Ukrainian Journal of Cardiovascular Surgery

Advances and Challenges of Ukrainian Cardiac Surgery during the Second Year of the Great War

Vasyl V. Lazoryshynets — Wed, 27 Mar 2024 00:00:00 +0200

MicroRNAs and Oxidative Stress Markers as Additional Diagnostic Criteria for Coronary Heart Disease

Oksana Yu. Marchenko, Nadiya M. Rudenko, Dmytro S. Krasnienkov — Wed, 27 Mar 2024 00:00:00 +0200

The aim. To examine the significance of microribonucleic acids (miRNAs) and oxidative stress markers in predicting the onset of atherosclerosis and the connection between oxidative stress levels and miRNAs in individuals with coronary heart disease.

Materials and methods. Initially, 40 patients were divided as follows: 10 subjects without any lesions in coronary arteries (group 0), 4 patients with non-stenotic atherosclerosis (group 1), and 26 patients with significant multivessel atherosclerotic lesions (group 2). Various biochemical parameters were analyzed, including miRNA expression levels and common oxidative stress markers.

Results. The groups were comparable in terms of the patients’ age, but there was unequal distribution of males and females in the angio-groups as per Fisher’s exact test. We also analyzed the data separately for females, but no significant difference was found. There were significant differences in miRNA-122 levels, N-terminal prohormone of brain natriuretic peptide levels, lipid profiles, and oxidative stress markers between group 0 and groups with atherosclerotic lesions. Specifically, miRNA-122 levels were elevated in group 0, along with N-terminal prohormone of brain natriuretic peptide, triglycerides, ratio of triglycerides to high-density lipoprotein cholesterol, and oxidative stress markers. Conversely, compared to group 0, total cholesterol, high-density lipoprotein cholesterol, bilirubin, and specific glutathione levels decreased in patients with coronary lesions.

Conclusions. The study demonstrated the potential of miRNAs, particularly miRNA-122, as predictive biomarkers for atherosclerosis. Further research with larger cohorts is warranted to validate these findings and explore additional miRNA candidates and therapeutic interventions for cardiovascular diseases.

The Influence of Myocardial Revascularization on the Condition of the Distal Part of Coronary Arteries in Patients with Type 2 Diabetes Mellitus

Georgiy B. Mankovsky, Yana Yu. Dzhun — Wed, 27 Mar 2024 00:00:00 +0200

The aim. To study the dynamics of the internal lumen of the distal part of coronary arteries after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with type 2 diabetes mellitus

Materials and methods. This retrospective study included 121 patients with coronary artery disease and type 2 diabetes mellitus after revascularization of coronary arteries through PCI or CABG. In order to evaluate the changes in the condition of the distal sections of the coronary arteries after stenting and CABG, we included patients with type 2 diabetes mellitus in whom repeated coronary angiography was performed 12-60 months after PCI or CABG. The quantitative method (quantitative coronary angiography) and semi-quantitative assessment scales were used to assess the dynamics of the distal part of the coronary arteries.

Results. The mean age of the patients was 56.2 ± 0.4 years for patients who underwent CABG and 54.3 ± 0.4 years for patients who underwent PCI. There were 64.7% men in the CABG group and 54.0% in the PCI group. The use of drug-eluting stents didn’t affect the internal lumen of the distal part of the arteries. After implantation of bare metal stents, progression of diffuse atherosclerotic lesions was detected. The use of arterial grafts during CABG improved the condition of the inner lumen of the bypassed vessel. However, after venous grafts placement, the patency of the distal coronary arteries may deteriorate in the future.

Conclusions. In people with type 2 diabetes mellitus and coronary artery disease, after cardiac surgery, the smaller branches of the blood vessels can become narrower over the next 1-5 years if a stent without medication or a vein graft is used. However, when a drug-eluting stent or an artery graft is used, the smaller vessel branches stay about the same or even improve over time.

