Aneurysm Of Left Ventricle Research Articles

Successful endovascular treatment of left ventricle aneurysm in a pediatric patient

Successful endovascular treatment of left ventricle aneurysm in a pediatric patient

Catastrophic Event Following Percutaneus Coronary Intervention Developing In-Stent Thrombosis Leading Massive Pericardial Effusion and Free Wall Rupture

BACKGROUND: One extremely unusual but serious side effect of an acute myocardial infarction is left ventricular free wall rupture. It was reported to happen either during the sub-acute phase with overt cardiac remodeling (type III, 45%) or early after the beginning of Myocardial Infarction (MI) (type I or II, about 55%). Large infarct sizes, female gender, and advanced age have all been linked to an increased risk of free wall rupture. Clinicians continue to face significant challenges in diagnosing and treating this condition because of the diverse clinical manifestations linked to elevated death rates. AIMS: This case report aims to highlight a rare occurrence of mechanical complication of acute myocardial infarction CASE: A 69-year-old male patient was referred because of chest pain and dyspneu. He had a primary Percutaneous Coronary Intervention (PCI) and was diagnosed with posterior ST-Evelation Myocardial Infarction (STEMI). The patient had a stent inserted into his ostial-distal Left Circumflex (LCx) artery. Three weeks later, a reangiography revealed a left ventricle (LV) aneurysm and stent thrombosis. Massive pericardial effusion with free wall rupture was seen on the echo. He was breathing heavily while in our emergency room. His blood pressure was 125/74 (94) heart rate was 94 bpm respiratory rate 24 times/minute, SpO2 was 98%, there were no rales, and his ankles had pitting edema. By the bedside, Echo revealed an LV aneurysm, a large, localized pericardial effusion without tamponade, and a possible free wall rupture. Later, he was taken to the intensive care unit and had heart surgery DISCUSSION: Complications from an acute myocardial infarction may be ischemic, mechanical, arrhythmic, embolic, or inflammatory. Significant short-term clinical improvement and long-term survival are linked to the emergence of mechanical problems following acute myocardial infarction. CONCLUSION: the fact that primary Percutaneous Coronary Intervention (PCI) has significantly reduced the prevalence of this deadly event. Our results indicate that one of the key predictors and primary causes of this problem is a longer symptom of angiography time.

Emergency Sternotomy for Ruptured Left Ventricular Aneurysm A Case Report From the André Festoc Center at the “Le Luxembourg” Mother and Child Hospital in Bamako, Mali

Left ventricular aneurysm is rare. It can be spontaneous or acquired, appearing most often after a transmural myocardial infarction but can also follow cardiac operations, trauma, inflammation or infection [1]. We report the first case of a patient initially referred by the cardiology department of the CHU-ME for the surgical management of a large pericardial effusion whose immediate operative consequences were complicated by significant hemorrhage through the pericardial drain, prompting an emergency sternotomy, surgical exploration of which revealed a ruptured left ventricle aneurysm in a 14-year-old boy. In conclusion surgical repair of left ventricular aneurysm can be performed with acceptable results.

Ventricular apical wall rupture and ventricular aneurysm formation concurrent with ventricular septal dissection and rupture due to ST-segment elevation myocardial infarction: a case report

The most common mechanical complications of acute myocardial infarction include free-wall rupture, ventricular septal rupture (VSR), papillary muscle rupture and pseudoaneurysm. It is rare for a patient to experience more than one mechanical complication simultaneously. Here, we present a case of ST-segment elevation myocardial infarction (STEMI) complicated with three mechanical complications, including ventricular apical wall rupture, ventricular aneurysm formation and ventricular septal dissection (VSD) with VSR. Cardiac auscultation revealed rhythmic S1 and S2 with a grade 3 holosystolic murmur at the left sternal border. Electrocardiogram indicated anterior ventricular STEMI. Serological tests showed a significant elevated troponin I. Bedside echocardiography revealed ventricular apical wall rupture, apical left ventricle aneurysm and VSD with VSR near the apex. This case demonstrates that several rare mechanical complications can occur simultaneously secondary to STEMI and highlights the importance of bedside echocardiography in the early diagnosis of mechanical complications.

Prophylactic Pulmonary Artery Banding in Pediatric Dilated Cardiomyopathy: An Additional Therapeutic Option.

