Ukrainian Journal of Cardiovascular Surgery最新文献

{"title":"Atrial Reentry Tachycardia: Mechanisms and Diagnosis","authors":"P. O. Almiz, B. Kravchuk","doi":"10.30702/ujcvs/23.31(04)/ak059-7478","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(04)/ak059-7478","url":null,"abstract":"Atrial tachycardia (AT) is a group of arrhythmias that differ in electrophysiological mechanisms and clinical course. There are three main forms of AT: focal AT, macroreentries, and localized reentries also known as “microreentries”. Macroreentries, as a rule, occur in the presence of fibrous changes in the myocardium, for example, in “atrial” cardiomyopathy or as a result of catheter or surgical interventions in the atria. Focal AT can also occur in the absence of structural pathology of the heart. The aim. To analyze modern ideas about electrophysiological mechanisms and diagnosis of atrial reentry tachycardia. In our research we used data from the literature as well as findings of our own previous studies. The work analyzed global data on the distribution of various types of AT. The data of electrocardiographic (ECG) diagnosis, electrophysiological methods of diagnosis and pharmacological tests were also analyzed to determine the mechanism of occurrence and course of AT. The main ECG differences of different types and localizations of AT were determined. The diagnostic value of various stimulation protocols in the differential diagnosis of focal and macro-reentrant AT was also analyzed. Conclusions. Atrial tachycardias with a reentrant mechanism are common in the general population. Differential diagnosis with other types of tachycardia is carried out on the basis of ECG data, the response to adenosine administration, the nature of the response during entrainment, and endocardial, particularly electroanatomical, mapping.","PeriodicalId":173557,"journal":{"name":"Ukrainian Journal of Cardiovascular Surgery","volume":"46 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139151411","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}

{"title":"The Influence of Carbohydrate Metabolism Disorders on the Course of Perioperative Period in Cardiac Surgery Patients with Post-Infarction Left Ventricular Aneurysms","authors":"O. Gogayeva","doi":"10.30702/ujcvs/23.31(04)/g062-2025","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(04)/g062-2025","url":null,"abstract":"The aim. To study the impact of carbohydrate metabolism disorders on perioperative period in cardiac surgery pa-tients with post-infarction left ventricular (LV) aneurysms. Materials and methods. Retrospective analysis of perioperative period in random 132 patients with post-infarction LV aneurysms of various locations, who were operated on and discharged from the department of surgical treatment of ischemic heart disease of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. Disorders of carbohydrate metabolism (DCM) were detected in 98 (74.2%) patients, among whom type 2 diabetes mellitus (DM) was diagnosed in 34 (25.7%) patients, impaired glucose tolerance (IGT) in 64 (48.5%). All the patients underwent general clinical examination, electrocardiography, echocardiography, coronary angiography and surgical treatment. Results. When analyzing the clinical picture in patients with post-infarction LV aneurysms, painless myocardial isch-emia was diagnosed in 41 (31.06%) patients, among whom type 2 DM in 11 (26.8%) cases and IGT in 18 (43.9%). No statistically significant difference was found in patients with and without DCM in the LV contractile function, presence of LV thrombosis, atrial fibrillation, chronic kidney disease, stenosis of brachiocephalic arteries and arteries of the lower extremities, gouty arthritis, and body weight. Intraoperatively, diameter of the coronary arteries in patients with type 2 DM was slightly smaller compared to patients without DCM. Its increase in cases of calcification of coronary arteries and aorta among patients of the study group with DCM was statistically insignificant. A careful analysis of the postoperative period in patients with and without DCM showed a statistically significant occurrence of paroxysms of atrial fibrillation in 30 (90.9%) and 3 (9.1%) cases, respectively (p=0.0115). The patients with DCM had longer stay in the intensive care unit: 4.03 ± 2.3 vs. 3.2 ± 1.3 days (p=0.0483). Acute kidney injury in the early postoperative period occurred in 8 (6.06%) patients, including 5 (62.5%) with type 2 DM (p=0.0142). Sternal wound infection occurred in 2 (1.5%) patients with type 2 DM (p=0.0156). Conclusions. Among cardiac surgical patients with postinfarction LV aneurysms, the major part is formed by patients with DCM (74.2%), the presence of which complicates the course of the postoperative period with the development of paroxysms of atrial fibrillation (p=0.0115), acute kidney injury (p=0.0142), sternal wound infection (p=0.0156), a long stay in the intensive care unit (p=0.0483).","PeriodicalId":173557,"journal":{"name":"Ukrainian Journal of Cardiovascular Surgery","volume":"24 28","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139148547","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}

