Endovascular repair of the aorti arch. / Éndovaskuliarnoe protezirovanie dugi aorty.

AIM: The study was aimed at assessing the in-hospital results of aortic arch endoprosthetic repair using different variants of endovascular supraaortic debranching. PATIENTS AND METHODS: The analysis included 27 patients subjected within the framework of aortic arch endoprosthetic repair to various types of supraaortic endobranching, including the technique of parallel prostheses and implantation of fenestrated stent grafts. We analysed the clinical and morphological status of patients prior to operation, peculiarities of the intervention (type of debranching and Ishimaru's classification zones in which the reconstruction was performed) and in-hospital results of treatment. RESULTS: The patients' mean age amounted to 66 years. The main nosology (70%) was an aortic aneurysm. Nearly in 30% of cases, the operation was performed emergently for acute aortic syndrome. The main causes of refusal from the traditional prosthetic repair included chronic kidney disease (22.5%), chronic obstructive pulmonary disease (11%), acute cerebral ischaemia within the previous 6 months (15%). The technical success rate of the operation was achieved in 100% of cases. The average duration of the intervention amounted to 226 min, with the mean blood loss equalling 355 ml. The majority of reconstructions were performed in zones 1 and 2 according to Ishimaru (59 and 33%, respectively), in 2 (7%) patients prosthetic repair was performed in zone 0. The total number of the aortic branches involved into reconstruction amounted to 45. Intervention-related complications included 3 (11%) cases of acute cerebral circulation impairment, 2 (7.4%) aortic branch occlusions, and 1 (3.7%) type II endoleak. The in-hospital and 30-day mortality rates amounted to 3.7 and 7.4%, respectively. CONCLUSION: Aortic arch endoprosthetic repair using supraaortic endobranching is considered to be an effective alternative method of treatment for patients with various pathology of the aortic arch and contraindications to traditional prosthetic repair involving artificial blood circulation.

[Capacities of multidetector spiral computed tomography in the planning and postoperative examination of patients undergoing coronary artery bypass surgery].

Multiple investigations show that multidetector spiral computed tomography (MSCT) bypass grafting becomes an alternative to invasive coronary angiography in detecting coronary graft stenoses and occlusions. The investigation retrospectively estimated the patency of aortocoronary and mammary coronary artery anastomoses by MSCT bypass grafting. Examinations were made in 85 (326 anastomoses) patients who had undergone aortocoronary and mammary coronary artery bypass surgery and had MSCT bypass grafting within 3 years after the surgery. In the first year following the surgery, 18 patients with graft stenotic changes, as evidenced by MSCT, underwent intervention coronary angiography, the sensitivity and specificity of which was 100%. The results of clinical and instrumental examinations were also compared with graft incompetence, as shown on MSCT that revealed that MSCT bypass grafting was the only noninvasive technique to evaluate early coronary graft closure both in the absence of clear signs of myocardial ischemia according to the data of exercise tests and in the presence of recurrent angina pectoris.

[Multislice spiral computed tomography in the planning of transcatheter aortic valve replacement].

Surgical treatment for aortic valve (AV) pathology is an urgent and important problem of modern medicine. The prevalence of valve disease is great and remains steadily high in the population. Due to a large number of patients who cannot undergo open AV surgery, alternative hybrid treatments are recently being actively improved. Multislice spiral computed tomography (MSCT) is mandatory prior to transcatheter AV replacement as the examination results determine if a hybrid treatment can be performed and the access is transfemoral or transapical. MSCT provides the data necessary to determine the sizes and types of AV prostheses. The application of the current systems of 320-640 spiral tomographs will further improve MSCT as the method of choice in examining patients before transcatheter AV replacement.

[The role of multidetector computed tomography in detection of myocardial infarction].