Prevalence of Coronary Microvascular Dysfunction in Patients after Coronary Artery Bypass Grafting

Yevhen Yu. Marushko, Oleksandr S. Stychynskyi — Wed, 27 Mar 2024 00:00:00 +0200

The aim. To analyze the prevalence of coronary microvascular dysfunction (CMD) in patients with coronary artery disease after coronary artery bypass grafting (CABG).

Materials and methods. The study was conducted in compliance with the provisions of the Declaration of Helsinki and was approved by the local ethics committee during 2018-2021. Due to recurrent complaints of discomfort/pain behind the sternum or shortness of breath during physical exertion in patients after CABG (average time of occurrence 18 ± 6 months after surgery), as well as positive or doubtful result of the stress testing, 31 patients were re-hospitalized for further examination. To diagnose CMD, echocardiography was performed with intravenous dipyridamole in order to determine the coronary flow reserve. The patency of the grafts was confirmed and newly formed hemodynamically significant coronary artery lesions were excluded during invasive coronary angiography.

Results. The mean age was 61.2 ± 2.3 years, the majority of the patients were male (20 [64.5%]). The most common comorbid pathologies in the patients were: hypertension in 29 patients (93.5%), impaired glucose metabolism (diabetes/prediabetes) in 17 (54.8%) subjects, 13 (41.9%) patients had a history of myocardial infarction. Left ventricular ejection fraction according to echocardiography was reduced (less than 55%) in 5 (16.1%) of 31 patients, in others it was preserved. After CABG, there was a trend towards the coronary flow reserve increase, but no significant difference was found (1.89 ± 0.08 vs. 2.11 ± 0.13; p > 0.05). The presence of CMD before and after CABG did not change significantly (13 [41.9%] vs. 12 [38.7%]; p > 0.05).

Conclusion. According to the results of the study, CMD is a common pathology in patients with obstructive coronary artery disease and is found in about 40% of patients with repeated myocardial ischemia after CABG. CABG did not affect the frequency of detection of CMD in patients with coronary artery disease before and after the operation.

Bidirectional Cavapulmonary Anastomosis as a Stage of Hemodynamic Correction of Hypoplastic Right Heart Syndrome

Wed, 27 Mar 2024 00:00:00 +0200

Hypoplastic right heart syndrome (HRHS) is a rare cyanotic congenital heart disease with a wide spectrum of cardiac anomalies characterized by underdevelopment of the right heart. Survival and type of surgery in these patients directly correlate with structural anatomy and circulatory physiology.

The aim. To evaluate perioperative characteristics in patients with HRHS, immediate and long-term results after bidirectional cavapulmonary anastomosis.

Materials and methods. In the period from 1996 to 2022, 80 patients with HRHS underwent hemodynamic correction at the National Amosov Institute of Cardiovascular Surgery. All the patients were divided into three age groups: group I (n = 18) with patients who underwent hemodynamic correction under the age of 1 year, group II (n = 33) including patients who underwent surgery between the ages of 12 and 36 months, and group III (n = 29) comprised of those operated at the age older than 3 years.

Results. In the early postoperative period, 5 (6%) deaths were reported among the patients of three groups: 3 in group I and 2 in group III. There were no deaths among patients of the group II. Median durations of mechanical ventilation, total exudation, hourly and total sympathomimetic support, hospital stay were significantly lower in group II in contrast to the comparison groups. An uncomplicated course of the early postoperative period was observed in 59 (74%) patients.

Conclusions. In patients with HRHS, the determination of treatment tactics requires a careful approach, especially in newborns and infants. The implementation of hemodynamic correction shows significantly better results in early childhood.

Comparison of the Effectiveness of Ductus Arteriosus Stenting and Systemic-to-Pulmonary Artery Shunt Placement in a Cohort of Newborns with Duct-Dependent Pulmonary Circulation

Wed, 27 Mar 2024 00:00:00 +0200

In newborns with congenital heart defects and duct-dependent pulmonary circulation, the first stage of palliative intervention may involve the systemic-to-pulmonary artery shunt (SPAS) placement or the patent ductus arteriosus (PDA) stenting. SPAS placement is a traditional method, but the trend towards reducing the invasiveness of surgical interventions has led to PDA stenting use as a preferred method to ensure a reliable source of pulmonary blood flow.

