Search

Dominating factor of development of functional mitral insufficiency in patients with ischemic heart disease and dilated cardiomyopathy is deformation of atrioventricular valve leaflets due to traction by chordae apparatus. In patients candidates for left ventricular reconstruction because of its postinfarction aneurism the problem of preexisting or recurrent dysfunction of mitral valve acquires special value as operation itself implies surgical ventricular remodeling and therefore change of mitral valve geometry. Supplementation of the volume of surgical intervention with resection of chordae responsible for impaired coaptation of mitral valve leaflets in some cases appears to be effective and simple method of correction of mitral insufficiency.

The character of lesions of the coronary bed and specific features of formation of collateral coronary circulation was studied in patients with post-infarction aneurysms of the left ventricle. Marked atherosclerotic lesion of coronary arteries, especially in the basin of the anterior interventricular artery, was observed in all examined patients with post-infarction aneurysms of the left ventricle (LV). Coronary collateral circulation is absent or formed extremely slightly in cases of multifocal lesion of the coronary arteries. It was found that impairment of the contractile function of the LV myocardium promoted dramatic disturbance of hemodynamics indices in patients with post-infarction aneurysms of the left ventricle.

Examinations and operations on 36 ischemic heart disease patients with postinfarction aneurysm of the left ventricle (PIALV) in combination with hemodynamically significant obliterating atherosclerosis of the lower extremity arteries were performed in the clinic during the period from 1995 through 2005. The first stage of the treatment included resection of PIALV and myocardium revascularization. Positive results were obtained in all 36 patients at the first stage of surgical treatment, without ischemia of the myocardium being observed in the postoperative period. The contractive function of the left ventricle as an ejection fraction due to resection of PIALV and its plasty was on average 17% greater, which created favorable conditions for the following stage of surgical treatment. At the second stage of surgery an individual approach was used for patients with generalized atherosclerotic lesions of the lower extremities with special reference to specific clinical picture, as well as non-standard surgical methods. Among the nonstandard surgical methods there were transprosthetic aortotomic shunts and the method of a reverse formation of anastomoses.

The echocardiographic functional features of the left ventricle after its geometrical reconstruction in combination with myocardial revascularization were studied in 31 patients. The most significant parameters were defined, by evaluating the course of an early postoperative period.

Aim: To assess value of single-photon emission computed tomography with (99m)Tc-sestamibi ((99m)Tc MIBI SPECT) for detection of post-infarction left ventricular aneurysm in patients with coronary artery disease., Material: Fifty nine patients were operated upon because of coronary heart disease. In 27 patients with post-infarction left ventricular aneurysm modified Dor operation (aneurysmectomy with endoventricular circular patch plasty reconstruction) was performed. In 24 patients with extended cardiosclerosis direct myocardial revascularization was conducted., Results and Conclusion: Comparison of (99m)Tc MIBI SPECT data obtained at rest and during dobutamine stress test revealed some diagnostic features characteristic of patients with left ventricular post-infarction aneurysm. Quantitative and qualitative assessment of viability of myocardium in basal and "borderline" zones influenced not only the volume of revascularization, it was important for preliminary determination of post-infarction left ventricular aneurysm resection level, selection of type of plasty, prognostication of complications in immediate and remote postoperative periods.

Myocardial perfusion scintigraphy was made at rest and during bicycle ergometer exercise to diagnose coronary heart disease (CHD), to define the site and extent of left ventricular aneurysms, and to determine the compensatory potentialities of coronary circulation, to evaluate the efficiency of drug therapy. This was performed on a two-detector emission tomograph by using 99mTc. The data obtained were processed by two protocols: 1) tomographic heart specimens and 2) large protruding eye. In patients with a questionable diagnosis, the method evidenced stenotic coronary arteries in 60% of cases and exclude coronary abnormality. In CHD patients, exercise testing could reveal the extent of resting perfusion defects and new defects, i.e. define the reserve potentialities of coronary circulation, which is of great prognostic value. The site and extent of lesions were specified in extensive myocardial cicatricial lesions and left ventricular aneurysms.

