Abstract:

Introduction: pulmonary arterial hypertension (PAH) is a disease characterized by a progressive increase in pulmonary vascular resistance that leads to the development of right ventricular heart failure and premature death of patients. Today, there are several ways to create an atrial communication: balloon dilatation, Park procedure, balloon knife atrial septostomy, atrial septum stenting and implantation of fenestrated occluder.

The main problem with positioning of the device is that the atrial septum is not visible on fluoroscopy, where the stent is visible throughout. And the stent is not visible throughout on echocardiography, where the septum is visible. Exactly for this operation, the combination of echo- and fluoroscopic image in real time is very useful in order to accurately place in the middle at the level of stent in the septum and to avoid its dislocation with embolization of right or left heart chambers, or vessels of pulmonary and systemic circuit.

Material and methods: we present a case report of atrial septostomy with stent implantation into the atrial septum using the EchoNavigator® hybrid imaging system in a patient with pulmonary arterial hypertension.Surgical intervention was performed on a patient with PAH: atrial septostomy with intubation anesthesia under the control of fluoroscopy and transesophageal echocardiography (TEE) using the EchoNavigator® system. The procedure was performed using a Palmaz stent, that was implanted without additional fixation.

Results: patient with pulmonary hypertension underwent an atrial septostomy using the EchoNavigator® hybrid imaging system, which was used for positioning and implantation of stent into the atrial septum as quickly and accurately as possible. This surgical intervention significantly improved patient's clinical condition, cardiac hemodynamics and, accordingly, increased the quality of life.

Conclusion: atrial septostomy is a surgical method for patients with severe pulmonary arterial hypertension. Carrying out this operation under the control of the EchoNavigator® system with the function of hybrid imaging in real time greatly facilitated the procedure for positioning and implanting of stent, facilitated the safe implementation.

References

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Abstract

Background: in patients with congestive heart failure (CHF), there is a change in indicators of heart mechanics against the background of myocardium remodeling. Currently, magnetic resonance imaging (MRI) and speckle tracking echocardiography provide additional options for assessing changes in heart mechanics. Evaluation of mechanics of the myocardium rotational movement according to coronarography (CAG) has not been found in available literature. In this regard, there is a need to develop a methodology that allows to obtain a mathematical description of rotation processes and heartbeat during the CAG.

Material and methods: study included 90 patients aged 30-71 to assess indicators of heart rotation mechanics. Subjects were divided into groups: with dilated cardiomyopathy (DCMP, n=30), left ventricular aneurysm (LVA, n=30) and patients with autonomic nervous system disorder (ANSD, n=30) without heart failure (control group). Mechanics of heart rotation was studied using the CAG technique, modified by us, based on mathematical calculations of the rotation angle in motion of points on the heart surface, determined on the coronary angiogram in two projections.

Results: study found out, that in patients with DCMP and LVA with chronic heart failure, the angle of rotation of the heart was significantly lower than in patients with ANSD who do not have heart disease (p <0,05). The link between impaired myocardial contractile function in patients with DCMP and LVA with chronic heart failure and a decrease in the heart rotation angle was confirmed (DCMP: ?²=9,774; df=1; P <0,05), (LVA: ?²=9,600; df=1; P <0,05).

Conclusion: coronarography technique that we modified, makes it possible to quantify changes in parameters of the heart mechanics in examined patients. This makes it possible to determine the presence or absence of heart failure, depending on results.

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Abstract:

The aim of the study was to define the factors, having influence to results of repeated percutaneous coronary interventions (PCI) such as isolated balloon angioplasty (BA) and BA in combination with rotational atherectomy (RA), used for treatment of stenosis inside stented segments of coronary arteries. 133 patients, submitted to repeated PCI due to development of stenosis in the stented coronary segments, were included in the study. Clinical and angiographic data were registered three times: at time of initial stenting, during repeated PCI and after 18 monthes of follow-up. Repeated PCI were done together with intracoronary ultrasonography. Decrease of neointimal volume and degree of balloon hyperinflation had not any influence on clinical end-points. Cross-luminal area of the vessel was the only significant prognostic facor for success of repeated PCI. Borderline value of the area was 4,7 sq.mm. Combined technique of PCI (BA + RA) had advantages over isolated BA only in those cases, when large cross-sectional lumen area must be achieved. Good clinical results of patients with cross-sectional lumen area >4,7 sq.mm, obtained after repeated PCI, give possoibility not to use additional interventions. If sufficient increase of the vessel lumen area can not be achieved, an active approach to therapy of such patients should be used after PCI.

