Сучасним методом прижиттєвої оцінки морфології вінцевих артерій є внутрішньосудинне ультразвукове дослідження. Цей сонографічний метод під контролем Х-променів дозволяє візуалізувати структуру стінки вінцевої артерії та її просвіту з люменальної поверхні судини.
The dynamic development of endovascular interventional cardiac procedures contributes to the study of the cardiovascular system in vivo. The intravital evaluation of the coronary bed of the heart can be conducted with the help of intravascular ultrasound, the advantage of which for morphologists is the ability to assess the anatomy and geometry of the coronary arteries from the lumenal surface of the vessel.
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.
Computed tomography is the "gold standard" for performing aortic morphometry during preoperative planning in invasive cardiology and cardiac surgery. Predictive modeling of indicators can significantly save resources. The purpose of the study: to make modelling of Valsalva sinuses and coronary artery ostia height parameters depending on age-anthropometric indicators in healthy men based on computed tomography. The material is represented by contrast-enhanced computed tomography images of the aorta and coronary arteries of forty-three men under normal conditions. Methods: morphometric and statistical analyses. A multifactorial correlation-regression analysis was conducted to establish the complex influence of age-anthropometric parameters on sinuses of Valsalva and coronary artery ostia height. The reliability of the obtained indicators was confirmed by Fisher's test (F). Using the Durbin-Watson autocorrelation criterion, the correctness of the built model was proved. In healthy men, weight (direct effect) and body mass index (inverse effect) significantly influenced the height of the lower edge of the right coronary artery ostia. The regression coefficient is R = +0.632, with p<0.001, the standard error of estimation (SEE) is 2.951. The obtained linear equation of the prognostic model: the level of the height of the departure of the lower edge of the right coronary artery ostia = 0.359 x А 1 - 1.099 x А 2 + 16.53. The correctness of the built model was checked using the Durbin-Watson autocorrelation test (2.181). The prognostic model for calculating the height of the left aortic sinus was formed by height and weight indicators (strong direct influence): R = +0.759, p<0.001, SEE = 2.208. The adjusted coefficient of multiple determination was R2 adj = +0.562. The Durbin- Watson autocorrelation criterion was within the normal range (2.241). The linear equation of the prognostic model with the obtained β -coefficients: the level of the height of the left sinus of the aorta = 35.83 x А 1 + 0.033 x А 2 - 42.22. The work of prognostic models for individuals with different anthropometric and age parameters was verified. Thus, a model of the dependence of the indicator of the height of the left sinus of the aorta on height and weight was created; of the height of the deviation of the lower edge of the right coronary artery from weight and body mass index in healthy men based on computed tomography.