Surgical treatment of the ischemic heart disease with lowered contractility of left ventricle and mitral valve insufficiency

Objective. To determine the impact of the mitral valve insufficiency in patients, suffering ischemic heart disease with lowered contractility of left ventricle and methods of its treatment. Materials and methods. During 01.01.2015-31.12.2018 yrs period in the Amosov National Institute of Cardiovascular Surgery there were conducted 2267 consecutive operations of coronary shunting, of them 190 (8.4%) - in patients, suffering the ischemic heart disease with lowered contractility of left ventricle. Reduction of the output fraction of left ventricle down to 35% and lower have served as criterion of inclusion of the patients into the Group. There were 170 (89.5%) men and 20 (10.5%) women. The patients’ age have constituted 29 - 83 yrs old, (61.1 ± 8.9) yrs old at average. Results. In 47.9% of the patients the lowering of the left ventricle contractility after myocardial infarction was followed by occurrence of regurgitation on a mitral valve. At the same time it was noted, that the regurgitation value have had correlated with degree of the left ventricle contractility lowered: in reduction of values of the left ventricle output fracture down to 25% and lower a moderate regurgitation on a mitral valve was registered up to 2 times, a significant one - in 2.5 times, and the pronounced one - in 1.5 times more frequently, than in values of the left ventricle output fracture, exceeding 25%. Occurrence of a mitral insufficiency in 18.7% patients was caused by direct damage of valvular apparatus, while in 81.3% patients the consequences of the heart cavities were present in disorder of contractile function of myocardium. Presence of postinfarction mitral insufficiency enhances the risk of an acute cardiac insufficiency in 1.7 times and necessitates intraoperative correction in values of the regurgitation fraction over 30%. Conclusion. The own data obtained witness, that noncorrected mitral insufficiency in the ischemic heart disease worsens significantly the postoperative period course after performance of coronary shunting, enhancing rate of an acute cardiac, respiratory and renal insufficiency. Thus, taking into account a negative impact of concomitant mitral valve insufficiency on efficacy of surgical interventions in the lowered contractility of left ventricle the need emerges to perform complex reconstructive intervention in patients, suffering ischemic heart disease with lowered contractility of left ventricle.

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MODERN PRINCIPLES OF DIAGNOSIS AND SURGICAL TREATMENT OF ISCHEMIC MITRAL INSUFFICIENCY

BULLETIN OF SURGERY IN KAZAKHSTAN ◽

10.35805/bsk2021iv011 ◽

2021 ◽

pp. 011-015

Author(s):

Rashad Mahmudov

Keyword(s):

Heart Disease ◽

Surgical Treatment ◽

Mitral Valve ◽

Ischemic Heart Disease ◽

Myocardial Revascularization ◽

Mitral Valve Insufficiency ◽

Mitral Insufficiency ◽

Valve Insufficiency ◽

Severe Degree ◽

Preoperative Examination

The purpose of the study is to evaluate and analyze the results of surgical treatment of patients with ischemic mitral insufficiency. Material and methods. The results of the examination and surgical treatment of 35 patients with ischemic mitral insufficiency are analyzed. In the operative period, in order to identify the degree of mitral insufficiency and the valvular apparatus, an echocardiography was performed, where the diameter of the fibrous ring, the interpapillary distance, the annulopapillary distance, the area of the cusp tension, and the depth of the coaptation of the valves were determined. Results. A preoperative examination proved the presence of mitral valve insufficiency with regurgitation of varying degrees. 15 patients underwent myocardial revascularization, 20 patients underwent myocardial revascularization + various options for correction of ischemic mitral insufficiency. After the operation, a significant improvement in the spatial-geometric correlation of the LV and mitral valve by reducing the tension forces acting on the valves and in the group of patients undergoing myocardial revascularization + various options for the correction of ischemic mitral insufficiency as the elimination of regurgitation. Conclusion. In patients with ischemic heart disease after echocardiographic studies, having determined the degree of mitral insufficiency with its moderate and severe degree, it is necessary to have a surgical correction of the mitral valve in its apparatus; the use of myocardial revascularization + various options for the correction of ischemic mitral insufficiency gives more tantalizing results than isolated myocardial revascularization.