The only significant beneficial prognostic factor for success of repeated PCA of the stenosed stented coronary segments was area of the vessels's lumen. It did not depend on technique of revascularisation. Such factors, as decrease of neointimal volume and degree of balloon hyperinflation, had not influence on frequency of restenosis and clinical end-points. 

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Abstract:

199 patients with ASD were included in the study. In 102 cases ASD was closed with Amplatzer system and in 97 cases cardiac surgery was performed. Analysis and comparison of ASD correction results (both short- and long-term) have been done, according to patient's age and type of ASD.

Reference 

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Abstract:

The article presents case report of step-by-step treatment of patient with coronary arteries disease (CAD). Male, 47 yrs in 1996 underwent aorto-coronary bypass with making of 7 bypasses. Due to progression of atherosclerotic disease in postoperative perion patient underwent percutaneous transluminal coronary angioplastics (PTCA). Despite of all procedures new coronary arteries and bypasses defeat appeared and restenosis of previously implanted stents was pointed. Patient was treated in different countries (Israel, Germany Japan, Russia) with different methods, including: drug-eluting stents, angioplasty with the help of excimer laser and rotational atherectomy Application of physical and mechanical isolation of hyperplastic intima (excimer laser, rotational atherectomy) did not give significant decrease of restenosis repeat. Implantation of drug-eluting stents also had no effect. Stent-in-stent implantation in case of drug-eluting stent restenosis led to repeated restenosis in this patient.

Thus, restenosis is a serious problem for interventional cardiologists. Any of available interventional methods provide optimum direct results, and the long-term results are even poorer.

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16.   Osiev A.G., Mironenko S.P., Krestyaninov O.V., Vereshagin M.A., Kretov E.I., Biryukov A.V., Grankin D.S., Prokopenko R.N. Clinical and angiographic efficacy of the coated balloon catheters in patients with restenosis of the coronary stents. Pathology of blood circulation and heart surgery. 2010; 4: 29-35 [In Russ]. 

Abstract:

Aim: was to carry out a comparative evaluation of results of stenting of bifurcation lesions in the segment of coronary chronic total occlusions (CTO) using different methods of percutaneous coronary intervention (PCI).

Materials and methods: present study is based on results of treatment of 146 patients (2010-2013) with coronary artery disease (CAD), who underwent CTO recanalization and had bifurcation with side-branch diameter more than 2mm. After successful recanalization of CTO, patients were randomized into two groups with respect to the used method of stenting: a group with stenting of major vessel and side branch with technique «Mini Crush», and a group with Provisional «Т-stenting» technique. The primary composite endpoint - incidence of major adverse cardiac and cerebrovascular events (MACCE), which includes thrombosis, restenosis, repeated intervention in the target vessel, acute myocardial infarction, stroke and cardiovascular death.

Results: absence of MACCE in the remote period of observation was significantly higher when using and amounted to 87,7% against 63,1% at 12 months after surgery

Conclusions: the use of technique «Mini crush» stenting is more effective (to reduce frequency of post-operative complications, risk of restenosis and repeat intervention in long term) in patients with bifurcation lesions in chronic total occlusion of coronary artery in comparison with using «T-provisional» stenting. 

References 

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2.    Colombo A., Moses J., Morice M., et al. The randomized study to evaluate sirolimus-eluting stents implanted in coronary bifurcation lesions. Circ. 2004; 109:1244-9.