Dilated cardiomyopathy (DCM) is the most common childhood cardiomyopathy and is associated with considerable early mortality. Heart transplantation is often the only viable life-saving option. Pulmonary artery banding (PAB) has been recently proposed as a bridge or alternative to transplantation for DCM. In our cohort, PAB was selectively addressed to heritable DCM or DCM with congenital left ventricle aneurysm (CLVA). This study aimed to describe the clinical evolution and left ventricle reverse remodeling (LVRR) over time (6 months and 1 year after surgery). Ten patients with severe DCM received PAB between 2016 and 2021 and underwent clinical and postoperative echocardiography follow-ups. The median age at PAB was <1 year. The in-hospital mortality was zero. Two patients died two months after PAB of end-stage heart failure. The modified Ross class was improved in the eight survivors with DCM and remained stable in the two patients with CLVA. We observed a positive LVRR (LV end-diastolic diameter Z-score: 8.4 ± 3.7 vs. 2.8 ± 3; p < 0.05; LV ejection fraction: 23.8 ± 5.8 to 44.5 ± 13.1 (p < 0.05)). PAB might be useful as part of the armamentarium available in infants and toddlers with severe DCM not sufficiently responding to medical treatment with limited probability of spontaneous recovery.

Perioperative Kidney Function of Cardiac Surgery Patients with Impaired Glucose Metabolism

Aimto study influence of impaired glucose metabolism on perioperative kidney function of cardiac surgery patients with coronary artery disease (CAD). Material and methodsretrospective analysis of 354 high-risk randomly selected patients with CAD who were discharged after cardiac surgery. For all patients performed laboratory tests, ECG, ECHO, coronary angiography and surgical myocardial revascularization in 194 cases, for 160 patients except CABG we performed correction of postinfarction aneurysm of left ventricle or valves pathology. Resultsimpaired glucose metabolism was found in 251 (70.9%) patients, between which type 2 diabetes mellitus (DM) had 90 (25.4%) pts, impaired glucose tolerance (IGT) – 161 (45.4%). Glomerular filtration rate (GFR) was lower in patients with impaired glucose metabolism (see table 1).Blood parameters and GFR in the perioperative period of patients depending on glucose metabolism, n=354Acute kidney injury (AKI) in postoperative period occurred in 10 (2.8%) patients, between which 6 (60%) had type 2 DM, 2 (20%) – IGT, 2 (20%) – with normal glucose metabolism. None of the patients required renal replacement therapy due to timely correction of drug therapy. Conclusionscardiac surgery patients with coronary artery disease in 70.9% cases had impaired glucose metabolism. Analyses of laboratory parameters in perioperative period had shown decrease of kidney function especially in patients with type 2 DM. AKI occurred in 10 patients, between which 80% had impaired glucose metabolism.

Left anterior minithoracotomy as a first-choice approach for isolated coronary artery bypass grafting and selective combined procedures.

Our goal was to describe the technique for and evaluate the results of the isolated coronary artery bypass grafting or combined grafting procedures with mitral valve repair/replacement and/or left ventricle aneurysm repair performed through a single left anterior minithoracotomy. Perioperative data of all patients who required isolated or combined coronary grafting from July 2017 to December 2021 were observed. The focus was on 560 patients who underwent isolated or combined multivessel coronary bypass using the "Total Coronary Revascularization via left Anterior Thoracotomy" technique. The main perioperative outcomes were analysed. A left anterior minithoracotomy was used in 521 (97.7%) out of 533 patients who required isolated multivessel surgical coronary revascularization and in 39 (32.5%) out of 120 patients who required combined procedures. In 39 patients, multivessel grafting was combined with 25 mitral valve and 22 left ventricular procedures. Mitral valve repair was performed through the aneurysm (n = 8) or through the interatrial septum (n = 17). Perioperative outcomes in isolated and combined groups were next: aortic cross-clamp time-71.9 (SD: 19.9) and 120 (SD: 25.8) min; cardiopulmonary bypass time-145.7 (SD: 33.5) and 216 (SD: 45.8) min; total operating time-269 (SD: 51.8) and 324 (SD: 52.1) min; intensive care unit stay-2 (2-2) and 2 (2-2) days; total hospital stay-6 (5-7) and 6 (5-7) days; and total 30-day mortality was 0.54 and 0%, respectively. A left anterior minithoracotomy can be effectively used as a first-choice approach to perform isolated multivessel coronary grafting and can be combined with mitral valve and/or left ventricular repair. Experience with isolated coronary grafting through an anterior minithoracotomy is required to achieve the satisfactory results in combined procedures.

