Takayasu arteritis

Takayasu arteritis is a rare form of the vasculitis of large arteries. It is a disease difficult to diagnose and treat, often unpredictable in terms of outcome and life-treatening. Despite its low prevalence, Takayasu arteritis deserves close attention for therapists, cardiologists, rheumatologists and angiosurgeons. This article presents classifications, features of the clinical course of the disease, possibilities of the visualization diagnosis of the lesions of arteries, assessment of the disease activity. The issues of the contemporary drug therapy, interventional and surgical treatment methods and complications of the disease are presented.

Nonbacterial thrombotic endocarditis as a cause of systemic embolism

We presented a clinical case of the non-bacterial thrombotic endocarditis in a patient with ischemic stroke of embolic origin. Imaging methods (transthoracic and transesophageal echocardiography) showed specific features of thrombotic vegetations on mitral and aortic heart valves. Laboratory work-up (blood culture, serological examination) excluded infective endocarditis as a cause of vegetations. Diagnostic work-up with computed tomography showed lung tumor with metastatic foci in bones. Presented case demonstrates need for awareness regarding nonbacterial thrombotic endocarditis in patients with systemic embolism and in specific groups of patients (autoimmune diseases and oncology). Key words: nonbacterial thrombotic endocarditis, marantic endocarditis, echocardiography, systemic embolism.

Intraoperative dynamics of interleukin-6 levels during planned coronary stenting with different approaches to analgesic sedation

The aim – to study the dynamics of the level of interleukin-6 (IL-6) under various drugs for analgesic sedation in the perioperative period of planned coronary stenting. Materials and methods. This study was conducted from September 2018 to March 2020 in 90 patients with coronary heart disease. Patients were evenly divided into three study groups, depending on the drugs that were used for intraoperative analgosedation. Group 1 – slow intravenous administration of 10 mg of diazepam solution and 100 μg of fentanyl solution for induction and repeated administration of these drugs in the same dose to maintain anesthesia during surgery; group 2 – slow intravenous administration of the solution of fentanyl 1.5 mg/kg per induction and 1.5 mg/kg for 1 h to maintain analgesia, propofol solution was used to maintain a certain level of sedation; group 3 – slow intravenous administration of 1 mg/kg of lidocaine solution for induction, for sedation – propofol solution as well. All patients underwent recanalization as planned. In our study, the main study parameter was the level of IL-6 at the beginning of surgery and 10 minutes after stent implantation. Results. When comparing operational indicators with the results that were obtained after stenting, in all groups, IL-6 indicators were lower than preoperative ones. The statistically significant difference between the studied index before surgery and 10 min after stent implantation was in the groups 2 and 3, in contrast to that in patients of the group 1: the level of IL-6 decreased to 30 % in group 2 (p = 0.005) and in group 3 (p = 0.001). Conclusions. The level of pro-inflammatory IL-6 in routine coronary artery stenting tends to decrease after stent placement, with lower rates under propofol solution usage as an anesthetic. At the same time, in group 3 (where nonopioid analgesia was used) the level of interleukin-6 at point 10 min after stent implantation was significantly lower than in first group. This fact might be explained by usage of lidocaine solution in patients of the third group. Key words: interleukin-6, planned coronary stenting, analgosedation, coronary heart disease.

A case of mitral valve plastics in the early postoperative period after orthotopic heart transplantation

Today, heart transplantation is a gold standard treatment of the terminal chronic heart failure. Despite the constant improvement of the technique of this operation and the emergence of new protocols of immunosuppressive therapy, one of the main problems in the development of heart transplantation in Ukraine is a limited donor pool. The article presents a clinical case of successful orthotopic heart transplantation, followed by mitral valve repair in the early postoperative period. Our experience shows that mitral valve repair after orthotopic heart transplantation provides good results in the medium term, and this type of intervention can potentially expand the donor pool, thus increasing the number of heart transplants. Key words: chronic heart failure, heart transplantation, mitral valve repair.

Mechanical thrombextraction in patient with acute ischemic stroke on background of oral anticoagulant therapy

Thrombolytic therapy, which is a priority treatment strategy in patients with acute ischemic stroke in the first 3-4.5 hours after start of the disease, has significant limitations in case of background anticoagulant therapy. Mechanic thrombextraction is considered to be an alternative therapeutic strategy in case of inefficacy or contraindications to thrombolytic therapy. The article presents a clinical case of the 75-year old female patient with acute cardioembolic stroke on background of heart failure and atrial fibrillation. Long-term background usage of the direct oral anticoagulant due to atrial fibrillation is a limitation to use thrombolytic therapy, therefore mechanical thrombextraction was performed. The case presents possibilities of the successful interventional treatment of acute cardioembolic ischemic stroke. An example of a possible drug-drug interaction possibly leading to reduction of the effectiveness of anticoagulant therapy is shown. Key words: ischemic stroke, anticoagulants, mechanical trombextraction.

