[Features of pulmonary thromboembolism in women].

Pulmonary artery embolism (PAE) is usually a diagnosis of exclusion. Verification of a more common pathology takes time, which may become critical for treatment of pulmonary embolism and saving the patient's life. Since PAE is an acute disease, the time window for medical care largely determines the prognosis. Therefore, the differential diagnostic process should include thromboembolism already at the first visit. It is important to determine risk factors for PAE taking into account the patient's personality and gender. Obtained data may help the physician to determine quickly the expedience of visualizing studies, such as ventilation/perfusion scintigraphy, angiopulmonography, computed tomographic angiopulmonography. For women, it is important to collect specific information, such as the presence of large uterine fibroids, use of combined oral contraceptives or hormonal replacement therapy; to ask how long ago the patient had pregnancy and delivery, whether she has thrombophilia or oncological diseases.

[Patient's way from acute pulmonary embolism to chronic thromboembolic pulmonary hypertension: diagnostic and treatment options].

Сhronic thromboembolic pulmonary hypertension (CTEPH) is a serious, under - diagnosed but potentially curable complication of pulmonary embolism (PE) due to medicine advancements. Lack of specific symptoms and signs makes its diagnosis challenging, requiring clinicians to be ready to suspect its presence in patients with dyspnea of unknown origin or persistent symptoms after the pulmonary embolism event. The success of the treatment of this disease depends entirely on early diagnosis. The complexity of the differential diagnosis is due to the problematic aspects including the lack of doctors' awareness of both the pathology itself and the possibilities of its modern treatment. Recently, in our country, the problem of the availability of expert centers with sufficient experience in providing highly specialized medical care to this rather difficult category of patients who need specific therapy has become very actual. The aim of this review is to provide contemporary information about epidemiology, pathophysiology, and clinical features of treating patients with CTEPH, and also, to increase awareness of potential PE→CTEPH transformation. In the article a 4-year - period of experience of the Meshalkin National Medical Research Center on management of CTEPH patients has been presented.

[Predictors of Cardiorespiratory Complications in Patients With Ischemic Heart Disease After Coronary Artery Bypass Grafting].

PURPOSE: to elucidate predictors of cardiorespiratory complications during the early postoperative period after coronary artery bypass grafting (CABG) in patients with ischemic heart disease (IHD). MATERIAL AND METHODS: We examined 180 patients with IHD (mean age 59.3+/-1.23years). Prior to surgery we assessed their clinical and functional status including state of respiratory function. Predictors of complications were determined by univariate logistic regression analysis. RESULT AND CONCLUSIONS: Early postoperative complications in this group of patients were atrial fibrillation, prolonged mechanical ventilation, and cognitive disorders. Main predictors of these complications were preoperative abnormalities of respiratory function (presence of chronic obstructive pulmonary disease, decreased efficiency of pulmonary ventilation), and concomitant diseases such as type 2 diabetes and multifocal atherosclerosis.

[Efficiency of Pulmonary Ventilation in Remote Period After Surgery in Patients With Chronic Pulmonary Thromboembolism].

AIM: to assess efficiency of pulmonary ventilation in remote period after surgical treatment of chronic pulmonary thromboembolism (CPTE). MATERIAL AND METHODS: We examined 29 patients with CPTE with median age 49 (38-60) years. Pulmonary ventilation was studied by body plethysmography and its efficiency was evaluated by oxygen utilization coefficient (OUC). RESULTS: Comparison of OUCs before and in the remote period after surgery showed that after surgical treatment efficiency of pulmonary ventilation increased by 26% at the account of reduced hyperventilation but remained below normal. Patients' age and duration of the disease had a direct impact on the baseline bronchial conductivity as well as on recovery of the respiratory system reserve in the remote period after surgery.

Left ventricular dimension and shape after postinfarction aneurysm repair.

