Severe acute mitral regurgitation is among the common causes of a lesser-identified complication such as unilateral pulmonary edema. The presence of consolidation syndrome in the upper right lobe could be considered as a suggestion for possible unilateral pulmonary edema in a patient with acute coronary syndrome. We present a case with unilateral pulmonary edema caused by acute mitral regurgitation from myocardial infarction, resolved after valve replacement with a mechanical valve, being monitored during 4 years postoperatively.
The national health system is currently going through several stages and reforms which are are expected to lead to the international standards’ achievement. The surgical treatment is basically most lasting solution of cardiac conditions’ problems. Thus, the number of people who became disabled as a result of cardiovascular disease is about 2800 yearly, 55% of whom can be treated by surgery and could be excluded from the disabled. Thereby, this year, within the Institute of Cardiology, we have implemented a model of patient-based on integration of several services - emergency cardiology, interventional cardiology, endovascular surgery, cardiac surgery, electrophysiology, as well as cardiac ablation, implantationof devices in the treatment of cardiac arrhythmias and cardiac rehabilitation.Increased number of hospitalized patients with emergency indications involves the diagnosis of acute pathologies, which require non-delayed surgical treatment, most of these patients being untransportable to specialized cardiac surgical institutions. Therefore, an imperative inEnsuring a collateral integration of the services of general cardiology, interventional cardiology, electrophysiology, cardiac surgery, anesthesiology and intensive care justifies its existence by fulfilling the tasks set before a specialized center to ensure: effectiveness, quality and economic efficiency.
Background. Heart failure (HF) is a well-defined risk factor for early mortality and morbidity after cardiac surgery.We aimed to analyze the evolution of the clinical phenotype of HF at an early stage after heart surgery.Methods. The study included 126 consecutive patients with established chronic HF who fulfilled the cardiac rehabilitation program after undergoing heart surgery (62.23±8.59 years, 67.5% - men). Subjects were divided into 3 groups according to the clinical phenotype of HF: group 1 - HF with reduced left ventricular (LV) ejection fraction (EF) (HFrEF), group 2 - HF with mildly reduced LV EF (HFmrEF) and group 3 - HF with preserved LV EF (HFpEF). All patients were investigated by electrocardiography, transthoracic echocardiography, 6 minutes walk test and assessment of serum NT-proBNP level. Results. Preoperatively, 23.9% of patients had HFrEF, 24.8% - HFmrEF and 51.3% - HFpEF. Analyzing the evolution of the HF phenotype in the early postoperative period, we found that most patients remained in the same group. However, among patients with preoperative HFmrEF, in 22.2% of patients there was an increase in LV EF over 50% and in 22.2% of patients was determined a reduced LV EF, p<0.001. The most obvious positive dynamic of the HF phenotype was attested in patients with HFrEF, where 37% of them presented a mildly reduced LV EF postoperatively, p <0.001. 78.9% of individuals with HFpEF remained in the same group, but 21% showed a decrease in LV EF, p<0.001. Conclusions. At the early stage after cardiac surgery, the most positive evolution of HF phenotype was noticed in the group of patients with HFrEF. Of the 44.4% of patients with HFmrEF who switched to another HF phenotype, only a half reported an increase in LV EF over 50%. The vast majority of patients with HFpEF had the same HF phenotype postoperatively.
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