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Issue. Articles

№2(46) // 2014

 

Обкладинка

 

1.

 

Postinfarction interventricular septum ruptures: incidence and results of surgical treatment

V. I. Ursulenko, A. V. Rudenko, V. P. Zakharova, A. A. Beregovyi, Yu.V. Panichkin, L. V. Jacob, N. L. Rudenko, B. V. Cherpak, I. A. Ditkovskiy, L. S. Dzahoуeva

The aim — to study the incidence of postinfarction interventricular septum ruptures (PIIVSR) at myocardial infarction, to elaborate tactics of preoperative treatment aimed at decreasing mortality during the first days and weeks after the rupture and evaluating results of PIIVSR surgical treatment.

Materials and methods. 65 patients with postinfarction PIIVSR were enrolled in the study. 49 case reports were studied of patients with PIIVSR treated in M. M. Amosov National Institute of Cardiovascular Surgery from 1991 to June 2013. 16 other observations composed case reports and postmortem studies of patients who died in 7 large cardiological departments where 1014 patients with acute myocardial infarction (AMI) were treated. PIIVSR complicated the course of AMI in 1.5 % cases.

Results and discussion. 47 out of 49 patients hospitalized in the Institute, were treated surgically. 3 patients had occluder closure of PIIVSR in terms up to 10 days after the rupture in order to decrease acute heart failure (AHF). 5 (11.5 %) out of 15 patients died after the first operations. The following 32 operations were fulfilled without lethal events.

Conclusions. The results obtained by us and publications data permit to conclude that PIIVSR are observed in 1.5 — 3 % cases of AMI. Ruptures of interventricular septa occur on the 2 — 7 days. Hospital mortality in case of PIIVSR occurs in 85 — 95 %. Restoration of interventricular septum integrity by the surgical method with the patch is accompanied by the risk of stitch cutting through in an early postoperative period, and by the risk of acute heart failure and high postoperative mortality. It is technically easier to fulfill the operation with a high degree of patients’ survival after the period of matured connective tissue intergrowth into the infarction zone. In order to reach acceptable terms of operation fulfillment, having no positive effect of medicamentouse treatment and of intra-aortic ballon contrapulsation it is possible to achieve positive results by the use of occluder closure of PIIVSR.

Keywords: interventricular septum ruptures, acute myocardial infarction, occluder.

2.

 

Efficacy and safety of endothelial growth factor in patients with IIa—III stage of chronic lower limb ischemia in the complex therapy

V. G. Mishalov, N. Yu. Litvinova, V. A. Chеrnyak

The aim — to evaluate the efficacy and safety of Neovasculgen in the complex therapy of the clinical course of IIa — III stage of chronic lower limb ischemia (CLLI) by Fontaine.

Materials and methods. The study was conducted from September 2013 to April 2014. The study group included 10 patients treated byNeovasculgen and the control group included 10 patients who underwent traditional therapy. Painless walking distance (PWD), pain at rest by visual-analog scale (VAS), ankle-brachial index (ABI), linear flow velocity (LFV), laser dopler-fluometry indicators (LDF) were studied. Integral assessment of efficacy was assessed on the basis of calculating the proportion of patients whose treatment could be regarded as successful: clinical cure — complete disappearance of clinical signs of ischemia; improvement — regression of clinical signs of ischemia, a decrease of pain during prolonged walking and its disappearance at rest.

Results and discussion. Adverse events, adverse reactions and complications were not recorded. During and after taking the drug, the patients of the study group felt satisfactory; local reactions were not registered. PWD during treatment was improved in both groups, but in the study group, the dynamics was more rapid. Pain at rest by VAS decreased in both groups. In the clinical group, ABI index rose compared to the baseline (0.46 ± 0.84) while taking the drug and in six months it was 0.53. Indicators of LFV increased slightly in both groups, however, their increase was not statistically significant, especially in patients with pain at rest. Although traditional treatment led to the increase of baseline LDF, it had almost no impact on the results of occlusion test, whereas in the study group, these indicators improved significantly, and the time to maximal blood flow decreased two-fold, which indicated an improvement of microcirculation in the foot.

