Abstract:

Introduction: dextrocardia - is a congenital heart disease, in which the heart is located in right half of chest. Incidence of ischemic heart disease in patients with dextrocardia is unknown, but some authors write that it is the same as in the general population. Guiding principles of endovascular treatment of chronic total occlusion (CTO) of coronary arteries, consider dualcatheter angiography to be an obligatory option for successful recanalization.

Aim: was to estimate possibilities of DRON-access and various radial accesses in treatment of multivessel disease in a patient with dextrocardia, severe comorbidity, and single vascular access.

Material and methods: we present case report of a 63-year-old female patient, who previously had ischemic stroke with tleft-sided hemiplegia; she was examined before surgery for instability of the prosthesis of right hip joint. Coronary angiography through traditional radial access revealed multivessel lesions of coronary arteries: chronic total occlusion (CTO) of right coronary artery, stenosis of the left anterior descending artery (LAD) in proximal and distal third; eccentric circumflex artery (Cx) stenosis. Further examination revealed: severe spastic paralysis of left hand, occlusion of left common femoral artery, chronic osteomyelitis of right leg with suppuration.

Medical consilium decided to perform staged endovascular revascularization of the myocardium.

For this purpose, to provide access for double-catheter recanalization of CTO and subsequent interventions, DRON-access (Distal radial and Radial One-handed accesses for interventions iN chronic occlusions of coronary arteries) and various radial accesses were used.

Results: at the first stage, using DRON-access, we performed double-catheter angiography and CTO recanalization of right coronary artery (RCA) with stenting. At the second stage, through traditional radial access, we performed angioplasty and stenting of LAD at two levels. After 3 months, control coronary angiography was performed through distal radial access: implanted stents had no signs of restenosis, there was no progression of atherosclerotic process. Patient was discharged to prepare for correction of instability of right hip joint prosthesis.

Conclusions: patients with severe and variable comorbidities require not only a multidisciplinary approach, but also, in various of clinical situations, need personalized approach. The use of DRON-access may allow operators to perform endovascular intervention using double-catheter angiography even in patients with single vascular access, which meets modern criteria for providing care for chronic coronary artery occlusions.

Abstract:

Aim: was to evaluate the efficacy of MSCT in assessment of long-term graft patency after coronary artery bypass graft surgery (CABG).

Material and methods: 25 patients with multi-vessel coronary artery disease were included in the research. To assess the 5-year graft patency, MSCT arteriography was performed.

Results: a total of 96 grafts (22 left internal thoracic artery (LITA) and 74 saphenous venous grafts (SVG)) were analyzed using MSCT There were 12 venous sequential grafts and 19 venous Y-shaped grafts determined. During the assessment of graft patency, 13 occlusions of venous grafts and 1 hemodynamically significant stenosis were detected. Occlusion and hemodynamically significant stenosis of mammary grafts were not observed.

Conclusion: MSCT arteriography, allows to determine occlusive and hemodynamically significant stenoses of SVG. Results of study shows the prevalence of SVG occlusions and stenosis over arterial grafts. CT angiography can be highly informative for assessing the patency of grafts in late periods after CABG. 

References

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Abstract:

Authors present results of simultaneous transluminal coronary interventions (TCI) (stenting) in coronary patients with triple vessel disease. Stenting of right coronary artery (RCA) and major branches of left coronary artery (LCA) was performed in 44 patients with coronary artery disease, having angina of III—IV functional classes. In total 1 83 coronary stents were implanted (1 66 «Cypher» and 17 «BxVelocity»). Stents «Bx Velocity» were used only coronary arteries with diameter > 3,5 mm. 3 stents were implanted in 22 cases, 4 — in 9, 5 — in 4, 6 — in 4 and 7 — in 7. TCI were successful in all patients, with restoration of coronary blood flow up to TIMI III through stented segments. Clinical effectiveneness of TCI during long-term follow-up (up to 32 months) was 100%, patient's survival — 90,9%. In 3 patients (6,8%) restenosis developed inside drug-coated stents (4,8%). Repeated stenting was performed with satisfactory clinical and angiographic results. Complete transluminal coronary revascularization is an effective method for treatment of patients with multiple coronary lesions. It provides return to high level of life quality.

