The optimal choice of landing zone of the aorta is the key to good long-term results of endovascular treatment on the descending thoracic aorta. In patients with Type B aortic dissection and retrograde dissection to the aortic arch, arterial debranching of the aortic arch branches allows to form a safe landing zone and reduce the risk of antegrade endoleak formation and retrograde dissection.
- To analyze chest penetrating chest wounds with heart injury by native computed tomography (CT).
- To differentiate groups of patients who need urgent surgery (life-saving procedures) at the mobile military hospitals and who might be safely transported to the specialized cardiac surgery departments without previous urgent surgical procedures.
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.
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.
Intravascular ultrasound (IVUS) is a modern method of visualizing the coronary arteries from the lumenal surface of the vessel [1]. The cross-sections of the intracoronary images make possible the measuring of the coronary artery size and assessing the structure of the vessel [2], which is extremely important in the context of cardiovascular diseases.The uniqueness of ultrasound is based on the fact that diferent layers of the coronary artery wall re"ect ultrasound waves diferently, anatomically preconditioned. Therefore, understanding the anatomical aspect of the vessel structure is the key to interpreting the intracoronary images. Even though IVUS is widely used in the leading clinics [3], for the majority, it is a less accessible procedure [4]. Unfortunately, IVUS remains an innovative procedure for much medical sta! and requires further explanation of coronary vessel morphology. The coronary artery size is variable and impacts the coronary stent implantation and optimization of the results of coronary revascularization [5, 6]. To our knowledge, there is no data on the size of coronary arteries ostia among the Ukrainian population using IVUS