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Orlov V.E.,Specialized Cardiological Clinical Hospital | Belousov Y.V.,Nizhny Novgorod State Medical Academy
Sovremennye Tehnologii v Medicine | Year: 2013

The aim of the investigation was to analyze the features of surgical interventions, correction technique, immediate and long-term results of the treatment of a rare morphological type of subaortal stenosis - dome-shaped membrane taking into consideration differential diagnosis with other congenital anomalies causing left ventricular outflow obstruction. Materials and Methods. Two medical cases were under study: a 20-year-old male patient and a 4-year-old girl operated in Nizhny Novgorod Specialized Cardiological Clinical Hospital. The operations were performed according to standard practice using transsternal median approach. Both patients underwent normothermic perfusion with aortic occlusion under pharmaco-hypothermic cardioplegia. Results. Echocardiography was found to be the most informative diagnostic technique of any anatomical variant of subaortal stenosis, since it enables to make a diagnosis and determine a morphological obstruction type on the way "left ventricle-ascending aorta". When determining the indications for a surgical correction of the studied anomaly, one should carry out a differential diagnosis of a dome-shaped morphological type of subaortal membrane with characteristic deformity of the anterior mitral leaflet as one of the causes of subaortal obstruction. The surgery technique for a dome-shaped membrane consists in circular resection of fibrous mass obstructing the left ventricular outflow. Source

Pichugin V.V.,Nizhny Novgorod State Medical Academy | Melnikov N.Y.,Specialized Cardiological Clinical Hospital | Bober V.M.,Specialized Cardiological Clinical Hospital | Bodashkov M.V.,Specialized Cardiological Clinical Hospital | And 4 more authors.
Sovremennye Tehnologii v Medicine | Year: 2013

The aim of the investigation was clinical assessment of sugammadex (Bridan) use efficiency for early activization of patients after openheart operations with cardiopulmonary bypass. Materials and Methods. We analyzed the results of sugammadex (Bridan) treatment of 30 patients after open-heart operations under cardiopulmonary bypass. Among them there were 17 male and 13 female aged from 25 to 62 years (mean age 49.4±5.3 years). Cardiopulmonary bypass time was from 50 to 129 min (mean time 78.9±10.4 min), aortic compression time, from 38 to 111 min (mean time 62.1±8.2 min). We studied clinical progression of postperfusion period, acid-base composition and blood gases, the change of central hemodynamics indices and TOF index (neuromuscular conduction index). Total dose of the administered drug was 4.3-6.9 mg/kg. Results. The recovery of a good muscle tone and autonomous breathing was observed immediately after the drug injection in 29 patients (96.7%). TOF index (neuromuscular conduction index) increased from 0.23±0.03 to 0.92±0.01 (p≤0.05) within 3-5 min after the drug administration. The drug had no effect on the changes of central hemodynamics indices, contributed to rapid and full recovery of muscle tone and autonomous breathing in patients. Extubation was performed in operating room, and activization time was 30-120 min (on average 47.0±10.4 min). 27 patients (90.0%) stayed in the intensive care unit (ICU) for 18 h on average, three patients stayed in ICU for 2 days due to the continuous cardiac pacing. The complication resulted from sugammadex usage was delayed vomiting (40-50 min after the drug administration) in 3 patients. Conclusion. The use of sugammadex (Bridan) for fast track extubation protocol of patients after cardiosurgical interventions with cardiopulmonary bypass is feasible and very efficient. Source

Petrova E.B.,Nizhny Novgorod State Medical Academy | Fedorova M.V.,Specialized Cardiological Clinical Hospital | Shakhov B.E.,Nizhny Novgorod State Medical Academy
Sovremennye Tehnologii v Medicine | Year: 2014