Conclusions. Neovasculgen is safe and clinically effective in the complex treatment of the clinical course of chronic ischemia of the lower extremities of IIa — III stage by А. V. Pokrovsky —Fontaine. Its administration led to an increase of pain-free walking distance by more than 100 %, reduction of pain at rest by (75.8 ± 15.7 %), ABI increase by 12.1 %. Improvement of the patients reflected mainly microcircular channel indicators, as evidenced by a significant change in the index of LDF, especially the time of maximum blood flow increase (decreased by 57 %). In the study group, the proportion of patients whose treatment was regarded as successful was 85.6 %, in the control group — 41.1 %; the difference is statistically significant.

Keywords: chronic lower limb ischemia, endothelial growth factors, therapy.

3.

 

Постинфарктный разрыв межжелудочковой перегородки: частота развития, результаты хирургического лечения

В. И. Урсуленко, А. В. Руденко, В. П. Захарова, А. А. Береговой, Ю. В. Паничкин, Л. В. Якоб, Н. Л. Руденко, Б. В. Черпак, И. А. Дитковский, Л. С. Дзахоева

Цель работы — изучить частоту возникновения постинфарктного разрыва межжелудочковой перегородки (РМЖП) при инфаркте миокарда, разработать тактику дооперационного лечения, направленного на снижение летальности в первые дни и недели после разрыва, и оценить результаты хирургического лечения больных с постинфарктным РМЖП.

Материалы и методы. Работа построена на изучении историй болезни 65 пациентов с постинфарктным РМЖП. 49 больных лечились в ГУ «НИССХ им. Н. М. Амосова НАМН Украины» в период с 1991 по 2013 г., 16 других наблюдений составили истории болезни и протоколы патологоанатомических вскрытий больных, умерших в 7 крупных кардиологических клиниках, где лечились 1014 пациентов с острым инфарктом миокарда (ОИМ). РМЖП осложнили течение ОИМ в 1,5 % случаев.

Результаты и обсуждение. Из 49 пациентов, госпитализированных в Институт, 47 были подвергнуты хирургическому лечению. Троим пациентам для уменьшения прогрессирования острой сердечной недостаточности (ОСН) дефект закрыли окклюдером в сроки до 10 дней после разрыва. После операции умерли 5 (11,5 %) пациентов из числа первых 15 прооперированных больных. Последующие 32 операции выполнены без летальных исходов.

Выводы. Полученные результаты исследования и данные публикаций позволяют заключить, что постинфарктные РМЖП наблюдаются в среднем в 1,5 — 3 % случаев. Разрыв перегородки возникает на 2 — 7-е сутки. Госпитальная летальность при РМЖП достигает 85 — 95 %. Восстановление целостности межжелудочковой перегородки хирургическим способом с помощью заплаты сопряжено с высоким риском прорезывания швов в ранний послеоперационный период, прогрессирования ОСН и высокой послеоперационной летальностью. После прорастания инфарктной зоны зрелой фиброзной тканью технически легче выполнить операцию с высокой степенью выживаемости больных. Для достижения приемлемых сроков выполнения операции при отсутствии эффекта от лекарств и внутриаортальной баллонной контрпульсации в ряде случаев положительного эффекта можно достичь использованием метода закрытия РМЖП окклюдером.

Keywords: разрыв межжелудочковой перегородки, острый инфаркт миокарда, окклюдер.

4.

 

Эффективность и безопасность применения фактора роста эндотелиоцитов у пациентов с хронической ишемией нижних конечностей IIa — III стадии в составе комплексной терапии

В. Г. Мишалов, Н. Ю. Литвинова, В. А. Черняк

Цель работы — оценить эффективность и безопасность препарата «Неоваскулген» в составе комплексной терапии хронической ишемии нижних конечностей IIa — III стадии по А. В. Покровскому — Фонтейну.

