Stent-assisted coiling of acute ruptured cerebral aneurysms

The necessity of quick surgical treatment of acute ruptured cerebral aneurysms was demonstrated in large studies by the ISAT and ISUIA, which also proved the advantage of the endovascular method over the surgical one. Ballonassistence is widely used in treatment of aneurysms with wide neck and unfavorable vascular anatomy, but the radicality of the treatment is insufficient. The aim of this study was to demonstrate the efficacy and safety of stent-assisted embolization of «acute» cerebral aneurysms. Material and methods. A retrospective analysis of the treatment of 234 patients with «acute» cerebral aneurysms was carried out. Results. Only coils were used in 40.6 % of cases (n = 95), balloon-assistance, in 40.2 % of cases (n = 94), and stent-assistance, in 19.2 % of cases (n = 45). There were 11.5 % (n = 27) clinically significant complications. Total aneurysm occlusion (Raymond-Roy I) was achieved in 187 cases (79.9 %); the radicality at the control examination was 67.1 % (157 patients). Discussion. The radicality of the treatment with stents was slightly higher then with balloons and coils at the end of operation (84.4 %, n = 38 and 78.8 %, n = 149, p > 0.05), but it was significantly higher at the control examination (80.0 %, n = 36 and 60.8 %, n = 115, respectively, p <0.05). Also, we had no statistically significant difference of the complication rate in the «stent» and «no stent» groups; therefore, the clinical outcomes of endovascular treatment of cerebral aneurysms did not depend on the choice of treatment method. Conclusions. Intracranial stents allow achieving good results of the embolization of complex aneurysms in the acute period of intracranial hemorrhage without increasing the risk of surgical treatment

ИНВАГИНАЦИЯ УШКА ЛЕВОГО ПРЕДСЕРДИЯ У РЕБЕНКА РАННЕГО ВОЗРАСТА ПОСЛЕ КОРРЕКЦИИ ДЕФЕКТА МЕЖЖЕЛУДОЧКОВОЙ ПЕРЕГОРОДКИ

The inversion of the left atrium appendage in infants is a very rare anomaly, which may occurs either after cardiac surgery. We introduce a case report of infant with left atrium appendage invagination after ventricular septal defect closure. Инвагинация ушка левого предсердия у детей раннего возраста является крайне редкой аномалией, которая возникает как после кардиохирургических операций, так и спонтанно при нарушениях ритма сердца. Мы представляем клинический случай у ребенка раннего возраста с инвагинацией ушка левого предсердия после коррекции дефекта межжелудочковой перегородки.

Морфофункциональные особенности левых отделов сердца после коррекции тотального аномального дренажа легочных вен

