ABSTRACT
AIM: To perform complex assessment of myocardial perfusion, metabolism, and regional contractility in patients with valvular heart disease (VHD) in remote period after surgical correction of heart defects. MATERIAL AND METHODS: We examined 30 patients with VHD in 1-8 years after heart valve replacement because of mitral (n=13) or aortic (n=17) valve defects of the following etiology: rheumatic heart disease (n=10), degeneration of connective tissue (n=13), infective endocarditis (n=7). For assessment of myocardial perfusion, metabolism, and regional contractility, we used single photon emission computed tomography (SPECT). RESULTS: Myocardium of patients who had undergone surgical correction of heart valve defects was characterized by dominating diffuse sclerotic changes localized mostly in basal segments. Hibernating myocardium was a less frequent finding. There were segments of borderline state with normal parameters of metabolism but slight impairment of perfusion without pronounced disturbances of kinetics. Patients with infectious etiology of valvular defects had combined perfusion and metabolic changes in multiple myocardial segments. Extensive derangements of perfusion and metabolism were characteristic for patients with connective tissue degeneration. CONCLUSION: Signs of cardiac failure caused by disturbances of myocardial perfusion and metabolism in patients with valvular heart disease can persist even after successful correction of valvular defect with normalization of intracardiac hemodynamics.
ABSTRACT
OBJECTIVE: To assess whether the quality of the results of myocardial perfusion single-photon emission computed tomography (SPECT) may be improved by applying an individual approach to choosing the exposure time of a study. MATERIAL AND METHODS: The results of myocardial perfusion SPECT with the radiotracer (RT) Technetril upon 25-sec (short) and 60-sec (long) exposures in 22 patients with valvular heart disease (VHD) and coronary heart disease (CHD) were retrospectively analyzed. The basis for the comparative assessment of the study results was the number of myocardial impulses (NMI). The reference informative value was taken as a NMI equal to 21,000-77,000. All the patients were divided into two groups: 1) those with a NMI of below 21,000 and 2) those with a NMI of above 21,000. The raw counts of RT and lesion extent were compared in each group during two exposure modes. RESULTS: No statistically significant differences were found between the raw counts of RT in the left ventricular segments upon short and long exposure regardless of NMI. Evaluation of lesion extent revealed differences in sizes and/or location in 14 (63,6%) patient upon various exposures, most (10 patients) of them were from Group I and only 4 patients were from Group 2, these patients having marked myocardial hypertrophy. CONCLUSION: To enhance the informative value of myocardial perfusion SPECT, it is expedient to individually choose exposure time for each patient, being oriented to the time taken to achieve a NMI of at least 21,000, which can be determined by making one planar scintigram in the left anterior oblique projection (LAO 45 degrees).
Subject(s)
Myocardial Ischemia/diagnostic imaging , Tomography, Emission-Computed, Single-Photon/methods , Dose-Response Relationship, Radiation , Female , Humans , Male , Middle Aged , Reproducibility of Results , Retrospective StudiesABSTRACT
Timely and accurate diagnosis of dissecting aneurysm of the aorta requires combined application of the current methods of examination among which are the obligatory routine X-ray examination, echocardiography and retrograde aortography. Indications to the use of roentgenokymography, tomography and computerized tomography are limited. Magnetic resonance tomography is a promising method for the diagnosis of dissecting aneurysm but is still not widely used. Use of intravenous digital subtraction angiography is justified in cases when retrograde aortography cannot be performed.
Subject(s)
Aortic Aneurysm/diagnosis , Aortic Dissection/diagnosis , Aortic Dissection/classification , Aortic Dissection/diagnostic imaging , Aorta, Abdominal/diagnostic imaging , Aorta, Abdominal/pathology , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/pathology , Aortic Aneurysm/classification , Aortic Aneurysm/diagnostic imaging , Aortography , False Negative Reactions , Humans , Magnetic Resonance Imaging , Tomography, X-Ray ComputedABSTRACT
The aspects of surgical tactics in management of dissecting aneurysms of the ascending aorta are analysed in relation to the disease etiology, the anatomical pattern of the aortic root, presence of attending aortic insufficiency, and dissection extension. Based on the experience of 32 operations (March 1979--February 1988), it is concluded that the abnormal type must be the best criterion for choosing the surgical technique. In dissecting aneurysms due to aortic wall degeneration, Bentall-De Bono and Cabrol's modifications are preferable. In dissecting aneurysms of atherosclerotic origin, the boundary of the proximal extension of dissection should be taken into account. When the dissection extends into the aortic root, the operation using a valve-containing conduit with reimplantation of the ostia of the coronary arteries is feasible. If the aortic root is not involved, isolated prosthesis of the ascending aorta or separate prosthesis of the aortic valve and ascending aorta may be performed depending on the presence of aortic failure.
Subject(s)
Aortic Aneurysm/surgery , Aortic Dissection/surgery , Adult , Female , Humans , Male , Methods , Middle AgedABSTRACT
Problems of the surgical treatment of vasorenal hypertension in children are elucidated as well as types of reconstruction of the renal arteries, indications and contra-indications for surgery. Results of 34 operations fulfilled for fibromuscular lesions of the renal arteries in 32 patients and causes of reoperations and resection of the organs are analyzed.
Subject(s)
Arterial Occlusive Diseases/surgery , Fibromuscular Dysplasia/surgery , Hypertension, Renovascular/surgery , Renal Artery Obstruction/surgery , Renal Artery/surgery , Adolescent , Aorta, Abdominal/surgery , Blood Vessel Prosthesis , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Male , Nephrectomy/methods , Replantation/methods , Veins/transplantationABSTRACT
Fifteen patients with idiopathic hyperaldosteronism were examined. Ten patients were subjected to surgery with 9 of them having an operation of the "portalization" of the renal and adrenal venous blood flow in combination with contralateral adrenalectomy aimed at inactivating the hormone of the adrenal cortex in the liver. One patient had unilateral adrenalectomy in combination with the incision of the celiac ganglions. There were no lethal outcomes following surgery. Postoperationally, all patients were followed up from 3 months to 2.5 years. In 78% of the cases the results of surgery were assessed as good, in 22% the arterial pressure decreased insignificantly although it became more sensitive to hypotensive therapy. The results obtained indicate the efficacy of surgery for the "portalization" of the renal and adrenal venous blood flow in conjunction with contralateral adrenalectomy in patients with idiopathic hyperaldosteronism.