Материалы и методы. Исследование проводили с сентября 2013 по апрель 2014 г. В группу изучения включены 10 пациентов, получавших лечение препаратом «Неоваскулген», в контрольную группу, в которой проводили традиционное лечение, вошли также 10 пациентов. Изучали дистанцию безболевой ходьбы, боли в покое по визуально-аналоговой шкале (ВАШ), косточково-плечевой индекс (КПИ), линейную скорость кровотока (ЛСК), показатели лазерной допплерофлуометрии (ЛДФ). Интегральную оценку эффективности проводили на основании вычисления доли пациентов, у которых лечение могло быть расценено как успешное: клиническое излечение — полное исчезновение клинических признаков ишемии; улучшение — регресс клинических признаков ишемии, уменьшение болевого синдрома при длительной ходьбе и исчезновение в состоянии покоя при горизонтальном положении конечности.

Результаты и обсуждение. Нежелательных явлений, побочных реакций и осложнений не зафиксировано. Самочувствие пациентов группы исследования при введении препарата и в дальнейшем оставалось удовлетворительным, местных реакций не зарегистрировано. На фоне лечения наблюдали увеличение дистанции безболевой ходьбы в обеих группах, но в группе наблюдения динамика оказалась более быстрой. Боли в состоянии покоя по ВАШ уменьшились в обеих группах. В группе исследования КПИ по сравнению с исходной величиной (0,46 ± 0,84) вырос на фоне применения препарата и через полгода составил 0,53. Показатели ЛСК незначительно повысились в обеих группах, однако это повышение не было достоверным, особенно у пациентов с болями покоя. Несмотря на то, что традиционное лечение увеличило базовые показатели ЛДФ, оно почти не повлияло на результаты окклюзионной пробы, в то время как в группе исследования показатели значительно улучшились, а время до максимального прироста кровотока уменьшилось вдвое, что свидетельствует об улучшении микроциркуляции на стопе.

Выводы. Препарат «Неоваскулген» является безопасным и клинически эффективным в составе комплексной терапии хронической ишемии нижних конечностей IIa — III стадии по А. В. Покровскому — Фонтейну: при его применении увеличилась дистанция безболевой ходьбы более чем на 100 %, уменьшились боли в состоянии покоя на (75,8 ± 15,7) %, увеличился КПИ на 12,1 %. Улучшение состояния пациентов происходит преимущественно за счет показателей микроциркуляторного русла, о чем свидетельствуют значительные изменения индексов ЛДФ, особенно времени до максимального прироста кровотока (уменьшение на 57 %). В группе исследования доля пациентов, у которых лечение было расценено как успешное, составила 85,6 %, в контрольной группе — 41,1 %; различия статистически достоверны.

Keywords: хроническая ишемия нижних конечностей, факторы роста эндотелиоцитов, терапия.

5.

 

Predictive value of circulating apoptotic microparticles to mononuclear proangiogenic progenitor cells ratio in patients with chronic heart failure

A. E. Berezin, A. A. Kremzer, T. A. Samura, Yu. V. Martovitskaya

Purpose — to evaluate the predictive value of circulating endothelial-derived apoptotic microparticles (EAMPs) to proangiogenic mononuclear cells (PMCs) ratio for cumulative survival in patients with chronic heart failure (CHF).

Materials and methods. A total of 154 patients with CHF of II — IV functional class were enrolled in the study. Flow cytometry analysis for quantifying the number of EAMPs and proangiogenic PMCs was used.

Results and discussion. Calculated EAMPs to PMCs ratios in patients that survived and died were 8.4 (95 % CI = (7.6 — 9.2) and 78.9 (95 % CI 53.0 — 116.6), respectively, (p = 0.001). For further analysis the values of EAMPs to PMCs ratio for entire patient population included in the study were presented by quartiles (Q): Q1 (median = 9.7; 95 % CI = 5.8 — 10.6); Q2 (median = 18.2; 95 % CI 11.0 — 22.2); Q3 (median = 41.4; 95 % CI 22.5 — 57.8); Q4 (median = 73.0; 95 % CI 58.9 — 96.6). Using Kaplan — Meier survival analysis we have found a significant divergence of survival curves in patients with top quartile (Q4) of EAMPs to PMCs ratio as compared to those with low quartiles (Q1-Q3).