The paper elucidates the nature of systolic peak cleavage in pulmonary venous blood flow into the major (J) and auxiliary (J') ones. A hypothesis has been forwarded, according to which the occurrence of the peak J' is associated with the kinetics of left ventricular walls and mitral ring due to regional left ventricular myocardial heterogeneity. The paper also provides indirect evidence for this hypothesis, which has been obtained by Doppler ultrasonic study of 13 healthy individuals and 34 patients with various cardiovascular diseases. It has been found that in most cases the cleavage of the peak J was observed in patients with pronounced regional left ventricular myocardial heterogeneity (postinfarct aneurysm, dilated cardiomyopathy, Wolff-Parkinson-White syndrome, etc.).

The data of X-ray, radiokymography and of intracardiac haemodynamic studies were compared in 45 cases of chronic cardiac aneurysms and varying degrees of circulatory insufficiency. Special attention was paid to the study of the functional state of the myocardium beyond the zone of the aneurysm that was conducted with the aid of radiokymography. A certain correlation was established between the amplitude of the radiokymographic curve along the left ventricular margin beyond the aneurysmal zone and the severity of the haemodynamic disorders. An unfavourable effect of a decreasing amplitude of the curve towards the cardiac apex was revealed.

Altogether 20 patients with aneurysm of the cardiac membranous septum (AMS) were examined. Biplane cineangiocardiography (CACG) of the left ventricle was performed in the left oblique position permitting the detection of AMS in 17.8% of the patients with the suspected interventricular septal defect (IVSD). Heart diseases were observed in all the patients, in 90% they were accompanied by IVSD in the cardiac wall. AMS regular contours and a wide base were signs of true AMS. A narrow base and irregular shape were indicative of false AMS. Slight aortic transposition was noted in 1/4 of the patients with AMS.

The authors discuss the methodology of the computer-aided tomography of the heart which is to include dynamic scanning with, if indicated, synchronous ECG paralleled with the intravenous bolus administration of the contrast medium. The synchronization with ECG makes it possible to obtain a computer-aided tomographic image of the heart at any phase of the cardiac cycle. Computer-aided tomography was performed in 306 patients with various forms of heart disease. Five levels of scanning can be identified under normal conditions which present all structural elements of the heart.

The authors conducted a scintigraphic study of the cardiac cavity in 140 patients to detect postinfarction aneurysms. 113m In Cl3 (185 MBq) and the conventional Picker I magna-scanner (USA) were employed. A conclusion has been made as to a good choice of the angiotropic marker 113m In for the diagnosis of postinfarction aneurysm of the left ventricle and the determination of a degree of its thrombosis. The use of the method for differential diagnosis between aortal aneurysm and a mediastinal tumor process was stressed.

Complete clinical and X-ray examination including catheterization of the heart cavities and selective coronarography was conducted in 116 patients suffering from postinfarction aneurysm of the heart. In 97.4% of cases the aneurysm of the heart was localized in the basin of the anterior interventricular branch of the left coronary artery. The size of the aneurysm was determined by the extent of affection of the coronary channel expresses as an overall value. Particular attention was focused on the study of the functional potentialities of the intact port of the left-ventricular myocardium. It is concluded that it is expedient to perform the operation for aortocoronary shunting to the affected arteries supplying blood to the part of the left-ventricular myocardium which is not involved in the aneurysm, so as to improve the function of the left ventricle after resection of the aneurysm.

A method for quantitative analysis of coronarograms permitting the determination of average total caliber of the coronary arteries and the angiographic coronary index is being reported. These parameters enable assessment of the degree, localization of not only segmentary but also diffuse lesions of the coronary arteries. The angiographic coronary index, which reflects the coordination of the coronary bed to the mass of the blood-fed myocardium, can be used for assessment of the relative insufficiency of the coronary blood flow.

Clinical and radiologic examination, including selective coronarography and catheterization of the cardiac cavities, was carried out in 110 patients with post-infarction aneurysm of the left ventricle. Three groups of patients were distinguished: patients with affection of one of the major cardiac arteries (44), those with affection of two coronary arteries (32) and patients with affection of three arteries (32). Two patients had no stenosis of the coronary arteries, The anterior interventricular artery was occluded in 95,8% of patients. Operation for aorticocoronary shunt to the artery in the zone of which the arteries were located proved impossible in 65% of patients. Other arteries with no aneurysms in their channels contribute to the formation of collateral circulation and form a network of anastomoses at the boundary with the heart aneurysm and in this improve the nutrition of the healthy part of the myocardium experiencing an additional load. In stenosis of these arteries, the creation of an aorticocoronary shunt is expedient.