In the majority of cases, left ventricular aneurysm is a result of a sustained transmural myocardial infarction, which leads to progressive cardiac insufficiency. The overriding priority of a surgical correction is to remove the non-functional myocardium and restore the geometric configuration of the left ventricle. The aim. To analyze the immediate and long-term results after surgical correction of left ventricular aneurysm. Materials and methods. Within the period from 2012 till 2017 at the Ukrainian Children`s Cardiac Center, 88 patients with left ventricular aneurysm were operated. However, we were able to assess long-term outcomes in 71 (80.1%) patients, due to the inaccessibility of patients owing to the difficult geopolitical situation in the country. Depending on the method of surgical correction, two groups were formed: group A (Dor procedure) comprising 17 patients, group B (linear repair) including 71 patients. In group A (n = 17), the vast majority of patients were male (n = 16, 94.1%) vs. only 1 female patient (5.9%). A similar trend was observed in group B: there were 56 male (78.9%) and 15 (21.1%) female patients. The following parameters were considered during the echocardiographic examination: left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-diastolic index (LVEDI), left ventricular endsystolic volume (LVESV), left ventricular end-systolic index (LVESI), localization of the aneurysm and its prevalence. Results and discussion. During the clinical and instrumental examination, ischemic cardiomyopathy was diagnosed in 6 (35.3%) patients of group A and in 8 (11.3%) patients of group B. Long-term mortality was higher in group B (n = 10, 17.2%) than in group A (n = 1, 7.7%). Conclusion. According to our study, long-term mortality was 7.7% in group A and 17.2% in group B. The factors that could influence the results were higher Euroscore II and incorrectly chosen tactics for patients with extensive akinesis of the walls of the heart in group B. We deem appropriate to perform cardiac MRI in all patients with left ventricular aneurysm at the stage of diagnosis in order to develop clear plan for surgical tactics.
Aortic valve replacement is a gold standard in the treatment of patients with severe aortic stenosis or combined aortic pathology. However, aortic valve pathology is often associated with a narrow aortic orifice, particularly in patients with severe aortic stenosis. In 1978, Rahimtoola first described the term of prosthesis-patient mismatch. He noted that effective orifice area of the prosthesis is smaller than that of the native valve. To minimize this complication, there are several surgical strategies: aortic root enlargement (ARE), implantation of a frameless biological prosthesis in the native position, neocuspidalization procedure, Ross procedure, aortic root replacement with xenograft or homograft. ARE is an excellent option, however, some authors outline additional perioperative risks. The aim. To analyze immediate results of ARE during isolated aortic valve replacement and in cases when it is combined with other heart pathologies. Materials and methods. Our study included 63 patients who underwent ARE. Isolated aortic valve replacement was performed in the majority of cases, but often aortic root replacement procedure was combined with coronary artery bypass grafting. Results and discussion. One of 63 patients died (hospital mortality 1.6%) at an early hospital stage (30 postoperative days). Measurement of the aortic valve ring was performed by two methods, through preoperative echocardiography and perioperative measurement using a valve sizer. However, perioperative dimension was chosen as the basis for the calculations. In 62 patients, the perioperative diameter of the aortic valve ring ranged from 19 to 23 mm, only one patient had a diameter of 24 mm. According to our findings, ARE enabled to achieve an average aortic ring size increase of 2.68 cm2 (from 1.5 to 3.4 cm2) and to prevent prosthesis-patient mismatch in 42 (66.7%) cases. Conclusions. Prosthesis-patient mismatch is considered a serious complication in the postoperative period. Narrow aortic root is a common pathology that should be considered during surgery. ARE is a safe procedure and is not associated with an increased risk of mortality and complications.
Коарктація аорти є однією з найчастіших вроджених вад серця і становить 6–7%. Коарктація аорти часто поєднана з іншими вадами серця – двостулковим аортальним клапаном, дефектом міжшлуночкової перегородки та ін. Мета роботи – висвітлити наш перший досвід одноетапної хірургічної корекції коарктації аорти і патології аортального клапана. Матеріали і методи. Чоловік, 56 років, поступив у відділення в плановому порядку із симптомами хронічної серцевої недостатності. Основними скаргами на момент госпіталізації були задишка при мінімальному фізичному навантаженні та підвищення артеріального тиску. Коарктація аорти була встановлена випадково, в ході проведення коронаровентрикулографії в іншому лікувальному закладі. Результати та обговорення. Незважаючи на велику кількість публікацій у закордонних джерелах, при огляді вітчизняної літератури не було знайдено жодного описаного випадку екстраанатомічного шунтування коарктації аорти з одночасною корекцією серцевої патології у дорослого пацієнта в Україні. Згідно із досвідом іноземних фахівців, наш пацієнт мав протипоказання до екстраанатомічного анастомозу із серединної стернотомії у зв’язку зі своєю конституційною особливістю – бочкоподібною грудною кліткою. Однак використання міні-інвазивного інструментарію дало можливість успішно виконати операцію і скоротити тривалість формування дистального анастомозу. Висновки. Екстраанатомічне формування анастомозу при коарктації аорти в комплексі із серцевою патологією є хорошим альтернативним методом лікування для дорослої когорти пацієнтів.
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