Conclusions. In patients with CHF of II — IV FC, top quartile values of EAMPs to PMCs ratio compared with low quartile values are associated with increased risk of all-cause mortality, CHF-related death and risk for recurrent hospitalization due to CHF.

Keywords: endothelial-derived apoptotic microparticles, proangiogenic mononuclear cells, chronic heart failure, survival, hospitalization, prognosis.

6.

 

Hypertriglyceridemic waist phenotype in patients with arterial hypertension: accent on glucometabolic profile and interleukins activity

T. V. Ashcheulova, O. M. Kovalyova, M. A. Syed

The aim — to investigate glycemic and lipid profile parameters, pro-inflammatory cytokine — interleukin-18 (IL-18) — and antiinflammatory cytokine — interleukine-10 (IL-10) — levels depending on hypertriglyceridemic waist phenotype presence and gender of patients with arterial hypertension (AH).

Materials and methods. 104 hypertensive patients were examined by clinical, laboratory, and instrumental methods. Patients were divided into groups: 1st group — patients with normal waist circumference (WC) (< 90 cm in males; < 85 cm in females) and elevated triglyceride (TG) levels (≥ 1.7 mmol/l); 2nd group — patients with increased WC and normal TG levels; 3rd group — increased WC and elevated TG levels, that is hypertriglyceridemic waist phenotype.

Results and discussion. It was found that patients with AH and hypertriglyceridemic waist phenotype were characterized by most unfavorable glucometabolic and atherogenic profile. We have detected pro-inflammatory chain of immune response activation in hypertensive patients with hypertriglyceridemic waist phenotype that was confirmed by significant elevation of pro-inflammatory cytokine IL-18 circulating levels and IL-18/IL-10 ratio. Gender differences in cytokines activation, more significant immunoactivation in hypertensive women as compared with hypertensive men was shown.

Conclusions. Patients with hypertension and Hypertriglyceridemic waist phenotype were characterized by unfavorable glucometabolic and atherogenic profile. They revealed hyperactivation of inflammatory immune response level, as evidenced by the significant increase in circulating levels of anti-inflammatory cytokine IL-18 and IL-18/IL-10 ratio. Level of cytokine activation in patients with hypertension is characterized by gender differences, namely: women have a more pronounced immunological activation.

Keywords: hypertriglyceridemic waist phenotype, glucometabolic profile, interleukin-18, interleukin-10, arterial hypertension.

7.

 

Independent predictors of unfavorable course of active native valve infective endocarditis

V. V. Boyko, O. V. Pyetkov, I. V. Polivenok, Yu. M. Skibo

Purpose — to reveal independent predictors of unfavorable course of active native valve infective endocarditis (ANVIE) and to determine their effect on the course of the disease.

Materials and methods. The study is based on management of 120 patients from Kharkiv region with ANVIE according to modified Duke criteria, that were observed in specialized centers within 2004 — 2012 years. Unfavorable or conditionally favorable course of ANVIE was determined in 94 of them prior to surgery. To reveal independent predictors of unfavorable course of the disease backward stepwise binary logistic regression analysis was used.

Results and discussion. Unfavorable course of ANVIE was observed in 36 (38 %) patients. Independent predictors of unfavorable course of ANVIE were identified: blood urea (odds ratio (OR) 1.22; 95 % confidence interval (CI) 1.07 — 1.39; p = 0.002), large (≥ 10 mm) vegetations (OR 5.29; 95 % CI 1.62 — 17.24; p = 0.006) and congestive heart failure (OR 4.58; 95 % CI 1.5 — 13.97; p = 0.007) (constant: –4.175). Overall 84 % cases could be predicted correctly by this statistical model.
Conclusions. If there are no indications for urgent or emergent surgery, quantification of the risk of unfavorable course of ANVIE without surgery could be used to compare with cardiac surgery risk to justify early surgery and, thus, to reduce the overall mortality.

Keywords: active native valve infective endocarditis, unfavorable course, independent predictors.

8.

