In modern medical care, there is an urgent need for the use of innovative technological medicine that expends the horizon for cardiovascular treatment. The introduction of innovations requires successful solutions and should be based on the experience of classical treatment of heart and vessels pathologies. For the development of interventional cardiology and cardiac surgery in Lviv, doctors of the cardiac surgery department of the Lviv Regional Clinical Hospital initiated the involvement of Polish colleagues to found a joint Ukraine-Polish heart center "Lviv" on the basis of the Lviv Regional Clinical Hospital. The purpose of the article is to inform the medical community about the availability of modern methods of diagnosis and treatment of heart and blood vessel diseases in Lviv and Western Ukraine. New diagnostic methods are being introduced that optimize the results of coronary endovascular revascularization. In particular, assessment of coronary physiology - instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) and intravascular ultrasound (IVUS) to determine the morphology of the affected coronary vessels. The wider use of endoprostheses for the descending thoracic aorta (EVAR) makes it possible to adequately stent the hard-to-reach segment of the aorta in its aneurysms or stratification, as well as to avoid complex traumatic open surgeries. Transcatheter aortic valve implantation (TAVI) was performed at this medical center on October 12, 2020 for the first time in Lviv and Western Ukraine.
Sinuses of Valsalva height is an important parameter in planning cardiac surgery, percutaneous coronary intervention and transcatheter aortic valve implantation (TAVI). The aim of the study is to analyze the height of the sinuses of Valsalva depending on height, weight, body mass index, body surface area, and sex using computed tomography angiography images in Ukrainian population. 59 chest computed tomography angiography examination for non-cardiac reasons were retrospectively evaluated. Data were collected from Ukrainian citizen. The height of the Sinuses of Valsalva was measured as the distance between aortic annulus and sinotubular junction. All three sinuses of Valsalva height were higher in men than in women (p<0.001). In men, three Sinuses of Valsalva had a correlation with height and body surface area (BSA) (р<0.05). In women, a correlation has been confirmed only between anthropometric measurements and the height of left and right coronary sinuses (р<0,05). The left coronary sinus height had a correlation with height, weight, body mass index (BMI) and BSA (р<0,05). The right coronary sinus height had a correlation with weight, BMI, and BSA (р<0.05). The parameters of the non-coronary sinus in women do not have confirmed direct correlations with any anthropometric measurements observed. The sinuses of Valsalva height is higher in males. The most significant confirmed correlations were between height and left and right coronary sinuses in men and women. Increased size of sinuses in men correlated with an increase of height, weight and decrease of BMI and BSA values.
Morphometric analysis of the structures of the aortic bulb and coronary arteries is necessary for the planning of cardiac surgery and endovascular interventions. The aim of the study was to determine the height of the coronary arteries branching in healthy women of Lviv city and Lviv region and to determine the relationship between the height of the location of the orifice of the coronary artery with anthropometric indicators. Fifteen computed tomography images with contrast of female thorax without heart and ascending aortic lesions (normal) were selected for the study. The height of the upper and lower edges of the coronary arteries was measured; height of Valsalva sinuses. The comparison of the mean values was performed according to the Student’s t-test. The correlation between the observed variables (age, height, body weight, body mass index, body surface area, height of the sinuses of Valsalva) was calculated using the Pearson linear correlation method (r). According to the study, the population group consisted of persons of the second period of adulthood (46.67 %) and the elderly (53.33 %). According to the body mass index, 80 % were overweight or obese I-II degree. The mean height of the coronary artery orifice in women without structural changes of the heart and ascending aorta was: 11.19±1.96 mm for the left and 11.68±1.80 mm for the right. The height of the orifice of the right and left coronary arteries were almost the same, without statistical significance (p=0.26). Analysis of the correlation between the values of the height of the orifice of the coronary artery did not show a probable dependence on height, weight, age, body mass index and body surface area. There is a direct relationship between the parameters of the height of the lower edge of the right coronary artery and the height of the upper edge of the right coronary artery (r=+0.75, p=0.001) and between the value of the lower edge of the left coronary artery and the upper edge of the left coronary artery (r=+0.63, p=0.01). Thus, the analysis of the correlation between the values of the height of the orifice of the coronary artery in women in norm and anthropometric indicators did not show a significant relationship. There was no statistical significance between the indicators of the height of the orifice of the right and left coronary arteries in women.
Situs inversus totalis is a rare condition of visceral transposition in thoracic and abdominal cavities. Computed tomography (CT)-based morphometric analysis of the cardiovascular system prior to the surgery helps to describe vessel topography and size, choose the right surgical insertion site, avoid vessel trauma, and prevent hemorrhage during surgical intervention. We present a case report of situs inversus totalis detected incidentally in a 74-year-old male with the acute abdominal syndrome. Appropriate detailed aorta measurements are used to choose an adequate size of the aortic prosthesis during open surgical repair or endovascular aneurysm repair. An accurate assessment of the vessels on CT scans assists in consideration of the catheter diameter and the most reliable cannulation site. Vessel size correlates with morphological conditions (kinking, stenosis, occlusion), which may be considered a risk of organ malperfusion. The anatomical analysis prior to surgery in different anatomical variations may ensure patient safety and predict complications.
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