scholarly journals Experience of using intra-aortic balloon counterpulsation during coronary bypass surgery and coronary stenting in patients with reduced left ventricular ejection fraction and mitral regurgitation of ischemic genesis

2021 ◽  
Vol 29 (3) ◽  
pp. 419-426
Author(s):  
Yuri D. Kostyamin ◽  
Vyacheslav Y. Mikhailichenko ◽  
Naira K. Basiyan-Kuhto ◽  
Ilya S. Grekov
Keyword(s):  
Coronary Artery ◽  
Surgical Treatment ◽  
Mitral Regurgitation ◽  
Coronary Bypass ◽  
Left Ventricular ◽  
Early Postoperative Period ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Intra Aortic Balloon Counterpulsation ◽  
Balloon Counterpulsation

AIM: To analyze the changes in the degree of mitral regurgitation (MR) of ischemic origin and of clinical outcomes in patients with reduced left ventricular ejection fraction (LVEF) and multi-vascular coronary artery disease during use of intra-aortic balloon counterpulsation (IABC). MATERIALS AND METHODS: The results of the treatment of 186 patients with ischemic mitral insufficiency who underwent intra-aortic balloon counterpulsation as a preoperative preparation in connection with a low LVEF were outlined in this manuscript. The patients were divided into 2 groups. Group 1 included 132 patients who underwent coronary bypass surgery while Group 2 included 54 patients who underwent coronary artery stenting. The dynamics of MR and LVEF before and after left ventricular revascularization were studied on the basis of echocardiographic data. RESULTS: In group 1, there was a decrease in the degree of mitral regurgitation by 58% using IABC (p 0.05) in the early postoperative period (based on the measurement of vena contracta, v.c., the width of the regurgitation jet on the valve), and by 54% (p 0.05) in more than 6 months following surgical treatment. In group 2, there was a significant decrease in the degree of MR (based on v.c.) by 42% (p 0.05) in the early postoperative period and by 41% (p 0.05) in more than 6 months following surgical treatment. CONCLUSION: The use of intra-aortic balloon counterpulsation in patients with low LVEF, moderate and severe MI, and with significant coronary artery pathology, led to the reduction in the duration of surgical treatment and the time of using artificial blood circulation through by excluding the need for the correction of MI, both directly during surgical revascularization and in the long-term period (more than 6 months).

Abstract 15083: Exercise Left Ventricular Ejection Fraction Predicts Long-term Brain Natriuretic Peptide Levels in Patients Undergoing Surgery for Severe Secondary Ischemic Mitral Regurgitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Carlo Fino ◽  
Isabelle Piazza ◽  
Bruno Vito Domenico ◽  
Philippe Pibarot ◽  
Attilio Iacovoni ◽  
...  
Keyword(s):  
Heart Failure ◽  
Surgical Treatment ◽  
Mitral Regurgitation ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Left Ventricular ◽  
Ischemic Mitral Regurgitation ◽  
Exercise Stress ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Background and Objective: Surgical treatment of severe secondary ischemic mitral regurgitation (IMR) may improve symptoms and functional capacity, however there are few data on its effect on long-on the evolution of heart failure. Time-course changes in brain natriuretic peptide (BNP) are a good marker of the heart failure status and outcomes. We investigated the association between the exercise stress echocardiographic (ESE) parameters and the changes in brain natriuretic peptide (BNP) following surgery for secondary IMR. Methods: We prospectively analyzed data on 50 patients (median age: 67, 61-64 y; EF: 35, 34-40%), undergoing mitral valve annuloplasty or replacement and coronary artery bypass graft (CABG). A valve annuloplasty with undersized ring was performed in 20 patients (40%) and a replacement in 30 (60%). A six minute walking test (6-MWT), BNP levels and ESE were performed at 1 year and at median follow-up (FU) of 6 years (4-7). Results: BNP level was: 388 (329-441) pg/ml before surgery, 175 (142-743) pg/ml at 1 y, and 123 (100-979) pg/ml at last FU (p=0.2). The relative changes of BNP from baseline to last FU significantly correlated with exercise tricuspid annulus plane systolic excursion (TAPSE) at last FU (r= -0.7, p<0.001), with preoperative and FU exercise LVEF, respectively ( r=-0.7 p= 0.01) (r=-0.93, p<0.001).On multivariable analysis, preoperative exercise EF was strongly and independently associated with independent BNP levels at last FU and with the changes in BNP from baseline to last FU. Conclusions: Despite surgical treatment of severe secondary IMR, BNP levels progressively increased over time in nearly 50% of the patients. Lower preoperative and 1-year FU exercise-stress EF was associated with increased levels of BNP during FU..