{"title":"Increasing Physical Tolerance during Cardiac Rehabilitation Helps to Restore Endothelial Function in Patients after Acute Coronary Syndrome","authors":"Nataliia M. Tereshchenko, Y. Y. Kovalchuk, V. O. Shumakov, Iryna E. Malynovska, Liana M. Babii","doi":"10.30702/ujcvs/23.31(04)/tk051-4048","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(04)/tk051-4048","url":null,"abstract":"In recent years, many studies have been aimed at exploring the possibilities of cardiac rehabilitation as a tool to improve the prognosis in patients after acute coronary syndrome (ACS). Endothelial dysfunction is one of the initiating mechanisms of cardiovascular diseases, and myocardial infarction in particular, so it is important to assess the dynamics of changes in the number of endothelial progenitor cells (EPCs) in patients during cardiac rehabilitation with the increase in physical activity. The aim. To establish the relationship between the level of recovery of exercise tolerance and the recovery of endothelial function by determining the number of EPCs in patients undergoing cardiac rehabilitation after ACS. Materials and methods. The study included 44 patients with ST-elevation myocardial infarction who underwent urgent stenting of the infarct-related artery, with a mean age of 59 years (Q1-Q3; 51-64). All the study participants underwent laboratory tests (CD45+/CD34+ cell count before and after the exercise test) and instrumental tests (echocardiography, bicycle ergometry, coronary angiography). Statistical processing was carried out using SPSS Statistics 23 (trial version). Results. According to the results of the exercise test at the first examination, the patients were divided into 2 groups: group 1 with low exercise tolerance (≤50 W) and group 2 with high exercise tolerance (>50 W). The data obtained indicate a link between better recovery of exercise tolerance after ACS and recovery of endothelial func-tion in patients with high exercise tolerance during follow-up compared to the patients whose exercise tolerance did not exceed 50 W, as evidenced by a statistically higher number of EPCs after exercise in patients with a favor-able course and high exercise tolerance (3633 vs. 2400 cells/ml) (p=0.006). Patients with low exercise tolerance were more likely to be diagnosed with lesions of left anterior descending coronary artery (96% vs. 70%, p=0.02). More severe coronary vascular lesions with stenosis of 75% of two or more arteries showed lower pre-exercise EPCs, but increased post-exercise EPCs (+228 cells/ml), whereas in the group with stenosis of more than 75% of one vessel, a decrease in post-exercise EPCs (–604 cells/ml) was observed (p=0.004). If patients have more than one stent, there is a 2.5-fold increased risk of decreased exercise tolerance to values of 25-50 W (relative risk = 1.8; 95% confidence interval: 1.3-2.4). Conclusions. The data obtained indicate that there is an association between a better recovery of exercise tolerance after ACS and recovery of endothelial function in patients with a favorable course at repeated examination, compared to patients whose level of exercise tolerance did not exceed 50 W (low exercise tolerance), as evidenced by a statistically greater number of EPCs after exercise test in patients with favorable course and high exercise tolerance compared with patients with unfavorable course ","PeriodicalId":173557,"journal":{"name":"Ukrainian Journal of Cardiovascular Surgery","volume":"9 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139151528","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}

