Complicated catheter ablation of premature ventricular contractions from the left sinus of Valsalva in a young female. Case presentation.

Idiopathic premature ventricular complexes (PVCs) are usually benign and are often treated conservatively. Data regarding radiofrequency catheter ablation (RFA) of PVCs from the aortic sinus of Valsalva are spare. Furthermore, there are limited data regarding complications and their solutions during RFA of PVCs from the aortic sinus of Valsalva. Here we describe a clinical case of symptomatic PVCs in a 27yrold young woman with reduced exercise tolerance and dyspnea. The patient had taken anti-arrhythmic group Ic, II, and III drugs with no significant effect. Successful catheter ablation of PVCs from the left sinus of Valsalva was complicated by acute occlusion of the left main coronary artery (LCA) followed by polymorphic ventricular tachycardia and ventricular fibrillation. Cardioversion and intravenous antiarrhythmic administration restored the sinus rhythm. The LCA was stented with a bioresorbable Magmaris stent with the support of extracorporeal membrane oxygenation that was required due to severe hypotension and ineffectiveness of vasopressors. After the procedure, a favorable angiographic effect was noted. The result of stenting was monitored with IVUS intravascular navigation. The patient was discharged in a satisfactory condition on the 10th day after the procedure. Special attention should be applied to prevent complications and to careful patient selection for RFA in the left sinus of Valsalva, and care must be taken to avoid injury to the LCA. Timely and correct procedures can result in patient survival even after acute LCA injury and occlusion.

[Aspects of risk stratification in acute coronary syndrome: prognostic value of evaluation of left ventricular myocardial viability according to the data of pharmacological stress echocardiography].

AIM: To define the prognostic value of the indicators of left ventricular myocardial viability according to the data of pharmacological stress echocardiography in patients with acute coronary syndrome (ACS). MATERIALS AND METHODS: The results of examinations were analyzed in a total of 91 patients with ACS; 71 of them were found to have areas of asynergy (these cases formed the key basis for statistical processing). An analysis of the outcomes registered in the established follow-up period (mean 14.3 +/- 0.7 months) took into consideration death from cardiac diseases, a recurrent acute coronary episode (nonfatal myocardial infarction (MI), unstable angina (UA)). RESULTS: Risk stratification for cardiac events in patients with ACS requires both the assessment of a myocardial viability testing result and the detection of stress-induced ischemia. An analysis of the impact of the indicators of myocardial viability on prognosis in the ACS group showed that the most important predictors of cardiac death were impaired segmental contractility index (ISCI), number of asynergic segments, and total ejection fraction (TEF) at rest; TEF, ISCI, number of segments with a negative response to low-dose drug infusion; TEF, deltaTEF (as compared to the baseline data), and a positive or negative peak stress testing result. The most important predictors of major cardiac events (death MI, UA) were ascertained to be ISCI, number of asynergic segments, resting TEF; TEF, ISCI, number of segments with a negative response to low-dose drug infusion; a positive or negative testing result, TEF, deltaTEF (as compared to the baseline data), and ISCI during the peak stress test. CONCLUSION: The low myocardial/coronary reserve increases mortality rates; the high one worsens the prognosis of major cardiac events, particularly when the test is positive, which tacitly transfers these patients to a very high risk group.

[Aspects of risk stratification in acute coronary syndrome (Part II): Prognostic value of evaluation of exercise-induced myocardial ischemia according to the data of pharmacological stress echocardiography].

AIM: To define the prognostic value of evaluation exercise-induced myocardial ischemia according to the data of pharmacological (dobutamine or dipyridamole) stress echocardiography (EchoCG) in patients with acute coronary syndrome (ACS). SUBJECTS AND METHODS: The results of examinations were analyzed in a total of 91 patients with ACS. An analysis of events in the established follow-up period (mean 14.3 +/- 0.7 months) took into consideration outcomes, such as death from cardiac diseases, a recurrent acute coronary episode (nonfatal myocardial infarction (MI), unstable angina (UA). RESULTS: Pharmacological stress EchoCG showed a positive result in 40 (44%) patients (Group 1) and a negative one in 51 (56%) patients (Group 2). Thus, the sensitivity and specificity of the pharmacological test in determining the risk for cardiac events were 89.3 and 76.2%, respectively; the prognostic value of positive and negative results was 62.5 and 94.1%, respectively. Analysis of EchoCG parameters used to identify poor prognostic factors in patients with ACS has indicated that the most important predictors of death and major cardiac events (cardiac death, acute MI, UA) are resting impaired segmental contractility index (ISCI), number of asynergic segments, and total ejection fraction (TEF) at baseline; TEF, ISCI, deltaISCI (as compared to the baseline data), and the number of segments with a negative response after low-dose drug infusion; a positive or negative result, TEF, deltaTEF (as compared to the baseline data), and ISCL at the test peak. CONCLUSION: Pharmacological stress EchoCG is a safe noninvasive diagnostic method in a group of patients with ACS. When the latter is diagnosed, it may be performed in the earliest periods (on day 4 after onset of the disease) to estimate its prognosis and to decide whether aggressive treatments should be used.

[Left ventricular remodeling in patients in patients with thyrotoxicosis].

