (3.79 ± 1.47) and (2.83 ± 1.19) mmole/l (p < 0.05) in patients of I group, and (4.79 ± 1.61) and (4.13 ± 0.84) mmole/l (p < 0.001) – in patients of II group. During the period of treatment no correction of angiotensin converting enzyme inhibitors dose was made and there was no significant change in the arterial pressure level in both groups.

Conclusions. The treatment of both types of DM patients with simvastatin in the dose of 20 mg a day for 3 months helps to decrease substantially the albumin excretion.

Keywords: diabetes mellitus, diabetic nephropathy, microalbuminuria, simvastatin.



Comparative evaluation of platelet aggregation with different inductors aimed at detection of biochemical aspirin resistance in patients with acute coronary syndrome without ST segment elevation

.. Amosova, N.V. Netyazhenko, G.I. Mishanych

Materials and methods. The study included 140 patients who were admitted to the myocardial infarction department of Oleksandrivska Clinical Hospital in Kyiv from January 1, 2006 to January 1, 2007 with the diagnosis of ACS without ST segment elevation, and who regularly (at least 5 to 7 days) took aspirin for prophylaxis in the dose of 80 to 100 mg/day (average 88 ± 21.2 mg/day) during the previous 6 months (average 1.2 ± 2.2). The exclusion criteria were the previous therapy with other disaggregants (clopidogrel, dypirydamol), the use of non-steroidal anti-inflammatory agents 6 months before the hospitalization, the presence of stable ST segment elevation or complete left bundle branch block on ECG, acute left ventricular heart failure (HF), signs of chronic HF of IIB-III stage in N.D. Strazhesko and V.Kh Vasilenko classification, left ventricle ejection fraction below 45 %, congenital and acquired heart diseases, myocarditis, cardiomyopathy, pericarditis, pulmonary hypertension and severe type 1 and 2 diabetes mellitus, serious chronic diseases of kidneys and liver with their dysfunction and other severe concomitant diseases that are likely to reduce the life expectancy over the next 12 months. The patients were included into the study within the first 24 hours after their hospitalization. The principle of this work was the determination of AR through assessing the results of aggregation of platelets with arachidonic acid (AA) inducer in all 140 patients on the first day after hospitalization, in the morning on an empty stomach, after preliminary loading dose of aspirin. Next, according to the results of this test, the patients were divided into 2 groups: I group consisted of 15 (10.7 %) patients with biochemically proven AR, II group – of 125 (89.3 %) patients without it. AA («», Russia) in the concentration of 0.5 mg/ml was used as an aggregation inducer to identify the AR. Under existing criteria, the patients with residual platelet aggregation ≥ 20 % in the course of taking aspirin were considered aspirin resistant. Aggregation of platelets with ADP in the dose of 5 μmole/l, adrenaline in the dose of 0.125 U/ml and rystocetyn in the dose of 15 mg / ml («», Russia) was also assessed in all patients.

Results and discussion. Using the AA as an inducer, we fixed very low frequency of AR (10.7 %) among patients with ACS without ST segment elevation. Comparing the mean values of platelet aggregation indicator in patients with ACS and healthy persons we revealed significant elevation of the aggregation level in all 140 patients with ACS as well as in patients of each group after the biochemical confirmation of AR (all p < 0.01). The group with the proven AR had higher rates of aggregation of platelets with all inductors as compared with the group without it. The results showed no reliable correlation between the degree of aggregation with AA and adrenaline and rystocetyn. At the same time, the correlation of average strength (r = 0.5, p < 0.05) was obtained for ADP. As evidenced by our results, the use of the suggested empirical methods, criteria for AR through assessing the aggregation with ADP, adrenaline and rystocetyn as compared to the AA significantly ‘overvalues’ the frequency of AR which we fixed using the gold AR-AA standard. At the same time, these criteria, according to our data, had very low specificity, particularly adrenaline) and rystocetyn-aggregation. This shows the impropriety of their use for the assessment of platelet response to the action of aspirin. At the same time, the increase of the ‘cutting point’ of aggregation with ADP to ≥ 85 % allows us to detect AR with sensitivity of 76 % and specificity 72 % and use ADP-aggregation to determine the AR if it is impossible to assess aggregation with AA for identifying AR and assess AA aggregation. Statistically significant correlation was found AA-aggregation to ADP-aggregation (r = 0.5, p < 0.05) suggests that in patients resistant to aspirin in some extent and impaired aggregation with ADP. Reliable correlation between AA-aggregation and ADP-aggregation (r = 0.5; p < 0.05) allows us to conclude that patients with aspirin resistance have some degree of ADP aggregation impairment.

