ABSTRACT
Early and long-term results of hereditary mitral valve dysplasia surgical treatment were obtained in 203 patients. All patients were divided in 2 groups: 73 (36%) patients after valve-preserving operations and 130 patients after universal chorda-preserving valve prosthetics. The choice of treatment modality depended on the type of anatomical changes and overall surgical volume. Hospital lethality rate was 2.46%. Surgery led to satisfactory functional results, thus, 83.3% of the operated patients have I-II NYHA functional class. Analysis of the own experience allowed to mark out factors, contraindicating the durable plastic mitral valve.
Subject(s)
Heart Valve Prosthesis Implantation/methods , Heart Valve Prosthesis Implantation/standards , Mitral Valve Insufficiency/surgery , Mitral Valve/abnormalities , Adult , Aged , Female , Humans , Male , Middle Aged , Mitral Valve/surgery , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
The orthotopic heart transplantation is an acknowledge method for the treatment of cardiomyopathies of various etiology. Specific vasculopathy of the transplanted heart is considered to be a significant problem of the long-term postoperative period and serves the reason of low 10-years survival rates (not more then 50%). The issue unites the experience of follow-up and intravital electronic microscopy of transplantated heart's biopsies from 20 patients. Previously unknown data can help the clarification of posttransplantational cardiomyopathy.
Subject(s)
Cardiomyopathy, Restrictive/pathology , Heart Transplantation/pathology , Tissue Donors , Adult , Biopsy , Cardiomyopathy, Restrictive/etiology , Cardiomyopathy, Restrictive/mortality , Disease Progression , Female , Heart Failure/surgery , Heart Transplantation/adverse effects , Heart Transplantation/mortality , Humans , Male , Microscopy, Electron , Middle Aged , Myocardium/ultrastructure , Postoperative Complications , Postoperative Period , Prognosis , Russia/epidemiology , Survival Rate/trends , Time Factors , Young AdultABSTRACT
We present here analysis of surgical treatment of 24 patients (5 women, 19 men, age 20-75, mean age 50.7 +/- 2.5 years) with dilated cardiomyopathy (DCM) operated during the period from 2008 to 2013. Duration of the disease ranged from 4 months to 12 years (mean 49.4 +/- 7.5 months). According to symptoms and results of 6-minute walk test 3 patients (13%) had heart failure NYHA class III and 21 patients (87%)--NYHA class IV. Average end-diastolic left ventricular size was 7.4 +/- 0.18 cm (6.0-9.2 cm), ejection fraction--26.7 +/- 2.1% (13-47%), mean pulmonary artery pressure 54.9 +/- 2.9 mm Hg (35-80 mmHg). All patients underwent organ-conserving surgery aimed at reverse remodeling of the heart. Surgery was accompanied with implantation of implantable cardioverter defibrillator in 3 patients and/or cardiac resynchronization therapy device in 6 patients. Two patients (8.3%) died during hospitalization of hemodynamically significant ventricular arrhythmias; seven patients (29.2%) died in the late postoperative period. The results of the analysis indicate that reverse-remodeling surgery may be effective in patients with DCM of any age group with preserved reserves of the liver, kidney, and lung function in the absence of active myocarditis. Further observations are needed to determine the place of this operation in the protocol of treatment of patients with DCM.
Subject(s)
Arrhythmias, Cardiac , Cardiac Surgical Procedures , Cardiomyopathy, Dilated/surgery , Postoperative Complications/mortality , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/mortality , Cardiac Resynchronization Therapy , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/instrumentation , Cardiac Surgical Procedures/methods , Cardiac Surgical Procedures/mortality , Cardiomyopathy, Dilated/classification , Cardiomyopathy, Dilated/drug therapy , Cardiomyopathy, Dilated/physiopathology , Cardiovascular Agents/therapeutic use , Defibrillators, Implantable , Female , Follow-Up Studies , Heart Function Tests/methods , Humans , Male , Middle Aged , Moscow/epidemiology , Organ Sparing Treatments/methods , Postoperative Period , Survival Analysis , Treatment OutcomeABSTRACT
A case is reported of a 23-year-old male patient who developed, after severe blunt injury of the lumbar region, massive thrombosis of the vena cava inferior (VCI), both renal veins, bilateral pulmonary artery thromboembolism (PATE), nephrotic syndrome (NS). In spite of anticoagulant therapy, the condition of the patient progressively aggravated for 1.5 year: thrombosis involved the ileac and femoral arteries on the right, thrombus floated in the right atrium with PATE recurrent episodes, pulmonary hypertension reached 120 mm Hg with formation of decompensated cor pulmnonale, proteinuria and hypoalbuminemia deteriorated, anasarca edema developed Multigenic thrombophilia was diagnosed (1 homozygous and 5 heterozygous mutations). A radical one-stage operation was successful: thromboectomy from the VCI, right ileac and left renal veins, thrombendarterectomy from the pulmonary arteries, suture of the interatrial septum defect, installation of cava-filter After the operation pulmonary pressure lowered to 40-45 mm Hg, right heart volume normalized, immunosuppressive therapy with prednisolone and cyclosporine led to nephropathy remission. The discussion covers mechanisms and factors (including genetic) of thrombosis progression, correlations between intravascular thrombosis, NS and chronic glomerulonephritis (possible NS development due to bilateral thrombosis of the renal veins and nephropathy role in thrombosis progression), approaches to conservative and surgical treatment of such patients. Global experience in conduction of pulmonary thrombendarterectomy and thrombectomy from VCI is reviewed (one-stage operations were not described earlier).
