Surgical treatment of multi-valve heart disease of infective endocarditis

Peculiarities of diagnosis and results of surgical treatment of multi-valve heart disease in infective endocarditis. Analyze data and clinical results operated 156 patients with infective endocarditis, of which 85 were men (56.5%), and women -71 (45.5%). Age Our patients ranged from 12 to 68 (mean 32.76 ± 1.6) years. Diagnosis was based on the classiϐication and criteria Durack D.T. The patients were divided into 2 groups: group 1, 89 (57.4%) patients who underwent a complex developed by the authors of antibiotic therapy, treatment and preventive measures. 2-group 67 (42.6%) patients who underwent the traditional surgical treatment scheme. The diagnosis used: electrocardiography (ECG), X-rays from Skopje, transthoracic echocardiography (TTEHOKG) - all patients, transesophageal echocardiography (TEHOKG) - at 40.5%; coronaroventriculography (CVG) and angiocardiography (ACG) - at 12.65%; blood culture study in 38.6% of patients, with light gistrology electron microscopy (LEM) - in 47.5% of patients.Intraoperative treatment - preventive measures (TPM) were as follows; mechanical and chemical sanitation of the infected area of the heart; valve implantation antibakteriyalnymi properties; hyperthermic perfusion; anti microbial therapy, including anti-fungal agents. Application of the above measures could reduce mortality in the study group and 5.1% in the control group - 9.3%. In dynamics, declined to 3.9% in the last Godi mortality in the study group.

The risk of renal and neurological complications after reconstructive surgery of the aortic arch in newborns

When reconstructing the aortic arch (AA), it is necessary to select a method that provides optimal protection of the internal organs and the brain. It was previously believed that the hypothermic circulatory method was optimal. However, recently, the application of antegrade cerebral perfusion with moderate hypothermia has proved preferable when performing reconstructive operations on the aorta on adult patients and some children. In these instances, continuous cerebral perfusion reduces the incidence of neurological complications. However, the degree of damage to the organ systems distal to the AA remains unclear.The objective of this study was to assess the effectiveness and safety of various methods for protecting the brain and internal organs during reconstructive operations on the AA in small children. A retrospective analysis of 60 patients who had received reconstructive operations on the AA was undertaken. The neurological status and the degree of damage to internal organs in the short- and long-term, combined with the application of various methods for protecting the brain, were assessed. Surgical correction of the congenital pathology of the AA under deep hypothermic circulatory arrest conditions was performed in 26 patients (Group I) and antegrade unilateral selective perfusion of the brain was used for 34 patients (Group II). Nervous system complications were detected in 28.5% of patients in Group I, whereas it affected 7.9% of patients in Group II. Thus, the odds ratio for development of the neurological case was signiϐicantly lower for Group II: 0.17 (0.06–0.69), p = 0.02. However, in this Group, patients with renal dysfunction equated to 58.7%, whereas this ϐigure was 23.7% for Group I, p = 0.02

Performance indicators of left ventricular strain, wall stress and serum brain natriuretic peptide levels in chronic hemodialysis patients

Background: Left ventricular (LV) global longitudinal strain (GLS) is a reliable determinant of LV systolic function. The precise relationship between LV wall stress and serum brain natriuretic peptide (BNP) concentrations in hemodialysis (HD) patients require clariϐication. BNP levels are raised in patients with endstage renal disease (ESRD) and could reflect LV impairment amongst HD patients. Objective: This study sought to evaluate the clinical utility of LV–GLS, wall stress and serum BNP levels in chronic HD patients. The correlations between BNP levels with both LV wall stress and LV–GLS were assessed. Methodology: A total of 30 ESRD patients on regular HD – divided into 15 patients with LV ejection fraction (EF) <50% and 15 patients with LV EF > 50% – and 15 agematched healthy subjects were assessed. LV function and structure were measured using conventional echocardiography, including LV meridional wall stress (LVMWS), LV mass index (LVM I) and two-dimensional speckle tracking echocardiography for determination of LV–GLS. Serum BNP levels were evaluated after HD sessions. Results: There were significant increases in LVM SW (189.2 ± 81 vs. 72.2 ± 20.6 dynes/cm 2 2 1000, P < 0.0001), higher levels of BNP (1238 ± 1085.5 vs. 71 ± 23.4 pg/ml, P<0.0001), w hilst LV–GLS was signiϐicantly reduced (15.1 ± 3.1 vs. 20.8 ± 1.7%, P <0.0001) in HD patients, when compared to the controls. Higher values of LVMWS (246.9 ± 67.5 vs. 131.5 ± 43.6 dynes/cm 2 2 1000, P <0.0001) and BNP (1925.4 ± 1087 vs. 550.5 ± 496.5pg/ml, P < 0.0005) with further impairment of LV–GLS (13.8 ± 2.5 vs. 16.4 ± 5.4%, P < 0.05) were found in patients with LV EF 0 50% than those with LV EF > 50%. Serum levels of BNP were positively correlated with LVM I (r = 0.896, P < 0.0001) and LVMW S (r = 0.697, P < 0.0001), but negatively correlated with LV–GLS (r = 0 0.587, P < 0.0001). Conclusion: LV–GLS and LVMWS are useful imaging markers for detection of LV dysfunction in HD patients. Serum BNP level is influenced by LV structural abnormalities, being regarded as a crucial hemodynamic biomarker in those patients.