3.    Garot P, Lefevre T., Savage M., et al. Nine-month outcome of patients treated by percutaneous coronary interventions for bifurcation lesions in the recent era: a report from the Prevention of Restenosis with Tranilast and its Outcomes (PRESTO) Trial. J. Am. Coll. Cardiol. 2005; 46:606-612.

4.    Nakamura S., Muthusamy T., Bae J., et al. Impact of sirolimus-eluting stent on the outcome of patients with chronic total occlusions: multicenter registry in Asia. J. Am. Coll. Cardiol. 2004; 43:35A.

5.    Werner G., Krack A., Schwarz G., et al. Prevention of lesion recurrence in chronic total coronary occlusions by paclitaxel-eluting stents. J. Am. Coll. Cardiol. 2004; 44: 2301-2306.

6.    Hoye A., Tanabe K., Lemos P, et al. Significant reduction in restenosis after the use of sirolimus-eluting stents in the treatment of chronic total occlusions. J. Am. Coll. Cardiol. 2004; 43: 1954-1958.

7.    Kini A., Lee P, Marmur J., et al. Correlation of post-percutaneous coronary intervention creatine kinase-MB and troponin I elevation in predicting mid-term mortality. Am. J. Cardiol. 2004; 93:18-23.

8.    Osiev A.G., Baystrukov V.I., Biryukov A.V. Taktika endovaskulyarnogo lecheniya pri bifurkacionnom porazhenii posle rekanalizacii khronicheskoy okklyuzii koronarnyh arteriy.[ Endovascular treatment tactics in patients with bifurcation lesions after recanalization of chronic coronary arteries occlusions]. Diagnosticheskaya i intervencionnaya radiologiya. 2013; 7(1): 27-31[In Russ].

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10.  Galassi A., Colombo A., Buchbinder M., et al. Long term outcome of bifurcation lesions after implantation of drug-eluting stents with the «Mini-Crush technique». Catheter. Cardiovasc. Interv. 2007; 69:976-83.

11.  Galassi A., Tomasello S., Capodanno D., et al. «Mini Crush» versus «T-provisional» techniques in bifurcation lesions: clinical and angiographic long-term outcome after implantation of drug-eluting stents. J. Am. Coll. Cardiol. Intv. 2009; 2: 185-94.

Abstract:

Aim: was to determine indications for various methods of stenting on the base of conducted earlier interventions on bifurcation lesions after previously coronary artery occlusion.

Methods. In NRICP we studied a group of patients who underwent PCI for occluded arteries since 2009 to 2011. The study included patients with chronic total occlusion and bifurcation lesion with a diameter of side brunch more than 2 mm and stenosis >50%. Patients were divided into two groups (proximal and distal lesions) with respect of the proximal cap occlusion to the bifurcation. The primary end point was the emergence of MACE during the hospital period, including death, myocardial infarction, or repeat revascularization of the target vessel. Immediate angiographic success was considered in the case of blood flow TIMI II-III after stenting and residual stenosis of less than 50%.

Results. For the period of 2009-2011 PCI was performed. 307 patients were included in the study. The group of proximal lesions included 148 cases. The group of distal lesions consisted of 159 patients. Immediate angiographic success was observed in 98.3% of cases. Deaths, myocardial infarction, cerebrovascular accident, re-PCI, CABG during the hospital period were not noted.

Conclusion. Bifurcation lesions occure in 57,9% of cases after recanalization of chronic occlusions. In both groups one stent technique dominated, but in a group of proximal lesions two stents technique was used 5,8 times more often than in the distal lesions group. In both groups, MACE in hospital period were not noted.

References 

1.    Nakamura S., Muthusamy T.S., Bae J.H., Cahyadi Y.H., Udayachalerm W., Tresukosol D. Impact of sirolimus-eluting stent on the outcome of patients6. with chronic total occlusions. Am. J. Cardiol. 2005; 95: 161-166.

2.    Werner G.S., Krack A., Schwarz G., Prochnau D., Betge S., Figulla HR. Prevention of lesion recurrence in chronic total coronary occlusions by paclitaxel-eluting stents. J. Am. Coll. Cardiol. 2004; 44: 2301-2306.

