[Traumatic myocardial infarction].

The paper reports development of acute myocardial infarction as a result of blunt chest injury in a woman having no signs of atherosclerosis. Coronary bleeding was caused by dissection of intima of the interior interventricular artery. Transdermal coronary intervention included balloon angioplasty and stenting of the anterior interventricular artery.

[Efficacy of reperfusion therapy in syndrome of predominant right ventricular dysfunction associated with inferior myocardial infarction].

Aim of the study was choice of optimal tactics of treatment of patients with syndrome of predominant right ventricular (RV) dysfunction, associated with inferior myocardial infarction. We compared immediate and remote results of 3 strategies of treatment of 100 patients admitted to N.V. Sklifosovsky Research Institute for Critical Care in 2003-2007: various methods of percutaneous coronary intervention (PCI), including delayed PCI in the acute period (n=48), thrombolytic therapy without subsequent PCI (n=20), conservative therapy without reperfusion therapy (n=32). Indications to delayed interventions were based on high risk of death due to RV infarction. It follows from the data obtained that optimal tactics of treatment of RV infarction is provision of availability of reperfusion therapy in the form of various types of PCI. Preferable are primary PCIs in the absence of which delayed PCIs acquire practical value. Thrombolytic therapy can be used as a component of combined reperfusion. Absence of signs of its efficacy on electrocardiogram during first 90 minutes serves as absolute indication for rescue PCI. Inaccessibility of the latter is a reason for provision of delayed interventions. Electrocardiographic signs of achieved pharmacological reperfusion do not exclude high probability of early recurrences of ischemia, expediency of application of PCI during the time preceding these recurrences. In the absence of PCI hospital and remote mortality have been very high. Optimization of accessibility of mechanical reperfusion including delayed allows to achieve efficacy of treatment of RV infarction, prevent development of complications and lethal outcomes.

[Turcot syndrome. Rare observation and literature review].

The Turcot syndrome is a rare disease which is characterized by a combination of a brain tumor with a y at which the neoplasm of the colon. About 150 of such observations are described in world literature. Our own observation and a literature review are presented in this article.

[Efficacy of early invasive strategy of diagnostics and treatment of unstable angina at the background of preexisting ischemic heart disease].

Study aim was assessment of efficacy of early invasive tactics of treatment of patients with various forms of unstable angina at the background of preexisting ischemic heart disease. We compared noninvasive and invasive estimation of risk in 354 patients admitted to the N.V.Sklifosofsky Institute of Urgent Aid in 2002 to 2008. Percutaneous coronary interventions on infarct related artery (IRA) during 1 procedure were carried out in 144 patients (41%), indications to coronary artery (CA) bypass surgery were found in 167 patients (47%), 43 patients (12%) were treated conservatively. Coronary angiography performed in the first 48 hours gives an opportunity to determine indications to myocardial revascularization, to avoid discrepancy between choice of treatment tactics and noninvasive assessment of risk. The latter can be used with the aim of optimization of timing of early invasive strategy. In high risk it is expedient to employ it immediately, in medium - without delay allowed in recommended time intervals. Rentgenoendovascular restoration of IRA conducted during one procedure is an optimal type of myocardial revascularization in many patients including those with multiple CA involvement. Method of choice in patients with stenoses of left CA trunk or its equivalents is surgical revascularization of the myocardium. Detection of indications for myocardial revascularization in patients with unstable angina including those at medium and low risk confirms necessity of application of early invasive strategy as conventional strategy ensuring timeliness of pathogenetic treatment. Absence of indications to myocardial revascularization in a limited group of patients gives an opportunity to clarify diagnosis, prescribe drug therapy and prevent unjustified hospitalizations.

[Early and postponed percutaneous coronary interventions in acute period of myocardial infarction].

Aim of the study was elaboration of indications to the application of postponed percutaneous coronary interventions (PCI) in acute period of myocardial Infarction (Ml) in patients without prior thrombolytic therapy. We fulfilled comparative assessment of efficacy of 3 strategies of treatment of 810 patients admitted to the N.V. Sklifosovsky Institute of Urgent Aid from 2003 to 2007: primary PCI carried out within first 12 hours (n=32), postponed PCI in acute period because of initially elevated risk (n=90), conservative treatment without reperfusion therapy (n=688). Elevated risk of death according to TIMI score was used as the basis for establishment of indications for postponed interventions. Right ventricular involvement and repeat MI were considered as additional predictors. The data obtained indicate that elevated risk of death allows to detect patients with high rate of persisting occlusions and subtotal stenoses in infarct related artery. Reperfusion therapy appears to be the main component of treatment of such patients. Necessity to perform primary PCI within first 12 hours does not exclude possibility of its later use in acute period of MI. Both strategies allow to substantially lower rates of complications and lethal outcomes. Shortening of terms of application of reperfusion therapy gives an opportunity to prevent most of unfavorable outcomes. Success of postponed interventions in acute period of MI opens opportunities of their active use in patients from other hospitals.