The aim. To compare pre- and postoperative indicators, complications, and long-term outcomes in two groups of patients after SPAS placement and PDA stenting.

Materials and methods. This single-center retrospective study included 82 newborns who underwent SPAS placement (Group I) and 47 patients who underwent PDA stenting (Group II) from 2015 to 2023. Baseline clinical data were similar in both groups. The arterial blood oxygen saturation (SaO₂) was significantly lower in the PDA stenting group compared to the SPAS group (65.7 ± 11.1% vs. 79.2 ± 10.6%, respectively) (p < 0.00001). There was higher percentage of genetic/concomitant pathology in Group II, 13 (27.6%) versus 10 (12.2%), p = 0.02.

Results. There was no statistically significant difference between the analyzed patient groups in clinical status indicators in the postoperative period, including: the duration of artificial lung ventilation (165.5 ± 94 and 150 ± 113 in groups I and II, respectively) (p = 0.87) and length of stay in the intensive care unit (14 ± 7 and 13.6 ± 9.4 days) (p = 0.76). However, SaO₂ was higher in Group I than in Group II (81 ± 5.5% vs. 85 ± 4.6%, respectively) (p = 0.02). Before the next stage of surgical correction, the Nakata index in Group II was significantly higher than that in Group I (225 ± 87.4 mm²/m² vs. 168 ± 35.9 mm²/m², respectively) (p = 0.048). The percentage of reoperations was higher in Group II (17 [36.1%] versus 14 [17.1%]), however, the overall (14.9% and 26.8%) and late (9.1% and 19.5%) mortality rates were lower in Group II.

Conclusion. Considering the similar results in both patient groups, stenting may be an effective option to increase the pulmonary blood flow in newborns. Due to its minimally invasive procedure, this method may be a choice for premature newborns and children with complex comorbidities. However, SPAS placement remains an important palliative intervention, particularly in cases where ductus arteriosus is tortuous and in congenital heart defects with complex intracardiac anatomy postponing radical correction until older age.

Experience of Morphologic Left Ventricle Training in Congenitally Corrected Transposition of the Great Arteries in Children: Evaluation of the Operation Results

Olena V. Stohova — Wed, 27 Mar 2024 00:00:00 +0200

The aim. To evaluate the efficacy of morphologic left ventricle (mLV) training through pulmonary artery banding (PAB) in pediatric patients with congenitally corrected transposition of the great arteries.

Materials and methods. From 2003 to 2023, 12 patients underwent PAB for mLV training at the Ukrainian Children`s Cardiac Center. The mean age of the patients was 30.3 ± 25.1 months, the mean weight was 11.6 ± 5.2 kg. Hemodynamic parameters were assessed to determine the size of the band applied to the pulmonary artery (PA) trunk during the operation. Intraoperative transesophageal echocardiography was performed in 6 patients. Transthoracic echocardiography (TTE) was performed in the early postoperative period. In the remote period, all the patients underwent TTE and X-ray angiography.

Results. During PAB, the mLV pressure averaged 58 ± 12.6% (from 40% to 80%) of the systemic arterial pressure. PAB dilatation was required for one patient in the early postoperative period (postoperative day 2) because of significant hemodynamic changes. In the early postoperative period, the maximum gradient across PA measured by TTE averaged 39.3 ± 10.0 mm Hg (from 25 to 60 mm Hg). There was no hospital mortality.

The follow-up period averaged 47.2 ± 26.0 months (8 to 113 months). In the long-term observation period, 2 patients (16.6%) died, one 8 months and the other 5 years after the operation. The double switch operation was performed in 6 patients, on average, 48.2 ± 6.9 months after PAB. According to angiography, the mLV pressure before the double switch operation was 90.2 ± 11.6% of that in the systemic right ventricle. The end-diastolic pressure in the mLV averaged 14 ± 4.1 mm Hg. The peak pressure gradient across the PA measured by echo was 81.3 ± 28.8 mm Hg. The mLV mass index averaged 62.9 ± 8.8 g/m², the mLV ejection fraction averaged 61.2 ± 2.9%. Overall radiographic and echocardiographic data in these patients indicated that mLV is trained and capable of performing the role of a systemic ventricle after anatomical correction.