Clinical case of heart transplantation in the conditions of «the recipient-to-donor» transportation

The main factor limiting the number of heart transplants in Ukraine is the small number of potential donors. In cases when the delivery time of the donor organ is more than 4 hours, the risks of the donor organ ischemic injury are multiplied. Transportation of the recipient to the location of the potential donor in such cases is a forced measure, as it increases the risk of adverse cardiovascular events in the recipient during transportation. Providing medical care to a recipient in such circumstances may be difficult. However, these measures are fully justified by the reduced risk of postoperative complications associated with the time of graft ischemia. The article describes a case of heart transplantation in the conditions of transporting the recipient to the donor. Heart transplantation was performed in a patient with NYHA functional class IV heart failure, refractory to conservative therapy. The postoperative period was uneventful. The time of cardiopulmonary bypass was 90 minutes, the total ischemia time was 180 minutes. On the 3rd day, the patient was transported to the specialized centre to continue treatment and rehabilitation. On the 21st day the patient was discharged in satisfactory condition for outpatient treatment. Key words: heart transplantation, cardiomyopathy, heart failure.

Echocardiography in acute critical care in cardiology

Diagnostic opportunities of echocardiography in the acute cardiac care are reviewed. It is shown in detail how to perform echocardiography in different scenarios of critical conditions, especially in acute chest pain, acute hypotension and shock, in acute dyspnoea, in chest trauma, in post-procedural and post-surgical complications. The advantages and disadvantages of the echocardiographic method in acute myocardial infarction with complications, in acute aortic dissection, in cardiac tamponade, in pulmonary embolism, in systolic left ventricular dysfunction and in acute valvular dysfunction are analyzed. Key words: critical care, echocardiography, dyspnoea, shock, chest pain, tamponade, pulmonary embolism, aortic dissection.

The first clinical experience of Marshall’s vein alcohol ablation in complex treatment of persistent atrial fibrillation

This article describes the first in Ukraine clinical experience of alcohol ablation of Marshall’s vein in the complex interventional treatment of persistent atrial fibrillation (AF). Current scientific data suggest that when drug therapy is ineffective, ablation of AF substrate is a most important stage in the treatment of arrhythmia, as well as optimal method of control and prevention of further cardiovascular events. The standard treatment for paroxysmal AF is radiofrequency ablation (RFA) with electrical isolation of the pulmonary veins (PVI). However, due to the involvement of other pathogenetic mechanisms, a sole PVI is less effective in persistent forms of arrhythmia. For example, in persistent AF forms pathological electrical activity often occurs beyond the pulmonary veins. In particular, it can be observed in the area of ​​the posterior wall of the left atrium and mitral isthmus resulting in perimitral atrial flutter. RFA in this area can reduce the rate of arrhythmia recurrence. However, achieving a stable bidirectional conduction block in the area of ​​lateral mitral isthmus with endocardial RFA is technically challenging. An option to improve the effectiveness of RFA in this case, apart from epicardial RFA in the distal coronary sinus, is an alternative method, i.e. alcoholic ablation of Marshall’s vein by introducing ethanol into its lumen, occluded by a balloon. The presented clinical case shows combined variant of persistent AF minimally invasive treatment using alcoholic Marshall’s vein ablation and RFA with PVI target. Key words: atrial fibrillation, radiofrequency ablation, alcoholic ablation, Marshall vein, clinical case.

Valve dysfunction in patients with cardiac myxomas: mechanism of damage and methods of correction

The aim – to analyze the frequency and nature of lesions of the valve apparatus, to evaluate the results of surgical correction of the affected valves in heart myxomas. Materials and methods. In one-centre study, during period from 01.01.1969 to 01.10.2020, 962 patients with morphologically verified primary heart tumors were observed. Myxomas of the heart were found in 856 (89.0 %) patients. The pathology of the valve apparatus in combination with cardiac myxomas was noted in 70 (8.1 %) patients. The volume and nature of valve damage differed and depended on size, consistency and localization of myxoma, the degree of its mobility, and the presence of areas of pronounced fibrosis and calcification on the tumor. Results. Surgical correction of lesions of valve structures was performed in 65 patients. In 5 patients, it was possible to remove tumor tissue from the valve apparatus, followed by prevention of disease recurrence without damaging valve and subvalvular structures. Surgical techniques included both plastic manipulation and valve replacement. The features of the long-term postoperative period in such patients include progressive valve dysfunction manifested by the progression of insufficiency due to further deformation of the valve apparatus. Conclusions. Alongside with myxoma removal, it is necessary to conduct a thorough examination of the valve apparatus and correction of valve damage by various methods, including plastic surgery and valve replacement, depending on the nature and severity of the damage. Key words: cardiac tumors, myxoma, valve structures, surgical treatment.

The recommended time ranges for functional studies

Key words: functional diagnostics, functional researches, time norms