10 research outputs found
Dedicated Bifurcation Stents
Bifurcations still remain one of the most challenging lesions to be treated in the modern PCI era. They are associated with lower procedural success rates, higher rates of periprocedural complications, and complicated long-term outcomes. Their incidence is assessed to be approximately 15β20%. There is still debate on how should they be treatedβone-stent versus two-stent techniques, whether there is a need for obligatory proximal optimization or kissing balloons. Multiple clinical trials have tested different PCI strategies. We will cover theoretical basics of treating bifurcations and describe different types of dedicated bifurcation stentsβNile PAX, Nile SIR, BiOSS Expert, BiOSS LIM, Stentys Tryton, and Axxess Plus. We will discuss the data from studies comparing these bifurcation devices and will show our own experience and results working with these devices. There will be a discussion, tips, and tricks treating bifurcation lesions with dedicated devicesβmost common pitfalls and how to deal with them
Vena cava superior syndrome. Analisis of interventional and medical treatment options
ΠΡΠ΅Π΄ΡΡΠ°Π²ΡΠΌΠ΅ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅Π½ ΡΠ»ΡΡΠ°ΠΉ Π½Π° 72-Π³ΠΎΠ΄ΠΈΡΠ΅Π½ ΠΌΡΠΆ Ρ Π°ΡΡΠ΅ΡΠΈΠ°Π»Π½Π° Ρ
ΠΈΠΏΠ΅ΡΡΠΎΠ½ΠΈΡ ΠΈ ΠΏΡΠ΅ΠΆΠΈΠ²ΡΠ½Π° SARS-CoV-2 ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡ, Ρ
ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·ΠΈΡΠ°Π½ ΠΏΠΎ ΡΠΏΠ΅ΡΠ½ΠΎΡΡ Π² ΠΈΠ½ΡΠ΅Π½Π·ΠΈΠ²Π΅Π½ ΠΊΠ°ΡΠ΄ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅Π½ ΡΠ΅ΠΊΡΠΎΡ, ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄ Π½Π° Π΄ΠΈΡΠΏΠ½Π΅Ρ Π² ΠΏΠΎΠΊΠΎΠΉ, Π·Π°ΡΠ΅ΡΠ²ΡΠ²Π°Π½Π΅ ΠΈ ΠΏΠΎΠ΄ΡΠ²Π°Π½Π΅ Π½Π° Π²ΡΠ°ΡΠ° ΠΈ Π»ΠΈΡΠ΅ΡΠΎ, Π³Π»Π°Π²ΠΎΠ±ΠΎΠ»ΠΈΠ΅ ΠΈ Π΄Π²ΡΠΊΡΠ°ΡΠ½Π° Π·Π°Π³ΡΠ±Π° Π½Π° ΡΡΠ·Π½Π°Π½ΠΈΠ΅. ΠΠΎΠ»Π½ΠΈΡΡ Π΅ Ρ Π΅Ρ
ΠΎ-ΠΠ Π΄Π°Π½Π½ΠΈ Π·Π° Π·Π°ΠΏΠ°Π·Π΅Π½Π° ΠΠ ΠΈ ΠΠ ΡΠΈΡΡΠΎΠ»Π½Π° ΡΡΠ½ΠΊΡΠΈΡ, Π±Π΅Π· Ρ
Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΡΠ½ΠΎ Π·Π½Π°ΡΠΈΠΌΠΈ ΠΊΠ»Π°ΠΏΠ½ΠΈ Π»Π΅Π·ΠΈΠΈ ΠΈ Π½ΠΎΡΠΌΠ°Π»Π½Π° ΠΠΠ. ΠΠ° ΡΠ»Π΅Π΄Π²Π°ΡΠΈΡΡ Π΄Π΅Π½ ΠΎΡ Ρ
ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΡΡΠ° Π΅ ΠΎΡΡΡΠ΅ΡΡΠ²Π΅Π½Π° ΠΊΠΎΠΌΠΏΡΡΡΡΠ½Π° ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΠΈΡ Π½Π° Π±ΡΠ» Π΄ΡΠΎΠ±, ΠΎΠ±Π΅ΠΊΡΠΈΠ²ΠΈΠ·ΠΈΡΠ°Π»Π° ΡΠΎΠ»ΠΈΠ΄Π΅Π½ ΠΠΠ ΠΎΡ ΡΠ΅Π½ΡΡΠ°Π»Π΅Π½ ΡΠΈΠΏ Π½Π° Π΄Π΅ΡΠ½ΠΈΡ Π±ΡΠ» Π΄ΡΠΎΠ±, ΠΊΠΎΠΌΠΏΡΠ΅ΡΠΈΡΠ°Ρ Π² Π·Π½Π°ΡΠΈΡΠ΅Π»Π½Π° ΡΡΠ΅ΠΏΠ΅Π½ Π²Π΅Π½Π° ΠΊΠ°Π²Π° ΡΡΠΏΠ΅ΡΠΈΠΎΡ. ΠΡΠΎΠ²Π΅Π΄Π΅Π½Π° Π΅ Π²Π΅Π½ΠΎΠ³ΡΠ°ΡΠΈΡ, ΠΊΠΎΡΡΠΎ Π΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠ° ΡΡΠ±ΡΠΎΡΠ°Π»Π½Π° ΡΡΠΎΠΌΠ±ΠΎΠ·Π° Π½Π° Π²Π΅Π½Π° ΠΊΠ°Π²Π° ΡΡΠΏΠ΅ΡΠΈΠΎΡ ΠΈ Π΅ ΠΎΡΡΡΠ΅ΡΡΠ²Π΅Π½ΠΎ ΡΡΠ΅Π½ΡΠΈΡΠ°Π½Π΅ Ρ Wallstent 16/60 mm. ΠΡΠ΅ Π½Π° 6-ΠΈΡ ΡΠ°Ρ ΠΎΡ ΠΈΠ½ΡΠ΅ΡΠ²Π΅Π½ΡΠΈΡΡΠ° ΡΠ΅ Π½Π°Π±Π»ΡΠ΄Π°Π²Π° ΠΊΠ»ΠΈΠ½ΠΈΡΠ½ΠΎ ΠΏΠΎΠ΄ΠΎΠ±ΡΠ΅Π½ΠΈΠ΅ β Π·Π½Π°ΡΠΈΡΠ΅Π»Π½ΠΎ Π½Π°ΠΌΠ°Π»ΡΠ²Π°Π½Π΅ Π½Π° ΠΎΡΠΎΠΊΠ° ΠΈ ΠΎΠ±Π»Π΅ΠΊΡΠ°Π²Π°Π½Π΅ Π½Π° ΡΠΈΠΌΠΏΡΠΎΠΌΠ°ΡΠΈΠΊΠ°ΡΠ°. We present a clinical case of a 72-year-old man with a history of hypertension and SARS-CoV-2 infection, urgently hospitalized in the intensive care unit due to dyspnea at rest, blushes and swelling of the neck and face, headache, and syncope. Echocardiography was performed and revealed preserved ejection fraction of left and right ventricle (EF β 57%, TAPSE β 21 mm), without hemodynamically significant valve lesions and normal ECG. On the next day of hospitalization, we performed a computer tomography (CT) scan of the lungs and it showed a tumor in right lung, compressing vena cava superior. Venography was performed and revealed subtotal thrombosis of vena cava superior and stenting with Wallstent 16/60 mm was performed. Six hours after the intervention a clinical improvement was achieved β reducing of the swelling and relieving of the symptoms
Acute coronary syndrome and ischemic stroke in the course of COVID-19 infection
ΠΠ°Π½Π΄Π΅ΠΌΠΈΡΡΠ° ΠΎΡ Β Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) ΡΠ΅ ΡΠ°Π·ΠΏΡΠΎΡΡΡΠ°Π½ΠΈ Π±ΡΡΠ·ΠΎ ΠΏΠΎ ΡΠ²Π΅ΡΠ° Ρ 314 ΠΌΠΈΠ»ΠΈΠΎΠ½Π° Π·Π°ΡΠ°Π·Π΅Π½ΠΈ ΠΈ 5 ΠΌΠΈΠ»ΠΈΠΎΠ½Π° ΠΆΠ΅ΡΡΠ²ΠΈ (ΠΊΡΠΌ Π΄Π΅ΠΊΠ΅ΠΌΠ²ΡΠΈ 2021 Π³.) Π² ΡΠ²Π΅ΡΠΎΠ²Π΅Π½ ΠΌΠ°ΡΠ°Π±. SARS-CoV-2 ΡΠ΅ ΠΎΠΊΠ°Π·Π° Π½Π΅ ΡΠ°ΠΌΠΎ ΠΏΡΠΈΡΠΈΠ½ΡΠ²Π°Ρ Π²ΠΈΡΡΡΠ½Π° ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΡ, Π½ΠΎ ΠΈ ΠΏΡΠΈΡΠΈΠ½Π° Π·Π° ΡΠ΅ΡΠΈΠΎΠ·Π½ΠΈ ΠΏΠΎΡΠ»Π΅Π΄ΠΈΡΠΈ Π·Π° ΡΡΡΠ΄Π΅ΡΠ½ΠΎ-ΡΡΠ΄ΠΎΠ²Π°ΡΠ° ΡΠΈΡΡΠ΅ΠΌΠ°. ΠΠΎΠΊΠ°Π·Π°Π½ΠΎ Π΅, ΡΠ΅ COVID-19 Β ΠΌΠΎΠΆΠ΅ Π΄Π° ΡΠ΅ ΡΡΠ»ΠΎΠΆΠ½ΠΈ Ρ ΠΎΡΡΡΡ ΠΊΠΎΡΠΎΠ½Π°ΡΠ΅Π½ ΡΠΈΠ½Π΄ΡΠΎΠΌ ΠΏΠΎΡΡΠ΅Π΄ΡΡΠ²ΠΎΠΌ ΡΡΠΏΡΡΡΠ° Π½Π° ΠΏΠ»Π°ΠΊΠ°, Π²Π°Π·ΠΎΡΠΏΠ°Π·ΡΠΌ ΠΈΠ»ΠΈ ΠΌΠΈΠΊΡΠΎΡΡΠΎΠΌΠ±ΠΈ Π²ΡΠ»Π΅Π΄ΡΡΠ²ΠΈΠ΅ Π½Π° ΡΠΈΡΡΠ΅ΠΌΠ½ΠΎΡΠΎ Π²ΡΠ·ΠΏΠ°Π»Π΅Π½ΠΈΠ΅ ΠΈΠ»ΠΈ ΡΠΈΡΠΎΠΊΠΈΠ½ΠΎΠ²Π°ΡΠ° Π±ΡΡΡ. ΠΠΎΠΏΡΠ»Π½ΠΈΡΠ΅Π»Π½Π° ΡΠΎΠ»Ρ ΠΊΡΠΌ ΡΠΎΠ²Π° ΠΈΠ³ΡΠ°ΡΡ Ρ
ΠΈΠΏΠ΅ΡΠΈΠΌΡΠ½Π½ΠΈΡΡ ΠΎΡΠ³ΠΎΠ²ΠΎΡ, ΠΊΠ°ΠΊΡΠΎ ΠΈ Π΅Π½Π΄ΠΎΡΠ΅Π»Π½Π°ΡΠ° Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΡ, ΠΊΠΎΠΈΡΠΎ Π΄ΠΎΠΏΡΠΈΠ½Π°ΡΡΡ Π·Π° Ρ
ΠΈΠΏΠ΅ΡΠΊΠΎΠ°Π³ΡΠ»Π°-ΡΠΈΠΎΠ½ΠΎΡΠΎ ΡΡΡΡΠΎΡΠ½ΠΈΠ΅. Π‘ΠΈΠ»Π½ΠΎ Π²Π΅ΡΠΎΡΡΠ½ΠΎ Π΅ Π²ΠΈΡΠΎΠΊΠΈΡΡ ΠΈΠ½ΡΠ»Π°ΠΌΠ°ΡΠΎΡΠ΅Π½ ΡΠΎΠ²Π°Ρ Π΄Π° Π΅ ΠΏΡΠΈΡΠΈΠ½Π° Π·Π° ΠΏΠΎΡΠ²Π°ΡΠ° Π½Π° de novo ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΈ Π»Π΅Π·ΠΈΠΈ. ΠΡΠ΅Π΄ΡΡΠ°Π²ΡΠΌΠ΅ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅Π½ ΡΠ»ΡΡΠ°ΠΉ Π½Π° 53-Π³ΠΎΠ΄ΠΈΡΠ΅Π½ ΠΌΡΠΆ, ΠΏΡΠ΅Π·Π΅Π½ΡΠΈΡΠ°Ρ ΡΠ΅ Ρ ΡΠΎΠΊΡΠΈ-ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ·Π΅Π½ ΡΠΈΠ½Π΄ΡΠΎΠΌ, ΡΡΠ΅Π½ΠΎΠΊΠ°ΡΠ΄Π½Π° ΡΠΈΠΌΠΏΡΠΎΠΌΠ°ΡΠΈΠΊΠ° ΠΈ Π΄ΠΈΡΠΏΠ½Π΅Ρ. ΠΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡΠ΅ ΠΏΠ°ΡΠ°ΠΊΠ»ΠΈΠ½ΠΈΡΠ½ΠΈ ΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡΠ½ΠΈ ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½ΠΈΡ ΠΎΠ±Π΅ΠΊΡΠΈΠ²ΠΈΠ·ΠΈΡΠ°Ρ