{"title":"Laboratory Predictors of Mortality in Patients with Heart Failure and Reduced Left Ventricular Ejection Fraction","authors":"M. V. Kucheriava, G.B. Mankovskyi","doi":"10.30702/ujcvs/23.31(04)/km056-5762","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(04)/km056-5762","url":null,"abstract":"Introduction. Heart failure (HF) is a growing epidemic with high morbidity and mortality rates. In general, mortality in patients with HF is 10.4% after 30 days from admission, 22% after 1 year, and 42.3% after 5 years, despite the introduction of new evidence-based drug therapy and advance in surgical interventions. There is a range of predictors/ factors that need to be addressed to reduce the risk of mortality and to assess prognosis in patients with heart failure and reduced left ventricular ejection fraction. The aim. To determine the laboratory factors predicting 2-year mortality in patients with coronary artery disease and heart failure and reduced left ventricular ejection fraction after percutaneous coronary intervention (PCI) by analysis of basic patient data. Materials and methods. This one-center analysis, conducted at the Ukrainian Children’s Cardiac Center, Clinic for Adults, included 178 patients who had chronic stable coronary artery disease with heart failure and reduced left ventricular ejection fraction, who underwent PCI in the period between January 2020 and January 2022. The endpoint of our study was all-cause mortality. The studied group of patients was divided into two subgroups: S (“survival”) with patients who survived during the observation period after PCI, and D (“death”) including patients who died before the end of this observation period after the PCI. A p-value of less than 0.05 was considered statistically significant. Results. The mean length of hospital stay was 3 (1-5) days. Total bilirubin, total cholesterol, sodium, N-terminal pro B-type natriuretic peptide (NT-proBNP) level, hemoglobin, albumin and lymphocytes were significantly different in the two subgroups. In the multivariate model, the strongest independent predictors of patient mortality were: elevated NT-proBNP (adjusted hazard ratio [HR] for one standard deviation 1.44, 95% confidence interval [CI] 1.32 to 1.57, p<0.0001), low albumin (HR 1.64, 95% CI 1.10 to 2.23, p=0.008), hyponatremia (HR 1.69, 95% CI 1.16 to 2.22, p<0.001), lymphopenia (HR 1.54, 95% CI 1.10 to 2.20, р<0.001, decreased hemoglobin level (HR 1.25, 95% CI 1.10 to 1.40, p<0.001) and low cholesterol (HR 1.59, 95% CI 1.17 to 2.01, p<0.001). Conclusion. In a population of patients with chronic stable coronary artery disease after myocardial revascularization with PCI, a decrease in the level of albumin, cholesterol, sodium, lymphocytes, hemoglobin, as well as an increase in the level of NT-proBNP were prognostic and statistically significant predictors of unfavorable prognosis in the form of all-cause mortality during 2 years of observation.","PeriodicalId":173557,"journal":{"name":"Ukrainian Journal of Cardiovascular Surgery","volume":"279 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139152622","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}

{"title":"Impact of Acute Myocardial Ischemia Duration on Reperfusion Outcomes in STEMI Patients","authors":"S. V. Salo, S. S. Shpak, V. O. Shumakov","doi":"10.30702/ujcvs/23.31(04)/ssh065-114120","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(04)/ssh065-114120","url":null,"abstract":"The aim. To analyze the influence of the duration of acute myocardial ischemia, specifically in ST-elevation myocardial infarction (STEMI) electrocardiographic patterns, on the outcomes of reperfusion interventions. We focused on the assessment of immediate angiographic data in the catheterization laboratory after stenting and investigated whether the frequency of the no-reflow phenomenon is dependent on the time since the onset of anginal pain. Our hypothesis of inferior immediate treatment outcomes is based on the pathophysiological course of ischemic-reperfusion injury in patients with late myocardial infarction. Primarily, this is due to the development of myocardial edema, leading to extravascular compression of the vessel, thereby influencing Thrombolysis in Myocardial Infarction grade 0 blood flow. Materials and methods. We conducted an analysis of 107 angiograms of STEMI patients, who underwent percutaneous coronary intervention at the Amosov National Institute of Cardiovascular Surgery between 2021 and 2023. The patients were categorized into four groups based on the duration of acute myocardial ischemia. The first group included patients with ischemia duration up to two hours, aligning with the golden window for revascularization recommended by the European guidelines. The second, third, and fourth groups consisted of patients with ischemia durations of 3-12 hours, 12-24 hours, and over 48 hours, respectively. Results. Of 104 patients, complete restoration of coronary circulation was achieved in 88 cases, while, unfortunately, 16 patients had TIMI 0/1 blood flow. Such a probability of complication is 15.3% in the studied cohort. According to the clinical profile, the patients were divided into those who had no-reflow (main group) and patients with complete restoration of blood flow (control group). In the group of unrestored blood flow, cardiogenic shock occurred more often, and the infarct-dependent