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HEART RATE VARIABILITY IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME, PRIMARY SNORING AND ISCHEMIC HEART DISEASE

Proceedings of the National Academy of Sciences of Belarus Medical series ◽

10.29235/1814-6023-2018-15-3-286-292 ◽

2018 ◽

Vol 15 (3) ◽

pp. 286-292

Author(s):

A. Bulgak ◽

E. Tarasik

Keyword(s):

Obstructive Sleep Apnea ◽

Heart Disease ◽

Sleep Apnea ◽

Ischemic Heart Disease ◽

Sinus Node ◽

Sleep Apnea Syndrome ◽

Ischemic Heart ◽

Primary Snoring ◽

Obstructive Sleep ◽

The Impact

The purpose of our study is to assess the impact of cardiac arrhythmias, heart rhythm variability in patients with ischemic heart disease, obstructive sleep apnea and primary snoring. 65 patients at an age of 40–68 years with ischemic heart disease, obstructive sleep apnea and primary snoring were researched.Obstructive sleep apnea and primary snoring lead to an increase in the sympathetic and parasympathetic activity of the autonomic nervous system on the sinus node in patients with ischemic heart disease, obstructive sleep apnea and primary snoring.

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ECHOCARDIOGRAPHIC INDICES OF SYSTOLIC AND DIASTOLIC FUNCTION OF THE LEFT VENTRICLE FOR ELDERLY PATIENTS WITH CHRONIC PULMONARY, HEART, BRONCHIAL AND PULMONARY GENESIS IN COMBINATION WITH ISCHEMIC HEART DISEASE

Bulletin of Problems Biology and Medicine ◽

10.29254/2077-4214-2020-1-155-208-211 ◽

2020 ◽

Vol 1 (1) ◽

pp. 208

Author(s):

S. I. Treumova ◽

T. A. Trybrat ◽

S. V. Shut ◽

I. V. Redchytsʹ ◽

Yu. M. Kazakov

Keyword(s):

Heart Disease ◽

Left Ventricle ◽

Elderly Patients ◽

Ischemic Heart Disease ◽

Diastolic Function ◽

Ischemic Heart ◽

Systolic And Diastolic Function

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ASSESSMENT OF MITRAL VALVE GEOMETRIC DEFORMITY IN PATIENTS WITH ISCHEMIC HEART DISEASE: THREE DIMENSIONAL ECHOCARDIOGRAPHIC STUDY

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2016.07.406 ◽

2016 ◽

Vol 32 (10) ◽

pp. S251-S252

Author(s):

M.H. El Sebaie ◽

A. M.N ◽

A. A.Z ◽

F. A.M

Keyword(s):

Heart Disease ◽

Mitral Valve ◽

Ischemic Heart Disease ◽

Three Dimensional ◽

Ischemic Heart ◽

Echocardiographic Study

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SURGICAL TREATMENT OF PSEUDOANEURYSM OF THE FREE LEFT VENTRICLE WALL: A CLINICAL CASE

Emergency Cardiology and Cardiovascular Risks ◽

10.51922/2616-633x.2021.5.2.1195 ◽

2021 ◽

Vol 5 (1) ◽

pp. 1195-1201

Author(s):

O. Kiziukevich ◽

◽

S. Spiridonov ◽

A. Zhyhalkovich ◽

D. Isachkin ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Disease ◽

Surgical Treatment ◽

Left Ventricle ◽

Ischemic Heart Disease ◽

Clinical Case ◽

Ischemic Heart ◽

Free Wall ◽

Heart Rupture ◽

Myocardial Rupture

Today diseases of the cardiovascular system are the leading cause of death in many countries. The key role in this pathology is played by ischemic heart disease. An extreme manifestation of ischemic heart disease - myocardial infarction is one of the main causes of complications and mortality in patients with ischemic heart disease. One of the most formidable complications of acute myocardial infarction is heart rupture, which most often leads to death, more than 60% of cases occurring in the prehospital stage. Many studies of similar groups of patients show a wide spread in assessing the incidence and mortality of this pathology. The development of myocardial ruptures has two frequency peaks: the first day and 5-7 days from the onset of AMI. The most common case is acute rupture of the free wall of the left ventricle with extensive hemorrhage in the pericardium leading to a fulminant death. The development of a pseudoaneurysm of the left ventricle is a very rare outcome of the myocardial rupture. There are no convincing data on the incidence of pseudoaneurysms as a result of myocardial infarction (according to many authors, it is less than 0.5% of all cases of myocardial infarction). This type of rupture is most favorable in terms of the possibility of providing assistance. The complexity of providing care to patients with pseudoaneurysms of the left ventricle lies in their low frequency of occurrence and often asymptomatic nature of the course, which complicates the diagnosis of this pathology. Timely diagnosis plays a key role in avoiding a fatal outcome, since the vast majority of pseudoaneurysms are extremely unstable and, except occasional cases, require urgent surgical intervention. This article describes a clinical case of a patient who underwent surgical treatment for pseudoaneurysm of the free wall of the left ventricle as a result of myocardial infarction. The article also presents a brief literature review of the available isolated data on risk factors for myocardial rupture, methods of diagnosis and treatment of this pathology.

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