Conclusions. The comparative evaluation of the degree of platelet aggregation in patients with ACS who had previously taken aspirin for at least 6 months along with AA on the one hand, and adrenaline and rystocetyn, on the other, shows a moderate correlation between parameters of AA- and ADP-aggregation and the lack of correlation between the other parameters. The use of the existing AR criteria in the literature, which are based on determining the residual aggregation with ADP, adrenaline and rystocetyn, is inappropriate because of their low specificity and sensitivity. The residual aggregation of platelets with ADP in the dose of 5 μmole/l with the assessment of residual aggregation ≥ 85 % (sensitivity 76 %, specificity 72 %) may be an additional criterion for biochemical AR, according to evaluation of aggregation with AA.

Keywords: acute coronary syndrome, aspirin resistance, platelet aggregation.



Diagnostic value of different radiodiagnosis methods for identification of long-term complications after cava-filters implantation

S.M. Genyk, S.M. Syroyd, O.Ya. Popadiuk

The aim – the estimation of the diagnostic value of radiodiagnosis methods for identification of complications caused by cava-filters in different terms after their implantation.

Materials and methods. 185 patients with implanted cava-filters of different models were examined. 19 of them with «Osot» cava-filters and 5 – with «Cordis» cava-filters underwent ultrasonic duplex scanning and spiral computer tomography of vena cava inferior in the area of cava-filters localization in the periods from 1 week to 6 years after implantation.

Results and discussion. The spiral computer tomography of the 24 patients with «Osot» filter allowed us to find out the following complications: the penetration of cava-filter retort outside the vena cava – in 4 (4.3 %), the perforation of vena)cava wall by filter legs – in 19 (20.4 %), the penetration of legs into the nearby organs, such as aorta – in 9 (9.7 %), arteria mesenterica – in 2 (2.15 %), ureter – in 1 (1.08 %), kidney tissue – in 2 (2.15 %), small intestine – in 5 (5.4 %), duodenum – in 1 (1.08 %), colon – in 1 (1.08 %), penetration into the muscles of the back – in 1 (1.07 %), angulation – in 19 (20.4 %), occlusion of the vena cava – in 3 (29.4 %), stenosis of the vena cava – in 13 (14 %), the contact of the leg with the neurocentrum and the formation of bone callosity – in 9 (9.7 %), destruction of the cava-filter – in 4 (4.4 %) and its expansion in the area of contact with the legs of the vena cava in – 1 case. During the perforation of the postcava back wall, the filter legs migrated to the body of the nearby vertebra and their contact resulted in the bone callosity of a pyramidal shape on the surface of the vertebra which covered 1.5 cm of the leg.

Conclusions. The methods of radiodiagnosis – ultrasound duplex scanning and spiral computer tomography – make it possible to detect the following complications after kava-filter implantation: angulation, perforation of postcava wall and adjacent organs, migration, filter destruction. The most reliable and accurate method of visualization and detection of kava-filters in the postcava and their position with regard to the adjacent organs is spiral computer tomography.

Keywords: thromboembolism of pulmonary artery, cava-filter, spiral computer tomography, ultrasonic duplex scanning.



Obesity as a risk factor for recurrence of atrial fibrillation

N.T. Vatutin, N.V. Kalinkina, A.M. Shevelyok

The aim – to evaluate the role of obesity as a possible risk factor of atrial fibrillation (AF) recurrences.

