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Cardiovascular diseases occupy a central place in the structure of morbidity and mortality in various population groups and in most cases occur with a heart rhythm disorder. One of the most common types of arrhythmia is atrial fibrillation, the morphological substrate for the development of which is the left atrium and the region of the pulmonary veins. In connection with the introduction of modern imaging systems into the practice of cardiac surgery, which enable a detailed study of the anatomy of the heart and its separate chambers, there is a need to study the features of the variant anatomy of the pulmonary veins of the human left atrium in the aspect of modern interventional cardiac surgery, which will make it possible to secure and accelerate surgical interventions performed in this area. The purpose of the study was the revealing of variant anatomy of the pulmonary veins using multislice computed tomography, depending on body type and gender. Heart tomograms of 70 patients were analyzed (8 of the 1st period of adulthood, 23 of the 2nd period of adulthood, 37 of the elderly, 2 of the senile age). Among them were 47 men - 67.1% and 23 women - 32.9%. As a result of the analysis of the obtained data, four variants of the confluence of the pulmonary veins into the left atrium were identified. Among all observations, a typical variant of the confluence of the pulmonary veins into the left atrium occurs in 78.6% of cases, in 85.7% of cases - in persons of the pyknic type, in 85.0% of cases - in the examined asthenic type and in 69.0% of cases - in representatives of the normosthenic body type. Less common are the common pulmonary vein collector on the left (12.9%), as well as the accessory pulmonary vein on the right (7.1%). An extremely rare anatomical variant was the common pulmonary vein collector on both sides (1.4%). Thus, the anatomy of the distal pulmonary veins is characterized by significant variability, there is a slight relationship with gender and body type. An in-depth study of the anatomy of the pulmonary veins remains relevant for the effective implementation of surgical interventions in this anatomical zone.
Cardiovascular diseases occupy a central place in the structure of morbidity and mortality in various population groups and in most cases occur with a heart rhythm disorder. One of the most common types of arrhythmia is atrial fibrillation, the morphological substrate for the development of which is the left atrium and the region of the pulmonary veins. In connection with the introduction of modern imaging systems into the practice of cardiac surgery, which enable a detailed study of the anatomy of the heart and its separate chambers, there is a need to study the features of the variant anatomy of the pulmonary veins of the human left atrium in the aspect of modern interventional cardiac surgery, which will make it possible to secure and accelerate surgical interventions performed in this area. The purpose of the study was the revealing of variant anatomy of the pulmonary veins using multislice computed tomography, depending on body type and gender. Heart tomograms of 70 patients were analyzed (8 of the 1st period of adulthood, 23 of the 2nd period of adulthood, 37 of the elderly, 2 of the senile age). Among them were 47 men - 67.1% and 23 women - 32.9%. As a result of the analysis of the obtained data, four variants of the confluence of the pulmonary veins into the left atrium were identified. Among all observations, a typical variant of the confluence of the pulmonary veins into the left atrium occurs in 78.6% of cases, in 85.7% of cases - in persons of the pyknic type, in 85.0% of cases - in the examined asthenic type and in 69.0% of cases - in representatives of the normosthenic body type. Less common are the common pulmonary vein collector on the left (12.9%), as well as the accessory pulmonary vein on the right (7.1%). An extremely rare anatomical variant was the common pulmonary vein collector on both sides (1.4%). Thus, the anatomy of the distal pulmonary veins is characterized by significant variability, there is a slight relationship with gender and body type. An in-depth study of the anatomy of the pulmonary veins remains relevant for the effective implementation of surgical interventions in this anatomical zone.
The aim of the study was to assess the quality of life in patients after endovascular prophylaxis (inferior vena cava filter) and PATE conservative (drug) therapy. Materials and Methods. The authors examined efficacy of treatment and assessed the quality of life in 226 patients with deep vein thrombosis, IVC thrombosis, and PATE. All the patients underwent medical treatment at the Ulyanovsk Regional Clinical Hospital in 2006–2016. Patients with IVC filter (n=91) were included in the main group. Experimental group consisted of patients undergoing conservative treatment (n=135). Hospital patients underwent some diagnostic measures, including Doppler ultrasound, X-ray computed tomography, and echocardiography. MOS 36-Item Short Form Health Survey was used to study the effect of long-term complications on the patients’ quality of life. Results. The number of complaints per patient was higher in the experimental group (6.67) than in the main group (4.13). However, instrumental research methods showed that IVC filter caused secondary complications in 31.11 % of patients from the main group. In the long-term follow-up, patients from the experimental group rated a number of their health parameters on the mental status scales reliably higher (“social functioning” – 8.1 in the main group and 25.4 in the experimental group, “role-emotional functioning” – 25.3 in the main group and 33.3 in the experimental group, “mental status” – 57.8 in the main group and 70.2 in the experimental group). Conclusion. Despite a greater number of subjective complaints from the patients of the experimental group, the patients of the main group had more long-term complications, which affected patients’ quality of life, namely social functioning, role-emotional functioning and mental status. Keywords: vascular surgery, IVC filter, pulmonary thromboembolism, floating deep vein thrombosis of the lower extremities. Цель исследования – оценить качество жизни пациентов после эндоваскулярной профилактики (имплантации кава-фильтра) и консервативной (медикаментозной) терапии ТЭЛА. Материалы и методы. Было проведено исследование эффективности лечения и оценка качества жизни 226 пациентов, находившихся на лечении в период с 2006 по 2016 г. в ГУЗ Ульяновская областная клиническая больница с диагнозами «тромбоз глубоких вен», «тромбоз НПВ», «ТЭЛА». Пациенты, которым была проведена имплантация кава-фильтров, составили основную группу (91 чел.); пациенты, получавшие консервативное лечение, – группу сравнения (135 чел.). В стационаре проводился комплекс диагностических мероприятий, включавший ультразвуковую доплерографию, рентгеновскую компьютерную томографию, эхокардиографию. Для изучения влияния отдаленных осложнений на качество жизни пациентов проводилось анкетирование с использованием опросника MOS 36-Item Short Form Health Survey. Результаты. Количество жалоб на одного пациента было больше в группе сравнения (6,67), чем в основной (4,13). Однако инструментальные методы исследования показали, что кава-фильтр стал причиной вторичных осложнений у 31,11 % пациентов основной группы. В отдаленные сроки наблюдения пациенты из группы сравнения достоверно выше оценивали ряд показателей своего здоровья по шкалам психического состояния («социальное функционирование» – 8,1 в основной группе и 25,4 в группе сравнения, «ролевое функционирование, обусловленное эмоциональным состоянием» – 25,3 в основной группе и 33,3 в группе сравнения, «психическое здоровье» – 57,8 в основной группе и 70,2 в группе сравнения). Выводы. Несмотря на большее количество субъективных жалоб у пациентов группы сравнения, объективно у пациентов основной группы отмечалось большее число отдаленных осложнений, которые сказывались на качестве жизни пациентов по шкалам «социального функционирования», «ролевого функционирования, обусловленного эмоциональным состоянием» и «психического здоровья». Ключевые слова: сосудистая хирургия, кава-фильтр, тромбоэмболия лёгочных артерий, флотирующий тромбоз глубоких вен нижних конечностей.
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