artery was more often occluded than suboccluded. The technique of percutaneous intervention was similar in both groups. Conclusion. The frequency of the no-reflow phenomenon increases with the duration of acute myocardial ischemia. Patients presenting later than 48 hours since the onset of ischemia are more prone to no-reflow (62.5% vs 37.5% if less than 48 hours). Cardiogenic shock is associated with a higher likelihood of the no-reflow phenomenon. The most significant reason for the delay in delivering a STEMI patient to catheterization laboratory anamnestically is the patient’s untimely medical care seeking. In our opinion, this delay can be avoided by increasing awareness about the initial signs of myocardial infarction and the necessity of seeking immediate medical care.","PeriodicalId":173557,"journal":{"name":"Ukrainian Journal of Cardiovascular Surgery","volume":"52 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139150426","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}

{"title":"A Clinical Case of Out-of-Hospital Cardiac Arrest and Post-Resuscitation Disease in a Patient with Acute Myocardial Infarction","authors":"Andriy P. Mazur, Elina I. Novikova, Natalia O. Kuzminova","doi":"10.30702/ujcvs/23.31(04)/mn022-12112","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(04)/mn022-12112","url":null,"abstract":"Background. Prediction of survival in adult patients after out-of-hospital cardiopulmonary resuscitation remains a difficult issue. This clinical case describes our experience of managing a patient after an out-of-hospital cardiac arrest due to an acute coronary syndrome with the development of postanoxic coma, with subsequent successful restoration of neurological function. Case description. Patient K., a 48-year-old man, was delivered unconscious (Glasgow Coma Scale score 7) without spontaneous breathing. During transportation to the hospital, ventricular fibrillation occurred, cardiopulmonary resuscitation lasting 1 hour was performed with restoration of sinus rhythm. Diagnosis: acute coronary syndrome with ST segment elevation; cardiogenic shock; condition after cardiopulmonary resuscitation. Stenting of the occluded circumflex artery was performed. During the patient’s stay in the intensive care unit (ICU), hemodynamics and laboratory tests were carefully monitored and no significant systemic disorders were detected. The patient stayed in the ICU for 19 days. At the time of discharge, the general condition was relatively satisfactory, Glasgow Coma Scale score was 14-15, with minimal neurological deficit. The patient was transferred to a neurological department for further rehabilitation. Results. Determining the probability of either good or bad outcome in comatose patients after cardiac arrest is one of the most important steps in treatment after stabilization of the heart activity. Recent data confirm the utility of electroencephalography (EEG) monitoring for prognosis. The pattern of response to sedative drugs may provide prognostic information. In this clinical case, when EEG was recorded during sedation, preservation of the response to stimuli was registered, and 48 hours after disconnection, patterns corresponding to awakening were registered, which was considered as a positive prognostic sign. Conclusions. In adult patients after cardiopulmonary resuscitation with postanoxic coma, clinical, neurophysiological and radiological tests predict poor neurologic outcome within the first week after cardiac arrest with a certain percentage of false positive rate. However, most predictors have low sensitivity and specificity. Accurate prognosing requires a comprehensive approach. Neurological examination remains the gold standard, but its result is affected by the effect of sedative drugs used in critical patients in the ICU. The use of EEG increases the accuracy of the prognosing.","PeriodicalId":173557,"journal":{"name":"Ukrainian Journal of Cardiovascular Surgery","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139150608","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}