Minimally invasive cardiac surgery via bilateral thoracotomy in treatment of left ventricle aneurysm: a case report

BackgroundLeft ventricle aneurysm (LVA) as a sequela to myocardial infarction or iatrogenic injury is required surgical treatment with full median sternotomy. Herein, we report a case of successful surgical treatment of left ventricle aneurysm performed by minimally invasive cardiac surgery (MICS).Case presentationWe describe a case of a LVA treated by minimally invasive cardiac surgery in an 82-year-old woman who reported to the hospital with the complaint of chest pains at rest. Computed tomography (CT) coronary angiography revealed a left ventricle apical aneurysm. The aneurysm was suspected to be a pseudoaneurysm caused by a previous myocardial infarction. Surgery was performed under general anesthesia, with the patient in a supine position. A small incision was made in the 3rd intercostal space through which an aortic root vent cannula and aortic clamp were inserted, followed by exposing the aneurysm via incision of the left 6th intercostal space. The aneurysm was resected and pathologically examined, revealing it to be a “true” aneurysm. The left ventricle wall was closed using polypropene mattress sutures. Postoperative CT scan revealed successful resection of the aneurysm. Usually, a surgical treatment with full median sternotomy and left ventriculostomy is indicated for LVA. We decided to treat the LVA with bilateral thoracotomy MICS. We preferred to perform this procedure under cardiac arrest to ensure safe and secure closure of the aneurysm. The right small thoracotomy was necessary for aortic cross-clamping and aortic root venting.ConclusionsThe procedure was safe and simple and yielded excellent postoperative outcomes. Therefore, we speculate that this method can be applied to the management of larger aneurysms.

Case report of optimizer implantation to modulate cardiac contractility in patients with chronic heart failure and atrial fibrillation

A cardiac contractility modulation device is a new treatment used in patients with heart failure. CCM therapy is associated with an increase in physical activity tolerance, improved quality of life, reduced hospitalizations due to heart failure, and reverse remodeling of the left ventricle in patients with systolic heart failure. In this case, the clinical benefit of cardiac contractility modulation in a patient with chronic heart failure, atrial fibrillation and postinfarction left ventricle aneurysm was reported. Development of postinfarction left ventricle aneurysm in patients with reduced ejection fraction is associated with a high risk of surgical complications. However, an adequate assessment of the functional reserve of the left ventricle myocardium and the choice of surgical correction method allows for receiving favorable outcomes of surgery. We present a case of a successful combination of interventional and surgical treatment of a patient with heart failure and post-infarction left ventricular aneurysm.

CLINICAL CONSEQUENCES DEPENDENCE OF ACUTE CORONARY SYNDROME INVASIVE TREATMENT ON THE CHARACTERISTICS OF SEGMENTAL INJURY OF CORONARY ARTERIES

Cardiovascular diseases are the main cause of mortality and disability factors. Prediction of the possible consequences of treatment, based on data on the features of anatomical localization of lesions, will obviously be able to improve the quality of treatment and reduce the level of disability. Optimization of interventional treatment methods depending on the coronary vasculature anatomical features, the development of collateral blood flow is aimed at the implementation of a personalized approach to the medical care.The aim of the work was to optimize interventional treatment of patients with acute coronary syndrome by studying the features of segmental formation of coronary arteries. The study analyzed the data of 121 patients with acute coronary syndrome who underwent coronary angiography with radial access and stenting of the infarct-related artery. Determination of coronary artery segments was performed according to the numbering method proposed by the American Heart Association. The severity of coronary artery disease was determined according to the Gensini scale. 88.43% of the patients included in the study had multivessel coronary disease. A relation was established between the lesion of segment 10 (r=0.312, p&lt;0.001), segment 11 (r=0.211, p=0.015) and segment 14 (r=0.228, p=0.008) with the occurrence of MI recurrences. In case of diagonal artery lesions (D2), recurrences of MI occurred in 40.0% of patients, in the circumflex artery: 14 segment – 25.0%, and 11segment – 14.29%. In the remaining cases, the proportion of MI recurrences was significantly lower (from 2.67 to 8.86%). Analysis of the segmental localization of the infarct-related area of the coronary artery shows that there are certain "typical" areas of lesions in right and left coronary arteries - the middle section of the right coronary artery and the proximal section of the anterior interventricular branch of the left coronary artery. We also consider the obtained data to be important for predicting the risk of myocardial infarction recurrence, which turned out to be greater with occlusion of the 10th, 11th, and 14th segments of the coronary artery. In patients over 63 years of age, attention should be paid to the fourth segment of the right coronary artery, since occlusion of this section occurs more often in this age group. Atherosclerotic injury to the proximal part of the right coronary artery usually is not accompanied by prodromal syndrome of myocardial infarction in the form of unstable angina pectoris.The number of implanted stents did not reliably affect mortality and long-term survival. Correlations of lesions of certain segments of coronary vessels with previous manifestations of unstable angina pectoris and recurrent course, age and gender differences, presence of comorbidity, especially with arterial hypertension and diabetes have been established. Structural and functional changes in the myocardium were found to be the most severe in pathology of the left main stem. The relation between the lesion of the left main stem and the deterioration in the left ventricle ejection fraction (r=-0.244, p=0.005), the development of the left ventricle aneurysm (r=0.211, p=0.015) was established in 16.67% (in other segments - from 0 to 5.55%), rhythm disorders such as atrial fibrillation (r=0.304, p&lt;0.001) in 25.00% (in other segments – from 2.17 to 9.52%), were more often accompanied by acute heart failure (Killip3-4) in 17.67% (in other segments - from 0 to 7.50%).