Conclusions. PA banding as a method of mLV training can be used in patients with congenitally corrected transposition of the great arteries with intact ventricular septum, restrictive ventricular septal defects and severe tricuspid regurgitation.

To evaluate the effectiveness of PAB for mLV training, a multimodal diagnostic approach is used, including non-invasive and invasive methods such as TTE, transesophageal echocardiography, and cardiac catheterization. The optimal age for PAB in patients of this group for the purpose of training the LV was on average 2-2.5 years.

Individual Approach to Prescribing Sodium-Glucose Co-Transporter 2 Inhibitors in Patients with Hypertrophic Cardiomyopathy

Wed, 27 Mar 2024 00:00:00 +0200

Hypertrophic cardiomyopathy (HCM) is a common hereditary disease of the myocardium. Sodium-glucose co-transporter 2 inhibitors are recognized as first-line drugs for the treatment of heart failure, but at the moment there is little known about their use in HCM.

The aim. To assess the possibility of using an acute test with empagliflozin in patients with HCM with echocardiographic assessment of left ventricular outflow tract (LVOT) obstruction.

Materials and methods. Twenty-six non-obstructive HCM patients were examined. All the patients underwent an acute test with sodium-glucose co-transporter 2 inhibitor using 10 mg of empagliflozin and echocardiographic examination before and 3 hours after administration. Twenty-four patients were included in the further analysis (2 patients were excluded due to arrhythmia). The patients were divided into two groups: group 1 included subjects with an increase in LVOT pressure after empagliflozin (12 patients), group 2 included those without an increase in the gradient (12 patients).

Results. During the acute test, an increase in LVOT gradient occurred in 12 patients, and in 6 patients the gradient increased significantly and reached more than 30 mm Hg. The indicator at rest in patients before the test was 11.2 (10.1-19), after the test it was 12.45 (8.9-17) mm Hg (p = 0.042). The indicator at the height of the Valsalva test also increased from 15 (11-29) to 15.45 (10.4-33) mm Hg (p=0.29). Comparative analysis of clinical and echocardiographic data did not show significant difference between the groups.

Conclusions. In some patients with HCM without signs of overt or latent obstruction at the baseline, a significant increase in LVOT pressure was noted after acute test with empagliflozin. Conducting an acute test in patients with HCM is appropriate to determine the possibility of the development of LVOT obstruction while taking the drug.

Safety of One-Stage Atrioventricular Junction Ablation after Pacemaker Implantation for Left Bundle Branch Pacing

Eugene O. Perepeka, Roman A. Sikhnevych — Wed, 27 Mar 2024 00:00:00 +0200

Atrial fibrillation (AF) is one of the most common arrhythmias. Atrioventricular (AV) junction ablation combined with pacemaker implantation has become an accepted, effective strategy for the treatment of symptomatic tachysystolic AF resistant to drug therapy, especially in the elderly. Left bundle branch (LBB) pacing is a physiological alternative to right ventricular pacing.

The aim. This study evaluated the effectiveness and safety of a one-stage application of the implantation system for LBB pacing and ablation of the AV junction.

Materials and methods. For the period from January 2023 to February 2024, LBB pacing was applied in 8 patients at the National Amosov Institute of Cardiovascular Surgery in the context of treatment of chronic tachysystolic form of AF with subsequent ablation of the AV junction, as a strategy to control heart rate.