Materials and methods. The study included 52 patients (34 men and 18 women, average age 54.7 ± 10.5 years) with moderate arterial hypertension (AH) of II stage, stable coronary heart disease (CHD) and left ventricular (LV) ejection fraction > 45 % who had the history of paroxysms of AF and the sinus rhythm at the time of the study initiation. We measured body mass index (BMI), waist circumference (WC), hip circumference (HC) and their ratio (WC/HC), as well as echocardiography (EchoCG) with the evaluation of parameters of systolic and diastolic functions of LV, thickness of LV posterior wall and interventricular septum, LV myocardial mass index and left atrial (LA) diameter. Subsequently, the patients were observed during 6 months, availability of AF paroxysms, their frequency and duration was estimated. The processing of the results was performed using the statistical analysis package «Statistica 6.0». Student’s criterion was used for comparison of mean values. The correlations between pairs of quantitative traits were measured using Pearson linear correlation coefficient. To identify the predictors of AF recurrence we used a logistic regression model, in which the indicators of BMI, WC, HC and WC/HC were independent variables. The odds ratio of recurrence of arrhythmia was determined with 95 % confidence interval. In all cases of hypotheses testing, the differences were considered statistically significant at p < 0.05.

Results and discussion. During the period of observation 28 (58 %) patients (1st group) had AF recurrences, while the rest 20 (42 %) (2nd group) maintained sinus rhythm. The patients of the 1st group had significantly higher values of BMI – (34.7 ± 8.2) and (26.7 ± 5.7) kg/m2, p = 0.003), WC – (108.54 ± 9.1) and (84.1 ± 6.4) cm, p < 0.001), HC – (116.6 ± 12.5) and (108.8 ± 9.6) cm, (p = 0.01) and WC/HC – (0.94 ± 0.04 and 0.79 ± 0.06, p < 0.001) than the patients of the 2nd group. On EchoCG, significant differences were only found in the diameter of the left atrium which in the 1st group was higher than in the 2nd one (4.2 ± 0.1) vs. (3.9 ± 0.1) cm, (p = 0.01). In the multivariant analysis, after standardization by the diameter of LA, the reliable (p < 0.05) AF recurrence independent risk factors were BMI > 33 kg/m2 (OR 1.06, CI 1.01–1.13) and WC/HC > 0.85 (OR 1.08, CI 1.03–1.13), with the sensitivity of 77 and 81 % and specificity of 56 and 72 %, respectively.

Conclusions. The independent predictors of AF development in patients with II stage AH and stable CAD are BMI and WC/HC. With the increase of BMI values 33 kg/m2 by one unit and WC/HC 0.85 by one hundredth, the chance of AF recurrence increased by 1.06 and 1.08 times, respectively, (sensitivity – 77 % and 81 % and specificity – 56 % and 72 %, respectively).

Keywords: atrial fibrillation, the risk of recurrence, body mass index, waist circumference, hip circumference.



Risk factors of unfavorable one-year prognosis of early post-infarction angina

.. Amosova, O.I. Rokita, O.A. Atamanenko, Z.V. Lysak, A.A. Kovalenko

The aim – to determine the occurrence of unfavorable one-year prognosis of early post-infarction angina (EPA) and its risk factors.

Materials and methods. 72 patients with acute myocardial infarction (MI) and EPA have been examined. The endothelium functions with the use of D. Celermajer method, cardiac rate variability with the estimation of SDNN, RMSSD, LF/HF indexes at rest and during the antiorthostatic test were examined in all patients on the 1st – 2nd day after EPA onset. The number of leucocytes (NL), the velocity of erythrocyte sedimentation, the serum level of fibrinogen (FN) were estimated right after the hospitalization, on the 1st – 2nd day after EPA onset, at the time of discharge from hospital and in a year. 52 (72.2 %) patients with EPA underwent X-ray contrast coronary arteriography (CA) in hospital. Outpatient observation was conducted during a one-year period: MI recurrences, hospitalizations for unstable angina, lethal outcomes were fixed as unfavorable outcomes of EPA. Sensitivity, specificity and prognostic value of risk factors of unfavorable one-year EPA prognosis were estimated.