 

Независимые предикторы неблагоприятного течения активного инфекционного эндокардита нативных клапанов

В. В. Бойко, А. В. Петков, И. В. Поливенок, Ю. Н. Скибо

Цель работы — выявить независимые предикторы неблагоприятного течения активного инфекционного эндокардита нативных клапанов (АИЭНК) и определить степень их влияния на течение заболевания.

Материалы и методы. Исследование основано на результатах обследования и лечения 120 пациентов Харьковского региона с АИЭКН в соответствии с критериями Duke, обследованных в специализированных центрах с 2004 по 2012 г. У 94 из них до начала хирургического лечения определили, было ли течение АИЭНК неблагоприятным или благоприятным (условно). С целью выявления независимых предикторов неблагоприятного течения заболевания использован метод бинарной логистической регрессии с пошаговым исключением.

Результаты и обсуждение. Неблагоприятное течение АИЭНК отмечено у 36 (38 %) пациентов. В качестве независимых предикторов неблагоприятного течения АИЭНК выделены уровень мочевины крови (отношение шансов (ОШ) 1,22; 95 % доверительный интервал (ДИ) 1,07 — 1,39; p = 0,002), наличие крупных (10 мм и более) вегетаций (ОШ 5,29; 95 %ДИ 1,62 — 17,24; p = 0,006) и тяжесть сердечной недостаточности (ОШ 4,58; 95 % ДИ 1,50 — 13,97; p = 0,007), константа в модели –4,175. Общее число правильно предсказанных результатов составило 84 %.

Выводы. При отсутствии показаний к экстренной или срочной операции на сердце количественная оценка риска неблагоприятного течения АИЭНК без хирургического вмешательства может быть использована для сравнения с кардиохирургическим риском с целью обоснования раннего хирургического вмешательства и снижения общей летальности.

Keywords: активный инфекционный эндокардит нативных клапанов, неблагоприятное течение, независимые предикторы.

9.

 

Nosological structure of acquired mitral valve diseases

V. P. Zakharova, A. R. Babochkina, E. V. Rudenko

The aim — to systematize the nosological structure of acquired mitral valve diseases (AMVD) and to perform the morphological study of different variants of mitral valve (MV) prolapse.

Materials and methods. The work is based on a morphological study of 1585 MV, which were resected during cardiosurgery treatment of patients with various AMVD. Macropreparations were described and photographed. Frozen and paraffin histological preparations were manufactured from modified portions of the valves, which allowed to evaluate the presence and status of cells (including smooth muscle cells and endothelial cells), extracellular matrix, fibrous connective tissue components, fats, fibrin. Results of morphological studies were compared with clinical data.

Results and discussion. 995 (62.8 %) out of 1585 MV under study showed signs of rheumatic process of varying degrees of activity: 709 (71.3 %) — post-rheumatic fibrosis and calcification, 6 (0.6 %) — rheumatism with «florid» granulomas of Ashof — Talalaev, the remaining 280 (28.6 %) stage — rheumavalvulitis of fading activity. A classification of etiopathogenetical AMVD was suggested.

Conclusions. Non-inflammatory changes were the basis for the development of insufficiency in 49.9 % of all acquired mitral valve diseases. Small congenital anomalies of mitral valve compose 74.6 % of all cases of non-inflammatory acquired mitral valve diseases; the signs of chordal apparatus dysplasia were stereotyped in 13.5 % of mitral valves, small congenital and individual anomalies of mitral valve were fixed in 61.1 %. Small congenital anomalies of mitral valve imped to optimal systolic coaptation of the mitral leaflets with their gradual anatomical and tissue remodeling and breach of their closing function and are usually verified as acquired mitral valve disease. 17.4 % of all acquired mitral non-inflammatory valve diseases of non-inflammatory genesis were caused by congenital deficiency of fibroelastic mitral valve structure which is realized in adulthood as valve insufficiency. In 8 % of patients, the mitral valve insufficiency was associated with a failure senile degenerative changes in its structures. Changes of inflammatory and noninflammatory genesis can be combined in one valve: rheumavalvulitis developed at the background of small congenital anomalies of mitral valve in 12.7 % of cases; infective endocarditis comlicated small congenital anomalies, fibroelastic dysplasia and degenerative changes in 71.2 % of cases. Lipoidosis can be layered on any pathological process in the mitral valve, and this increases the extent of the valve injury.