Results. In all the patients, LBB pacing criteria were achieved: Qr or qR in V1 QRS complex morphology type during pacing (100%); St-V6RWPT interval < 80 ms (mean 75.8 ± 13.9 ms); the difference between the intervals St-V1RWPT – St-V6RWPT > 44 ms (mean 55.57 ± 10.09 ms). In 3 out of 8 patients (37%) it was possible to register LBB potential. Mean paced QRS width in the studied group was 130 ± 18.02 ms. The mean intraoperative LBB pacing threshold was 1.71 ± 0.39 V for 0.4 ms, the anodal pacing threshold was 3.25 ± 0.5 V for 0.4 ms (we could demonstrate it in 6 out of 8 patients [75%]). Intraoperative lead perforation through the interventricular septum could be observed in 2 out of 8 cases (25%), but after that it was possible to successfully reimplant the lead in the area of the LBB. In all the patients of the studied group, it was possible to successfully perform radiofrequency ablation of the AV junction with the aim of heart rate control in chronic tachysystolic AF. There was no endocardial lead dislodgement in the postoperative period in any of the patients.

Conclusions. In the studied group, no complications and hemodynamic disturbances were observed in the acute postoperative period and during follow-up one week after the pacemaker implantation for LBB pacing and AV junction ablation. Intraoperative transseptal perforation of the endocardial lead did not complicate reimplantation of the lead in the LBB area. A single-stage pacemaker implantation for LBB pacing and AV junction ablation can significantly shorten the patient’s stay in a medical institution. The subject requires further research on a larger number of patients with long-term follow-up.

Characteristics of Local Endograms at the Site of Successful Arrhythmia Suppression During Activation Mapping of Idiopathic Ventricular Arrhythmias Using 3D Navigation

Serhii Yu. Prorok, Yelizaveta O. Lebedieva — Wed, 27 Mar 2024 00:00:00 +0200

A topical issue is the determination of the optimal values of activation time of local endograms (LE) and bipolar signal morphology during ablation in patients with idiopathic ventricular arrhythmias (VA) at the site of successful suppression, and the influence of 3D navigation on these values.

The aim. To study earliest activation time (EAT) and LE morphology in the area of successful suppression during ablation of idiopathic VA using 3D navigation.

Materials and methods. Analysis of the results of ablation in 57 patients with idiopathic VA was made. The patients were divided into two groups. Group I included 30 (52.6%) patients in whom mapping was performed using 3D navigation (EnSite Velocity Cardiac Mapping System). Group II included 27 (47.4%) patients who were mapped using conventional methods.

In group I, extrasystole was found in 20 (66.7%) patients, while ventricular tachycardia was observed in 10 (33.3%) patients. In group II, extrasystole was revealed in 16 (59.3%) patients, and ventricular tachycardia in 11 (40.7%) patients.

Group I included 21 (70%) patients with right ventricular localization of arrhythmia and 9 (30%) patients with left ventricular localization. Meanwhile, group II included 17 (63%) patients with a focus in the right ventricle and 10 (33%) patients with that in the left ventricle.

The morphology of the LE was evaluated according to criteria such as polarity (positive or negative) and degree of signal fragmentation (monomorphic or fragmented). Polarity was determined by the initial direction of the signal during the first 10 ms, regardless of further changes in the endogram. The signal was considered fragmented if there were three or more polarity changes.

Results. In group I, EAT of LE was -38.0±7.0 ms, while in group II it was -38.0±8.5 ms. No difference was found between the studied groups (p=0.834).

Among all patients in both groups, the average value of EAT of LE at the site of successful arrhythmia elimination was -37.0±8.5 ms. In 92.9% cases EAT of LE was -30 ms or earlier. Only in four (7.1%) patients it was possible to achieve suppression of the arrhythmia with EAT of LE not earlier than -30 ms, while in all these cases the focus was always localized in the right ventricle. The minimum value of EAT of LE at the site of successful suppression of arrhythmia was -27 ms.

The dominant morphology at the site of successful suppression among the patients in both groups, regardless of the type of mapping, was positive polarity of endogram.

Conclusions. Regardless of the mapping method, in the site of successful idiopathic VA suppression LE must precede QRS by at least 27 ms.

