Представлен клинический случай успешного хирургического лечения пациентки с инфекционным эндокардитом, осложненным абсцессом корня аорты. Пациентка поступила с диагнозом вторичного подострого инфекционного эндокардита аортального клапана в стадии ремиссии и была оперирована через 3 мес от момента манифестации заболевания. Реконструктивное вмешательство включало пластику зоны митрально-аортального контакта ложной аневризмы корня аорты и создание неофиброзного кольца с помощью ксеноперикардиальной заплаты с последующим протезированием аортального клапана. Ближайший послеоперационный период протекал без существенных особенностей, пациентка была выписана из стационара на 9-е сутки после операции в удовлетворительном состоянии.

Background Stenosis of a coronary artery results in an increase in flow velocity in the pathologic segment. Effective grafting should decrease the stenotic native coronary velocity according to hemodynamic law. The range of decreased velocity before and after cardiac surgery can hypothetically reflect the effectiveness of a graft. The aim of the study is to determine if measuring coronary flow velocity changes during coronary artery bypass grafting (CABG) can predict intraoperative myocardial infarction. Methods One hundred sixty-six (166) consecutive patients (121 men, 64±9 years old) referred for cardiac surgery, were prospectively included in the study. A standard basic perioperative transesophageal echocardiography (TEE) examination was performed with additional scans of the left main, left anterior descending (LAD), and circumflex (LCx) arteries' proximal segments. Measurements of coronary flow velocities were performed before and after grafting in the same sites of the arteries. The maximal value of cardiac troponin I (cTnI) after CABG and the additive criteria were accounted for in the analysis as it is described in the expert consensus document for Type 5 myocardial infarction (MI) definition. Results One hundred sixty-three patients (98%) had arterial hypertension, 28 patients (17%) had diabetes mellitus, 35 patients (21%) were currently smokers. The feasibility of coronary flow assessment during cardiac operations was 95%. Before grafting, the mean velocity in the left main artery was 91±49 cm/s, in LAD 101±35 cm/s, and in LCx 117±49 cm/s. There was a significant correlation between changes in coronary flow velocities during operation and the value of cTnI (R=0.34, p<0.0001). Ten patients met the criteria for Type 5 MI. There were no differences in age, body mass index, number of coronary arteries with stenoses, frequency of prior MI, ejection fraction or coronary flow velocity before surgery in patients with and without Type 5 MI. The group of patients with Type 5 MI had an increase in native artery velocities during surgery in comparison with patients without MI, who had a significant decrease in coronary flow velocity after grafting (30±48 vs. −10±30 cm/s; p<0.0006). Increases in native coronary velocities greater than 3 cm/s predicted Type 5 MI with 81% accuracy (sensitivity 88%, specificity 70%). Conclusion Coronary flow velocity assessment during cardiac surgery could predict an elevation of cardiac troponins and Type 5 MI. Funding Acknowledgement Type of funding source: None

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Background Stenosis of a coronary artery results in an increase in flow velocity in the pathologic segment. Effective grafting should decrease the stenotic native coronary velocity according to a hemodynamic law. The range of decreased velocity can hypothetically reflect the effectiveness of a graft. Grafting effect insufficiencies often cause elevations in periprocedural cardiac troponin (cTn) elevation. The aim of the study is to determine, if measuring coronary flow velocity changes during coronary artery bypass grafting (CABG) can predict further cTn elevation. Methods and results Consecutive 68 patients (48 men, 64 ± 9 years old), who were referred for CABG, were included into the study. A standard basic perioperative transesophageal echocardiography (TEE) examination was performed with additional scans of the left main, left anterior descending (LAD), and circumflex (LCx) arteries’ proximal segments. Measurements of coronary flow velocities was performed before and after grafting in the same sites of the arteries. The maximal value of cTnI within 48 hours after CABG was accounted for in the analysis. All patients had arterial hypertension, 15 patients (22%) had diabetes mellitus, 12 patients (18%) was current smokers. Forty-one patients (60%) had prior myocardial infarctions, 18 persons (26%) had previous coronary stenting. The ejection fraction before the operation was 56 ± 13%. Before grafting the mean velocity in the left main artery was 79 cm/s (25th-75th quartile, 42-111), in LAD 98 cm/s (25th-75th quartile, 71-125), and in LCx 116 cm/s (25th-75th quartile, 68-156). There was a strong significant correlation between changes in coronary flow velocities and the value of cTnI (R = 0.56, p < 0.0004). The patients with and without significant elevations in cTnI had differences in coronary velocity changes before and after grafting (p < 0.009). Patients with elevated cTnI in more than 5 times, had, on average, an increase in the velocities for native arteries of 21 ± 19 cm/s. Conclusion Coronary flow velocity assessment during CABG could predict an elevation of cardiac troponins after cardiac surgery. Abstract P1564 Figure.

сердечно-сосудистой хирургии Министерства здравоохранения РФ, гл. врачд. м. н. В. А. Сакович; 2 ГБОУ ВПО Красноярский государственный медицинский университет имени проф. В. Ф. Войно-Ясенецкого Министерства здравоохранения РФ, ректор-д. м. н., проф. И. П. Артюхов; кафедра клиника сердечно-сосудистой хирургии ИПО, зав.-д. м. н. В. А. Сакович; 3 КГБУЗ Красноярский краевой клинический онкологический диспансер имени А. А. Крыжановского, гл. врач-к. м. н. А. А. Модестов. p%'>,%. В данном клиническом примере представлена симультантная операция на двух жизненно важных системах организма (дыхательная и сердечно-сосудистая) с использованием искусственного кровообращения. Пациенту с выраженным аортальным стенозом и тяжелой сердечной недостаточностью, в сочетании со злокачественным новообразованием верхушки правого легкого одномоментно выполнена операция-резекция доли легкого и протезирование аортального клапана с удовлетворительными результатами при выписке. Определены показания к этой операции, этапность подхода, а также проанализированы непосредственные результаты проведенной операции. j+>7%";% 1+." : симультантные операции, аортальный стеноз, рак легкого.