Highlights. The geometry of the left atrium and the growth of the left heart after correction of total anomalous pulmonary venous connection are evaluated for the first time.Aim. To assess the morphological and functional characteristics of the left heart after correction of total anomalous pulmonary venous connection.Methods. 40 patients referred to the correction of total anomalous pulmonary venous connection were enrolled in a pilot, two-center, simple, blind, prospective randomized study. Patients were assigned to the sutureless repair group (n = 20) and conventional repair group (n = 20).Results. In the early postoperative period, the indexed left atrial volume in the group of sutureless repair was 15 (13.65; 17.25) versus 12.85 (10.95; 15.15) in the group of conventional repair, p = 0.057. The end diastolic volume index in the sutureless repair group was 38 (28.5; 45), while in the conventional repair group - 37.1 (31; 47.75), p = 0.48. At the follow-up, the indexed left atrial volume in the group of sutureless repair was 37 (34.5; 38.9) versus 31 (23.6; 35) in the group of conventional repair, p = 0.01. The end diastolic volume index (EDVI) in the group of sutureless repair was 50 (43; 57), while in the group of conventional repair - 50.2 (28.8; 60.9), p = 0.49.Conclusion. The growth of the left atrium depended on the chosen technique for correcting total anomalous pulmonary venous connection and was higher in the group of sutureless repair (37) compared to the group of conventional repair (31). The proportionality of the growth of the left ventricle did not depend on the surgical technique and was equivalent in both groups.Основные положения. Впервые оценены геометрия левого предсердия и рост левых отделов сердца после коррекции тотального аномального дренажа легочных вен.Цель. Оценить морфофункциональные особенности левых отделов сердца после коррекции тотального аномального дренажа легочных вен (ТАДЛВ).Материалы и методы. В представленном пилотном двуцентровом рандомизированном проспективном простом слепом исследовании выполнена оценка качества жизни 40 пациентов в возрасте до года, подвергшихся хирургической коррекции ТАДЛВ: процедура Sutureless (бесшовная коррекция, n = 20) и конвенциональная биатриальная коррекция (n = 20).Результаты. В раннем послеоперационном периоде индексированный объем левого предсердия в группе бесшовной методики составил 15 (13,65; 17,25) мл/м2, в группе конвенциональной коррекции - 12,85 (10,95; 15,15) мл/м2; p = 0,057. Индекс конечного диастолического объема в группе бесшовной методики составил 38 (28,5; 45) мл/м2, в группе конвенциональной биатриальной коррекции - 37,1 (31; 47,75) мл/м2; p = 0,48. В отдаленном периоде индексированный объем левого предсердия в группе бесшовной методики составил 37 (34,5; 38,9) против 31 (23,6;35) мл/м2 соответственно; p = 0,01. Индекс конечного диастолического объема - 50 (43; 57) против 50,2 (28,8; 60,9) соответственно; p = 0,49.Заключение. Индексированный объем левого предсердия зависел от способа коррекции ТАДЛВ и был выше в группе бесшовной методики: 37 против 31 мл/м2 в группе конвенциональной биатриальной коррекции. Пропорциональность увеличения левого желудочка не зависела от тактики вмешательства и не различалась между исследуемыми пациентами

The efficiency of transvenous access for embolization of convexital cerebral arteriovenous malformations

Introduction. Convexital localization of cerebral arteriovenous malformations (AVM) is a good prognostic criterion for successful endovascular treatment. Difficulties begin in the final stages of large AVMs, in the transit nature of afferents. Transvenous embolization has been developed as an alternative to microsurgery and radiosurgery for a limited range of malformations. Materials, methods, results. January 2011 - December 2016, the National Medical Research Center treated 440 patients with cerebral arteriovenous malformations who underwent more than 1200 embolization sessions. From this number, a transvenous access to the AVM was performed in 43 patients. AVMs were localized in the cerebral cortex of 12 patients; in 2 of them (17 %) the transvenous embolization was the single treatment option; the rest of the patients required 2 to 4 preliminary transarterial staged embolizations. In the group, no lethal outcomes and significant persistent neurological deficit were recorded. Total deactivation was achieved in 9 patients (75 %); 2 patients (16.7 %) required microsurgical removal of residual AVM network; in 1 patient (8.3 %), radiosurgical treatment was performed. Discussion. Comparing the results of transvenous treatment of convexital malformations with an of patients treated with the classic transarterial technique, no statistically significant difference (p > 0.05) in morbidity and mortality was achieved. The total occlusion rate of transvenous embolization is significantly higher (p < 0.05). Conclusions. A gradual expansion of indications for the transvenous access increases the efficiency of surgical treatment of this pathology without significantly increasing the risks of adverse outcomes. This access should only be used in centers with significant experience of transarterial embolization

EXTRACORPORAL CARDIOPULMONARY RESUSCITATION (ECPR) FOLLOWING PULMONARY ARTERY RUPTURE IN AN INFANT

The rupture of the pulmonary artery during balloon valvular dilatation is rare and the severest complication. In this clinical case we described the rupture of the pulmonary artery in a 10-month-old baby with cardiac tamponada and an extreme hemodilution due to blood loss. CPR has been using for 40 minutes but being ineffective. For 3 days we have been applying ECMO. This patient was discharged without any neurological disorders