The Effect of the Use of Activation 3D Mapping on the Patient X-Ray Load During Radiofrequency Ablation of Typical Atrial Flutter

Andriy V. Yakushev, Borys B. Kravchuk — Wed, 27 Mar 2024 00:00:00 +0200

Supraventricular macro re-entry tachyarrhythmias occupy the leading places among all types of tachyarrhythmias. The most common in this category is typical atrial flutter (AFL). This heart rhythm disorder has a negative impact on the patients’ quality of life. Its complications can lead to disability and death due to possible thromboembolism. Therapeutic treatment is limited in effectiveness. The main method of intervention is catheter radiofrequency ablation (RFA). The standard approach of RFA of AFL is performed without the use of navigation systems under fluoroscopy guidance. However, this results in an increased radiation exposure to the patient and the medical personnel. Modern technologies in the field of invasive electrophysiology make it possible to create anatomical models of heart and reproduce the spread of electrical excitation. However, the routine use of additional navigation methods remains controversial.

The aim. To compare the duration of RFA of typical AFL and radiation exposure with the use of anatomical and propagation mapping.

Materials and methods. This study is based on the analysis of the treatment results obtained for 53 patients at the National Amosov Institute of Cardiovascular Surgery in the period from 2014 to 2023. Depending on imaging methods, the patients were divided into two groups. The first group included 27 patients with an anatomical mapping of the right atrium. The second group included 26 patients with propagation mapping.

Results. In all the patients we have achieved a bidirectional conduction block through cavotricuspid isthmus. In the first group, the total duration of confirming the diagnosis and creating the anatomical model was 312 ± 26 seconds. The mean time to the moment of AFL termination and restoration of sinus rhythm was 230 ± 19 seconds. The average duration of the procedure was 41.5 ± 3.5 minutes, the average fluoroscopy time was 120 ± 10 seconds, the average dose area product (DAP) was 15 ± 1.3 Gy·cm². In the second group, the average time for creating a 3D propagation model of right atrium and verifying the diagnosis was 748 ± 65 seconds. The average time from the first application to the termination of tachycardia was 227 ± 20 seconds. The average duration of the procedure was 55 ± 4.7 minutes, X-ray time was 93 ± 8 seconds, average DAP was 13 ± 1.1 Gy·cm². The duration of the procedure in the second group was significantly longer (p = 0.03), however, the radiation exposure and DAP were not statistically different (p = 0.31) between the observation groups.

Conclusions. The use of propagation mapping increases the time of the procedure by 24.5% and does not give a significant advantage in reducing the radiation exposure. The use of a navigation system during cavotricuspid isthmus RFA is recommended for concomitant radical treatment of complex supraventricular arrhythmias, such as atrial fibrillation.

Urgent Cardiosurgical Treatment of a Military Servant with a Moving Thrombus in the Area of the Left Ventricular Apical Aneurysm (Case Report)

Wed, 27 Mar 2024 00:00:00 +0200

Against the background of military operations, post-traumatic stress disorder, the progression of the atherosclerotic process is observed, which can lead to myocardial infarction even in young people. Left ventricular aneurysm (LVA) in military personnel is the result of untimely revascularization of an infarct-related artery, gunshot wound to the heart, chest trauma, etc. The presence of a dyskinetic area promotes formation of blood clots in the LVA cavity. LVA thrombosis is associated with an increased risk of embolism, ischemic stroke, and death.

Case description. A 37-year-old military servant A. was urgently hospitalized to the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with a mobile thrombus in the area of LVA, size 4.5 x 3 cm, with signs of lysis and a threat of separation according to echo data. The patient was found to suffer Q-wave myocardial infarction 5 months ago; at the time of examination there was decompensation of the condition and a decrease in the left ventricular contractility to 34%. The patient underwent urgent operation: on-pump coronary artery bypass grafting, LVA resection with thrombectomy. The duration of the operation was 7 hours, the aortic cross-clamp time was 53 minutes, the perfusion time was 93 minutes, the blood loss was 500 ml. The postoperative period was uneventful. The patient was discharged on the 7th day with improvement, the ejection fraction was 40%.