Π° ΠΎΡΡΡΡ ΠΊΠΎΡΠΎΠ½Π°ΡΠ΅Π½ ΡΠΈΠ½Π΄ΡΠΎΠΌ Π±Π΅Π· ST-Π΅Π»Π΅Π²Π°ΡΠΈΡ, Π»Π΅Π²ΠΎΠΊΠ°ΠΌΠ΅ΡΠ½Π° ΡΡΠΎΠΌΠ±ΠΎΠ·Π°, Π°ΠΊΡΠΈΠ²Π½Π° SARS-CoV-2 ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡ ΠΈ Π΄Π²ΡΡΡΡΠ°Π½Π½Π° ΠΈΠ½ΡΠ΅ΡΡΡΠΈΡΠΈΠ°Π»Π½Π° ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΡ. ΠΠ°ΡΠΈΠ΅Π½ΡΡΡ Π±Π΅ΡΠ΅ Π»Π΅ΠΊΡΠ²Π°Π½ Ρ ΠΏΠ΅ΡΠΊΡΡΠ°Π½Π½Π° ΠΊΠΎΡΠΎΠ½Π°ΡΠ½Π° ΠΈΠ½ΡΠ΅Π²Π΅Π½ΡΠΈΡ Π½Π° LAD Ρ ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠΈΡ Π½Π° ΠΌΠ΅Π΄ΠΈΠΊΠ°ΠΌΠ΅Π½Ρ-ΠΈΠ·-Π»ΡΡΠ²Π°Ρ ΡΡΠ΅Π½Ρ, Π°Π½ΡΠΈΠΊΠΎΠ³ΡΠ»Π°Π½ΡΠ½Π° ΡΠ΅ΡΠ°ΠΏΠΈΡ, Π΄Π²ΠΎΠΉΠ½Π° Π°Π½ΡΠΈΠ°Π³ΡΠ΅Π³Π°Π½ΡΠ½Π° ΠΈ ΠΏΡΠΎΡΠΈΠ²ΠΎΠ²ΡΠ·ΠΏΠ°Π»ΠΈΡΠ΅Π»Π½Π° ΡΠ΅ΡΠ°ΠΏΠΈΡ, Π±Π΅ΡΠ°-Π±Π»ΠΎΠΊΠ΅Ρ ΠΈ ΠΠ‘Π ΠΈΠ½Ρ
ΠΈΠ±ΠΈΡΠΎΡ. ΠΠ° 4-ΠΈΡ Π΄Π΅Π½ ΠΎΡ Ρ
ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΡΡΠ° ΡΠ΅Π°Π»ΠΈΠ·ΠΈΡΠ° ΠΈΡΡ
Π΅ΠΌΠΈΡΠ΅Π½ ΠΌΠΎΠ·ΡΡΠ΅Π½ ΠΈΠ½ΡΡΠ»Ρ Π² Π±Π°ΡΠ΅ΠΉΠ½Π° Π½Π° Π»ΡΠ²Π°ΡΠ° ΡΡΠ΅Π΄Π½ΠΎΠΌΠΎΠ·ΡΡΠ½Π° Π°ΡΡΠ΅ΡΠΈΡ. ΠΠ°ΡΠΈΡΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅Π½ ΡΠ»ΡΡΠ°ΠΉ Π΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠ°, ΡΠ½ΠΈΠΊΠ°Π»Π½ΠΈΡΠ΅ ΠΏΡΠΎΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠ½ΠΈ ΡΠ²ΠΎΠΉΡΡΠ²Π° Π½Π° SARS-CoV-2, ΠΎΠ±ΡΡΠ»ΠΎΠ²Π΅Π½ΠΈ ΠΎΡ ΡΠ°Π·Π»ΠΈΡΠ½ΠΈ ΠΌΠ΅Ρ
Π°Π½ΠΈΠ·ΠΌΠΈ ΠΈ ΡΡΠ»ΠΎΠΆ-Π½ΡΠ²Π°ΡΠΈ ΡΠ΅ Ρ ΡΡΠΎΠΌΠ±ΠΎΠ΅ΠΌΠ±ΠΎΠ»ΠΈΡΠ½ΠΈ ΠΈΠ½ΡΠΈΠ΄Π΅Π½ΡΠΈ. The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-Cov-2) pandemic has spread rapidly worldwide with 314 million infected and 5 million deceased worldwide (as of December 2021). SARS-Cov-2 has been shown to not only cause viral pneumonia, but also to lead to serious effects on the cardiovascular system. It has been proven that COVID-19 can be complicated by the Acute Coronary Syndrome through plaque rupture, vasospasm or microthrombi due to systemic inflammation or cytokine storm. An additional role is played by the hyperimmune response as well as the endothelial dysfunction, which contribute to the hypercoagulable state. Π’here is a strong possibility that the high inflammatory load is the cause of de novo coronary lesions. We present a clinical case of a 53-year-old man presenting with toxico-infectious syndrome, angina and dyspnea. Conducted paraclinical andΒ clinical studies showed acut coronary syndrome without ST-elevation, left ventricular thrombosis, active SARS-CoV-2 infection and bilateral interstitial pneumonia. The patient was treated with percutaneous coronary intervention of LAD with drug-eluting stent, anticoagulant therapy, dual antiplatelet and anti-inflamatory therapy, beta blocker and ACE-inhibitor. On the 4th day of hospitalization the patient realized Left Middle Cerebral Artery Stroke. Our clinical case demonstrates unique prothromobotic properties of SARS-CoV-2, due to different mechanisms and complicated by thromboembolic events
