РЕЗЮМЕ. Постперикардиотомный синдром (ПКТС) развивается после кардиохирургических операций в рамках неспецифической системной воспалительной реакции организма (SIRS) и проявляется признаками общей интоксикации и симптомами вовлечения в аутоиммунный воспалительный процесс листков плевры и/или перикарда с образованием выпота в плевральной и/или перикардиальной полостях. ПКТС не является редким патологическим состоянием и часто сопровождает операции на сердце, особенно проводимые в условиях искусственного кровообращения. Однако он может протекать под маской заболеваний легких и плевры, сердечной недостаточности и других осложнений кардиологических заболеваний и кардиохирургических вмешательств. Учитывая специфичность терапии данного синдрома, его правильная и своевременная диагностика призвана облегчить и без того неудовлетворительное состояние больного, перенесшего операцию на сердце, и его послеоперационный прогноз. Несмотря на то, что эта патология описана в середине прошлого века, методы ее лечения обсуждаются до сих пор, в частности, сравнивается эффективность глюкокортикостероидов и колхицина, и рассматривается применение последнего для профилактики ПКТС. В данной работе представлен клинический случай ПКТС, толерантного к гормональной терапии и купированного с помощью колхицина.
In the natural course of postductal aortic coarction, the average life expectancy of the patient is 30 years. The quality of life depends largely on the severity of narrowing, the presence of an open arterial duct and the development of collaterals providing blood flow in the descending aortic basin. Adult patients are characterized by hypertension syndrome symptomatic angina pectoris arrhythmias and heart failure. Pathology is diagnosed by means of two-dimensional echocardiography with color dopplerography and three-dimensional and four-dimensional ultrasonic reconstruction. The obtained data are significantly refined and supplemented by magnetic resonance or contrast multispiral computer tomography. Timely and correct diagnosis can save a patient’s life or significantly improve its quality, preventing the consequences of persistent hypertension and the development of heart failure. The present paper considers a clinical case of pronounced aortic coarctation, first diagnosed in a man aged 30 years, previously observed with a diagnosis of hypertension, despite the signs of hypoxemia of the lower half of the trunk. The algorithm of examination is discussed, which provides timely diagnosis of this defect in order to prevent its complications.
<p>The present paper discusses one of the serious complications of electrocardiostimulator implantation: electrode perforation of the right ventricle wall, a condition that can occur in both the early and late postoperative periods. The latter occurs less frequently, and the patient may be asymptomatic; this results in an adverse effect on the patient’s quality of life and disease prognosis. Knowledge about the symptoms of late perforation and algorithms to examine patients suspected to have this complication contributes to timely surgical intervention as well as prevention of heart failure progression and fatal outcomes. This paper describes a clinical case of right ventricular perforation 1.5 years after electrocardiostimulator implantation, wherein, despite the absence of pronounced clinical symptoms, the patient was successfully diagnosed with pacemaker testing, Holter diagnostics, echocardiography and computed tomography of thoracic organs. Myocardial damage was accompanied by small left-hand bone-diaphragm hydrotorax and hydropericardium. The risk factors of perforation in the present case were low body weight and age. In the course of the surgical operation performed with the exact observance of the chosen technique, the integrity of the myocardium of the right ventricle and the function of the electrocardiostimulator were restored. Thus, the life-threatening consequences of the described complication were prevented.</p><p>Received 12 September 2019. Revised 20 December 2019. Accepted 23 December 2019.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>
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