scholarly journals Retrospective Analysis of Surgical Treatment Results of Postinfarction Ventricular Septal Rupture

2021 ◽  
pp. 85-90
Author(s):  
R. A. Aliyev
Keyword(s):  
Heart Failure ◽  
Surgical Treatment ◽  
Nyha Class ◽  
Scar Tissue ◽  
Long Term Results ◽  
Ventricular Septal Rupture ◽  
Class Iii ◽  
Endovascular Interventions ◽  
Vessel Stenosis

Ventricular septal rupture (VSR) is the most dramatic complication of acute myocardial infarction (MI). It manifests itself most often in the first week after infarction, with the maximum fatal complications occurring on day 1 and day 3–5 after MI. Patients receiving conservative treatment mostly die of progressive heart failure within few hours or days. Even now, in the era of endovascular interventions, surgical treatment remains the gold standard for the treatment of this pa-thology. Our research is mainly aimed at studying the factors of operative mortality, describing our methods of treatment and analyzing the survival rate and long-term outcomes after surgical treatment of this pathology. We studied 90 patients with postinfarction VSR who underwent surgical intervention in 2002–2019. Twelve of them were operated at the Central Clinical Hospital in Baku, and 78 at the National Amosov Institute of Cardiovascular Surgery in Ukraine. The mean age of the patients was 59.9 ± 9.59 years, 65 (72.2%) were men and 25 (27.8 %) were women. Fifteen (16.6%) patients were smokers, 31 (34.4%) were diabetic, 70 (77.7%) patients had arterial hypertension, 62% of patients had NYHA class III heart failure with average ejection fraction of 43.9 ± 10.4%. According to the results of coronary angiography, single vessel stenosis of the coronary arteries was detected in 18 (20%), two-vessel lesion in 32 (35.5%), and three-vessel lesion in 40 (44.4%) patients. There were no patients with left main coronary artery (LMCA) stenosis. Long-term results of surgical treatment were followed for 1 to 8 years, on average in 18 (28.6%) patients. Within 1, 3 and 8 years 17, 12 and 2 patients were examined, respectively. Good results within 5 and 10 years after surgical treatment were observed in 87.5% and 64.3% patients, respectively. Repeated complaints in our group and those observed in the literature are associated with worsening of heart failure after venticulotomy and changes in the geometry of the left ventricle. Recurrence of heart failure and coronary symptoms within 3 years and after 3 to 8 years were observed in 6 (33.3%) and 3 (25%) patients, respectively. Repeated endovascular revascularization was performed in 5 patients. ICD was im-planted in 4 patients, and in 2 patients CRT-D was implanted within 4 years 2 months and 7 years, respectively. There were no hemorrhagic complications within 8 years. Four (22.2%) patients died in the long-term period, the cause of death was unknown. In intensive care department the treatment strategy suggested hemodynamic stabilization with the help of conserva-tive therapy and IABP. The patients who underwent surgery in ≥ 3 weeks after the diagnosis of postinfarction VSR survived within 30 days after surgery. Delayed planned recovery is stipulated by the formation of scar tissue in the myocardium, which enables to facilitate the technical aspects of recovery. The time of the operation depends mainly on hemodynamic status of the patient. Patients with cardiogenic shock should undergo immediate surgical treatment.

152 Long term results after surgical treatment for heart failure

2003 ◽  
Vol 2 (1) ◽  
pp. 26-27
Author(s):  
N RADOVANOVIC ◽  
L PETROVIC ◽  
B MIHAJLOVIC ◽  
M KOVAC ◽  
M POPOV ◽  
...  
Keyword(s):  
Heart Failure ◽  
Surgical Treatment ◽  
Long Term Results

scholarly journals Long-term results after surgical treatment of postinfarction ventricular septal rupture

2014 ◽  
Vol 47 (4) ◽  
pp. 720-724 ◽  
Author(s):  
H. Takahashi ◽  
R. Arif ◽  
A. Almashhoor ◽  
A. Ruhparwar ◽  
M. Karck ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Long Term Results ◽  
Ventricular Septal Rupture ◽  
Postinfarction Ventricular Septal Rupture

scholarly journals Ūminės kylančiosios aortos disekacijos chirurginio gydymo rezultatai

