ABSTRACT
The article deals with intraoperative assessment of the blood flow in the coronary arteries and internal thoracic artery before and after myocardial revascularization. This is accompanied and followed by ultrasonographic characteristics of the coronary blood flow before and after surgical intervention, as well as competence of anastomoses and functional state of revascularization depending on the degree of the atherosclerotic lesion and the diameter of coronary arteries. The average linear and volumetric velocities of the blood flow in the coronary arteries were found to depend upon the degree of the lesion of coronary arteries, the diameter and capacity of the coronary bed. The work was based on studying a total of forty-eight patients presenting with coronary artery disease and subjected to myocardial revascularization using the internal thoracic artery (ITA). Also determined was efficacy of myocardial revascularization in different diameters of the coronary arteries and parameters of the ITA blood flow.
Subject(s)
Coronary Artery Bypass/methods , Coronary Artery Disease/physiopathology , Coronary Artery Disease/surgery , Coronary Vessels , Mammary Arteries/surgery , Ultrasonography, Doppler, Color/methods , Aged , Anastomosis, Surgical/methods , Blood Flow Velocity , Coronary Angiography , Coronary Artery Disease/diagnosis , Coronary Artery Disease/etiology , Coronary Vessels/pathology , Coronary Vessels/surgery , Female , Humans , Male , Middle Aged , Monitoring, Intraoperative/methods , Plaque, Atherosclerotic/complications , Plaque, Atherosclerotic/pathology , Plaque, Atherosclerotic/physiopathology , Treatment Outcome , Vascular PatencyABSTRACT
The article is dedicated to comparative analysis of surgical management of elderly and aged patients presenting with complicated forms of coronary artery disease (CAD). Suggested herein is an algorithm of concerning the choice of methods aimed at surgical correction of postinfarction aneurysms of the right ventricle of the heart and postinfarction ruptures of the interventricular septum in these patients, depending on the morphological structure of the right-ventricular postinfarction aneurysms and postinfarction ruptures of the interventricular septum, followed by determining the incidence rate of using "complete" and "incomplete" myocardial revascularization in elderly and aged patients with complicated forms of CAD depending on peculiarities of the coronary blood flow. Also considered herein is efficacy of preventing rethrombosis following correction of right-ventricular postinfarction aneurysms and thrombectomy. The article is based on studying a total of forty-two 60-to-78-year-old patients with CAD. The measures taken made it possible to decrease postoperative lethality and postoperative complications rate in the patients concerned.
Subject(s)
Cardiovascular Surgical Procedures , Heart Aneurysm/surgery , Myocardial Infarction , Postoperative Complications/prevention & control , Thrombosis/surgery , Ventricular Septal Rupture/surgery , Age Factors , Aged , Cardiovascular Surgical Procedures/adverse effects , Cardiovascular Surgical Procedures/methods , Cardiovascular Surgical Procedures/standards , Chemoprevention , Fibrinolytic Agents/therapeutic use , Heart Aneurysm/etiology , Heart Aneurysm/physiopathology , Heart Ventricles/physiopathology , Heart Ventricles/surgery , Humans , Male , Middle Aged , Myocardial Infarction/complications , Myocardial Infarction/physiopathology , Myocardial Infarction/surgery , Outcome and Process Assessment, Health Care , Postoperative Care/methods , Postoperative Care/standards , Risk Adjustment , Thrombosis/etiology , Thrombosis/physiopathology , Ventricular Septal Rupture/etiology , Ventricular Septal Rupture/physiopathologyABSTRACT
Surgical repair of posttraumatic ventricular septal defects, aortic-right ventricular fistulas and postinfarction ruptures of interventricular septum was carried out in 15 patients aged 18-75 years. Methods of radical correction included suturing, plastic repair with synthetic and autopericardial patches, and amputation of cardiac apex. Procedures were performed 14 days - 12 months after myocardial infarction and 1-12 months after penetrating knife wounds of the chest and the heart. Duration of follow-up was from 1 month to 9.5 years. There were no cases of defect recanalization and deaths.