The Role of rs2238296 of the Mitochondrial DNA Polymerase Gamma Gene in Combination with Polymorphic Variants of Antioxidant Defense Genes in the Development of Postinfarction Left Ventricular Aneurysm

Studied the relationship of the polymorphic variant of the mitochondrial DNA polymerase gamma gene (POLG rs2238296) in combination with single-nucleotide polymorphic variants of the genes of the antioxidant system of the body (mitochondrial transcription factor A (TFAM rs1937), superoxide dismutase (SOD2 rs4880), glutathione peroxidase (GPX1 rs1050450), catalase (CAT rs1001179), paraoxonase 1 (PON1 rs854560) and NADP-H oxidase (CYBA rs4673)) with features of postinfarction remodeling of the left ventricle (LV). One hundred and fifty-three patients with coronary heart disease (137 men and 16 women) aged 56 (50; 60.5) years were examined. Genotyping was carried out using a polymerase chain reaction followed by analysis of the polymorphism of the lengths of restriction fragments. No significant difference was found in the SOD2, GPX1, CAT, PON1, TFAM genes in the studied groups. Significant differences were found with respect to the POLG and CYBA genes: the CC rs2238296 genotype of the POLG gene was found in every third patient with LV aneurysm (30.3%), where as in the group without aneurysm – only in every eighth case (12.3%, p = 0.006). The CC rs4673 genotype of the CYBA gene was found in every second patient with an aneurysm (51.8%) and in 32% without LV aneurysm (p = 0.01). Patients with a combination of CC (POLG) and CC (CYBA) genotypes were represented exclusively by younger men, who were characterized by a less burdened comorbid background, in comparison with patients with a different genotype of these genes. At the same time, the LV ejection fraction in such patients was significantly lower (40 (27; 52) and 50 (40; 61), p = = 0.006), and the development of LV aneurysm was recorded in 73% of cases.

Early Left Ventricular Thrombus Following Ventricular Fibrillation/Ventricular Tachycardia Electrical Storm.

Left ventricular thrombus (LVT) formation is a serious clinical complication of low-flow states that may be seen in an ischaemic, arrhythmic heart. While LVT formation has a poor prognosis, in the setting of myocardial infarction it is usually a result of post-infarct sequelae such as left ventricle aneurysms, and inflammatory changes from damaged tissue, with the LVT taking several days to form. Arrythmias such as ventricular tachycardia (VT) or ventricular fibrillation (VF) may also lead to thrombus formation, as they contribute to stasis due to decreased cardiac output. Large anterolateral myocardial infarctions can cause electrical or arrhythmic storm, characterized by more than three episodes of VT or VF in a 24-hour period. This prolonged state of dyskinesis further increases the risk of thrombosis, creating a compounding effect. Here, we report the case of a patient who had a VF cardiac arrest with electrical storm secondary to anterolateral myocardial infarction complicated with LVT formation found on echocardiogram after the cardiac arrest, which was absent on presentation. This thrombus formation occurred particularly early during the course of the patient’s arrest, possibly due to the compounding factors increasing the risk of thrombosis. Herein, we discuss in detail the risk factors for LVT formation, its mechanism and management options. A review of the literature also shows that LVT formation in the acute phase of arrest, as seen in our patient, is rare.LEARNING POINTSLeft ventricular thrombus (LVT) formation occurs 3–14 days after myocardial infarction, but in the setting of concomitant ventricular fibrillation arrest, may occur within the first 24 hours.Risk factors for LVT formation include a large infarct, anterior/anterior apical infarction, decreased ejection fraction (particularly <30–35%), left ventricular aneurysm, and delayed time to revascularization.Although diagnosis is generally made on transthoracic echocardiography with intravenous contrast, cardiac MRI with contrast has better sensitivity and specificity.Treatment consists of anticoagulation with a vitamin K antagonist or heparin for 3–6 months with a repeat echocardiogram to confirm the thrombus has organized or resolved. Further trials are needed to assess the efficacy of direct oral anticoagulants.