Results and discussions. According to the results of the one-year observation, 52.8 % patients had unfavorable EPA outcomes including cardio-vascular deaths in 12.5 %. They constituted I group (n = 38); the patients without such «events» constituted II group (n = 34). The groups were matched by age, gender and occurrence of concomitant arterial hypertension and diabetes mellitus. EPA progression in the patients of I group was characterized by a more frequent development of this disease in earlier terms – during the first 10 days (in 50 % patients vs. 23.5 % in II group; p < 0.001), nocturnal anginal pain (71.1 vs. 14.7 %; p < 0.001) and spontaneous ischemic changes on ECG (92.1 vs. 52.9 %; p < 0.001). EPA patients with unfavorable outcomes had a more pronounced endothelium dysfunction – endothelium dependent vasodilation in I group was (3.9 ± 0.4) %, in group – (5.1 ± 0.6) % (p < 0.001)) and higher frequency of paradoxical reaction cardiac rate variability during the antiorthostatic test (76.3 vs. 29.4 %; p < 0.001). The patients of I group had significantly higher values of NL in the course of EPA progression – (12.3 ± 1.1) vs. (9.8 ± 0.7) · 109/l; p < 0.001), as well as of FN serum level – (5.3 ± 0.3) vs. (4.3 ± 0.2) g/l (p < 0.001). The most frequent coronary artery lesion on CA in patients of I group was the presence of unstable plaques in the non-infarction dependent coronary artery (non-IDA) with permeative or impassable infarction dependent artery (IDA) – 66.7 vs. 16 % in II group (p < 0.001).

Conclusions. Unfavorable EPA consequences within one year period were fixed in 52.8 % patients. The main risk factors of unfavorable one-year EPA prognosis are: the onset of this disease during the first 10 days after MI development, nocturnal anginal pain, episodes of spontaneous myocardial ischemia on ECG, endothelium dependent vasodilation decrease < 4.4 %, cardiac rate variability paradoxical reaction during the antiorthostatic test, NL increase during the development of EPA > 10 · 109/l. CA demonstrates that 66.7 % patients with unfavorable consequences of EPA have unstable plaques in the non-IDA with the permeative or impassable IDA.

Keywords: myocardial infarction, early post-infarction angina, risk factors, prognosis, coronary artery.



Ischemic heart disease and erectile dysfunction

O.V. Synyachenko, .V. Yakovlenko, T.V. Anikeyeva

The literature review shows that the erectile dysfunction (ED) is a important predictor of ischemic heart disease (IHD) and that there exists a distinct direct relation between the occurrence of IHD and ED at men. On the one hand, after occurrence of ED signs during 10 years, the probability of IHD and myocardial infarction development makes up near 40 %, on the other hand, 60–80 % of men with IHD lose the erectile function. Through the system of estimation of latter, it is even possible to allocate an IHD risk group within the epidemiological researches. The common pathogenic factors of IHD and ED are endothelial dysfunction, metabolic syndrome, a sedentary way of life, smoking, psychoemotional stresses, depressions, and 25 % cases of ED occurrence are connected with taking medications for IHD.

Keywords: ischemic heart disease, erectile dysfunction.



The salt hypothesis pro et contra: controversial issues of natrium chloride significance in the genesis and development of arterial hypertension

.. Bobrishev, V.V. Kolomiets

The review analyzes the evidence of salt hypothesis, i. e. causative relationship between «regular» salt consumption in industrialized societies and development of arterial hypertension (AH). It has been demonstrated that none of the evidence has absolutely convincing confirmation. Thus, the clinical studies were characterized by major design mistakes and mostly included patients with AH of renal origin. Experimental studies did not reproduce the real animal sodium consumption and conditions of AH emergence. The cross-cultural and migrational observations took into account neither socio-cultural differences between populations under comparison nor important features of Paleolithic diet. The epidemiologic studies had methodological limitations caused by incorrect evaluation of the statistical data. Meta-analyses cover researches of different scientific value and demonstrate unfavorable influence of sodium chloride restriction on human neurohumoral and metabolic profiles.

