scholarly journals Surgical treatment of a patient with combined lesion of the coronary and carotid arterial systems

2021 ◽  
pp. 21-28
Author(s):  
V. Yu. Ridel ◽  
K. M. Mikhailov ◽  
M. D. Sentsova ◽  
N. M. Mikhailov
Keyword(s):  
Coronary Artery ◽  
Surgical Treatment ◽  
Clinical Case ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Second Stage ◽  
Staged Surgery ◽  
Combined Lesions ◽  
Carotid Arterial ◽  
Vessel Coronary Artery

A clinical case of surgical treatment of a patient with atherosclerotic combined lesions of the coronary and carotid areas is presented. A staged surgery was performed. The first stage was carotid endarterectomy sequentially on both sides. The second stage is three-vessel coronary artery bypass grafting. The patient was examined 2 years after the operation. There are no data on restenosis of the reconstruction zone of the carotid system. The return of angina pectoris is not noted.

scholarly journals Clinical case study: combined surgical treatment of ischemic mitral regurgitation

2020 ◽  
Vol 19 (2) ◽  
pp. 24-31
Author(s):  
V. V. Krylov
Keyword(s):  
Coronary Artery ◽  
Surgical Treatment ◽  
Coronary Artery Bypass Grafting ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Coronary Artery Bypass ◽  
Clinical Case ◽  
Artery Bypass ◽  
Ischemic Mitral Regurgitation ◽  
Bypass Grafting

Relevance. An active study of ischemic mitral regurgitation and a modern aggressive approach to its surgical treatment in combination with continuous improvement of plastic valve-retaining methods make the surgical treatment of ischemic mitral regurgitation the most promising, however, the choice of optimal surgical tactics for this pathology continues to be discussed. Objective. The clinical case of combined surgical treatment of severe ischemic mitral regurgitation (plication of the anterolateral commissure by pulling the prolapsing segment of AML (А1), suturing and reimplantation of the ruptured marginal chordae and annuloplasty with the rigid complete annuloplasty ring), formed on the background of progressive ischemic heart disease after myocardial infarction, in combination with CABG (autovenous coronary artery bypass grafting of right coronary artery, posterolateral branch and obtuse marginal branch and mammary coronary artery bypass grafting of diagonal branch). Conclusion. The presence of a «classic» dilatation of the fibrous ring of the mitral valve and an ischemic damage of the leaflets and subvalvular structures (tearing of the chords with impaired coaptation of the leaflets, malfunctioning of the papillary muscles) requires plastic correction of these defects in addition to «classic» annuloplasty of the fibrous ring of the mitral valve, which results to the absence of residual and recurrent mitral regurgitation in the immediate postoperative period.

scholarly journals Hybrid minimally invasive multivessel coronary artery bypass grafting to achieve complete myocardial revascularisation: the first clinical case

2020 ◽  
Vol 24 (3S) ◽  
pp. 108
Author(s):  
I. F. Shabaev ◽  
K. A. Kozyrin ◽  
R. S. Tarasov
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Conflict Of Interest ◽  
Graft Failure ◽  
Clinical Case ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Myocardial Revascularisation

<p><strong>Aim</strong>. To report the first clinical case of the hybrid procedure combining off-pump minimally invasive multivessel coronary artery bypass grafting (MICS-CABG) and percutaneous coronary intervention (PCI) of the obtuse marginal (OM) artery to achieve complete myocardial revascularisation.</p><p><strong>Clinical case</strong>. Bilateral in situ skeletonised left internal mammary artery (IMA) grafting to the left anterior descending artery was performed, and a Y-shape anastomosis was created from the left IMA-right IMA to the circumflex branch. At 2 hours postoperatively, graft failure caused by subtotal stenosis at the graft was diagnosed. Reconstruction of the anastomosis improved the transit time flow measurement by 3.5 hours postoperatively. Acute myocardial infarction did not develop. On postoperative day 1, graft patency was assessed, and then the OM stent was placed. On postoperative day 8, the patient was discharged and referred to the outpatient centre for further treatment and rehabilitation. Hybrid revascularisation offers the advantages of both CABG and PCI; however, the technical complexity is a major limitation for its widespread use. This case reports the development of adverse events during the surgeon's training to perform this nonstandard technology. Timely diagnosis of the initial graft failure and surgical revision led to a successful and complication-free outcome and avoided prolonged patient rehabilitation.</p><p><strong>Conclusion</strong>. Hybrid revascularisation combining MICS-CABG and PCI with new-generation drug-eluting stents can be a worthwhile alternative to conventional multivessel CABG with minimal invasiveness and complete revascularisation.</p><p>Received 5 June 2020. Revised 10 September 2020. Accepted 15 September 2020.</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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