ECHOCARDIOGRAPHIC PREDICTORS OF THE EARLY POSTOPERATIVE PERIOD IN PATIENTS AFTER CORONARY ARTERY BYPASS GRAFT SURGERY.

OBJECTIVE: The aim: The purpose of the present research was to study the results of coronary artery bypass graft (CABG) surgery depending on the degree of left ventricular ejection fraction (LVEF) reduction with the aim to identify additional echocardiographic predictors of the early postoperative period. PATIENTS AND METHODS: Materials and methods: Were fixed, the results of CABG in 97 patients operated on in the "Bikard" private clinic from March 2016 to December 2018 were the material of the research. All patients underwent CABG surgery under cardiopulmonary bypass and cardioplegia, and in the preoperative period underwent echocardiographic examination according to the standard technique on the Vivid 7 machine. Patients, in dependent of the LVEF, were divided into 3 groups: group 1 35 people (LVEF < 40%), group 2 32 people ( 40% < LVEF < 50%), group 3 30 people (LVEF > 50%). RESULTS: Results: Our studies showed that the most important echocardiographic predictors of a complicated development of the disease in the early postoperative period, in addition to LVEF of the heart, can be the size of the left ventricle and left atrial, the presence and severity of mitral regurgitation and diastolic dysfunction of the left ventricle of the heart. CONCLUSION: Conclusions: Comprehensive measurement of these echocardiographic parameters will allow more accurately predict the results of coronary artery bypass grafting in the early postoperative period.

The first reported case of embolic protection device implantation in a patient with prosthetic valve thrombosis treated with thrombolytic therapy: a case report.

Background: Prosthetic valve thrombosis (PVT) is a rare but one of the most dreaded complications of implanted mechanical valves. Although surgery is the first-line treatment modality particularly in symptomatic obstructive mechanical valve thrombosis, it is associated with high rates of morbidity and mortality. Thrombolytic therapy has also been used as an alternative to surgical treatment. The risk for cerebral thromboembolism associated with thrombolytic therapy seems to be the main limitation for its use in left-sided mechanical valve thrombosis. To the best of our knowledge, this is the first case of implantation of embolic protection devices during thrombolytic therapy of PVT. Case summary: Our report describes management of patient with obstructive PVT of the aortic valve. Fluoroscopy showed an immobile anterior disc of the aortic prosthesis. Transoesophageal echocardiography (TOE) detected the severely restricted prosthetic valve motions and a huge mass at the supravalvular site. A patient had very high surgical risks. Although, thrombolytic treatment was not without risk due to the large thrombus (>10 mm) increasing the risk of thromboembolism. We implanted embolic protection devices into both internal carotid arteries followed by the administration of a thrombolytic therapy with 50 mg Alteplase. After the procedure an embolized thrombus was detected at the apex at the left-sided placed device. There were no signs of transient ischaemic attack nor stroke, and the procedure was ended uneventful. The TOE performed on the next day confirmed successful resolution of the thrombus. Discussion: Mechanical left-sided prosthetic valve obstruction is a serious complication with high mortality and morbidity and requires urgent therapy. The choice between surgery, thrombolysis, and escalation of anticoagulation is considered on an individual basis. In patients with high surgical risk and high risk of embolization, an embolic protection device may be used in conjunction with thrombolytic therapy to decrease the risk of embolic cerebral events.