Nowadays magnetic resonance imaging (MRI) is a gold standard for diagnosing abnormalities of left ventricular geometry and function, however, it is not universally accessible. Furthermore, MRI is not compatible with pacemakers and similar devices. 3D speckle tracking echocardiography (3D STE) is a cutting-edge echocardiography imaging technique for myocardial deformation assessment. As such, 3D STE looks very promising for diagnosing structural complications of myocardial infarction (MI) and choosing the optimal surgical techniques. In this case study, we used 3D STE to assess left ventricular function in a patient with left ventricular aneurysm. The patient was admitted to National Amosov Institute of Cardiovascular Surgery three weeks after having a second MI (the first MI was reported 4 years ago). His coronary angiography showed diffuse coronary artery disease. 2D echocardiography (performed on Toshiba Artida) results: end-diastolic volume (EDV) 206 ml, end-systolic volume (ESV) 141 ml, ejection fraction (EF) (Simpson’s method) 31%. An object sized 2.2*1.6 cm was discovered in the apical region (left ventricular thrombus). 3D STE results: EDV 209 ml, ESV 182 ml, EF 13%. Global area strain (GAS) was considerably decreased (–13.7 %) showing the pattern of ischemic cardiomyopathy with multivessel disease. Due to several reasons, it was impossible to obtain an MRI scan, so a CT coronary angiography was performed (Toshiba Aquilion One). The results of multi-slice computed tomography (MSCT) were consistent with those of echocardiography. According to the results, the initial plan to resect the apical akinesia region was ruled out. The patient underwent coronary artery bypass grafting (CABG) (4 shunts), the removal of thrombi from the left ventricle (additional fresh thrombi were discovered during the surgical intervention), and left ventricular aneurysm repair under cardiopulmonary bypass. Post-treatment 3D STE results: EDV dropped to 135 ml, EF rose from 13% to 32%. GAS increased up to –20.4 %, while the strains of all segments increased to subnormal levels. The overall dynamics was positive, and the patient was discharged to undergo postoperative rehabilitation. The case shows that 3D STE data is consistent with CT data in patients with abnormal ventricular remodeling. 3D STE is a good method for differentiation between akinetic scar tissue and a dyskinetic left ventricular aneurysm.
Aim of the study. To determine the effect of surgical tactics on the duration of ischemic period with simultaneous combined correction of two or three valves of the heart and myocardial revascularization Materials and methods. The work is based on the analysis of the results of single-stage multivalve correction in conjunction with coronary artery bypass grafting in 93 patients, which was performed at the National Amosov Institute of Cardiovascular Surgery for the period from 2014 to 2016. Depending on the tactical approach and the sequence of surgical procedures, patients were divided into groups. 1 – “CABG off pump and subsequent correction of heart valves” (n = 15); 2 – “Correction of heart valves and bypass grafting in conditions of cardioplegia” (n = 78). Results. Using different approaches to achieve high-quality protection of the myocardium at the time of its ischemia, minimizing the impact of artificial circulation on the body by improving the conditions and reducing the ischemic heart time showed significant advantages of the method of pre-shunting CA in the working heart. Conclusions.1. Correction of combined multiple valve pathology with coronary heart disease requires prolonged cardiopulmonary bypass time and ischemic heart time, which requires reliable protection of the myocardium, which is difficult to carry out in the presence of stenoses in the lumen of the CA. 2. The use of the method of preventive restoration of coronary blood flow by bypassing the spacecraft on the working heart before clamping of the aorta, has significant advantages in the duration of the cardiopulmonary bypass time and ischemic time of the heart.
Introduction. Cardiac tumors (CT) occur in 0.3-0.7% of general population according to autopsies. The combination of CT with coronary artery disease (CAD) significantly complicates the clinical course of the disease. The aim. To study the frequency, features of the course and surgical treatment of patients with CT combined with CAD. Materials and methods. In the period from 01.01.1969 to 31.12.2020, surgical treatment of 976 patients with CT was performed at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine, and 41 (4.2%) of these patients had lesions of the coronary arteries. In 39 patients (95.1%), CT were represented by benign tumors (myxomas), in 2 (2.4%) by malignant, poorly differentiated sarcoma and immature teratoma. For the correction of the pathology of coronary vessels, a whole range of surgical methods was used: stenting of left anterior descending artery (LAD), which was performed immediately before surgery to remove CT, in 3 patients (7.3%); coronary artery bypass grafting in 35 patients (85.4%); in cases of the presence of a muscular bridge that narrowed the LAD, dissection of this structure was performed in 2 patients (4.9%); left ventricular aneurysm repair surgery in 1 patient (2.4%). In 7 patients (17.1%), the operation was performed on urgent indications. Results. The average number of grafted arteries was 1.9 ± 0.3 (1 to 4) per patient. There were no mortality. Of the 41 patients with coronary artery lesions with CT, there were 2 cases of acute CAD as a result of their embolism by tumor fragments. Clinical manifestations in these patients differed significantly. Conclusions. Occurrence of coronary artery embolism in patients with CT according to our data is 0.2% of all patients with CT. CAD accompanies tumor lesions in 4.1% of cases and is diagnosed by angiography and computed tomography. To correct the lesion of the coronary arteries in CT, the full range of surgical techniques is used, including stenting of the coronary artery (spacecraft), coronary artery bypass grafting, removal of the myocardial bridge.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.