A clinical case of a patient after COVID 19 infection and a thrombus in the right atrium, deep phlebothrombosis, and pulmonary embolism
ΠΡΠ²Π΅Π΄Π΅Π½ΠΈΠ΅: ΠΠ°Π±ΠΎΠ»ΡΠ²Π°Π½Π΅ΡΠΎ ΠΎΡ COVID-19 Π²ΠΎΠ΄ΠΈ Π΄ΠΎ ΠΌΡΠ»ΡΠΈΠΎΡΠ³Π°Π½Π½ΠΎ Π·Π°ΡΡΠ³Π°Π½Π΅, Π΅Π½Π΄ΠΎΡΠ΅Π»Π½ΠΎ Π²ΡΠ·ΠΏΠ°Π»Π΅Π½ΠΈΠ΅ ΠΈ ΠΌΠΈΠΊΡΠΎ- ΠΈ ΠΌΠ°ΠΊΡΠΎΠ²Π°ΡΠΊΡΠ»ΠΈΡ, ΠΏΡΠΈ ΠΊΠΎΠΈΡΠΎ ΠΌΠΎΠΆΠ΅ Π΄Π° Π½Π°ΡΡΡΠΏΠΈ ΡΡΠΎΠΌΠ±ΠΎΠ·Π° Π² ΠΌΠ°Π»ΠΊΠΈΡΠ΅ ΡΡΠ΄ΠΎΠ²Π΅, Π² ΡΡΠ΄ΠΎΠ²Π΅ Π² ΡΠ°Π·Π»ΠΈΡΠ½ΠΈ ΠΎΡΠ³Π°Π½ΠΈ, ΠΊΠ°ΠΊΡΠΎ ΠΈ Π² ΡΡΡΠ΄Π΅ΡΠ½ΠΈΡΠ΅ ΠΊΡΡ
ΠΈΠ½ΠΈ. ΠΡΠΊΠΎΠΈ ΠΎΡ ΡΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡΡΠ° ΠΌΠΎΠΆΠ΅ Π΄Π° ΠΏΠ΅ΡΡΠΈΡΡΠΈΡΠ°Ρ, ΠΊΠΎΠ΅ΡΠΎ ΡΠ΅ Π½Π°Π±Π»ΡΠ΄Π°Π²Π° Π² Π½Π°ΡΠΈΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅Π½ ΡΠ»ΡΡΠ°ΠΉ ΠΈ ΡΠΎΠ²Π° Π³ΠΎ ΠΏΡΠ°Π²ΠΈ ΠΎΡΠΎΠ±Π΅Π½ΠΎ ΠΈΠ½ΡΠ΅ΡΠ΅ΡΠ΅Π½. ΠΠ»ΠΈΠ½ΠΈΡΠ΅Π½ ΡΠ»ΡΡΠ°ΠΉ: ΠΡΠ΅Π΄ΡΡΠ°Π²ΡΠΌΠ΅ 73-Π³ΠΎΠ΄ΠΈΡΠ΅Π½ ΠΏΠ°ΡΠΈΠ΅Π½Ρ Ρ ΠΈΠ·Π²Π΅ΡΡΠ½ΠΎ ΠΏΠ΅ΡΠΌΠ°Π½Π΅Π½ΡΠ½ΠΎ ΠΏΡΠ΅Π΄ΡΡΡΠ΄Π½ΠΎ ΠΌΡΠΆΠ΄Π΅Π½Π΅ ΠΈ ΠΏΡΠΎΡΠ²ΠΈ Π½Π° Ρ
ΡΠΎΠ½ΠΈΡΠ½Π° ΡΡΡΠ΄Π΅ΡΠ½Π° Π½Π΅Π΄ΠΎΡΡΠ°ΡΡΡΠ½ΠΎΡΡ, ΠΏΠΎΠΏΠ»ΠΈΡΠ΅Π°Π»Π½Π° ΡΠ»Π΅Π±ΠΎΡΡΠΎΠΌΠ±ΠΎΠ·Π° ΠΈ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΡ Π½Π° Π»ΡΠ²Π° ΡΠ°Π·ΠΎΠ±Π΅Π΄ΡΠ΅Π½Π° ΡΡΠ°Π²Π°. 53 Π΄Π½ΠΈ ΡΠ»Π΅Π΄ Π΄ΠΎΠΊΠ°Π·Π°Π½ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»Π΅Π½ ΡΠ΅ΡΡ Π·Π° COVID-19 ΠΏΠΎΡΠ°Π΄ΠΈ ΠΎΠΏΠ»Π°ΠΊΠ²Π°Π½ΠΈΡ ΠΎΡ ΡΠ΅Π±ΡΠΈΠ»ΠΈΡΠ΅Ρ ΠΈ ΠΊΠ°ΡΠ»ΠΈΡΠ° Π½Π° ΡΠΎΠ½Π° Π½Π° Π½Π΅Π³Π°ΡΠΈΠ²Π΅Π½ Π²Π°ΠΊΡΠΈΠ½Π°ΡΠΈΠΎΠ½Π΅Π½ ΡΡΠ°ΡΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡΡ Π΅ Ρ
ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·ΠΈΡΠ°Π½ Ρ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠ° Π½Π° Π»Π΅ΠΊΠ° Π΄ΠΈΡ
Π°ΡΠ΅Π»Π½Π° Π½Π΅Π΄ΠΎΡΡΠ°ΡΡΡΠ½ΠΎΡΡ ΠΈ ΠΊΠ°ΡΠ΄ΠΈΠΎΠ³Π΅Π½Π΅Π½ ΡΠΎΠΊ. ΠΡ Π½Π°ΠΏΡΠ°Π²Π΅Π½ΠΈΡΠ΅ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΠΈ ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½ΠΈΡ ΡΠ΅ ΡΡΡΠ°Π½ΠΎΠ²ΠΈΡ
Π° ΠΏΠΎΠ²ΠΈΡΠ΅Π½ΠΈ ΠΌΠ°ΡΠΊΠ΅ΡΠΈ Π·Π° Π²ΡΠ·ΠΏΠ°Π»Π΅Π½ΠΈΠ΅. ΠΠΠ ΠΏΠΎΠΊΠ°Π·Π° ΡΠ°Ρ
ΠΈΠ°ΡΠΈΡΠΌΠΈΡ (170 ΡΠ΄./min) ΠΈ ΠΏΡΠ΅Π΄ΡΡΡΠ΄Π½ΠΎ ΠΌΡΠΆΠ΄Π΅Π½Π΅. ΠΡ
ΠΎΠΠ ΡΠ°Π·ΠΊΡΠΈ Π½Π°Π»ΠΈΡΠΈΠ΅ΡΠΎ Π½Π° ΠΠ-ΡΠΈΡΡΠΎΠ»Π½Π° Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΡ, ΠΏΡΠ»ΠΌΠΎΠ½Π°Π»Π½Π° Ρ
ΠΈΠΏΠ΅ΡΡΠΎΠ½ΠΈΡ ΠΈ ΠΌΠ°ΡΠΈΠ²Π΅Π½ ΡΡΠΎΠΌΠ± Π² Π΄ΡΡΠ½ΠΎΡΠΎ ΠΏΡΠ΅Π΄ΡΡΡΠ΄ΠΈΠ΅. Π‘ ΠΏΠΎΠΌΠΎΡΡΠ° Π½Π° ΠΠΎΠΏΠ»Π΅Ρ ΡΠ΅ Π΄ΠΎΠΊΠ°Π·Π° ΡΠ΅ΠΌΠΎΡΠΎΠΏΠΎΠΏΠ»ΠΈΡΠ΅Π°Π»Π½Π° ΡΡΠΎΠΌΠ±ΠΎΠ·Π° Π²Π΄ΡΡΠ½ΠΎ, Π° CT-ΠΏΡΠ»ΠΌΠΎΠ°Π½Π³ΠΈΠΎΠ³ΡΠ°ΡΠΈΡΡΠ° ΠΏΠΎΠΊΠ°Π·Π° Π΄Π°Π½Π½ΠΈ Π·Π° ΠΌΠ°ΡΠΈΠ²Π½Π° Π΄Π²ΡΡΡΡΠ°Π½Π½Π° ΠΠ’Π. ΠΠ·Π΅ ΡΠ΅ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ Π·Π° ΠΏΡΠΎΠ²Π΅ΠΆΠ΄Π°Π½Π΅ Π½Π° ΡΠΈΡΡΠ΅ΠΌΠ½Π° ΡΠΈΠ±ΡΠΈΠ½ΠΎΠ»ΠΈΠ·Π°, ΠΊΠΎΡΡΠΎ ΡΠ΅ ΠΏΠΎΠ½Π΅ΡΠ΅ Π±Π΅Π· ΡΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ. ΠΠΎ Π²ΡΠ΅ΠΌΠ΅ Π½Π° Ρ
ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΡΡΠ° Π½Π΅ ΡΠ΅ ΡΡΡΠ°Π½ΠΎΠ²ΠΈ Π½Π°Π»ΠΈΡΠΈΠ΅ Π½Π° Π½Π΅ΠΎΠΏΠ»Π°ΡΡΠΈΡΠ½ΠΎ Π·Π°Π±ΠΎΠ»ΡΠ²Π°Π½Π΅. ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅: Π’ΠΎΠ·ΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅Π½ ΡΠ»ΡΡΠ°ΠΉ ΠΏΠΎΡΠ²ΡΡΠΆΠ΄Π°Π²Π° Π²ΠΈΡΠΎΠΊΠΈΡ ΡΠΈΡΠΊ ΠΎΡ ΡΡΠΎΠΌΠ±ΠΎΠ·ΠΈ Π²ΡΠ»Π΅Π΄ΡΡΠ²ΠΈΠ΅ Π½Π° ΠΠΎΠ²ΠΈΠ΄ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡ (ΡΠ»Π΅Π±ΠΎΡΡΠΎΠΌΠ±ΠΎΠ·Π°, ΠΏΡΠ΅Π΄ΡΡΡΠ΄Π½Π° ΡΡΠΎΠΌΠ±ΠΎΠ·Π° ΠΈ ΠΌΠ°ΡΠΈΠ²Π½Π° Π΄Π²ΡΡΡΡΠ°Π½Π½Π° ΠΠ’Π) Π±Π΅Π· ΠΎΠΏΡΠΈΠΌΠ°Π»Π½Π° Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»Π°Π½ΡΠ½Π° ΡΠ΅ΡΠ°ΠΏΠΈΡ ΠΈ ΠΏΡΠΈ ΠΏΡΠΈΠ΅ΠΌ Π½Π° Π°Π½ΡΠΈΠ°Π³ΡΠ΅Π³Π°Π½Ρ ΠΎΠΊΠΎΠ»ΠΎ 2 ΠΌΠ΅ΡΠ΅ΡΠ° ΡΠ»Π΅Π΄ Π½Π°ΡΠ°Π»ΠΎΡΠΎ Π½Π° ΡΠΈΠΌΠΏΡΠΎΠΌΠΈΡΠ΅. Background: The coronavirus disease (COVID-19 disease) leads to multiple organ disease, inflammation of the endothelium, and micro- or macrovasculitis that may result in thrombosis of the small vessels, and thrombosis of vessels in various organs, as well as intracardiac thrombosis. Some of the complications may be long-lasting, as in our case, which makes it particularly interesting to discuss. Case report: We present a 73-year-old male patient with a history of permanent atrial fibrillation and chronic heart failure (II NYHA class), popliteal phlebothrombosis, and surgery of the left hip joint. 53 days after a positive rapid test for Covid 19 performed because of fever and coughing, the patient, who is not vaccinated for Covid 19, was hospitalised at our Department with clinical signs of mild respiratory failure and cardiogenic shock.Β The laboratory tests revealed elevated markers of inflammation. The ECG showed tachyarrhythmia (170/min) and atrial fibrillation. The EchoCG displayed evidence of right systolic dysfunction, pulmonary hypertension, and a massive thrombus in the right atrium. The Doppler ultrasonography revealed the presence of right femoropopliteal thrombosis, while the CT-pulmoangiography showed evidence of massive bilateral PE. A decision was made to perform systemic fibrinolysis, which the patient tolerated without complications. During the hospitalisation, the examinations revealed no evidence of an oncological disease. Conclusion: The reported clinical case confirms the high risk of thrombosis due to a COVID-19 infection, such as phlebothrombosis, atrial thrombosis, and massive bilateral PE, in the absence of optimal anticoagulant therapy and against the backdrop of the administration of antiplatelet therapy roughly 2 months after the onset of the COVID-19 symptoms