Reference 

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8.     Babunashvili A.M., Iudin I.E., Dundua D.P., Kartashov D.S., Kavteladze Z.A. Efficacy of the use of sirolimus covered stents in the treatment of diffuse atherosclerotic lesions of coronary arteries. Cardiology. 2006; 46 (11): 21- 29.

Abstract:

Purpose. Оf the study was to determine abilities of multislice spiral tomography (MSCT) in detection coronary artery disease (CAD) in patients with atypical angina..

Material and methods. Sixty patients (39 men) with atypical chest pain and suspected ischemic heart disease underwent complex diagnostic strategy. Value of MSCT in detection of significant (more than 50%) coronary artery stenoses was assessed by segmental analysis, vascular bed involvement, and patient analysis.

Results. Significant CAD in 8% of patients with atypical angina was revealed. In 98,7% (58 of 60 cases) MSCT allowed to specify coronary anatomy. In 53 (88,3%) of patients no significant CAD was found, in 5 cases (8,3%) MSCT confirmed significant coronary artery stenoses. Sensitivity, specificity, positive and negative prognostic value of MSCT were correspondingly 100%, 99,3%, 71,4%, 100% in segmental analysis (n = 295). Vascular territory involvement analysis (n = 91) showed 100% sensitivity, 97,7% specificity, positive prognostic value 71,4% and negative prognostic value 100%.

Conclusions. High prognostic value, as well as high sensitivity and specificity of MSCT allow us to include this method into the CAD diagnostic algorithm in patients with atypical chest pain. This method is highly reliable in eliminating of significant CAD and detecting coronary artery stenoses.

References 

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Abstract:

For long time the only method of postinfarction myocardial «scars» topical diagnostics was ECG. Contrast-enhanced magnetic resonance (CE-CMR) is considered to be a highly informative technique for location and quantification of myocardial necrotic areas, but there are few studies comparing the method with conventional ECG. CE-MR/ECG correlation was studied in 59 patients with postinfarction changes. The global concordance between CE-MR and ECG was of 80%. In 5 cases (1 - anterolateral, 2 - inferior and 2 - inferolateral). ECG-pattern was misleading.

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Abstract:

Revascularization strategy definition in acute coronary syndrome in patients with multivessel coronary artery disease is a significant problem of modern intervention cardiology Aim: was to evaluate effectiveness of special PC programs «Sapphire 2015 - Right dominance» and «Sapphire 2015 - Left dominance» designed to the revascularization strategy definition ir acute coronary syndrome patients.

Materials and methods: revascularization strategy of 50 acute coronary syndrome patients was analyzed. In all cases the revascularization strategy was defined by the group of intervention cardiologists with the help of independent experts and special PC programs «Sapphire 2015 - Right dominance» and «Sapphire 2015 - Left dominance». Experts-, physicians-, and soft- based revascularization strategies were compared among themselves.

Results: complete coincidence between expert-based and soft-based revascularization strategies was registered in 66% patients and the incomplete coincidence - in 32% patients. Complete mismatch between expert-based and soft-based revascularization strategies was registered in 2% patients. The complete coincidence between physicians-based and soft-based revascularization strategies was registered in 42% patients and the incomplete coincidence - ir 52% patients. Complete mismatch between physicians-based and soft-based revascularization strategies was registered in 6% patients

Conclusion: as well as experts, special PC programs «Sapphire 2015 - Right dominance» and «Sapphire 2015 - Left dominance» provide success in the revascularization strategy definition 1г acute coronary syndrome patients with multivessel coronary artery disease.

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