[Successful experience in the correction of post-infarction ventricular septal defect].

Rupture of the interventricular septum (MVP) as a complication of acute myocardial infarction is a rare event and associated with high mortality without timely surgical treatment. We present a case of a 68-year-old patient who had an acute myocardial infarc­ tion with ST-segment elevation complicated by a rupture of MVP. In this article we discusse the difficulties of patient management with this pathology and the problem of choice of treatment tactics.

[Comparative efficacy of pharmacoinvasive strategy of myocardial reperfusion and primary angioplasty in patients with acute ST elevation myocardial infarction].

In order to assess comparative efficacy of pharmacoinvasive strategy of myocardial reperfusion and primary angioplasty in ST elevation acute myocardial infarction 289 patients were randomized at prehospital stage within first 6 hours of the disease into 2 groups: primary angioplasty (group 1), and prehospital thrombolysis with subsequent rescue or delayed angioplasty depending on efficacy of thrombolysis. We analyzed clinical and anamnestic characteristics of patients, efficacy of reperfusion measures, dimensions of myocardial necrosis, and clinical course of the disease. Pharmacoinvasive myocardial reperfusion with prehospital thrombolysis compared with primary coronary angioplasty decreased time of myocardial ischemia (224.65 +/- 71 vs. 278 +/- 184 min, p < 0.03), increased rate of achievement of TIMI grade 3 flow after percutaneous coronary intervention (80.5% vs. 71.4%, p = 0.002) and more effectively preserved left ventricular ejection fraction (60.0 +/- 14.9% vs. 54.9 +/- 12.3%, p < 0.01). Prehospital thrombolysis before coronary angioplasty compared with primary angioplasty was associated with lower rate of development of no-reflow syndrome (1.4% vs. 11.6%, p < 0.003).

[Comparative assessment of the left chest EKG leads V7-V9 and bipolar Slapak and Partilla leads in the diagnosis of posterior and posteriobasal myocardial infarction]. / Sravnitel'naia otsenka levykh grudnykh otvedenii ékg v7-v9 i dvukhpoliusnykh po Shlapak i Partilla v diagnostike zadnego i zadnebazal'nogo infarkta miokarda.

The study included 100 patients with acute inferoposterior myocardial infarction consequently admitted to hospital. Both the standard ECG in 12 leads as well as additional V7-V9 and Slapak & Partilla leads were recorded in each patient. Two-dimensional echo at rest was performed to evaluate regional wall motion. The criterion of dividing patients into any MI subgroup was the presence of abnormal Q wave in any system leads. Posterior + inferior MI was found in 88%, limited posterobasal--in 2% and diaphragmal (inferior)--in 10% of patients. Good correlation of Q-wave in II, aVF and S1-S4, V7-V9 and S1-S4 was found. The more abnormal Q waves were revealed in lead systems the more was necrosis size as assessed by echo. We conclude, that additional lead systems are of value in revealing necrosis size and its location in patients with damaged posterior wall.

[Effectiveness of pre-hospital thrombolytic therapy in acute myocardial infarction]. / Effektivnost' tromboliticheskoi terapii ostrogo infarkta miokarda na dogospital'nom étape.

The efficacy and risk of prehospital thrombolysis for acute myocardial infarction (MI) were evaluated in a randomized trial. Patients received streptokinase, 500,000 U, and heparin, 10,000 U, intravenously within 5-10 minutes before (Group 1, n = 50) or after (Group 2, n = 50) hospital admission. One hundred patients took conventional therapy (Group 3). The mean time interval between the onset of symptoms and thrombolytic therapy was 2.2, 4.5, and 3.8 hours in Groups 1, 2, and 3, respectively (p < 0.001). Severe hemorrhages were absent. The rate of ventricular fibrillation was the same in Groups 1 and 3 prior to hospitalization. Left ventricular contractility was identical in Groups 1 and 2. By the end of the fourth week, Group 1 showed a 14% increase in ejection fraction and a 14.5% decrease in akinetic segment, these parameters substantially unchanged in Group 2. The MI size assessed by ECG and the maximum myoglobin concentrations was significantly less in Group 1 than that in Group 2. The patients from Group 1 had fewer MI complications than those from Groups 2 and 3. Three patients died in Group 1, 6 in Group 2, and 16 in Group 3. (p < 0.05).

[Changes in contractile function of the left ventricle under the effect of thrombolytic reperfusion of the coronary arteries in acute myocardial infarct]. / Izmenenie sokratitel'noi funktsii levogo zheludochka pod vliianiem tromboliticheskoi reperfuzii koronarnykh arterii pri ostrom infarkte miokarda.