2010 ◽  
Vol 8 (3) ◽  
pp. 0-0
Author(s):  
Gintaras Turkevičius ◽  
Vytautas Sirvydis ◽  
Arimantas Grebelis ◽  
Rasa Čypienė ◽  
Palmyra Semėnienė ◽  
...  
Keyword(s):  
Heart Failure ◽  
Surgical Treatment ◽  
Heart Surgery ◽  
Postoperative Bleeding ◽  
Multiple Organ ◽  
Ascending Aorta ◽  
University Hospital ◽  
Long Term Results ◽  
Vilnius University

Gintaras Turkevičius1, Vytautas Sirvydis1, Arimantas Grebelis1, Rasa Čypienė1, Palmyra Semėnienė1, Vilija Jakumaitė2, Gediminas Kitra2, Gediminas Kundrotas2, Pranas Šerpytis3 1 Vilniaus universiteto Širdies ir kraujagyslių ligų klinikos Širdies chirurgijos centras, Santariškių g. 2, LT-08661 Vilnius El. paštas: [email protected] Klaipėdos jūrininkų ligoninė3 Vilniaus universiteto Kardiologijos ir angiologijos centras Darbo tikslas: Išanalizuoti ligonių, sergančių ūmine kylančiosios aortos disekacija, chirurginio gydymo rezultatus. Ligoniai ir metodai: 1997–2007 metais operuoti 89 ligoniai, sergantys ūmine aortos disekacija. Išanalizuota ligonių priešoperacinė būklė, pasirinktas širdies operacijos metodas, ankstyvieji ir vėlyvieji gydymo rezultatai. Rezultatai: Pooperaciniu laikotarpiu mirė 26 ligoniai (29,2 %). Mirties priežastys: nesustabdomas pooperacinis kraujavimas – 11, širdies nepakankamumas – 5, galvos smegenų pažeidimas – 8 ir dauginis organų nepakankamumas – 2 ligoniams. Labiausiai kraujavo operuojant Bental de Bono metodika. Priešoperaciniu laikotarpiu 23 ligoniams (25,8 %) diagnozuota širdies tamponada ir akivaizdus širdies nepakankamumas. Iš šių ligonių 19 (82,6 %) teko atlikti retorakotomiją dėl kraujavimo ir 6 (26,0 %) gydyti sunkų inkstų funkcijos nepakankamumą. Vėlyvuoju laikotarpiu iš išgyvenusių 63 ligonių du mirė nepraėjus 12 mėnesių, 5 – praėjus 1–6 metams po operacijos. Išvados: Kylančiosios aortos disekacijos operacinio gydymo rezultatai priklauso nuo ligonių būklės prieš operaciją ir operacijos pobūdžio. Širdies tamponada prieš operaciją ir didelio laipsnio širdies nepakankamumas labai didina operacijos riziką. Vėlyvieji chirurginio gydymo rezultatai yra geri. Reikšminiai žodžiai: kylančioji aorta, disekacija, chirurgija Acute dissection of ascending aorta: data of surgical treatment Gintaras Turkevičius1, Vytautas Sirvydis1, Arimantas Grebelis1, Rasa Čypienė1, Palmyra Semėnienė1, Vilija Jakumaitė2, Gediminas Kitra2, Gediminas Kundrotas2, Pranas Šerpytis3 1 Vilnius University, Clinic of Cardiovascular Diseases, Heart Surgery Centre, Vilnius University Hospital Santariškių Clinics, Santariškių str. 2, LT-08661 Vilnius, Lithuania E-mail: [email protected] Klaipėda Seamen’s Hospital3 Vilnius University, Cardiology and Angiology Centre Objective: The aim of present study was to analyze the results of surgical treatment of patients suffering from dissecation of the ascending aorta. Patients and methods: During the period 1997–2007, 89 patients underwent operations because of acute dissecation of aorta. The preoperative data, methods of surgery and short-term as well as long-term results of treatment were analyzed. Results:There were 26 postoperative deaths (29.2  %). The causes of death included fatal postoperative bleeding (11), heart failure (5), brain impairment (8), multiple organ insufficiency (2). Bleeding was mostly characteristic of Bental-De Bono operations. In 23 patients (25.8  %), heart tamponade and marked heart failure were diagnosed preoperatively. In 19 of these patients (86.2  %), a rethoracotomy was required because of bleeding, and 6 (26.2  %), suffered from marked renal insufficiency. Seven of 63 survivors died during the long-term observation period (the survival time in two patients was up to 1 year, and 5 patients survived 1–6 years after the operation). Conclusion: The results of surgery for ascending aorta dissection depend on the preoperative condition of the patients and the mode of operation. The preoperative cardiac tamponade with a marked heart failure increases the risk of operation. The long-term results of the treatment are excellent. Key words: ascending aorta, dissection, surgery.