Keywords: acquired mitral valve diseases, prolapse, nosological structure, morphology.

10.

 

Immediate and long-term results of revascularization of lower extremities in patients with critical limb ischemia

O. I. Pityk

Purpose — to compare the efficiency of endovascular and surgical revascularization in patients with critical limb ischemia (CLI) resulting from lesions of infrainguinal arteries.

Materials and methods. This retrospective study included 342 CLI patients, who underwent infrainguinal revascularization of lower extremities at V. T. Zaitsev Institute of General and Emergency Surgery of NAMS of Ukraine during 2008 — 2012. The patients were divided into 2 groups. I group included 239 patients who underwent percutaneous endovascular interventions. II group included 103 patients who underwent bypass surgery. Limb salvage and survival rates were assessed by Kaplan-Meier method during 5 years.

Results and discussion. Immediate technical success and clinical improvement in the first and second groups were similar and reached 93 % and 91 %. The number of complications and major amputations was significantly higher in the surgical group than in the endovascular one. Long-term outcomes between the groups were not significantly different. At 1.3 and 5 years, limb salvage rates were 89 %; 75 %; 63 % vs. 91 %; 77 %; 69 %; survival rates were 82 %; 64 %; 38 % vs. 93 %; 73 %; 47 %; and amputation-free survival rates were 83 %; 50 %; 34 % vs. 83 %; 59 %; 38 % in endovascular and surgical groups respectively. The number of repeated operations in the long-term period due to CLI recurrence was significantly higher in the endovascular group.

Conclusions. Endovascular and open surgical techniques provided similar immediate and long-term results for patients with CLI caused by lesions of infrainguinal arteries, but the choice of revascularization method must necessarily take into account the localization and length of arterial lesions, suitable autovein for bypass, level of perioperative risk and life expectancy.

Keywords: critical limb ischemia, endovascular therapy, bypass surgery.

11.

 

Anomalies of the coronary arteries

D. D. Zerbino, О. B. Kuryliak, O. I. Boiko

Anomalies of the coronary arteries are extremely rare with a frequency of 0.3 — 1.6 %. There are large and small coronary anomalies, anomalies of quantity, topographical origin, degree of passability, communication. In most cases, anomalies of the coronary arteries don’t manifest clinically and debut sudden cardiac death. There is a risk of sudden death in childhood and in adulthood, especially during exercise. Children with such disorders are at high risk of myocardial infarction and heart failure. If the signs of myocardial ischemia occur in children, it is important to suspect the anomalies of coronary arteries and to perform coronary angiography or multidetector computed tomography. Detailed examination of the coronary arteries should be an integral part of the autopsy, especially in cases of sudden death in infancy.

Keywords: anomalies of coronary arteries, sudden death of children, myocardial infarction in children.

12.

 

Permanent pacing and medical support of patients

I. V. Shanina, D. E. Volkov, V. V. Boyko, N. I. Yabluchansky

Permanent pacing today is the main method of bradyarrhythmia rhythm disturbances treatment and chronic heart failure resistant to drug therapy. QRS complex duration is significant prognostic parameter in patients with a pacemaker, and in the case of cardiac resynchronization therapy, QRS complex duration is the criterion of patient selection and possible response to therapy. It should be noted that the implantation of the pacemaker does not negate the medication support. Coronary heart disease, arterial hypertension, atrial fibrillation, congestive heart failure and other cardiovascular diseases and syndromes in their co-and multimorbidity require the prescription of inhibitors of the renin-aldosterone-angiotensin system, antiarrhythmics antiplatelet drugs, statins, diuretics and other medications. Further problems arise with the permanent pacemaker, such as pacemaker-modulated arrhythmias. The Purpose of this review is an analysis of contemporary literature sources to assess the importance of QRS complex duration in the management of patients with permanent pacemaker in bradyarrhythmias and for cardiac resynchronization therapy.