Balloon aortic valvuloplasty in degenerative aortic stenosis
ΠΠ°Π»ΠΎΠ½Π½Π°ΡΠ° Π²Π°Π»Π²ΡΠ»ΠΎΠΏΠ»Π°ΡΡΠΈΠΊΠ° Π½Π° Π°ΠΎΡΡΠ½Π° ΠΊΠ»Π°ΠΏΠ° (BAV) ΠΏΡΠΈ Π°ΠΎΡΡΠ½Π° ΡΡΠ΅Π½ΠΎΠ·Π° ΡΠ΅ ΠΏΡΠ°ΠΊΡΠΈΠΊΡΠ²Π° ΠΎΡ Π½Π°Π΄ 35 Π³ΠΎΠ΄ΠΈΠ½ΠΈ. ΠΡΡΠ²ΠΎΠ½Π°ΡΠ°Π»Π½ΠΈΡ Π΅Π½ΡΡΡΠΈΠ°Π·ΡΠΌ, ΠΏΠΎΡΠΎΠ΄Π΅Π½ ΠΎΡ ΠΎΡΠ»ΠΈΡΠ½ΠΈΡ Π½Π΅ΠΏΠΎΡΡΠ΅Π΄ΡΡΠ²Π΅Π½ Ρ
Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅Π½ Π΅ΡΠ΅ΠΊΡ ΠΎΡ ΠΏΡΠΎΡΠ΅Π΄ΡΡΠ°ΡΠ°, ΠΈΠ·ΡΠ΅Π·Π²Π° ΠΏΠΎΡΠ°Π΄ΠΈ Π±ΡΡΠ·Π°ΡΠ° ΡΠ΅ΡΡΠ΅Π½ΠΎΠ·Π° Π½Π° Π°ΠΎΡΡΠ½Π°ΡΠ° ΠΊΠ»Π°ΠΏΠ° ΡΠ»Π΅Π΄ ΠΈΠ½ΡΠ΅ΡΠ²Π΅Π½ΡΠΈΡ. Π Π΅Π·ΡΠ»ΡΠ°ΡΠΈΡΠ΅ ΠΎΡ ΡΡΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΠΈΡΠ΅ ΠΌΠ΅ΡΠΎΠ΄ΠΈ Π·Π° Π΄Π΅ΡΠΈΠ½ΠΈΡΠΈΠ²Π½ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Π½Π° Π°ΠΎΡΡΠ½Π°ΡΠ° ΠΊΠ»Π°ΠΏΠ½Π° ΡΡΠ΅Π½ΠΎΠ·Π° β sAVR ΠΈ TAVI, ΡΠ° ΠΎΡΠ»ΠΈΡΠ½ΠΈ, Π±Π»Π°Π³ΠΎΠ΄Π°ΡΠ΅Π½ΠΈΠ΅ Π½Π° ΠΊΠΎΠ΅ΡΠΎ ΡΠ° Π·Π΄ΡΠ°Π²ΠΎ Π·Π°Π»Π΅Π³Π½Π°Π»ΠΈ Π² ΡΡΠΊΠΎΠ²ΠΎΠ΄ΡΡΠ²Π°ΡΠ° Π·Π° Π»Π΅ΡΠ΅Π½ΠΈΠ΅. ΠΡΠΏΡΠ΅ΠΊΠΈ ΡΠΎΠ²Π° BAV ΠΈΠΌΠ° ΡΠ²ΠΎΠΈΡΠ΅ ΠΈΠ½Π΄ΠΈΠΊΠ°ΡΠΈΠΈ ΠΏΡΠΈ ΡΠΈΠΌΠΏΡΠΎΠΌΠ½ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ, ΠΊΠΎΠΈΡΠΎ Π½Π΅ ΡΠ° ΠΏΠΎΠ΄Ρ
ΠΎΠ΄ΡΡΠΈ Π·Π° Π΄Π΅ΡΠΈΠ½ΠΈΡΠΈΠ²Π½ΠΈΡΠ΅ ΠΈΠ½ΡΠ΅ΡΠ²Π΅Π½ΡΠΈΠΈ. ΠΠ°ΡΡΠΎΡΡΠ°ΡΠ° ΠΏΡΠ±Π»ΠΈΠΊΠ°ΡΠΈΡ ΡΠ°Π·Π³Π»Π΅ΠΆΠ΄Π° ΡΡΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΠΈΡΠ΅ ΠΈΠ½Π΄ΠΈΠΊΠ°ΡΠΈΠΈ Π·Π° BAV, ΠΎΡΠ½ΠΎΠ²Π½ΠΈΡΠ΅ Π΅ΡΠ°ΠΏΠΈ ΠΎΡ ΠΏΡΠΎΡΠ΅Π΄ΡΡΠ°ΡΠ°, Π²ΡΠ·ΠΌΠΎΠΆΠ½ΠΈΡΠ΅ ΡΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ, ΠΊΠ°ΠΊΡΠΎ ΠΈ ΡΠ΅Π·ΡΠ»ΡΠ°ΡΠΈΡΠ΅ ΠΎΡ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ΡΠΎ. Balloon valvuloplasty of the aortic valve (BAV) in aortic stenosis has been practiced for over 35 years. The initial enthusiasm caused by the excellent immediate hemodynamic effect of the procedure disappears due to the rapid restenosis of the aortic valve after intervention. The results of modern methods for defi nitive treatment of aortic valve stenosis β AVR and TAVI are excellent, thanks to which they are fi rmly rooted in treatment guidelines. However, BAV has its indications in symptomatic patients who are not suitable for defi nitive interventions. This publication discusses current indications for BAV, the main stages of the procedure, possible complications, and treatment outcomes
Interventional treatment of pulmonary embolism - where do we currently stand?