A total of 73 patients with myocardial infarction (MI) were included into a prospective study involving intravenous and/or intracoronary streptokinase administration. The total ejection fraction (EF) and the extent of left ventricular dys- and akinetic areas were measured by contrast ventriculography in the first 3-9 hours and 4 weeks after the onset of MI symptoms. Coronary reperfusion performed in the first 3 hours after the onset of symptoms in patients with anterior MI (n = 8) and following 3-9 hours (mean 6.6 +/- 0.89 hours) in patients with inferior MI (n = 17) significantly (p less than 0.05) reduced the extent of dys- and akinetic areas from 20.5 +/- 4.16 to 6.0 +/- 3.99 and 10.0 +/- 1.56 to 5.0 +/- 1.74%, respectively) following 4 weeks. EF significantly (p less than 0.01) increased in the former and tended to show an increase from 51.0 +/- 2.44 to 64.0 +/- 2.26% (p less than 0.1) in the latter. In patients with anterior MI (n = 19) there was a tendency to a decrease in the extent of dys- and akinetic areas from 26.0 +/- 2.85 to 17.0 +/- 3.9 (p less than 0.1) following 3-9 hours. No substantial changes were observed in the values of left ventricular dys- and akinesis and EF in patients with anterior (n = 13) and inferior (n = 16) MI without coronary reperfusion.

[Relation between microcirculatory disorders and coronary circulation in patients with a history of myocardial infarction (clinico- angiographic study)]. / Vzaimosviaz' rasstroistv mikrotsirkuliatsii i koronarnogo krovo- obrashcheniia u bol'nykh, perenesshikh infarkt miokarda (kliniko- angiologicheskoe issledovanie).

The interrelationship between bulbar conjunctival microcirculation and coronary blood flow was studied in patients who had sustained myocardial infarction. It was shown that the trends in abnormal changes occurring in the cardiac vessels and their severity might be judged from microcirculatory alterations in the bulbar conjunctiva.

[Comparison of intracoronary and intravenous methods of thrombolytic streptokinase therapy of patients with myocardial infarct]. / Sravnenie vnutrikoronarnogo i vnutrivennogo metodov tromboliticheskoiterapii streptokinazoi bol'nykh ostrym infarktom miokarda.

Intracoronary streptokinase (250.000 units over 60-90 min) was administered within 7.8 +/- 0.4 hrs after the onset of myocardial infarction symptoms to 85 patients, and intravenous streptokinase (500.000 units over 5-10 min) was given within 4.8 +/- 0.4 hrs to 46 myocardial infarction patients. Coronary angiography was conducted 1 to 3 hours after intravenous streptokinase administration. Coronary arterial reperfusion was achieved in 62% of patients in the former group, and in 66% in the latter one. Reperfusion was seen in 84% of patients in the first 3 hours after the onset of infarction, and in 60-66% at later dates. Hypofibrinogenemia did not become critical and persisted for one more day in cases of intravenous streptokinase infusions, as compared to the intracoronary route. Intravenous administration of 500.000 units streptokinase at the rate of 100.000-50.000 U/min is an effective and safe method for the treatment of myocardial infarction, and its prospective application in health practices appears quite promising.

[Effect of intracoronary streptokinase infusion and verapamil treatment on the size of the affected area in myocardial infarct patients]. / Vliianie vnutrikoronarnoi infuzii streptokinazy i lecheniia verapamilom na razmer zony porazheniia u bol'nykh infarktom miokarda.

The effect of intracoronary streptokinase administration (31 patients), verapamil treatment (23 patients) and conventional therapy (27 patients) on the size of the affected area was examined in patients with acute myocardial infarction (MI). Streptokinase was administered in a dose of 250,000-500,000 IU within the first 3 to 20 hours of myocardial infarction, and verapamil, 360 to 400 mg, daily within the first 5 to 12 hours of the attack. The occluded coronary artery was recanalized in response to streptokinase administration in 21 patients. Serial measurements of CPK activity and serum myoglobin levels, and electrocardiographic precordial cartograms demonstrated a reduction in MI size following streptokinase administration. Verapamil had no basic effect on the final size of myocardial lesion, although it improved somewhat the clinical course of the disease.

[Limitation of the extent of a myocardial infarct by lysing the thrombus using intracoronary streptokinase]. / Ogranichenie razmera infarkta miokarda u bol'nykh putem lizisa tromba vnutrikoronarnym vvedeniem streptokinazy.

A total of 66 patients with acute myocardial infarction (MI) were examined: 39 of them received treatment with intracoronary administration of streptokinase within the first 3-20 h from the beginning of anginal pains, the other 27 patients (controls) were treated using routine methods. Occlusion of the coronary artery (CA) was found in 31 of 39 patients of the intervention group, stenosis over 75% was found in 8 patients. CA recanalization was achieved in 21 of 31 patients with CA occlusion. CA stenosis of various degree remained at the site of former occlusion in all the patients after recanalization. Repeated coronarography in 28 days showed reocclusion of the coronary artery at the site of stenosis in 20% of the cases. Blood flow restoration in the CA was often accompanied by the appearance of ventricular arrhythmias. Data on precordial ECG mapping (35 leads) showed the development of lesser size MI in the patients with the restored blood flow in the CA as compared to the group on routine therapy.