Keywords: review, sodium chloride, arterial hypertension, salt hypothesis, reduction of salt consumption.



The aim and role of arteriovenous fistula in lower limb arterial reconstructions

I.M. Gudz, O.I Gudz

We sometimes make an arteriovenous fistula to reduce peripheral resistance in distal anastomosis during the reconstruction of crural and pedal arteries in the presence of chronic critical ischemia. A lot of scientific materials show that the expediency of this intrusion is a disputable question. Unfortunately, multicentre randomized trials which might form an evidential base of the aim and role of arteriovenous fistula in distal reconstructions are absent as well.

Keywords: arteriovenous fistula, reconstruction of the arteries, lower limb.



Management of atrial fibrillation

O.J. Zharinov

Strategy and tactics of management of atrial fibrillation (AF) are determined by many factors which may be evaluated at routine clinical examination. These are the clinical form, etiology and triggers, clinical symptoms, duration, frequency and possibilities to restore sinus rhythm. In case the probable cause of the paroxysm is established, the treatment is directed at its correction (restriction of the necrosis zone in myocardial infarction, treatment of thyroid dysfunction, desintoxication, usage of drugs containing potassium and magnesium). The evaluation of the etiologic factors of AF directly influences the choice of optimal means to decrease the heart rate and anti-arrhythmic therapy. Some background heart diseases decrease the efficacy and increase the risk of the arrhythmogenic action of 1 class anti-arrhythmic drugs. Significant hemodynamic disturbances (symptomatic arterial hypotension, cardiac asthma or pulmonary edema) are an absolute indication for urgent electrical cardioversion. The priorities of the management of patients with asymptomatic AF are the prevention of AF thromboembolic complications and (if necessary) correction of the increased heart rate. Concomitant arrhythmias and conduction disorders also play an important role in choice of strategy and tactics of the treatment. The main tasks of management of different AF forms are heart rate control and prevention of thromboembolic complications. Depending on the clinical variant of AF, expressiveness of symptoms and changes of the patient's life quality, the physician makes the choice between the strategies of heart rate control and the restoration and maintenance of the sinus rhythm. The optimal antithrombotic therapy tactics is based on the evaluation of stroke risk markers. The critical analysis and systemization of these aspects are based on the common guidelines of the American College of Cardiology, American Heart Association and European Society of Cardiology (2006).

Keywords: atrial fibrillation, sinus rhythm, heart rate, thromboembolic complications, anti-arrhythmic therapy.



Case of myocardial infarction with subsequent formation of thrombotic left ventricle aneurysm in a patient with myocardial bridge

V.I. Ursulenko, O.K. Gogayeva

The aim – to demonstrate the role of transient systolic compression of coronary artery in the development of transmural myocardial infarction with the formation of thrombotic left ventricle aneurysm in the absence of atherosclerotic plaques in coronary arteries.

Materials and methods. Patient D., 40 years old, with transmural myocardial infarction in anamnesis, underwent comprehensive examination and surgical treatment.

Results and discussion. Angiographic diagnosis of myocardial «bridge» over the middle third of the anterior interventricular branch of the coronary artery with 100 % systolic compression and thrombotic left ventricle aneurysm was confirmed intraoperatively. Supracoronary myotomy, coronary arterial bypass graft with resection of the thrombotic left ventricle aneurysm under condition of artificial circulation were performed.

Conclusions. Transient systolic compression of the coronary artery by a myocardial «bridge» can lead to myocardial infarction with the formation of thrombotic left ventricle aneurysm.

Keywords: myocardial bridges, myocardial infarction, aneurysm of the left ventricle.

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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