SURGICAL MANAGEMENT OF MULTIPLE INSTENT RESTENOSIS WITH CORONARY ENDARTERECTOMY AND STENTECTOMY

In-stent restenosis remain the most important problem of coronary stent implantation. The number of patients with in-stent restenosis of coronary arteries is increasing in the practice of heart surgeons. We report a successful treatment of a patient with multiple in-stent restenosis of coronary arteries. LAD was treated with long arteriotomy of about 8 sm followed by open coronary endarteriectomy and stentectomy. The arteriotomy was then reconstructed with a venous patch and distal anastomosis with the LIMA then performed. The patient’s postoperative period was uncomplicated. At a 6-month followup examination, the patient is doing well and is asymptomatic. Combined open endarterectomy and stentectomy appears to be an effective alternative surgical treatment of FMJ-LAD and multiple intra-stent restenoses and gives a chance of full revascularization for such patients. Key words: Surgical management, coronary endarterectomy, stentectomy, arteriotomy, patient, FMJ-LAD

SURGICAL REPAIR OF CONGENITAL STENOSIS OF THE INFERIOR VENA CAVA

The congenital stenosis of the inferior vena cava (IVC) is a rare anomaly causing numerous clinical manifestations, depending on the variant of drainage patterns or collaterals. This case presents a ϐive-year-old Azerbaijani male, who suffered with massive ascites and a leg edema for three months. IVC stenosis was detected on echocardiography, due to a high velocity ϐlow and visualisation of a focal narrowing between the IVC oriϐice and the proximal end of the hepatic vein entry. The IVC stenosis was conϐirmed by computed tomography. Surgical dilatation of the IVC using xeno-pericardial patchplasty was performed under the cardiopulmonary bypass. This successful surgical correction of IVC stenosis is the only case ever reported in Azerbaijan. Key words: surgical repair, congenital stenosis, inferior vena cava, computed tomography , IVC stenosis

THE RISK FACTORS OF MITRAL INSUFFICIENCY RECURRENCE AFTER CORONARY ARTERY BYPASS GRAFTING WITH OR WITHOUT MITRAL VALVE REPAIR IN PATIENTS WITH ISCHEMIC CARDIOMYOPATHY

Background and Objective: This study aimed to identify risk factors for mitral insufϐiciency (MI) recurrence after isolated coronary artery bypass grafting (CABG) and for CABG with mitral valve (MV) repair of moderate MI in patients with ischemic cardiomyopathy. Methodology: This is a single-centre prospective study. We included 76 patients with moderate MI and poor left ventricular function (EF <35%). The patients underwent isolated CABG or CABG with MV repair. The age of the patients was 57±8 years, and 90% were men. MV repair was restricting annuloplasty using a rigid ring with a size of 26–30. Results: The total complications in the long-term period were 19 (52.7%) and 8 (23.5%) in the isolated CABG and CABG + MV repair groups, respectively (p=0.015). After isolated CABG in patients suffering ischemic cardiomyopathy (IC) and moderate MI, progression of MI (grade 3) initially 0%, after 12 months, 31%, after 36 months, 71%, p <0.001 is observed. Conclusions: Isolated CABG or CABG with MV repair in patients with IC does not result in a signiϐicant decrease in MI in the long-term, when compared with the baseline. The revealing of the predictors of the progression of MI made it possible to determine the threshold values of the performance indicators of MV repair and assisted with the determination of the surgical treatment strategies for patients with moderate MI. Key words: Ischemic cardiomyopathy, mitral insufϐiciency, coronary artery bypass grafting