After three years of the outbreak of Coronavirus Disease 2019 (COVID-19) pandemic, main tasks as to treatment and vaccination are still pending their solution. Today, it is known that SARS-CoV 2 coronaviruses are intracellular viral infections having an inevitable negative impact on all cells of the human body, including the blood cells. It is established that COVID-19 patients can be classified into mild, moderate, and severe. Modern literature does not describe ultrastructural changes of circulatory blood cells in patients with moderate course of this disease.
Introduction. Patients with acute myocardial infarction should be treated with early revascularization. Patients over 73
years have a higher risk of infarct-related cardiogenic shock, which is a leading cause of lethality. Unfortunately, little
is known about myocardial revascularization care for elderly people in Ukraine. We presented a 92-year-old lady with
an acute chest pain case report, which was not revealed by analgesics.
Important clinical findings. Coronary angiography revealed thrombotic occlusion of the distal segment of the left anterior descending artery (LAD) and floated thrombus in LAD mid-segment; stenosis of the left circumflex artery (LCx) close to the first obtuse marginal artery (OM1).
The main diagnosis. Acute myocardial infarction with ST-segment elevation of the left ventricle anterior wall (anteriorSTEMI). Calcific aortic valve disease, severe aortic valve stenosis, significant mitral and tricuspid valve regurgitation,
pulmonary hypertension. Heart failure with reduced LVEF (<40%), NYHA class III symptoms.
Intervention. The decision was to perform urgent stenting in LAD and balloon angioplasty in LCx. Successful hospital discharge was after 14 days.
Conclusions. Take-away lessons: Elderly patients with acute myocardial infarction can be successfully treated in Ukraine. Age and comorbidities are not a contraindication for early myocardial revascularization.
Застосування опіоїдів є ефективним методом лікування сильного та гострого болю, однак при їх неналежному використанні, окрім своїх потужних знеболюючих властивостей, опіоїди зумовлюють виникнення значних побічних ефектів. Початкові зміни в організмі людини, що спричинені вживанням наркотичних речовин (опіатів), виявляють у ротовій порожнині, зокрема, у слинних залозах. Наявність цілої низки невирішених питань щодо проблем структурної перебудови слинних залоз при вживанні наркотичних середників обумовило вибір тематики дослідження.
Від початку пандемії Covid-19 минає два роки, але головні задачі щодо лікування і вакцинації, ще чекають на своє вирішення. На сьогодні відомо, що коронавіруси SARS-CoV-2 є внутрішньоклітинною вірусною інфекцією, яка має неминучий негативний вплив на усі клітини організму людини, в тому числі і на формені елементи крові.
Aortic valve stenosis remains the most dominant form of valvular heart disease. The aortic valve area below 1.0 cm2 is an assignment to the interventions. The modern senile aortic valve stenosis treatment options are mini-surgical valve replacement (mini-SVR), balloon aortic valvuloplasty (BAV), and transcatheter aortic valve implantation (TAVI). This study aims to inform readers about up-to-date interventions for patients with senile calcific aortic valve stenosis in Ukraine, based on the experience of the Cardiac surgery department in Lviv, Ukraine.
Methods.
From a single-centre retrospective registry (10/2015-02/2022), 204 patients were included. One hundred seven patients underwent mini-SVR, tree BAV, and four – TAVI. Diagnostic modalities used to assess the anatomy of the aortic valve were: ECHO, ECG-gated computer tomography with aortic valve calcic scoring, and Angiography.
Interventional procedure techniques were BAV, TAVI; surgical: mini-SVR via upper ministernotomy or right-sided minithoracotomy.
Results.
Anatomical assessment of the aortic valve in senile aortic valve stenosis was based on the morphology of the aortic valve (bicuspid or tricuspid aortic valve), asymmetrical hypertrophy of the left ventricular outflow tract, and coronary ostia height. The age-related anatomical features were calcium deposits in the leaflet, coronary ostium and mitral annular calcification. Ministernotomy (in 67 cases) and a right-sided minithoracotomy (in 40 cases) were performed to secure the “heart step” without instability of the chest cage with the smaller valve size implantation than was expected before. Preserving the chest cage and avoiding aortic cross-clamp/cardio-pulmonary bypass were advantages of TAVI. Fragile patients expected TAVI risks: aortic root damage, paravalvular leak, moderate aortic insufficient, the risk of atrioventricular block and embolic stroke, and kidney dysfunction.
Conclusions.
Mini-surgical valve replacement and transcatheter aortic valve implantation are accessible procedures in Ukraine for senile calcific aortic valve stenosis treatment.