UNLABELLED: The aim of the study was to assess the diagnostic value of multidetector computed tomography (MDCT) in detection of myocardial infarction (MI) in acute and chromic stages. MATERIAL AND METHODS: 49 patients with suspected MI were included in the study. In 44 patients the diagnosis of acute MI had been confirmed according to standard criteria. Contrast-enhanced MDCT of the heart and vessels was performed with 4-row MDCT scanner. RESULTS: MDCT detected areas of MI in 39 of 44 patients with proven MI. In 66,7% of cases they were transmural and in 33,3% -- subendocardial. In arterial phase the density of infarcted area was significantly lower than in normal myocardium (mean, 32,6 +/- 3,7 HU versus 101,9 +/- 3,7 HU, correspondingly, p < 0,0001). Mean values of myocardial density in the area of the MI did not change during follow-up (32,6 +/- 3,7 HU vs 41,3 +/- 4,5 HU, ns). In comparison to SPECT, sensitivity and specificity of MDCT in detection of transmural MI were 96,9% and 100%. corr. In the whole group of patients, taking results of troponin test as a gold standard, the sensitivity of MDCT in detection of Q-MI and non-Q MI were 89,1% and 93,5%, correspondingly. CONCLUSION: Cardiac MDCT can reliably detect and localize areas of acute and chronic MI. Contrary to SPECT, it also gives information about stenosis and occlusions in the coronary arteries.

[Quantitative analysis of coronary artery calcinosis: comparative informative value of multispiral computed tomography and electron-beam tomography].

AIM: To compare informative value (IV) of electron-beam tomography (EBT) and multispiral computed tomography (MSCT) in the assay of coronary artery calcinosis with participation of one group of patients. MATERIAL AND METHODS: EBT and MSCT were conducted in 210 patients whose mean age was 60.6+/-7.7years (67% males, mean age 60.2+/-7.6 years; 33% females, mean age 61.5+/-8.3 years) with a verified diagnosis of ischemic heart disease (IHD). RESULTS: 185 patients had calcium index (CI) from 21 to 2636 units. EBT and MSCT have not detected coronary artery calcinates in 34 patients. In one patient CI was 2 units by EBT and 0 units by MSCT. Mean CI by EBT was 499.4+/-598.2 units, by MSCT--533.7 +/-594.9 units (p = 0.8). The correlation coefficient between IV of the two methods was 0.976 (p < 0.0001). Mean difference between CI by both methods was 34.3 +/-133.6, variation coefficient 22%. There were differences between compatibility of CI in groups of patients with different CI, correlation and variation coefficients in dividing the patients into the subgroups depending on CI. In CI equal to 0-99 units EBT and MSCT correlation coefficient made up 0. 72, coefficient of variation 66%, in CI being 100-399 units these were 0.81 and 27%, in CI of 400-1000 units--0.85 and 16%, in CI exceeding 1000 units--0.95 and 0.4%, respectively. CONCLUSION. High IV correlation was found of MSCT and EBT for coronary artery calcinosis assay. Compatability of the MSCT and EBT data depends on CI

[Role of electron-beam tomography in diagnosing patency of aortocoronary and mammary-coronary shunts (from data from a 3-year study)]. / Rol' élektronno-luchevoi tomografii v diagnostike prokodimosti aortokoronarnykh i mammarokoronarnykh shuntov (po dannym 3-letnego nabliudeniia).

AIM: To assess informative value of electron-beam tomography (EBT) and to compare dynamics of occlusive defects of autovenous and autoarterial shunts. MATERIAL AND METHODS: 36 patients with coronary heart disease entered the study. All the patients have undergone coronary artery bypass operation and/or mammarocoronary bypass operation (CABO and MCBO, respectively). For three years after the surgery the patients were annually examined with EBT-shuntography. The contrast agent was injected intravenously in a dose 135-140 ml with the injection rate 3.5-4.0 ml/s. In addition to EBT-shuntography, selective x-ray contrast shuntography was conducted one year after CABO. RESULTS: By a comparative analysis, EBT sensitivity and specificity in examination of autovenous shunts patency is 100%, in assessment of patency of mammary shunts is 93 and 100%, respectively. The 3-year retrospective analysis has revealed occlusions in 17.1% venous shunts and 2.7% arterial ones in the first year after CABO and MCBO, 5.2 and 2.8% in the second year, respectively, and in 1.8% venous shunts in the third year. CONCLUSION: EBT-shuntography is a highly informative non-invasive method of diagnosis of aortocoronary shunts patency.