Direct Myocardial Implantation of Human Fetal Stem Cells in Heart Failure Patients: Long-term Results

2010 ◽  
Vol 13 (1) ◽  
pp. 31 ◽  
Author(s):  
Federico Benetti ◽  
Ernesto Pe�herrera ◽  
Teodoro Maldonado ◽  
Yan Duarte Vera ◽  
Valvanur Subramanian ◽  
...  
Keyword(s):  
Heart Failure ◽  
Stem Cells ◽  
Cardiac Function ◽  
Nyha Class ◽  
Left Ventricular ◽  
Long Term Results ◽  
Walk Test ◽  
The Mean ◽  
6 Minute Walk Test ◽  
Minute Walk

Background: End-stage heart failure (HF) is refractory to current standard medical therapy, and the number of donor hearts is insufficient to meet the demand for transplantation. Recent studies suggest autologous stem cell therapy may regenerate cardiomyocytes, stimulate neovascularization, and improve cardiac function and clinical status. Although human fetal-derived stem cells (HFDSCs) have been studied for the treatment of a variety of conditions, no clinical studies have been reported to date on their use in treating HF. We sought to determine the efficacy and safety of HFDSC treatment in HF patients.Methods and Results: Direct myocardial transplantation of HFDSCs by open-chest surgical procedure was performed in 10 patients with HF due to nonischemic, nonchagasic dilated cardiomyopathy. Before and after the procedure, and with no changes in their preoperative doses of medications (digoxin, furosemide, spironolactone, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, betablockers), patients were assessed for New York Heart Association (NYHA) class, performance in the exercise tolerance test (ETT), ejection fraction (EF), left ventricular end-diastolic dimension (LVEDD) via transthoracic echocardiography, performance in the 6-minute walk test, and performance in the Minnesota congestive HF test. All 10 patients survived the operation. One patient had a stroke 3 days after the procedure, and although she later recovered, she was unable to perform the follow-up tests. Another male patient experienced pericardial effusion 3 weeks after the procedure. Although it resolved spontaneously, the patient abandoned his control tests and died 5 months after the procedure. An autopsy of the myocardium suggested that new young cells were present in the cardiomyocyte mix. At 40 months, the mean (SD) NYHA class decreased from 3.4 0.5 to 1.33 0.5 (P = .001); the mean EF increased 31%, from 26.6% 4% to 34.8% 7.2% (P = .005); and the mean ETT increased 291.3%, from 4.25 minutes to 16.63 minutes (128.9% increase in metabolic equivalents, from 2.46 to 5.63) (P < .0001); the mean LVEDD decreased 15%, from 6.85 0.6 cm to 5.80 0.58 cm (P < .001); mean performance in the 6-minute walk test increased by 43.2%, from 251 113.1 seconds to 360 0 seconds (P = .01); the mean distance increased 64.4%, from 284.4 144.9 m to 468.2 89.8 m (P = .004); and the mean result in the Minnesota test decreased from 71 27.3 to 6 5.9 (P < .001).Conclusion: Although these initial findings suggest direct myocardial implantation of HFDSCs is feasible and improves cardiac function in HF patients at 40 months, more clinical research is required to confirm these observations.

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