CT-Based Simulation of Left Ventricular Hemodynamics: A Pilot Study in Mitral Regurgitation and Left Ventricle Aneurysm Patients.

BackgroundCardiac CT (CCT) is well suited for a detailed analysis of heart structures due to its high spatial resolution, but in contrast to MRI and echocardiography, CCT does not allow an assessment of intracardiac flow. Computational fluid dynamics (CFD) can complement this shortcoming. It enables the computation of hemodynamics at a high spatio-temporal resolution based on medical images. The aim of this proposed study is to establish a CCT-based CFD methodology for the analysis of left ventricle (LV) hemodynamics and to assess the usability of the computational framework for clinical practice.Materials and MethodsThe methodology is demonstrated by means of four cases selected from a cohort of 125 multiphase CCT examinations of heart failure patients. These cases represent subcohorts of patients with and without LV aneurysm and with severe and no mitral regurgitation (MR). All selected LVs are dilated and characterized by a reduced ejection fraction (EF). End-diastolic and end-systolic image data was used to reconstruct LV geometries with 2D valves as well as the ventricular movement. The intraventricular hemodynamics were computed with a prescribed-motion CFD approach and evaluated in terms of large-scale flow patterns, energetic behavior, and intraventricular washout.ResultsIn the MR patients, a disrupted E-wave jet, a fragmentary diastolic vortex formation and an increased specific energy dissipation in systole are observed. In all cases, regions with an impaired washout are visible. The results furthermore indicate that considering several cycles might provide a more detailed view of the washout process. The pre-processing times and computational expenses are in reach of clinical feasibility.ConclusionThe proposed CCT-based CFD method allows to compute patient-specific intraventricular hemodynamics and thus complements the informative value of CCT. The method can be applied to any CCT data of common quality and represents a fair balance between model accuracy and overall expenses. With further model enhancements, the computational framework has the potential to be embedded in clinical routine workflows, to support clinical decision making and treatment planning.

Chronic Coronary Syndrome with Left Ventricular Apicoseptal Aneurysm

The left ventricular aneurysm is one of the worst complications of acute myocardial infarction episodes. Fibrous tissue replacing dead myocardial cells in an infarcted area can’t perform contraction and herniate outward during systole. In turn, a left ventricle aneurysm will present devastating clinical outcomes such as heart failure, ventricular arrhythmias, even sudden cardiac death. A 65 year-old man came to our hospital complaining of worsened chest pain 5 days before admission, located on the left side of his chest. It was described to have a squeezing character. The symptom was inducted when he doing some mild activities and relieved with a short time rest. He had this symptom for one year. In the past, this symptom was inducted by heavier activities. He also complains of having shortness of breath for the past 2 months, the symptom was also relieved by resting. He had been admitted to the hospital for a heart attack twice before.. He has diabetes and hypertension, thus he consumed metformin 500 mg 3 times a day, and amlodipine 5 mg daily. He also had a history of kidney stone and prostate hypertrophy operation on March 2021. No remarkable abnormality was found in physical examination. On laboratory workup, there was a slight elevation of serum creatinine concentration. The troponin level was in the normal range. ECG and Echocardiography finding supported the ventricular aneurysm as one of the complications of acute myocardial infarction.