[Effectiveness of early invasive strategy of treatment of angina of new onset].

Aim of the study was to assess effectiveness of early invasive strategy of treatment of angina of new onset (ANO). We conducted comparative assessment on invasive and noninvasive risk estimation in 106 patients admitted to N.V.Sklifosofsky Institute of Urgent Aid in 2003-2007. Percutaneous coronary interventions (PCI) on symptom related artery (SRA) within single procedure were carried out in 74 cases (70%), indications to coronary artery bypass surgery were detected in 16 cases (15%), in 16 more cases conservative treatment was used. The data obtained showed that it is rational to consider ANO as unstable angina in all cases including those without progression. Visualization of coronary arteries gives possibility to define significance of SRA and zone at risk of injury, determine indications to myocardial revascularization, and avoid inadequacy of noninvasive assessment of risk and choice of treatment tactics. The method of choice in the treatment of patients with ANO is PCI performed during single procedure. Detection of indications to coronary artery bypass surgery in low risk patients and in absence of progression confirm necessity of routine use of invasive strategy which provides timely pathogenetic treatment. Absence of indications to myocardial revascularization detected in sporadic cases provides possibility to avoid groundless hospitalizations.

[Percutaneous coronary interventions in patients with acute myocardial infarction after unsuccessful thrombolysis].

In 176 patients with acute myocardial infarction admitted to N.V. Sklifosofsky institute of urgent aid in 2003-20007 we compared efficacy of 3 strategies of treatment after unsuccessful thrombolytic therapy (TLT): percutaneous coronary intervention (PCI) during first 24 hours (n = 30), PCI on days 2 or 3 (n = 38); conservative treatment (n = 108). The data obtained show that it is expedient to consider absence of 50% reduction of STAsegment elevations in 90 min after start of TLT as indication to urgent late PCI when possibilities for immediate intervention after unsuccessful thrombolysis are lacking. Alternative reperfusion is the only type of effective treatment of patients with failed pharmacological reperfusion. Necessity to perform PCI during first 12 hours after unsuccessful TLT does not exclude possibility of its later fulfillment in acute period of myocardial infarction. Efficacy of the latter is comparable with success rate of rescue PCI. The use of both invasive strategies has allowed to lessen rate of complications and prevent lethal outcomes. Success of late urgent interventions in acute period of infarction after failed thrombolysis opens possibilities for their active use in patients transferred from other hospitals.

[Percutaneous coronary interventions in patients with acute myocardial infarction after successful thrombolysis].

In 259 patients with acute myocardial infarction admitted to N.V. Sklifosofsky Institute of Urgent Aid in 2003-20007 we compared efficacy of 3 strategies of treatment after successful thrombolytic therapy (TLT): percutaneous coronary intervention (PCI) because of recurrent ischemia within 5 days after thrombolytic therapy (n = 66), PCI in patients with elevated risk of death according to TIMI during 12-24 hours after TLT (n = 26); conservative treatment after TLT (n = 167). Differences at comparison of two invasive strategies were related to the state of infarct-related artery and clinical effect. The use of PCI in patients with elevated risk of death in 12-24 hours after TLT was in all cases associated with timely provision of completed reperfusion, improvement of contractility, prevention of development of left ventricular aneurism. The use of both invasive strategies allowed to lessen rate of complications, and achieve several fold lowering of mortality. The data obtained show that for more objective and timely selection of patients for PCI after effective TLT it is expedient to use quantitative estimation of risk according to TIMI. Such approach allows without waiting for ischemia recurrence to detect patients with elevated risk and critical stenoses being in acute need of combined reperfusion.

[Extended indications for percutaneous coronary interventions after successful thrombolysis].

UNLABELLED: The study compared the efficiency of percutaneous coronary interventions (PCI) into infarction-related coronary artery (IRCA) in high-risk patients with acute myocardial infarction (AMI), that were fulfilled 12-24 hours since the pain syndrome onset or during recurrent ischemic episodes 3 days after successful thrombolysis. In the first group (68 patients) invasive restoration of blood flow was fulfilled in 3 days (at average 48 hours) after AMI onset due to recurrent ischemia. In the second group (56 patients) IRCA recanalization was fulfilled in 12-24 hours (at average 20 hours) since pain syndrome onset due to clinical signs of unfavorable outcome high risk. IRCA recanalization was successful in 91% and 97% of cases in the first and second groups, respectively. In all cases injection of contrast media Ultravist 370 was diagnostically significant and visualized coronary arteries free of adverse events. In control group (conservative treatment) IRCA occlusion or subtotal stenosis was diagnosed in 18% and 39% of cases, respectively; stenosis >75% and <75% - in 27% and 16%, respectively. CONCLUSION: in high-risk patients with AMI percutaneous coronary interventions into IRCA can be effective 12-24 hours after successful thrombolytic therapy.