OBJECTIVE: We evaluated left ventricular dimensions and shape in the patients with postinfarction LV aneurysm before and after different techniques of ventricular reconstruction. METHODS: From January 1997 to December 2003, 158 patients underwent LV aneurysm repair. There were 152 men and 6 women, with a mean age 50+/-8.4 years. Ventricular reconstruction was performed by using linear plasty of the Cooley technique in 35 patients, septal plasty of the Stoney technique-in 57 patients, and endoventriculoplasty of the Dor technique-in 66 patients. Left ventricular volumes and dimensions, global and contractile left ventricular function, diastolic sphericity were analyzed before and after operation over a period of 10 days to 5 years. RESULTS: The EchoCG studies showed a significant postoperative improvement of the LV contracting function regardless of LV plasty technique used. The index of sphericity changed from 0.71+/-0.08 to 0.72+/-0.06 after linear plasty, from 0.71+/-0.05 to 0.73+/-0.07 after septal plasty, from 0.74+/-0.06 to 0.56+/-0.05 after endoventriculoplasty. The hospital mortality rate was 6.3%. There is no significant difference in hospital mortality rates between the different techniques of LV aneurysm repair. CONCLUSIONS: Our results show the effectiveness of different techniques of LV aneurysm repair, when the differentional approach to choice an adequate method of ventricular reconstruction was applied.

Preoperative modeling of an optimal left ventricle volume for surgical treatment of ventricular aneurysms.

OBJECTIVE: We evaluated the results of surgical treatment postinfarction ventricular aneurysms, with preoperative modeling of an optimal left ventricle volume. METHODS: From January 1998 to December 2000, 41 patients underwent left ventricular (LV) aneurysm repair. There were 39 men and two women, with a mean age 45.6+/-6.2 years. With echocardiography study, an optimal end-diastolic volume of LV was modeled on the basis of the proper stroke index and the contractile ejection fraction (EF). A permissible area of aneurysm resection was calculated by using a difference between the initial and the projected surface area of LV. The patch position and sizes were measured preoperatively. Ventricular reconstruction was performed by using linear plasty in eight patients, septal plasty of the Stoney et al. technique in 14 patients, and endoventriculoplasty of the Dor et al. technique in 19 patients. RESULTS: The mean NYHA functional class decreased from 2.9+/-0.6 to 1.6+/-0.7 postoperatively. The improvement of LV contracting function made itself evident in a decreased end-diastolic volume from 216+/-98 to 158+/-35 ml, and end-systolic volume from 133+/-85 to 80+/-34 ml postoperatively. The mean EF increased from 38+/-11 to 49+/-9% after operation. We noted that preoperative contractile EF corresponded with postoperative EF (49.8+/-11% and 49.3+/-9%, respectively). The projected optimal end-diastolic volume of LV estimated before operation agreed with postoperative data (152+/-33 ml and 158+/-35 ml, respectively). The hospital mortality rate was 7.3%. CONCLUSIONS: Preoperative modeling of an optimal LV volume allows for the estimation of a permissible area of aneurysm resection, the position and sizes of the patch, as well as for the prevention of an excessive reduction of the LV cavity after aneurysm repair.

Application of technetium-99m hexamethylpropylene amine oxime single-photon emission tomography to neurologic prognosis in patients undergoing urgent carotid surgery.

In this study we aimed to work out a quantitative prognostic index for preoperative assessment of brain technetium-99m hexamethylpropylene amine oxime (HMPAO) single-photon emission tomography (SPET) in patients referred for urgent carotid endarterectomy due to acute obstructive disease of the internal carotid artery (ICA) and neurological deficit. To this end we compared data from preoperative SPET studies with the postinterventional changes in neurological status in 20 patients (17 males, three females; mean age 53 years, SD 4 years) with acute ischaemic cerebral disorders induced by obstruction of the ICA. Carotid obstruction was diagnosed by ultrasound B-mode study. All patients underwent urgent carotid endarterectomy from the ICA. Patients were divided into two groups in accordance with the results of postoperative follow-up: group A comprised patients with significant (more than 3 points) postoperative improvement in neurological condition as quantified by the Canadian Neurological Scale (11 patients); group B consisted of patients with minimal improvement or deterioration (nine, three of whom died). All patients were studied preoperatively by 99mTc-HMPAO SPET. The volume of nonperfused tissue (VS, cm3) was quantified using the Mountz technique. Hypoperfused volume (Vhypoperf, cm3) in the affected hemisphere was calculated as the total volume of voxels with 99mTc-HMPAO uptake < 90% of the contralateral symmetric voxels. Discriminant prognostic function was calculated by discriminant analysis as: PF = 0.072 x VS + 29.46x(VS/Vhypoperf). Patients with preoperative PF values < 8.20 demonstrated postoperative improvement in neurological status, while the group with PF > 8.90 comprised patients who demonstrated minimal improvement or deterioration. PF values in the range 8.20-8.90 carried an indefinite prognosis. We conclude that the preoperative 99mTc-HMPAO SPET can be used for the selection of patients in whom improvement in neurological status may be expected after urgent surgical correction of acute extracranial obstruction of the ICA.