The aim of the investigation was to estimate the diagnostic capabilities of left ventricular (LV) functional indices in patients with coronary heart disease (CHD) using conventional imaging techniques (echoCG) and VVI technology.Materials and Methods: 52 patients with CHD were examined. By visual estimation (echoCG) of LV segmental contractility all patients were divided into two groups: without LV contractile dysfunction (n=26); with segmental contractile dysfunction (n=26).The investigation of LV function using VVI system included the study of longitudinal, radial and circular LV fibers, and the analysis of rotation indices.Results and Discussion: VVI system helped to reveal in all patients systolic dysfunction and abnormal strain rate of LV myocardium. Patients of both groups were found to have dysfunction of longitudinal and circular fibers of LV myocardium. Decreased indices of radial fiber function were recorded in a group of patients with segmental contractility dysfunction.Rotation function analysis was impossible in visual estimation. VVI application enabled to find disturbed rotation of basal and apical LV parts. So, the patients of both groups had decreased apical rotation indices, and 14 of them were recorded to have disturbed apical and basal rotational direction of LV.Conclusion: The use of VVI system enables to study in more detail the characteristics of LV function in CHD patients and reveal the alteration of those indices which are not found in visual control. The detection of disturbed strain and rotational properties of LV myocardium is the most urgent problem in patients with regular contractility that makes it possible to define well the management of such patients. © 2014, Nizhny Novgorod State Medical Academy. All rights reserved. Source

The aim of the investigation is to study the influence of echocardiological parameters of the left ventricle (LV) on lethality and reversion of LV remodelation in the long-term period after aortic valve replacement for aortic valve failure. Materials and methods. 154 patients were included into the study: 86 patients with aortic stenosis (56%), 68 - with aortic insufficiency (44%). Echocardiogram consisted of the following measurements: end-diastolic LV dimension, the thickness of posterior wall and interventricular septum. There were determined end-diastolic and end-systolic volumes and ejection fraction, myocardium mass, LV wall relative thickness index. Results. Four LV structural and geometrical types (SGT) were distinguished. The best results of LV hypertrophy regression were observed in SGT-II group (aortic stenosis with moderate hypertrophy). In hospital period the patients with SGT-III (aortic stenosis with LV marked hypertrophy) and those with SGT-IV (aortic stenosis with LV dilatation) had the same lethality risk. In a long-term period high lethality was revealed in the patients with SGT-IV. Conclusion. The use of LV structural and geometrical types enables to make prognoses about the risk and the results of aortic valve failure correction. Source

Chebotar E.V.,Specialized Cardiological Clinical Hospital | Britvina O.V.,Nizhny Novgorod State Medical Academy | Shakhov B.E.,Nizhny Novgorod State Medical Academy
Sovremennye Tehnologii v Medicine | Year: 2012

The aim of the investigation is to study the results of endovascular treatment of patients with coronary bifurcation disorders performed under the control of selective coronography and intravascular manometry, and to assess on the basis of their analysis the manometric findings of blood flow in bifurcation branches when choosing endovascular correction management. Materials and methods. The analysis of peculiarities and the results of endovascular correction of coronary bifurcations was performed in 67 patients with test T-stenting. The bifurcation state of the 1st group patients (n=32) was assessed by contrast angiography and the measurement of fractional flow reserve, the patients of the 2nd group (n=35) - by angiography findings only. Long-term results (follow-up period is 12 months) were studied in 30 patients (93.8%) of the 1st group, and in 33 patients (94.3%) of the 2nd group. Results. In 11 of 32 cases angiographic assessment of stenosis in the lateral branch mouth was different from that of manometric one. There was determined an average degree of correlation (R=0.46; r{cyrillic}=0.008). In Y-type bifurcation there was no correlation between the assessments of hemodynamic significance of stenosis in the lateral branch (R=0.21; r{cyrillic}=0.464). In a follow-up period, angina recurrence or the increase of its degree was revealed in 3 patients (10.0%) of the 1st group, and in 11 patients (33.3%) of the 2nd one (r{cyrillic}=0.035). Restenoses in lateral branches were found in 2 patients (6.7%) of the group under study and in 10 patients (30.3%) in the control group (r{cyrillic}=0.024). Conclusion. The use of complex approach to the assessment of the results of coronary bifurcation correction improves the results of surgeries due to the decrease of restenoses rate and the necessity of re-revascularization in the follow-up. The advantage of the approach is more accurate assessment of hemodynamic changes in bifurcation branches and, therefore, the possibility to choose an optimal technique of endovascular correction. Source

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