The aim of this paper was to investigate cardiac remodelling in thyrotoxicosis. The geometric parameters of the left ventricle (LV) and the readings of tissue Doppler echocardiography were compared in 27 patients (mean age 53.3±9.2 years) who had first-diagnosed moderate thyrotoxicosis without concomitant cardiac pathology and in 16 healthy individuals (mean age 45.1±4.7 years). The baseline data and the results of incremental treadmill exercise tests were analyzed. It was shown that in the relatively early periods of thyrotoxicosis development, there were decreases in the left ventricle (LV) longitudinally and transversely and in the thickness of LV, without altering its sphericity and conicity. Along with weight loss, there were reductions in cardiac sizes with decreases in the local rates of cardiac wall movement, peak systolic and early diastolic rates of mitral movement velocities. During a treadmill test, there was a drastic reduction in the exercise tolerance threshold as compared to healthy individuals: 57.81±14.7 and 148.3±11.7 W, respectively.

[Cardiac functional reserve and left ventricular parameters in patients with diffuse toxic goiter after drug correction of euthyroidism with thiamazol].

The aim of the investigation was to assess the time course of structural-and-functional and spatiogeometric changes following drug correction of euthyroidism in patients with diffuse toxic goiter and to determine prospects for restoring the cardiac functional reserve after elimination of thyrotoxicosis. The geometric parameters of the left ventricle (LV) and the readings of tissue Doppler echocardiography and exercise tests were compared in 27 female patients (mean age 53.3±9.2 years) who had thyrotoxicosis and 6 months after thyrosole-induced normalization of thyroid-stimulating and thyroid hormone. There were significant increases in myocardial mass and peak systolic and diastolic mitral ring motion rates and an increasing trend for LV linear sizes after correction of euthyroidism. Despite the fact that there were no significant differences in the majority of LV geometric parameters, with euthyroidism achievement, the cardiac functional reserve doubled as compared with the baseline values (105.7±11.4 and 57.8±14.7 W, respectively; p < 0.001), but remained below the control level (148.7±11.7 W; p < 0.05), which may contribute to the development of heart failure in future under certain conditions.

[Acute coronary syndrome and cell technologies].

The authors researched into the possibility of autologous bone marrow stem cell (MSC) application in patients with acute myocardial infarction (AMI). 10 patients with AMI received cell therapy after giving an informed consent. ECG and EchoCG revealed myocardial infarction (MI) in the basin of the anterior interventricular branch (AIB) of the left coronary artery (LCA) in 4 patients, in the basin of the circumflex branch (CB) of the LCA--in 3 patients, and in the basin of the right coronary artery (RCA)--in 3 patients. Patients older than 70, patients with acute heart failure and those who developed AMI more than 48 hours ago, were excluded from the study. All the patients were male, aged 56.3 +/- 5.2 years, mean time from pain onset to the performance of myocardial revascularization was 11.4 +/- 7.2 hours. Marrow mononuclear fraction was introduced into the infarction-related artery on the 5th-7th day after primary angioplasty and stenting. Marrow sampling and cell material introduction did not cause any complications. All the patients were re-studied 1 month after the MSC transplantation. All the patients' condition improved; no complications or side effects of the interventions were observed. Left ventricle ejection fraction increased from 42.9% to 51.4%; the average number of asynergic segments was 5.3 +/- 0.7 before the intervention and decreased to 2.6 +/- 0.7 (p < 0.01) afterwards. Systolic velocity before the intervention was 2.5 cm/sec, and after the procedure it increased to 4.6 cm/sec in the segments submitted to isolated revascularization and to 6.1 cm/sec--in segments where the intervention was accompanied by the introduction of MSC (p < 0.01). Contrast EchoCG demonstrated an increase of myocardial perfusion in the area of cell therapy. The chief results of the study are as follows: 1) autologous MSC transplantation in patients with acute coronary syndrome is a safe and well-tolerated procedure; 2) myocardial revascularization in combination with MSC introduction in AMI area improves total and local contractile myocardial function and normalizes diastolic filling process in the LV; 3) cell therapy improves the myocardial perfusion.

[Relationship between myocardial viability and ventricular late potentials in patients with history of myocardial infarction]. / Vzaimosviaz' mezhdu zhiznesposobnost'iu miokarda i nalichiem pozdnikh potentsialov zheludochkov u patsientov, perenesshikh infarkt miokarda.

AIM: To study relationship between presence and volume of viable myocardium and registration of late ventricular potentials in patients with history of myocardial infarction. MATERIAL AND METHODS: High resolution ECG, dobutamine stress echocardiography and Holter ECG monitoring were carried out 34 patients (mean age 54.1-/+3.1 years) with history of documented myocardial infarction. RESULTS: According to data of dobutamine stress echo patients were divided into 2 groups: with irreversible myocardial dysfunction (n=16, group 1) and with hibernating myocardium (n=18, group 2). Ventricular late potentials were registered in 3 (18.7%) and 11 (61,1%) patients in groups 1 and 2, respectively. Group 2 patients more often had high-grade ventricular arrhythmias. There was no association between presence of ventricular late potentials and Lown grade of ventricular arrhythmias on Holter ECG. Duration of filtered QRS (QRSt) complex correlated directly with index of regional wall motion abnormality, end-diastolic volume, and negatively - with total ejection fraction. CONCLUSION: Among myocardial infarction survivors patients in whom dobutamine stress echo detects viable myocardium significantly more often have ventricular late potentials and high grade ventricular arrhythmias compared with patients with myocardial scars without viable myocardium.