ΠΡΡΡΠ°ΡΠ° Π±Π΅Π»ΠΎΠ΄ΡΠΎΠ±Π½Π° ΡΡΠΎΠΌΠ±ΠΎΠ΅ΠΌΠ±ΠΎΠ»ΠΈΡ Π΅ ΡΡΠ΅ΡΠ°ΡΠ° Π½Π°ΠΉ-ΡΠ΅ΡΡΠ° ΠΏΡΠΈΡΠΈΠ½Π° Π·Π° ΡΡΡΠ΄Π΅ΡΠ½ΠΎ-ΡΡΠ΄ΠΎΠ²Π° ΡΠΌΡΡΡΠ½ΠΎΡΡ Π² ΡΠ²Π΅ΡΠ°. ΠΠ½Π΅Π·Π°ΠΏΠ½ΠΎΡΠΎ ΡΠ΅Π½ΡΠΈΠΎΠ½Π½ΠΎ ΠΎΠ±ΡΠ΅ΠΌΠ΅Π½ΡΠ²Π°Π½Π΅ Π½Π° Π΄ΡΡΠ½Π°ΡΠ° ΠΊΠ°ΠΌΠ΅ΡΠ°, ΠΏΡΠ΅Π΄ΠΈΠ·Π²ΠΈΠΊΠ°Π½ΠΎ ΠΎΡ ΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠ½ΠΈΡΠ΅ ΠΌΠ°ΡΠΈ Π² ΠΏΡΠ»ΠΌΠΎΠ½Π°Π»Π½Π°ΡΠ° Π°ΡΡΠ΅ΡΠΈΡ, ΠΌΠΎΠΆΠ΅ Π±ΡΡΠ·ΠΎ Π΄Π° ΠΏΡΠΎΠ³ΡΠ΅ΡΠΈΡΠ° Π΄ΠΎ ΠΊΠ»ΠΈΠ½ΠΈΡΠ½Π° ΠΊΠ°ΡΡΠΈΠ½Π° Π½Π° ΡΠ΅ΠΆΡΠΊ ΠΊΠ°ΡΠ΄ΠΈΠΎΠ³Π΅Π½Π΅Π½ ΡΠΎΠΊ. Π’ΠΎΠ²Π° ΠΌΠΎΠΆΠ΅ Π΄Π° Π΄ΠΎΠ²Π΅Π΄Π΅ Π΄ΠΎ ΡΠΌΡΡΡΠ½ΠΎΡΡ Π½Π°Π΄ 50%, ΠΏΡΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ Ρ ΠΌΠ°ΡΠΈΠ²Π½Π° ΡΠΎΡΠΌΠ° Π½Π° Π±Π΅Π»ΠΎΠ΄ΡΠΎΠ±Π½Π° ΡΡΠΎΠΌΠ±ΠΎΠ΅ΠΌΠ±ΠΎΠ»ΠΈΡ. Π ΡΠ°ΠΊΠΈΠ²Π° ΡΠ»ΡΡΠ°ΠΈ Π΅ ΠΌΠΎΡΠΈΠ²ΠΈΡΠ°Π½ΠΎ ΠΏΡΠΎΠ²Π΅ΠΆΠ΄Π°Π½Π΅ΡΠΎ Π½Π° ΡΠΈΡΡΠ΅ΠΌΠ½Π° ΡΠΈΠ±ΡΠΈΠ½ΠΎΠ»ΠΈΠ·Π°, ΠΊΠΎΠ΅ΡΠΎ Π²ΠΎΠ΄ΠΈ Π΄ΠΎ Π±ΡΡΠ·ΠΎ ΠΏΠΎΠ΄ΠΎΠ±ΡΠ΅Π½ΠΈΠ΅ Π² Π΄Π΅ΡΠ½ΠΎΠΊΠ°ΠΌΠ΅ΡΠ½Π°ΡΠ° ΡΡΠ½ΠΊΡΠΈΡ ΠΈ ΡΡΠ°Π±ΠΈΠ»ΠΈΠ·ΠΈΡΠ°Π½Π΅ Π½Π° Ρ
Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΠΊΠ°ΡΠ°. Π’ΡΠΎΠΌΠ±ΠΎΠ»ΠΈΡΠΈΡΠ½ΠΈΡΡ Π΅ΡΠ΅ΠΊΡ Π½Π° ΡΠΈΡΡΠ΅ΠΌΠ½Π°ΡΠ° ΡΠΈΠ±ΡΠΈΠ½ΠΎΠ»ΠΈΠ·Π°, Π·Π° ΡΡΠΆΠ°Π»Π΅Π½ΠΈΠ΅, e ΡΡΠΏΡΠΎΠ²ΠΎΠ΄Π΅Π½ ΠΎΡ ΠΏΠ΅ΡΠΊΡΠ°ΡΠ½ΠΎ ΠΏΠΎΠ²ΠΈΡΠ΅Π½ ΡΠΈΡΠΊ ΠΎΡ ΠΊΡΡΠ²Π΅Π½Π΅, ΠΎΡΠΎΠ±Π΅Π½ΠΎ Π²ΡΡΡΠ΅ΡΠ΅ΡΠ΅ΠΏΠ½ΠΎ. Π‘Π»Π΅Π΄ΠΎΠ²Π°ΡΠ΅Π»Π½ΠΎ Π² ΠΏΠΎΠ²Π΅ΡΠ΅ΡΠΎ ΡΠ»ΡΡΠ°ΠΈ Ρ
Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΡΠ½ΠΎ ΡΡΠ°Π±ΠΈΠ»Π½ΠΈΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ Π±ΠΈΠ²Π°Ρ ΡΡΠ΅ΡΠΈΡΠ°Π½ΠΈ ΡΠ°ΠΌΠΎ Ρ Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»Π°Π½ΡΠ½Π° ΡΠ΅ΡΠ°ΠΏΠΈΡ. ΠΠ½ΡΠ΅ΡΠ²Π΅Π½ΡΠΈΠΎΠ½Π°Π»Π½ΠΎΡΠΎ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Π½Π° ΠΎΡΡΡΠ°ΡΠ° Π±Π΅Π»ΠΎΠ΄ΡΠΎΠ±Π½Π° Π΅ΠΌΠ±ΠΎΠ»ΠΈΡ Π²ΠΊΠ»ΡΡΠ²Π° ΡΠΏΠΎΡΡΠ΅Π±Π°ΡΠ° Π½Π° ΡΡΡΡΠΎΠΉΡΡΠ²Π°, ΠΈΠ·ΠΏΠΎΠ»Π·Π²Π°ΡΠΈ Π½ΠΈΡΠΊΠ° Π΄ΠΎΠ·Π° ΡΠΈΠ±ΡΠΈΠ½ΠΎΠ»ΠΈΡΠΈΠΊ ΠΈΠ»ΠΈ ΡΠ°ΠΊΠΈΠ²Π° Π·Π° ΠΏΠ΅ΡΠΊΡΡΠ°Π½Π½Π° ΡΡΠΎΠΌΠ±Π°ΡΠΏΠΈΡΠ°ΡΠΈΡ. Π¦Π΅Π»ΡΠ° Π΅ Π΄Π° ΡΠ΅ ΠΏΠΎΡΡΠΈΠ³Π½Π΅ Π±ΡΡΠ·ΠΎ ΠΎΡΡΡΡΠ°Π½ΡΠ²Π°Π½Π΅ Π½Π° ΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠ½ΠΈΡΠ΅ ΠΌΠ°ΡΠΈ ΠΎΡ ΠΏΡΠ»ΠΌΠΎΠ½Π°Π»Π½Π°ΡΠ° Π°ΡΡΠ΅ΡΠΈΡ, ΠΊΠ°ΡΠΎ Π΅Π΄Π½ΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎ ΡΠ΅ ΡΠ²Π΅Π΄Π΅ Π΄ΠΎ ΠΌΠΈΠ½ΠΈΠΌΡΠΌ Ρ
Π΅ΠΌΠΎΡΠ°Π³ΠΈΡΠ½ΠΈΡΡ ΡΠΈΡΠΊ. Π’ΠΎΠ·ΠΈ ΠΎΠ±Π·ΠΎΡ ΡΠ΅ ΡΠ΅ ΠΎΠΏΠΈΡΠ° Π΄Π° ΠΏΡΠ΅Π΄ΠΎΡΡΠ°Π²ΠΈ ΠΊΡΠ°ΡΡΠΊ ΠΏΡΠ΅Π³Π»Π΅Π΄ Π½Π° Π½Π°ΠΉ-ΡΠ΅ΡΡΠΎ ΠΈΠ·ΠΏΠΎΠ»Π·Π²Π°Π½ΠΈΡΠ΅ ΠΈ Π½Π°Π»ΠΈΡΠ½ΠΈ Π½Π° ΠΏΠ°Π·Π°ΡΠ° ΡΡΡΡΠΎΠΉΡΡΠ²Π°, ΠΊΠ°ΠΊΡΠΎ ΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡΠ½ΠΈΡΠ΅ Π΄Π°Π½Π½ΠΈ, ΠΏΠΎΠ΄ΠΊΡΠ΅ΠΏΡΡΠΈ ΡΡΡ
Π½Π°ΡΠ° ΡΠΏΠΎΡΡΠ΅Π±Π°. Π‘ΡΡΠΎ ΡΠ°ΠΊΠ°, ΡΠ΅ Π±ΡΠ΄Π°Ρ ΡΠ°Π·Π³Π»Π΅Π΄Π°Π½ΠΈ ΠΏΠ΅ΡΡΠΏΠ΅ΠΊΡΠΈΠ²ΠΈΡΠ΅ Π² ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ΡΠΎ Π½Π° Π΅Π½Π΄ΠΎΠ²Π°ΡΠΊΡΠ»Π°ΡΠ½ΠΎΡΠΎ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Π½Π° ΠΎΡΡΡΠ°ΡΠ° Π±Π΅Π»ΠΎΠ΄ΡΠΎΠ±Π½Π° ΡΡΠΎΠΌΠ±ΠΎΠ΅ΠΌΠ±ΠΎΠ»ΠΈΡ. Acute pulmonary embolism is the third most common cause of cardiovascular mortality in the world. The sudden pressure overload of the right ventricle, caused by the thrombotic masses in the pulmonary artery, may quickly progress to profound