scholarly journals The possibilities of using levosimendan in medical preparation to Coronary Artery Bypass Grafting in coronary artery disease patients with low left ventricular ejection fraction

2020 ◽  
Vol 92 (1) ◽  
pp. 43-48
Author(s):  
V P Gazizova ◽  
E E Vlasova ◽  
E V Dzybinskaya ◽  
V V Gramovich ◽  
O V Stukalova ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Early Postoperative Period ◽  
Left Ventricular Ejection ◽  
Drug Preparation ◽  
Ventricular Ejection Fraction ◽  
Artery Disease

Aim: to work out an approach of preoperative drug preparation for CAD patients with low LVEF and varying degrees of compensation for CHF, to study the possibility of using levosimendan (L) in this preparation. Materials and methods. We studied 82 patients with severe angina pectoris, multivascular coronary disease, extensive postinfarction zone, LVEF ≤35%, chronic heart failure and proven viable myocardium, which performed CABG. All patients received long - term standard CHF therapy before surgery: loop diuretic, ACE/ARA, beta - blocker, aldosterone antagonist. In the first, retrospective part of the study (39 pts), it was determined which factors could be associated with perioperative AHF. In the second, prospective part (43 pts), the course of the operation and the early postoperative period in patients with compensated and uncompensated heart failure were compared; uncompensated pts received L 2 days before surgery in addition to standard therapy. The third, retro - prospective part of the study (37 pts) was the assessment of operation outcome in patients only with uncompensated pre - operative CHF, but with different preoperative drug preparation. Results. Statistically significant direct influence on the perioperative AHF development was provided by the combined clinical sign - venous pulmonary congestion+orthopnea (p

Relationships between Coronary Artery Obstruction, Asynergy, Presence of Collaterals and the Ejection Fraction of the Left Ventricle in Patients with Coronary Heart Disease

1986 ◽  
Vol 27 (4) ◽  
pp. 413-418 ◽  
Author(s):  
C. Backman ◽  
Å. Billström ◽  
M. Ericsson ◽  
K.-A. Jacobsson ◽  
O. Johnson ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Ejection Fraction ◽  
Coronary Bypass ◽  
Left Ventricular ◽  
Functional Improvement ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Additional Information

Cardioangiographic scores of coronary artery obstructions and corresponding myocardial involvement (MCOS), presence of collaterals (CollS), and asynergy of the left ventricular wall (LVMS) as well as the left ventricular ejection fraction (EF) were examined in 67 patients with coronary heart disease. A covariation was found between LVMS, EF, ECG changes, and a history indicating a previous myocardial infarction (MI). In a multiple regression analysis the EF covariated with LVMS but not with MCOS and CollS. LVMS indicated a previous MI with at least the same sensitivity and specificity as EF. MCOS and CollS give additional information. Collaterals as well as a high MCOS in relation to the LVMS indicate obstruction of coronary arteries which subserve ‘non-fibrotic’ myocardium. A patient with a high MCOS and CollS and a low LVMS should be expected to gain most functional improvement from coronary bypass surgery. The scores MCOS, CollS and LVMS are comparatively easy to determine and give a more diversified picture of the state of the myocardium than the EF alone.

scholarly journals A pebble clogging a river: a case report of thrombosed coronary aneurysmal ectasia