778 Acute clinical valve thrombosis after transcatheter mitral valve-in-valve replacement

Abstract Aims Transcatheter heart valve (THV) thrombosis is a frequent and potentially life-threatening complication of transcatheter mitral valve replacement (TMVR), occurring in approximately 12% of patients (mainly within the first 3 months after the procedure). The majority of THV thromboses is non-obstructive and subclinical, and remains undetected until a routine echocardiogram is performed. Methods A 65 years old male was suffering from post-ischaemic dilated cardiomyopathy and severe left ventricle systolic dysfunction (LVEF 28%), secondary to a previous STEMI in 2010 treated with primary PCI on proximal LAD; after the STEMI he developed a left ventricle aneurysm and a subsequent severe secondary mitral regurgitation. In late 2020 he underwent a surgical valve replacement with a biologic valve (Perimount Magna Mitral Ease n. 27), alongside a left ventricle reshaping (Dor procedure). After a few months, the patient developed worsening dyspnoea and severe exercise intolerance; a transesophageal echocardiogram (TEE) showed an extensive valve degeneration with diffuse leaflet thickening determining severe valve stenosis and regurgitation. The patient was then admitted to the Cardiology department. A coronary angiography was performed, showing good result of previous PCI and excluding other critical stenoses. The patient then underwent a transcatheter valve-in-valve replacement with a Sapien S3 n. 29 in mitral position. The patient was already in chronic therapy with acetilsalicilic acid (ASA), and after the procedure anticoagulant therapy with Warfarin was started. In the post-procedural period the patient developed an acute worsening of the LVEF with severe hypotension, likely due to after-load mismatch; hence, supportive inotropic therapy with Adrenalin and Enoximone was required. A TEE performed 7 days after the procedure showed absence of diastolic excursion of posterior and lateral cusps and leaflet thickening with a 4 mm thrombotic apposition on the ventricular side, determining severe valve stenosis with markedly increased transvalvular gradients (peak gradient 20 mmHg, mean gradient 11 mmHg). A CT scan of the heart confirmed the valve thrombosis on the inferior and lateral leaflets. Results Unfractioned heparin (UFH) was then added to ASA and Warfarin (INR target of 3.0). After 11 days of aggressive antithrombotic therapy a new TEE was performed, showing marked reduction in transvalvular gradients (peak gradient 10 mmHg, mean gradient 5 mmHg) due to partial dissolution of the thrombotic formation. Warfarin was then stopped, and after switching from UFH to Enoxaparin the patient was discharged asymptomatic and in good general conditions, with indication of follow-up with TEE at 1 month. Conclusions Valve-in-valve TMVR is a relatively new and still infrequent procedure, therefore few evidences about its complications are currently available. Thrombosis on these valves is not rare (12%), but usually develops on the atrial side of the leaflets; interestingly, in this patient the thrombosis was on the ventricular side, likely due to an acute reduction in flow velocity caused by the after-load mismatch and the subsequent cardiogenic shock.

Surgical Treatment of Left Ventricular Aneurysm Combined with Ischemic Mitral Regurgitation Using a Modified Technique

Background. Ischemic mitral regurgitation (IMR) is the second most common cause of mitral regurgitation (MR). IMR occurs in patients with myocardial infarction due to a rupture of the subvalvular apparatus. Pathological remodel-ing, dilatation and dysfunction of the left ventricle (LV) play a significant role in the development of IMR. The presence of a postinfarction LV aneurysm can lead to the development of MR due to dysfunction, relative and true shortening of the papillary muscles. There are various methods of surgical correction of IMR. The aim. To show the effectiveness of surgical treatment of left ventricular aneurysm combined with ischemic mitral regurgitation using a modified technique. Materials and methods. From January 2011 to December 2019, 20 patients with IMR combined with LV aneurysm underwent surgical intervention using a modified technique at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine. According to this technique, access to the mitral valve was performed through the left ventricle. The mean age of the patients was 61.2 ± 10.1 years. Among patients with IMR, the majority were men (60.0%). The overwhelming majority of patients (80.0%) had the history of hypertension. Diabetes mellitus was detected in 35.0% of patients. Mitral ring dilatation was observed in 25.0% (5) of the cases, papillary muscle displacement in 40.0% (8), chords rupture in 15.0% (3), papillary muscle infarction in 20.0% (4) of the cases. All the patients had reduced LV ejection fraction with a mean value of 34.5 ± 7.8%. Results. Aortic cross-clamp time through ventricular access was 112.9 ± 18.7 minutes. The duration of mechanical ventilation was 19.1 ± 20.6 hours. The length of stay of patients in the ICU was 99.2 ± 43.5 hours. There were no signs of acute heart failure in the early postoperative period in one in five patients (20.0%). The rate of degree III heart failure after intervention using the modified technique was 20.0% (4). The study of the incidence of cardiac arrhythmias after combined intervention showed that 85.0% (17) of patients operated using the modified technique had no cardiac arrhythmias. Conclusions. In patients who underwent surgery using the modified technique, the mortality rate was 5.0%. This is 1.6-2.8 times less than that in patients undergoing conventional operation. Postoperative occurrence of arrhythmias is much less common than that described in the literature.