{"title":"Strategy of Surgical Correction of Postcoarctation Thoracic Aortic Aneurysms","authors":"Vitaliy Kravchenko, Yurii M. Tarasenko, Alla V. Derkach, Ivan M. Kravchenko","doi":"10.30702/ujcvs/23.31(04)/kt007-6973","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(04)/kt007-6973","url":null,"abstract":"The aim. To analyze the experience of surgical treatment of postcoarctation aneurysms and to propose an optimal strategy in choosing a correction method. Materials and methods. An analysis of 91 cases of postcoarctation aneurysm over a 25-year period was carried out. Eighty-five people (93.4%) were operated on, 6 patients (6.6%) were not operated on for various reasons. The patients were divided into clinical groups depending on the method: group I included 69 patients (75.8%) who underwent open correction of postcoarctation aneurysm. Group II consisted of 16 patients (17.6%) after endovascular or hybrid treatment. Results. The obtained results demonstrated significant achievements and pronounced clinical effect of the performed surgical correction of postcoarctation aneurysms. We identified indications and contraindications for the correction of postcoarctation aneurysms by various methods: open, endovascular, and hybrid. It was found that the advantages of the endovascular technique are: minimally invasive approach, absence of a large surgical wound, shorter duration of the operation, faster activation of the patient after the intervention, shorter length of hospital stay in the postoperative period, faster return to a full active life. When studying the long-term results, based on the SF-36 questionnaire scores, it was established that the quality of life was higher among patients who underwent endovascular and hybrid correction of postcoarctation aneurysms. Conclusion. Clear indications for surgical correction of postcoarctation aneurysm and the choice between open surgery, endovascular or hybrid intervention should be determined based on detailed analysis and with the participation of the entire heart team with mandatory consideration of: patient age, comorbidities, expected duration and quality of life of each patient after surgery.","PeriodicalId":173557,"journal":{"name":"Ukrainian Journal of Cardiovascular Surgery","volume":"14 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139148531","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}

{"title":"VAC Therapy as Part of Complex Treatment of Deep Sternal Wound Infection in Cardiosurgical Patients: First Experience","authors":"V. Osaulenko, K. Chmul, Rasim I. Budagov","doi":"10.30702/ujcvs/23.31(04)/och053-106113","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(04)/och053-106113","url":null,"abstract":"The aim. To improve the immediate and long-term results of treatment of cardiac surgery patients, by determining the feasibility of using wound therapy with negative pressure (vacuum assisted closure [VAC] therapy) as part of the complex tactics of postoperative management of patients with deep sternal wound infection (DSWI). Materials and methods. A single-center, retrospective, observational study of the clinical data of 12 patients who underwent open-heart surgery using median sternotomy and who developed a DSWI was conducted. The mean age of the patients was 66.2 ± 2.2 years. The patients were divided into 2 groups, depending on the type of the treatment they received: group 1 included 5 (41.67%) subjects with the installation of a flow-washing system; group 2 included 7 (58.33%) subjects receiving negative pressure wound therapy. Results. The use of VAC therapy contributed to the reduction of all indicators characterizing the course of the wound process, compared to patients treated with traditional methods. The duration of hospitalization was 36.2 ± 3.3 days in group 1 and 42 ± 4.0 days in group 2. The level of in-hospital mortality in the studied group receiving negative pressure wound therapy was 14.29% (1 patient) versus 80% (4 patients) in the group with flow-irrigation drainage. Conclusions. Deep sternal wound infection is a very serious postoperative complication in cardiac surgical patients with a high in-hospital mortality rate. Diabetes mellitus, obesity, immunopathies are the main risk factors. VAC therapy in patients with DSWI allows to adequately repair the wound in a shorter time while maintaining the patient’s mobility, as well as to significantly reduce the duration of wound drainage and, as a result, the length of hospitalization.","PeriodicalId":173557,"journal":{"name":"Ukrainian Journal of Cardiovascular Surgery","volume":"7 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139151593","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}

