Abstract:

Lesions of the LCA stem are found in 2,5-4 % of patients with coronary heart disease who endured coronography, and are accompanied by more severe symptomatology, higher morbidity and mortality rates, and difficulty of radical correction. According to the generally accepted guidelines, the operation of coronary artery bypass has up to now been a method of choice in treatment of the LCA stem. Nevertheless, endovascular methods of treatment for LCA stem lesions have relatively long been used, while implementation into clinical practice of drug-eluding stents has considerably improved the remote outcomes, which made it possible to consider LCA stem stenting as a real alternative to ACB. Hence, the problem concerning indications for and contraindications to LCA stem stenting remains unsolved today. We retrospectively analysed a total of 75 endovascular interventions on the LCA stem in 67 patients, with an isolated lesion of the LCA stem being found only in 7,4 % of the patients. The remaining subjects had lesions of the LCA stem on the background of a multivascular lesion of the coronary bed, including occlusion of the RCA observed in 16,4 % of cases. Successive revascularization was performed in 98,64 % of cases, with no lethal outcomes. One patient required urgent ACB due to development of occluding dissection of the circumflex branch. Complications in the immediate postoperative period were observed in two patients and were represented by non-Q myocardial infarction and stroke. LCA stem stenting proved an efficient and safe method of treatment for coronary heart disease. A comparative analysis of the immediate results of LCA stem stenting and ACB revealed advantages of stenting, consisting in no lethal outcomes (in our series) and a lower short-term rate of postoperative complications.

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16.   Бокерия Л. А., Алекян Б. Г., Бузиашвили Ю. И. и др

Abstract:

We had analyzed percutaneous coronary intervention (PCI) of non-standard complications - coronary artery dissection with extension on the eft main coronary artery (LMCA) and aorta. There was the coronary dissection of LMCA and aorta after left internal thoracic arteries and left anterior descending anastomosis (LIMA-LAD) balloon predilatation. Satisfactory angiographic result was achieved with blood flow TIMI III after stent implantation. In connection with the stable condition of the patient there was no endovascular or surgical treatment. The patient had stable hemodynamics in hospital period. The angiografic control was performed after 8 days. There was no coronary and aorta dissection and stent-thrombosis.

In conclusion in can be said that conservative tactics may be useful in a case of retrograde coronary and aorta dissection after LIMA-LAD stent mplantation.

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Abstract:

Importance: despite generally promising outcomes after stenting for unprotected left main coronary artery (ULMCA) disease, the ULMCA bifurcation lesions remain challenging, and their restenosis rate is still relatively high.

Objective: aim of the current study was to analyze possible factors influencing one year MACE rate in distal ULMCA patients.

Design, setting and patients: from year 2002 until end of year 2011 at Latvian Centre of Cardiology Pauls Stradins Clinical University hospital in ULMCA registry 1052 patients were enrolled. Interventions: In 723 patients distal bifurcations were treated, out of them in 449 patients one year follow-up were completed and those patients were included in current analyses Main outcome measures: cardiac death, target vessel revascularization (TVR), target lesion revascularization (TLR), major cardiac adverse events (MACE) were assessed at one year.

Results: two stent technique was used in 8,5% of cases. MACE, cardiac death, TVR and TLR rates at one year was 15,6%, 2,9%, 4,7% and 12,9%, respectively Cardiac death was associated with diabetes mellitus and NSTEMI, however, TLR was associated with SYNTAX score >30. MACE was associated with NSTEMI and 2 stent technique. True bifurcation was not associated with adverse cardiovascular outcomes.

Conclusions: Use of two stent technique and NSTEMI at presentation were associated of MACE at one year in distal ULMCA patients. 

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Abstract:

Aim: was to show capabilities of MDCT-angiography of coronary arteries in the detection and characterization of rare forms of anomalous coronary arteries from the pulmonary artery in adult patients

Materials and methods: we made retrospective study of anomalous coronary arteries from pulmonary arteries in patients who have been examined and operated in our Center for the period of 2008-2013. All patients on admission underwent: echocardiography, selective coronary angiography and MDCT coronarography Postoperatively - echocardiography and MDCT coronarography.

Results: for the period of 5 years about 30,000 patients underwent examination in our center, and congenital anomalous coronary arteries from the pulmonary artery was identified only in 6(0,02 %) cases. 4( 0,013%) of them had «infantile» type - ALCAPA. In adults, anomalous coronary arteries from the pulmonary artery revealed in 2 cases: a 31 year woman had «adult» type ALCAPA (0,003%) and 17-year boy - isolated form ARCAPA (0,003%). Preoperative MDCT provided direct visualization of anomalous coronary arteries from the pulmonary artery, displayed the spatial relationship of coronary vessels in the three-dimensional image that helped to clarify and demonstrate for cardiac surgeons individual characteristics of congenital disorder. Marked dilatation and tortuous course of trunks and branches of coronary arteries, the severity of which declined after surgical correction. Adult patients successfully underwent surgical correction: reimplantation of anomalous coronary arteries in orthotopic position in cardiopulmonary bypass with the creation of two-coronary blood supply of the heart

Conclusions: Even in cases where a definitive diagnosis of anomalous coronary arteries from the pulmonary artery can be diagnosed by echocardiography and coronary angiography, before surgery is recommended to perform MDCT angiography to clarify the anatomy and more specific spatial representation of the topography of the anomalous vessel. In the late postoperative period this method allows to assess in details the condition of coronary flow and effectiveness of coronary intervention. 

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