[Different methods of myocardial revascularization in non-stable stenocardia].

The purpose of the study was to evaluate different methods of myocardial revascularization. Three hundred and twenty-two patients with non-stable stenocardia were divided into two groups: group one consisted of 226 patients with mono-, bi-, or tri-vascular lesion of the coronary arteries (CA), who underwent percutaneous coronary intervention (PCCI) on the symptom-related CA (128 patients) or coronary bypass surgery (CBS) without cardiopulmonary bypass (59 patients); group two consisted of 96 patients with tri-vascular lesion of CA only, who underwent CBS with cardiopulmonary bypass (CPB) (32 patients) or without CPB (52 patients). The rest patients in both groups received drug therapy. The data from the research show that PCCI on the symptom-related CA is the method of choice in most patients, including those with tri-vascular lesion. In cases with extensive isolated stenosis of anterior descendent coronary artery and chronic occlusions preference may be given to CBS without CPB. CBS with CPB is the method of choice in patients with left CA trunk stenosis and left ventricular dysfunction. In this group of patients, CBS without CPB does not lead to complete myocardial revascularization and thus does not make surgery successful.

[Diagnostics and treatment of right ventricular infarction].

In order to evaluate the effectiveness of reperfusive therapy, 33 patients with right ventricular (RV) myocardial infarction (MI) were examined. Thirty-two of the RVMI patients had acute MI of inferior localization; in one case RVMI was found during postmortem examination in a patient who had anterior MI complicated by myocardial rapture. Thrombolytic therapy (TLT) was conducted in 23 patients, including 17 cases where TLT was combined with successful transcutaneous intervention (TCCI) in the infarction-associated right coronary artery (RCA) (16 cases) and anterior descending artery (ADA) (1 case). Among those patients, in 4 out of 7 TCCI was performed right after unsuccessful thrombolysis, in 7 out of 9 patients it was performed because of ischemia recurrence, and in 6 out of 7 cases it was carried out on the next day after successful thrombolysis because of subtotal RCA occlusion. In 5 cases successful TCCI in the infarction-associated coronary artery was performed during the first 3 hours, and in 3 cases it was done on the 2nd or 3d day from the onset of the disease. In 5 cases TCCI in ADA was carried out in addition to TCCI the infarction-associated RCA. Elective coronary bypass surgery with cardiopulmonary bypass was recommended in 6 cases. Lethal outcome took place in 2 patients who had undergone TLT within the first hours after admission. Early detection of ST segment elevation in the right thoracic leads in patients with inferior MI allows for timely diagnosis of RVMI and choice of correct therapeutic strategy. Successful thrombolysis should not be considered completed reperfusive therapy. TLT in this category of patients is accompanied by high frequency of ischemia recurrence, which is connected with critical lesion RCA and ADA, which participate in RV blood supply with collateral vessels. The success of primary and deferred TCCI in the infarction-associated, including patients after TLT, shows that invasive interventions in such patients are methods of choice; they provide the completeness of reperfusive therapy and improve the course and prognosis of the disease significantly.

[Diagnostics and treatment of traumatic myocardial infarction].

The authors describe their own clinical observations of four patients with acute chest injury, who developed myocardial infarction due to traumatic dissection of anterior interventricular artery intima and a subsequent thrombosis of the artery. The authors adduce clinicolaboratory characterization of traumatic myocardial infarction and describe early and long-term (three years) results of transcutaneous coronary operations (balloon angioplasty and stenting) performed in these patients.

[Use of neoton and finoptin to correct metabolic disorders of the brain in craniocerebral injuries]. / Ispol'zovanie neotona i finoptina dlia korrektsii metabolicheskikh narushenii v golovnom mozge pri cherepno-mozgovoi travme.

Experiments on 55 outbred adult white rats narcotized with calipsol (50 mg/kg intraperitoneally) showed that separate infusions of a synthetic creatine phosphate analog neoton (100 mg/kg) and calcium antagonist finoptin (0.1 mg/kg) into the carotid artery directly after infliction of dosed craniocerebral injury improve energy metabolism and limit the intensity of lipid peroxidation in the brain during the first hour of the posttraumatic period.