This article provides an analysis of the results of surgical treatment of patients with various forms of coronary artery disease, the study of the quality and reliability of myocardial revascularization, assessment of patency and functional viability of coronary grafts in the early postoperative period using echocardiogra-phy and myocardial perfusion scintigraphy. The retrospective material of our study is based on the results of surgical treatment of 130 patients with coronary artery disease who were operated on in the IHD department over the past year. All patients underwent examination according to a standard protocol: electrocardiography, 24-hour Holter monitoring, selective coronary ventriculography and shuntography, echocardiography, perfusion scintigraphy before and after surgery, drug stress test to assess myocardial perfusion and contractility and its differentiation (ischemia, scarring) with hypoperfusion.
L.Yu. Kossovich, I.V. Kirillova, E.M. Shpilyansky, M.N. Konysov, D.V. Ivanov, T. V. Sukhareva, K.M. Morozov, named after N. G. Chernyshevsky 1SSU, қ. Саратов, . РФ
A case of non-penetrating neck injury with contusion and dissection of the common carotid artery with transition to the internal carotid artery is presented in a clinical observation. The clinical picture of the development of brain failure after thrombosis of the common and internal carotid arteries and regression of brain symptoms after reconstructive surgery is presented. A mathematical model of the lesion mechanism is analyzed separately. It is concluded that in case of a non-penetrating wound of the neck with a traumatic weapon, the revision of the underlying tissues should be mandatory.
Keywords
neck injury, carotid artery dissection with thrombosis, reconstructive surgery
This article provides a review of the literature on bile duct injuries after laparoscopic cholecystectomy. Laparascopy is considered the gold standard in the treatment of gallstone disease. This technique has a number of positive advantages: minimally invasiveness, quick rehabilitation, a shorter hospital stay, a good cosmetic effect, and a low lethal outcome. Along with these advantages, the number of complications also increased: damage to the bile ducts, hepatic vessels, bile leakage, formation of strictures, defects in drain-age of the biliary tract and improper treatment of the cystic duct, insufficient drainage of the abdominal cavity. Today, many aspects of surgical treatment and prevention of bile duct injuries remain controversial and are still considered relevant. The main reasons for this complication are: lack of experience of the surgeon, inattention, ignorance of the main options and possible anomalies of important anatomical structures in the area of the hepatic hilum and hepato-duodenal ligament, technical errors.
Keywords
iatrogenic trauma to the bile ducts, damage to the bile ducts
The article describes the types of correction of the supracardial form of abnormal drainage of the pulmonary veins. One of the methods of correcting this defect is the Warden operation, which includes: after sternotomy, connection of artificial circulation, cardioplegia, the superior vena cava is cut off, the proximal end is sutured. Next, a right atriotomy is performed, an anastomosis is formed using an autopericardial patch between the abnormal drainage and the left atrium through the ASD. Then an anastomosis is formed between the auricle of the right atrium and the distal end of the supe-rior vena cava. As a result, blood from the abnormal pulmonary veins begins to drain into the left atrium through the ASD.
Keywords
abnormal drainage of the pulmo-nary veins, Warden procedure
Peripheral artery aneurysms are dangerous with possible complications such as ruptures, bleeding, thromboembolism in the distal bed with subsequent tissue ischemia, neurological disorders due to pressure of closely located nerve trunks. One of the most common causes of peripheral artery aneurysms is trauma. Special attention should be paid to a sig-nificant increase in the number of iatrogenic injuries. From 2000 to 2019, 46 patients were operated on the arteries of the lower extremities. Operations of various types of reconstructions were performed. The total age of the patients ranged from 30 to 76 years, the average age of the patients was 43.3± 6.5 years. A total of 6 (9.2%) patients were operated on with combined aneurysmal lesion of the femoral and popliteal arteries. In the postoperative period, 91.5% of patients with peripheral artery aneurysm had positive clinical. results. 4 (8.5%) de-veloped complications. Long-term results were tracked in the period from 3 months to 3 years. A clinical examination was performed, supplemented by ultrasound control. 2 cases of thrombosis in the distal anastomosis were identified, which were restored after reconstruction of the distal anastomosis.
Objective: to improve the diagnosis and results of surgical treatment of patients with lower limb arteries.
Keywords
surgical treatment of peripheral artery aneurysm, common femo-ral artery aneurysm, Popliteal artery
Stroke is one of the leading causes of death and disability. According to the WHO, mortality due to stroke and other cerebrovascular diseases ranks second after cardiovascular disease. Timely revascularization of the carotid arteries has been shown to be effective in reducing the risk of cerebrovascular accident in patients with symptomatic carotid stenosis of atherosclerotic genesis. However, despite the high efficiency, there are risks of ischemic stroke in the postoperative and long-term period. This review presents statistical data on recurrent strokes and predictors of stroke development after carotid endarterectomy and carotid artery stenting.
Objective is to evaluate the effectiveness of closed-loop surgeries with the planned duration of cardiopulmonary bypass more than 2 hours in the immediate postoperative period..
Materials and methods. A study was carried out in the clinic over 10 patients (average age 47-56 years) with Diagnoses: Ascending aortic aneurysm, FC 3 aortic valve insufficiency, who underwent surgery for ascending aorta replacement, aortic valve replacement with coronary artery reimplantation. The patients were divided into 2 groups, the 1st group (5 patients) is the control group using an open cardiopulmonary bypass circuit, the 2nd group (5 patients) is the patients using a closed cardiopulmonary bypass circuit. The total time of cardiopulmonary bypass in both groups was 125-187 minutes..
Results. In the 2nd study group, drainage blood loss significantly decreased, on average 60-100 ml compared to the control group, where the average drainage loss was 600-1500 ml. The need for blood transfusion was 5.1% in the 2nd group, compared with 43.4% in the control group. In the study group 2, the number of platelets in the postoperative period in patients was higher than in the control group..
Conclusion. This study shows that a closed circuit, compared to an open one, allows complex heart surgeries with a planned duration of extracorporeal circulation of more than 2-3 hours.
This article summarizes a little experience in the treatment of patellar dislocations by the arthroscopic method. In total, from 2018 to 2021, we performed 450 arthroscopic operations on the knee joint, of which the stabilization of the patella in case of dislocation was 7. Thus: in the case of primary traumatic dislocation, we performed 4 operations, with the usual - 3. e carrying out arthroscopy, which allows you to restore the biomechanical axis with the elimination of patellar dislocation simultaneously or sequentially at the stage of treatment, allows you to get positive results.
Ambulatory cardiac monitoring is a rapidly expanding field of functional diagnostics. Today, the main direction of car-diac monitoring is outpatient monitoring of the electrocardiogram, an important diagnostic tool that is used daily by doctors in many specialties. Therefore, both wearable and subcutaneous technologies of electrocardiographic monitoring are now widely used. A number of devices can be placed under the patient’s skin and have the ability to wirelessly transmit data to home transmitters, which, in turn, then transmit data to the doctor via cloud interfaces, so that, they allow remote monitor-ing and monitoring of the patient’s condition. Such systems are widely used in various countries of the world, approved in the USA, and are also used for remote monitoring of patients in Europe and Kazakhstan, where their implementation is gaining momentum. This review presents the technical aspects of subcutaneous monitoring, provides a schematic repre-sentation of the operation of systems existing on the market, discusses the advantages of this method, as well as the disad-vantages of existing implantable cardiac monitors. The issues of the future development of this technology and indications for the use of existing devices approved by the professional cardiological communities are considered.