3.    Valent R.I., Migliorini A., Signorini U., Vergara R., Parodi G., Carrabba N., et al. Impact of complete revascularization with percutaneous coronary intervention on survival in patients with at least one chronic total occlusion. Eur. Heart. J.2008; 29: 2336-2342.

4.    Kahn J.K. Angiographic suitability for catheter revascularization of total coronary occlusions in patients from a community hospital setting. Am. Heart J. 1993; 126: 561-4.

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6.    Garot P., Lefevre T., Savage M., Louvard Y., Bamlet W.R., Willerson J.T., Morice M.C., Holmes D.R. Jr. Nine-month outcome of patients treated by percutaneous coronary interventions for bifurcation lesions in the recent era: a report from the Prevention of Restenosis with Tranilast and its Outcomes(PRESTO) trial. J. Am Coll. Cardiol. 2005; 46: 606-12.

7.    Colombo A., Moses J.W., Morice M.C., Ludwig J., Holmes D.R. Jr., Spanos V., Louvard Y., Desmedt B., Di Mario C., Leon M.B. Randomized study to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions. Circulation. 2004; 109:1244-9.

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Abstract:

Aim: was to estimate possibilities of two-dimensional and three-dimensional transesophageal echocardiography (TEE) in the diagnosis of atrial septal defects (ASD).

Material and methods: 52 patients with atrial septal defect underwent TEE. In 32 cases - 3D TEE, 20-2D TEE. 44 patients further underwent endovascular closure of ASD, 8 underwent cardiac surgical correction of ASD with extracorporeal circulation.

Results: 3D TEE allows to make more accurately and correctly measure of ASD, to determine its location, shape, and number of defects and to quantify all edges, including top, and to measure the length of the partition in three standard areas and additional-caval from lower to upper edge.

Conclusions: 3D TEE gives the most correct estimation of localization, shape and size of the defect, as well as contributes the proper determination of the optimal tactics of surgical correction of the defect.

References

1.    Tkachev I.V., Kondrabulatova S.S., Tarasov D.S. Rol' trehmernoj jehokardiografii v predoperacionnoj ocenke defektov mezhpredserdnoj peregorodki[The role of 3D echocardiography in preoperative estimation of atrial septal defects] Patologija krovoobrashhenija i kardiohirurgija. 2014; 1:58-61 [In Russ].

2.     Klinicheskaja kardiologija: diagnostika i lechenie v treh tomah [Clinical cardiology: diagnostics and treatment in 3 volumes. Under edition of L.A. Bokeria, E.Z.Golukhov]. T 1. ( pod redakciej L.A. Bokerija., E.Z. Goluhova) M.: NCSSH im. A.N. Bakuleva RAMN. 2011; 518-52[ In Russ].

3.    Narcyssova G.P., Malahova O.Ju., Osiev A.G. Ul'trazvukovye kriterii otbora pacientov s defektom mezhpredserdnoj peregorodki na jendovaskuljarnuju korrekciju sistemoj AMPLATZER i ocenku rezul'tatov - medicinskaja tehnologija. [Ultrasound criteria for selection of patients with atrial septal defect for endovascular correction with AMPLATZER system and the evaluation of results.] Novosibirsk. 2012; 10-11 [In Russ]

4.    Prakticheskaja jehokardiografija[Practical echocardiography (under edition Frank A. Flaksamph, translation from germany - V.A. Sandrikova] (pod red. Franka A. Flaksampfa perevod s nem. pod obshhej red. V.A. Sandrikova) M.MED-press-inform. 2013; 224-234 [In Russ].

5.    Tkacheva A.V. Diagnostika i jendovaskuljarnoe zakrytie vtorichnogo defekta mezhpredserdnoj peregorodki ustrojstvom «AMPLATZER» [Diagnosis and endovascular closure of secondary atrial septal defect with «AMPLATZER» device] Avtoreferat. Diss. kand. med. nauk. M. 2008; 24 [In Russ].