Long-term follow-up of giant coronary aneurysms of Kawasaki disease in a non-Japanese cohort

Giant coronary aneurysms are rare in Kawasaki disease and their outcomes after timely and appropriate treatment of KD are scarcely known in French population. Over a 20 years period, we identified 46 cases of giant coronary aneurysms in KD, defined as a diameter of at least one coronary artery ≥ 8 mm or with a z-score ≥ 10. Mean age at diagnosis was 2.2 ± 2.9 years (min 0.1 – max 14.3) with 30% of patients being younger than 6 months of age. Mean number of day fever between IVIG was 10 ± 5 days. Mean LMCA Z-score was 8.2 ± 4.5, LAD 16.6 ± 8.8, circumflex 6.7 ± 5.2 and RCA 13.1 ± 6.7. Sixty-three percent had bilateral lesions. All the patients have had at least one coronary angiogram or CT scan during follow-up. All patients received vitamin K antagonist and aspirin after discharge. Cardiac complications were defined as myocardial infarction, coronary stenosis, thrombosis or occlusion and aneurysm of the left ventricle. In 33/46 patients, coronary artery imaging shows normal luminal dimensions ( n = 23) or reduction of coronary aneurysm ( n = 10), and 13 had persistent giant aneurysms after a mean follow-up of 1 ± 0.2 years. Mean follow-up was 7 ± 5.6 years. Thirteen cardiac events occurred in 9 patients: 3 early myocardial infarction, 5 coronary stenosis, 2 coronary thrombosis, 1 coronary occlusion and 2 left ventricle aneurysms. There were no reported deaths. One patient had a double coronary by-pass (LAD and RCA at 17.8 years) preceded by a RCA stenting at 16.1 years and one patient had a left ventricle aneurysm surgical repaired at 2.1 years. Giant coronary aneurysms in KD are impressive at diagnosis. Favorable outcome is frequent with normalization of luminal dimensions in half of the patients. Persisting giant aneurysm requiring long-term anticoagulation concerned one fourth of the patients.

The estimation of intensity of inflammatory alterations of blood in early postinfarction remodeling

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Structural postinfarction abnormalities is connected with inflammation. For better understanding of pathogenesis of postinfarction remodeling, it was studied the intensity of inflammatory disorders in early postinfarction period. Purpose Research of the intensity of inflammatory response in early postinfarction remodeling. Materials and methods 772 of patients with myocardial infarction (MI) were examined. Clinical blood analysis was performed at admission and on the 5th day of MI, as well as immunological examination, Echocardiography. Results In patients with end-diastolic diameter (EDD) of left ventricle (LV) ≥ 55 mm, 5 day MI white blood cells (WBC) level (8,0 ±2,1*109/l vs 7,3 ± 1,9*109/l, p = 0,0001), absolute number of neutrophils (5,0 ± 1,7* 109/l vs 4,5 ± 1,4*109/l, p = 0,0006) and monocytes (0,64 ± 0,30*109/l vs 0,57 ± 0,30*109/l, p = 0,005) were higher compared patients with EDD ≤ 55 mm. The inflammatory alterations in patients with increased end-diastolic volume (EDV) and end-systolic volume (ESV) of left ventricle was similar. The LV EDD was correlated with WBC level (r = 0,3; p = 0,00002), also with absolute number of neutrophils (r = 0,3; p = 0,0002) and monocytes (r = 0,3; p = 0,007). The positive connection of EDV LF with level of WBC (r = 0,3; P = 0,007) and absolute number of neutrophils (r = 0,3; p = 0,0002) was revealed. The positive connection of ESV LV with absolute number of neutrophils (r = 0,3, р=0,04; accordingly). It should be noted that increase of ESD LV more 37mm was not accompanied by authentic increase of inflammatory factors, but the connection of ESV LV with Il-6 was noted (ρ=0,3; р=0,03). As far as contractive function of myocardium declined, it was registered the increase of neutrophils (neutrophils on the 5 day in EF 55% and more - 4,5 ± 1,4*109/l, EF 55-40% - 4,8 ± 1,5*109/l, EF less 40% - 5,1 ± 2,1*109/l, p = 0,002), also in formation of areas of akinesia (neutrophils on the 1 days - 9,2 ± 3,3*109/l vs 8,3 ± 3,1*109/l, р=0,05) and aneurysm of LV (5,08 ± 1,71*109/l vs 4,52 ± 1,48*109/l, р=0,0006). It should be noticed that functional activity of monocytes in patients with aneurism of LV was lower than in patients without aneurism (CD14 0,035 ± 0,02*109/l vs 0,049 ± 0,02*109/l, р=0,05). It appears important obtained data that with hypertrophy LV and diastolic disfunction was noticed authentic increase of lymphocytes, expressing the marker of apoptosis CD95 (0,458 ± 0,276*109/l vs 0,335 ± 0,155*109/l, р=0,05; 0,441 ± 0,26*109/l vs 0,342 ± 0,21*109/л, р=0,01, accordingly). Conclusion The increased activity of inflammatory markers, decline of functional activity of monocytes, the elevation of apoptosis marker, associated with bigger intensity of postinfarction remodeling processes. The acute phase of inflammation is necessary stage of healing, but with long-term clinical case, excessive activation or alteration of functional activity of leukocytes can lead to growth of structural and electrical remodeling.