Conclusion. The lack of an opportunity to conduct timely electrocardiography and echo for military personnel with acute chest pain reduces the chances of diagnosis and treatment of myocardial infarction within the therapeutic window, which leads to the occurrence of complicated forms of coronary heart disease, namely LVA. Echo is of crucial importance in deciding on emergency cardiac surgery for thrombosed LVA.

Treatment of Late Infective Prosthetic Endocarditis Complicated by Cerebral Infarction with Vegetations: Pharmacotherapeutic Approach (Case Report)

Wed, 27 Mar 2024 00:00:00 +0200

Prosthetic endocarditis is a serious complication in a long term. Vegetation as a thromboembolic complication leads to neurologic deficit varying in severity.

Case description. A 35-year-old female patient F. underwent surgical treatment at the Department of Surgical Treatment of Acquired Heart Diseases of the National Amosov Institute of Cardiovascular Surgery on September 07, 2016: aortic valve replacement with wrapping tape operation II. The patient was discharged from the hospital on the 9th day after surgery in a satisfactory condition. On November 20, 2019, the patient was admitted to the Institute with the diagnosis of late infective prosthetic aortic valve endocarditis, status post aortic valve replacement and wrapping tape operation in 2016, first-degree atrioventricular block, cerebral infarctions in multiple locations with hemorrhagic transformation, with aphasia elements, ataxia, right-sided pyramidal insufficiency and suspected meningitis. After 21 days of drug therapy, the patient responded to treatment successfully and was discharged from the hospital in a satisfactory condition without surgical treatment.

Conclusions. Taking into consideration the serious condition of the patient, timely and carefully selected drug therapy can be the correct solution for the treatment of patients with late infective endocarditis. Thus, surgery is not always the treatment of choice.

Surgical Treatment of Coronary Heart Disease Against the Background of Coagulopathy of Unknown Etiology. Case Report

Mykola L. Rudenko, Olha M. Unitska, Anna Yu. Cherpak — Wed, 27 Mar 2024 00:00:00 +0200

Coronary heart disease (CHD) is one of the most common cardiovascular diseases and one of the leading causes of death in the world. Diet is the first step in the prevention of CHD. Vegetarians have significantly lower risk of death from CHD, but also have changes in the hemostasis system due to a deficiency of blood clotting factors. Cardiosurgical intervention for patients with hemostatic disorders should be performed in specialized centers with the necessary support.

Case description. A 73-year-old patient G. was hospitalized to the National Amosov Institute of Cardiovascular Surgery with angina pectoris, weakness and edema. From the past medical history it is known that the patient has been following a diet with complete exclusion of meat and dairy products for 20 years, rarely eats fish; in addition, he smoked for 20 years at a young age. After coronary angiography, the patient developed bleeding from the oral cavity of unknown origin, which resolved on its own. According to the examination, the patient was found to have a multivessel lesion of the coronary arteries, and cardiosurgical intervention was indicated: coronary bypass surgery. At a case conference with cardiovascular surgeons, anesthesiologist and cardiologist, a decision was made to perform salvage cardiac surgery. The predicted mortality risk was 7.0% by the EuroSCORE II. The early postoperative period was complicated by bleeding with subsequent revision of the pericardium to identify the source of bleeding. Coagulopathy of unknown origin was suspected. Replacement hemostatic therapy was started, which included massive blood transfusions. The pace and level of exudation significantly decreased, the operation was completed. After surgical interventions and hemotransfusions, thromboelastography was performed and plasma hypercoagulation was detected. The patient was discharged for continued cardiopulmonary rehabilitation, and outpatient treatment was prescribed.

Conclusions. This case report describes successful treatment of multivessel coronary artery disease by bypass grafting in a vegetarian patient with a coagulation disorder. Studies of the effects of a vegetarian diet on the hemostatic system indicate that vegetarians may have lower concentrations of hemostatic factors and that thrombin time is also prolonged due to the nutritional guidance provided by this diet. In addition, timely detection of a deficiency of blood coagulation factors in the plasma of a patient with such history can facilitate the diagnosis of the hemostasis system.