{"title":"Ductus Arteriosus Stenting as a Method of Palliative Treatment of Truncus Arteriosus Type A3: Literature Review and Clinical Case","authors":"Tetyana Ye. Hura, Anzhelika O. Mykhailovska, O. Motrechko, A. Maksymenko","doi":"10.30702/ujcvs/23.31(04)/hm068-6368","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(04)/hm068-6368","url":null,"abstract":"Introduction. Van Praagh A3 variant of truncus arteriosus (TA A3) is a condition when the one pulmonary artery branch origins from the TA, the other is filled through the patent ductus arteriosus (PDA). PDA constriction in the early neonatal period can cause absence of blood supply to the one pulmonary artery branch. To prevent this, prolonged infusion of prostaglandin E1, PDA stenting or systemic-to-pulmonary shunt are used. These methods allow to postpone total repair (TR) and reduce mortality risks associated with neonatal period. The aim. To analyze research papers dedicated to endovascular approach of TA A3 staged treatment and to present our own experience. Materials and methods. We conducted a systematic literature search and analyzed various options for the TA A3 staged treatment. After the review, we used endovascular approach as the first stage of treatment in our clinical case. We studied a newborn weighing 4 kg with TA A3 (left pulmonary artery branch origins from the non-coronary sinus of the truncal valve, right pulmonary artery branch filling through the PDA). Nakata index was 83 mm2/m2. McGoon ratio was 1. We decided to perform PDA stenting with the aim of postponing surgical correction until the patient’s optimal age and weight. Discussion. In total, the number of publications about TA A3 staged treatment is limited. Most institutions prefer TA A3 staged treatment in newborns, because it is associated with a lower risk of complications than early TR. In our clinical case, the first step was PDA stenting. The staged approach allowed us to perform TR with a good result at the age of 3 months. Before TR, Nakata index and McGoon ratio were increased to 248 mm2/m2 and 1.9, respectively. Conclusions. The current trend of TA A3 repair has few different options of staged treatment. Staged approach helps to get out of the newborn period and achieves the optimal condition for TR. Our patient successfully received PDA stenting as the first stage of treatment, which created conditions for the pulmonary artery branches growth. The second stage was TR with good long-term results. After analyzing the publications, we noted that the use of endovascular PDA stenting is a good and safe alternative to surgical palliative treatment.","PeriodicalId":173557,"journal":{"name":"Ukrainian Journal of Cardiovascular Surgery","volume":"314 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139152411","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}

{"title":"Algorithm for Diagnosis of Patients with Ischemic Heart Disease Depending on the Presence of Significant Coronary Artery Lesions","authors":"Y. Marushko, Nadiya M. Rudenko, Ya.Yu. Dzhun","doi":"10.30702/ujcvs/23.31(04)/mr055-3439","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(04)/mr055-3439","url":null,"abstract":"The aim. To analyze the structure of ischemic heart disease and the prevalence of myocardial ischemia with no ob-structive coronary arteries among patients who underwent elective coronary angiography. Materials and methods. We examined 1,200 patients with a clinical diagnosis of ischemic heart disease. After coro-nary angiography all the patients with non-stenotic coronary arteries underwent hyperventilation challenge test to ex-clude vasospastic angina and echocardiographic study with intravenous administration of dipyridamole to assess the index of coronary reserve and longitudinal strain. Results. The mean age of the study participants was 59.1 ± 4.2 years. The number of male and female subjects was comparable, amounting to 493 (48.8%) and 517 (51.2%), respectively. Stenotic coronary arteries were detected in 699 patients (74.1%). The number of women without hemodynamically significant lesions was twice as large than that of men (210 [67.5%] vs. 101 [32.5%]). Among the examined patients with non-stenotic atherosclerosis of the coronary arteries, 241 patients (77.4%) were diagnosed with coronary microvascular dysfunction, 19 (6.1%) with vasospasm of the coronary arteries, and 2 patients (0.6%) were diagnosed with a combination of vasospastic and microvascular angina. In 36 (73.5%) of 49 patients, a segmental decrease in longitudinal strain of the apex/individual apical segments of the left ventricle was found. In patients without obvious micro- and macrovascular pathology, the interventricular septum was significant enlarged. In 9 (18.4%) of 49 patients, a diagnosis of hypertrophic cardiomyopathy was established. Conclusion. Patients with ischemia with no obstructive coronary arteries require careful examination and compari-son of clinical signs with the results of objective tests. Understanding the prevalence and mechanisms of the problem is a key to improving the diagnosis and treatment of cardiovascular complications in this group.","PeriodicalId":173557,"journal":{"name":"Ukrainian Journal of Cardiovascular Surgery","volume":"56 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139150974","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}