The value of perioperative ECG in patients with complicated forms of coronary artery disease

The aim: to analyze the informativeness and features of the perioperative electrocardiogram dynamics in complicated forms of coronary artery disease (CAD). Material and methods: retrospective ECG analysis of 100 randomized high-risk patients with complicated forms of CAD who underwent surgery in the National M. Amosov Institute of Cardiovascular Surgery Affiliated to National Academy of Medical Sciences of Ukraine from 2009 to 2019. All the patients included in the study were classified as high-risk group for complications and mortality and had an average risk of 8.60 % (from 5.02 % to 39.38 %) according to the EuroSCORE II scale. Results. Postinfarction left ventricular aneurysm (ALV) was localized in the anteroseptal region of the left ventricle (LV) in 94 (94 %) cases, and posterior-basal LV aneurysm (PBALV) was diagnosed in 6 (6 %) patients. Mitral insufficiency (MI) was detected in 8 (8.5 %) patients with anterior ALV and in 2 (33.3 %) cases of PBALV. Tricuspid valve insufficiency (TI) was diagnosed in 4 (4.2 %) patients with anterior ALV, and postinfarction defect of the interventricular septum (VSD) was verified in 2 (33.3 %) patients with PBALV. Diagnostics of anteroseptal ALV using ECG is highly accurate, the specificity of the method is 94 %, and the sensitivity is 95.6 %. ECG interpretation after surgery presents with certain difficulties, since nonspecific changes of the terminal part of the ventricular complex often occur that being interpreted correctly determine further treatment tactics. Positive ECG dynamics was detected in 66 (66 %) patients in the form of improved intraventricular conduction and the appearance of the R wave in leads I, avL, V2-V6, a lack of dynamics – in 11 (11 %), as a rule, in patients with complete left bundle branch block (LBBB), dry pericarditis of II–III stage was diagnosed in 23 (23 %) patients. Conclusions. ECG retains its importance and remains an informative and available method in modern cardiology. The correct ECG interpretation before surgery helps to assess the initial severity of the condition and timely correct the therapy and management tactics in the early postoperative period.

Surgical treatment of postinfarction of the left ventricular aneurism, complicated by massive pulmonary embolism

Postinfarction heart aneurysm is one of the most dangerous complications of acute myocardial infarction, determining high mortality rates. Despite the improvement of modern diagnostic methods, as well as the modernization of the system for providing highly specialized medical care to patients with acute coronary syndrome, the issues related to this issue have not lost their relevance. The publications available at this time are few and relate only to specific cases that demonstrate the advantages of a particular type of surgical correction. This clinical observation demonstrates a tactical approach to a patient with acute thrombosed postinfarction aneurysm of the upper left ventricle, when postoperative period was complicated by the development of a massive pulmonary embolism. The obtained results of stage-by-stage surgical treatment clearly show the effectiveness of the active surgical approach in relation to patients with a high premorbid profile.