Keywords: QRS complex duration, permanent pacing, cardiac resynchronization therapy.

13.

 

Thrombangiitis obliterans: difficulties of diagnosis and treatment

V. E. Kondratiuk, A. V. Beiko, L. G. Karpovich, T. A. Kovganich, M. B. Stanytska, S. Ch. Ter-Vartanian

The lecture presents data on the epidemiology, etiology, pathogenesis, symptoms, diagnosis, differential diagnosis and treatment of thrombangiitis obliterans (TO). Criteria of the diagnosis of thrombangiitis obliterans are: age younger than 45 years, current or recent history of tobacco use; the presence of distal-extremity ischemia, claudication, pain at rest, ischemic ulcers, or gangrene documented by noninvasive vascular testing; exclusion of autoimmune diseases, connective tissue pathologies, hypercoagulable states, and diabetes mellitus confirmed by laboratory tests; exclusion of a proximal source of emboli by echocardiography and arteriography; and consistent arteriographic changes in the clinically involved and noninvolved limbs. Confident clinical diagnosis of TO may be made only if all requirements have been fulfilled. A biopsy is rarely needed, only if the patient is over 45 years old and has uncommon symptoms, such as large-artery involvement. A case from our own practice is described in detail. The peculiarity of the case is the difficulty in making a diagnosis of TO which is probably related to a lack of awareness of physicians of this pathological condition.

Keywords: thromboangiitis obliterans, venous and arterial thromboses, diagnosis, treatment.

14.

 

Simultaneous coronary bypass surgery with resection of left ventricular aneurysm and hemithyroidectomy

A. V. Rudenko, M. M. Bagirov, O. K. Hohayeva, O. V. Seykovsky, L. S. Dzahoyeva, V. P. Zakharova, S. M. Solomka, L. A. Klimenko

A case has been presented of simultaneous coronary bypass surgery, resection of left ventricular aneurysm with hemithyroidectomy on the right for accompanying giant intrathoracic goiter in a patient with a complicated form of ischemic heart disease manifested as a thrombotic aneurysm of the left ventricle. Thrombotic aneurysm of the left ventricle resulting from transmural myocardial infarction was diagnosed by ECG, echocardiography and coronaroventriculography. Giant intrathoracic goiter was diagnosed by CT, X-ray of the chest and thyroid-utofluoroscopy. The patient underwent simultaneous surgery: removal of a giant intrathoracic goiter on the right, coronary bypass surgery with resection of the thrombotic left ventricular aneurysm under artificial circulation. Perioperative period ran smoothly, the patient was discharged on the 8th day after the operation. Simultaneous operation allows performing multiple surgeries under one anesthetic, which reduces the risk of complications and speeds up the process of recovery.

Keywords: simultaneous surgery, coronary bypass surgery, thyroidectomy.

15.

 

Cases of systemic amyloidosis with dominating cardiac involvement

A. V. Ushakov, A. V. Legkonogov, A. A. Gagarina, T. V. Konstantinova, N. V. Tatarevsky, O. A. Ulchenko, A. G. Nos, V. V. Shalanin

Two cases of systemic amyloidosis with cardiac involvement are presented. In both cases cardiac disturbances dominated in clinical picture of the disease and determined its prognosis. Difficulties in diagnosis caused by rareness of the pathology, multiplicity of clinical manifestations, laboratory abnormalities, ultrasound and electrocardiographic data are discussed. The cases presented illustrate the importance of thorough evaluation of the combination of clinical manifestations of the disease, laboratory results, imaging methods data for the determination of the nature of heart failure, polyorganic insufficiency and edema syndromes. It’s been concluded that the presence of hypertrophic and restrictive patterns of cardiac remodeling combined with polyorganic involvement (liver, kidneys, nervous system) and the presence of increased myocardial walls thickness associated with reduced ECG voltage require considering the systemic amyloidosis as a probable diagnosis.

Keywords: heart, primary amyloidosis, diagnosis.

Current Issue Highlights

№4(60) // 2017

Cover preview

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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