Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2023; 20 (2): 89-202 ➤ Периоперационная эхокардиография у больных ишемической болезнью сердца с постинфарктной аневризмой левого желудочка и постинфарктным разрывом межжелудочковой перегородки

Preoperative echocardiography in patients with postinfarction left ventricle aneurysm and postinfarction ventricular septal defect

Authors: Kopylova N.S., Sokolskaya N.O., Alshibaya M.D., Skripnik Е.V.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2023-20-2-128-139

UDC: 616.12-008.46+616.124.2-007.64+616.124.6-007.253]-073.43

Link: Clinical Physiology of Blood Circulaiton. 2023; 2 (20): 128-139

Quote as: Kopylova N.S., Sokolskaya N.O., Alshibaya M.D., Skripnik Е.V. Preoperative echocardiography in patients with postinfarction left ventricle aneurysm and postinfarction ventricular septal defect. Clinical Physiology of Circulation. 2023; 20 (2): 128–39 (in Russ.). DOI: 10.24022/1814-6910-2023-20-2-128-139

Keywords:  echocardiography postinfarction left ventricle aneurysm postinfarction septal defect early postoperative period

Received / Accepted:  01.06.2023 / 26.06.2023

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Abstract

Objective. Using modern echocardiography technologies to study the perioperative features of the anatomical and functional myocardium condition in patients with coronary artery disease with postinfarction aneurysm of the left ventricle (LV) and interventricular septum rupture, to identify echocardiographic predictors that determine an unfavorable prognosis in terms of the course of the early postoperative period and the outcome of the operation.

Material and methods. The study included 28 patients (16 men and 12 women, the average age was 61 ± 8 years) with a diagnosis of coronary artery disease, postinfarction left ventricle aneurysm, postinfarction ventricular septal defect. In all patients the operation included a geometric reconstruction of the LV cavity according to the Dor, plasty of the ventricular septal defect. Intraoperative transesophageal echocardiography was performed before and after surgery and transthoracic echocardiography in the early postoperative period. Depending on the value of the vasoactive inotropic index (VII), the patients were divided into 2 groups: the 1st group included 16 patients with VII ≤ 29, the 2nd group included 12 patients with VII ≥ 29.

Results. Before surgery all our patients had dilatation of the left and right parts of the heart, decreased pumping myocardium function of both ventricles, significant pulmonary hypertension, severe insufficiency of tricuspid valve. As a result of the performed operation everyone had a significant reduction of LV volume, pulmonary hypertension decrease. After surgery the second group of patients had reduction of LV ejection fraction, low cardiac index, as well as significant residual shunt in the patch area and signs of right ventricular overload.

Conclusion. The features of the functional state of the myocardium in an extremely severe category patients with ventricular septal rupture and left ventricular aneurysm after myocardial infarction were examined in the perioperative period. Echocardiography predictors of the severe course of the postoperative period with a high probability of death were LV ejection fraction reduction and hemodynamically significant residual shunt in the patch area.

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****
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About Authors

  • Natalya S. Kopylova, Cand. Med. Sci., Senior Research Associate of Emergency Ultrasound and Functional Diagnostics Group; ORCID
  • Nadezhda O. Sokolskaya, Dr. Med. Sci., Head of Emergency Ultrasound and Functional Diagnostics Group; ORCID
  • Mikhail D. Alshibaya, Dr. Med. Sci., Professor, Head of the Department of Surgical Treatment of Coronary Heart Disease; ORCID
  • Elena V. Skripnik, Junior Research Associate of Emergency Ultrasound and Functional Diagnostics Group; ORCID

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