Abstract:

Introduction: the problem of the shortage of donor organs can be partially solved by expanding the donor selection criteria. The consequence of this is an increase in the risk of transmission of atherosclerotic lesions of the coronary arteries from the donor to the recipient. According to current publications, endovascular correction is the preferred treatment. Assessment of the hemodynamic significance of borderline stenosis of the coronary arteries in recipients, detected at the first coronary angiography in the early postoperative period, remains a topical issue.

Case report: article presents case report of results of endovascular correction of donor-associated lesion of coronary arteries in recipient under control of iFr.

Conclusion: due to the severity of patient's condition, the use of non-invasive methods for verifying myocardial ischemia is sharply limited, which determines the high importance of endovascular technologies for the physiological assessment of stenosis.

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https://doi.org/10.1056/NEJMoa1616540

12.   Andell P, Berntorp K, Christiansen EH, et al. Reclassification of Treatment Strategy With Instantaneous Wave-Free Ratio and В Fractional Flow Reserve: A Substudy From the iFR-SWEDEHEART Trial. JACC: Cardiovascular Interventions. 2018; 11(20): 2084-2094.

https://doi.org/10.1016/j.jcin.2018.07.035

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https://doi.org/10.1093/eurheartj/ehy394

Abstract

Heart transplantation (HTx) leads to a marked increase in the duration and quality of life of patients with terminal chronic heart failure. However, in the long-term period, recipients are faced with the problem of cardiac allograft vasculopathy (CAV), which significantly limits the survival of the heart transplant.

Aim: was to assess main approaches to the diagnosis and treatment of cardiac allograft vasculopathy, basing on analysis of literature data on the diagnostic value of invasive methods for assessing the condition of the coronary flow in CAV.

Materials and methods: 43 scientific sources of leading domestic and foreign journals were analyzed.

Results: the review provides data on modern imaging methods in assessing of intimal hyperplasia and neovascularization in patients with a transplanted heart. Possibilities of therapy and prevention of CAV are considered. Information on the role of myocardial revascularization by endovascular and surgical methods in treatment of CAV in various variants of coronary disease is analyzed.

Conclusion: CAV is the main cause of death of recipients in the long term after HTx. A prevention strategy should be based on early diagnosis to identify initial signs of the disease. Endovascular imaging methods are better than others to identify the development of CAV in early stages. Development of methods for the early diagnosis, prevention and treatment of transplant coronary artery disease is one of main tasks of modern transplantology.

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Abstract:

Aim: was to estimate parameters of left ventricle (LV) perfusion and kinetics at ischemic chronic heart failure (CHF), which initial values are predictors of increased myocardial functional reserve and patients clinical status improvement as a result of revascularization.

Materials and methods: examined 157 patients (146 men and 11 women; age from 33 to 72 years) before and in 2 - 3 days after percutaneous coronary intervention with diagnosis: CAD, CHF with NYHA class III-IV echocardiography parameters of LV: ejection fraction less than 40%, end-diastolic volume is more than 200 ml. Perfusion and function disorders were estimated with use of ECG-gated single photon emission computed tomography (SPECT).

Results: in 48% of cases 6-minute walk test increased more than 150%; NYHA class decreased by 2 classes (group 1). In 52% cases 6-minute walk test increased less than 50% and the NYHA class decreased on 1 class or did not change (group 2). Comparison of initial LV condition and clinical effect revealed following conformities. The revascularization effect is limited not to extent of coronary blood flow recovery, but first of all a cardiac muscle condition, the quantitative relation of the functioning myocardium and a focal cardiosclerosis. Thus, critical size to define the favorable forecast of revascularization is perfusion disorder more than a half of LV and kinetics disorder more than a third of cardiac muscle volume. Prevalence of a cardiosclerosis over the functioning myocardium limits clinical effect of a revascularization and growth of a functional reserve.

Conclusion: degree of initial LV myocardium perfusion and movement disorders at patients with severe ischemic heart failure is the key indicator, influencing clinical efficiency of coronary intervention

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