2020 ◽  
Author(s):  
Akshar Jaglan ◽  
Tarek Ajam ◽  
Steven C Port ◽  
Tanvir Bajwa ◽  
A Jamil Tajik
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Treatment Options ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Coronary Artery Ectasia ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Patient Reported

Abstract Background Coronary artery ectasia (CAE) is a rare anomaly that can present at any age. Predisposing risk factors include Kawasaki disease in a younger population and atherosclerosis in the older generation. We present a unique case of the management of a young woman diagnosed with multivessel CAE with aneurysmal changes in the setting of acute coronary syndrome and subsequently during pregnancy. Case summary A 23-year-old woman presented with acute onset chest pain. Electrocardiogram revealed no ischaemic changes; however, troponin I peaked at 16 ng/mL (reference range 0–0.04 ng/mL). Echocardiogram showed apical dyskinesis with preserved left ventricular ejection fraction. Coronary angiography showed multivessel CAE along with significant thrombus burden in an ectatic lesion of the left anterior descending artery. Since the patient was haemodynamically stable, conservative management with dual antiplatelet therapy and anticoagulation was started. On follow-up, coronary computed tomographic angiogram illustrated resolution of the coronary thrombi and echocardiogram showed improvement to the apical dyskinesis. It was presumed that Kawasaki disease was the most likely aetiology of her disease. Subsequently the patient reported that, contrary to medical advice, she was pregnant, adding another layer of complexity to her case. Discussion Coronary artery ectasia can be discovered as an incidental finding or can present with an acute coronary syndrome. Management is challenging in the absence of randomized trials and large-scale data. Treatment options include medications, percutaneous intervention, and surgical revascularization. Close surveillance is required in these patients to assess progression of disease. Here we discuss treatment options during acute coronary syndrome and pregnancy.

scholarly journals Forward Left Ventricular Ejection Fraction as a Predictor of Postoperative Left Ventricular Dysfunction in Patients with Degenerative Mitral Regurgitation

2021 ◽  
Vol 10 (14) ◽  
pp. 3013
Author(s):  
Juyoun Kim ◽  
Jae-Sik Nam ◽  
Youngdo Kim ◽  
Ji-Hyun Chin ◽  
In-Cheol Choi
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Left Ventricular Dysfunction ◽  
Predictive Value ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Normal Lvef

Background: Left ventricular dysfunction (LVD) can occur immediately after mitral valve repair (MVr) for degenerative mitral regurgitation (DMR) in some patients with normal preoperative left ventricular ejection fraction (LVEF). This study investigated whether forward LVEF, calculated as left ventricular outflow tract stroke volume divided by left ventricular end-diastolic volume, could predict LVD immediately after MVr in patients with DMR and normal LVEF. Methods: Echocardiographic and clinical data were retrospectively evaluated in 234 patients with DMR ≥ moderate and preoperative LVEF ≥ 60%. LVD and non-LVD were defined as LVEF < 50% and ≥50%, respectively, as measured by echocardiography after MVr and before discharge. Results: Of the 234 patients, 52 (22.2%) developed LVD at median three days (interquartile range: 3–4 days). Preoperative forward LVEF in the LVD and non-LVD groups were 24.0% (18.9–29.5%) and 33.2% (26.4–39.4%), respectively (p < 0.001). Receiver operating characteristic (ROC) analyses showed that forward LVEF was predictive of LVD, with an area under the ROC curve of 0.79 (95% confidence interval: 0.73–0.86), and an optimal cut-off was 31.8% (sensitivity: 88.5%, specificity: 58.2%, positive predictive value: 37.7%, and negative predictive value: 94.6%). Preoperative forward LVEF significantly correlated with preoperative mitral regurgitant volume (correlation coefficient [CC] = −0.86, p < 0.001) and regurgitant fraction (CC = −0.98, p < 0.001), but not with preoperative LVEF (CC = 0.112, p = 0.088). Conclusion: Preoperative forward LVEF could be useful in predicting postoperative LVD immediately after MVr in patients with DMR and normal LVEF, with an optimal cut-off of 31.8%.

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