cardiogenic shock. That results in a mortality rate of more than 50% in patients with a massive form of pulmonary embolism. In such cases, systemic fibrinolysis is warranted, which leads to rapid improvement of the right ventricular function and hemodynamic stabilization. The thrombolytic effect of systemic fibrinolysis is, unfortunately, accompanied by an almost 5 times increased risk of bleeding, especially intracranial one. Therefore, in most cases, for patients with uncompromised hemodynamics, only anticoagulation treatment is offered. Interventional treatment of acute pulmonary embolism consists of the usage of very low-dose fibrinolytic devices or percutaneous thrombus aspiration devices. The goal is to provide rapid removal of the thrombotic masses from the pulmonary artery circulation while keeping the hemorrhagic risk at a minimum. This paper will try to provide a concise review of the most widely used and available devices, together with the latest clinical data, supporting their use. Also, the future perspectives in the field of endovascular treatment of acute pulmonary embolism will be presented
Endovascular treatment of subclavian artery stenosis
ΠΠ°ΠΉ-ΡΠ΅ΡΡΠ°ΡΠ° Π»ΠΎΠΊΠ°Π»ΠΈΠ·Π°ΡΠΈΡ Π·Π° Π°ΡΠ΅ΡΠΎΡΠΊΠ»Π΅ΡΠΎΠ·Π°ΡΠ° Π½Π° Π³ΠΎΡΠ½ΠΈΡΠ΅ ΠΊΡΠ°ΠΉΠ½ΠΈΡΠΈ ΡΠ° Π°ΡΡΠ΅ΡΠΈΡ ΡΡΠ±ΠΊΠ»Π°Π²ΠΈΡ ΠΈ ΡΡΡΠ½ΠΊΡΡ Π±ΡΠ°Ρ
ΠΈΠΎΡΠ΅ΡΠ°Π»ΠΈΠΊΡΡ. Π‘ΠΈΠ³Π½ΠΈΡΠΈΠΊΠ°Π½ΡΠ½Π°ΡΠ° ΡΡΠ΅Π½ΠΎΠ·Π° Π½Π° Π°ΡΡΠ΅ΡΠΈΡ ΡΡΠ±ΠΊΠ»Π°Π²ΠΈΡ ΡΠ΅ ΡΡΠ΅ΡΠ° ΠΏΡΠΈΠ±ΡΠΈΠ»ΠΈΠ·ΠΈΡΠ΅Π»Π½ΠΎ ΠΏΡΠΈ 2% ΠΎΡ ΠΏΠΎΠΏΡΠ»Π°ΡΠΈΡΡΠ° ΠΈ Π² 7-11% ΠΎΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈΡΠ΅ Ρ ΠΌΠ°Π½ΠΈΡΠ΅ΡΡΠ½ΠΎ ΡΡΡΠ΄Π΅ΡΠ½ΠΎ-ΡΡΠ΄ΠΎΠ²ΠΎ Π·Π°Π±ΠΎΠ»ΡΠ²Π°Π½Π΅. Π Π΅Π²Π°ΡΠΊΡΠ»Π°ΡΠΈΠ·Π°ΡΠΈΡΡΠ° Π΅ ΠΏΠΎΠΊΠ°Π·Π°Π½Π° ΠΏΡΠΈ ΡΠΈΠΌΠΏΡΠΎΠΌΠ½ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ ΠΈΠ»ΠΈ Π°ΡΠΈΠΌΠΏΡΠΎΠΌΠ½ΠΈ Ρ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎ Π·Π°Π±ΠΎΠ»ΡΠ²Π°Π½Π΅ Ρ ΠΏΠ»Π°Π½ΠΈΡΠ°Π½Π° ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ²Π½Π° ΡΠ΅Π²Π°ΡΠΊΡΠ»Π°ΡΠΈΠ·Π°ΡΠΈΡ. ΠΡΠ²Π΅Π½ Π°ΡΠ΅ΡΠΎΡΠΊΠ»Π΅ΡΠΎΠ·Π° Π΄ΡΡΠ³ΠΈ ΠΏΡΠΈΡΠΈΠ½ΠΈ Π·Π° ΠΈΠ·ΡΠ²Π°ΡΠ° Π½Π° ΡΡΠ΅Π½ΠΎΠ·Π° Π½Π° Π°ΡΡΠ΅ΡΠΈΡ ΡΡΠ±ΠΊΠ»Π°Π²ΠΈΡ Π²ΠΊΠ»ΡΡΠ²Π°Ρ Π΄ΠΈΡΠ΅ΠΊΠ°ΡΠΈΡ, ΠΏΡΠ΅Π΄ΠΈΠ·Π²ΠΈΠΊΠ°Π½Π° ΠΎΡ ΡΠ°Π΄ΠΈΠ°ΡΠΈΡ, Π²ΡΠ·ΠΏΠ°Π»Π΅Π½ΠΈΠ΅ Π½Π° ΡΠΈΠ±ΡΠΎΠΌΡΡΠΊΡΠ»Π°ΡΡΡΠ°ΡΠ° ΠΈ ΡΠ°Π·Π»ΠΈΡΠ½ΠΈ Π²Π°ΡΠΊΡΠ»ΠΈΡΠΈ, ΠΎΡΠΎΠ±Π΅Π½ΠΎ Π°ΡΡΠ΅ΡΠΈΠΈΡ Π½Π° Π’Π°ΠΊΠ°ΡΡΡ. ΠΡΠ²Π°ΡΠ° ΠΏΠΎΠ΄ΠΊΠ»ΡΡΠΈΡΠ½Π° Π°ΡΡΠ΅ΡΠΈΡ Π΅ ΠΎΠΊΠΎΠ»ΠΎ ΡΠ΅ΡΠΈΡΠΈ ΠΏΡΡΠΈ ΠΏΠΎ-Π²Π΅ΡΠΎΡΡΠ½ΠΎ Π΄Π° Π±ΡΠ΄Π΅ Π·Π°ΡΠ΅Π³Π½Π°ΡΠ°, ΠΎΡΠΊΠΎΠ»ΠΊΠΎΡΠΎ Π΄ΡΡΠ½Π°ΡΠ°. Π‘ΡΠ΅ΡΠ° ΡΠ΅ ΠΎΠ±ΠΈΠΊΠ½ΠΎΠ²Π΅Π½ΠΎ Π½Π° Π²ΡΠ·ΡΠ°ΡΡ Π½Π°Π΄ 50 Π³ΠΎΠ΄ΠΈΠ½ΠΈ ΠΈ Π² 1,5-2 ΠΏΡΡΠΈ ΠΏΠΎ-ΡΠ΅ΡΡΠΎ ΠΏΡΠΈ ΠΌΡΠΆΠ΅ΡΠ΅, ΠΎΡΠΊΠΎΠ»ΠΊΠΎΡΠΎ ΠΏΡΠΈ ΠΆΠ΅Π½ΠΈΡΠ΅. ΠΠ°Π±ΠΎΠ»ΡΠ²Π°Π½Π΅ΡΠΎ Π½Π° ΠΏΠΎΠ΄ΠΊΠ»ΡΡΠΈΡΠ½Π°ΡΠ° Π°ΡΡΠ΅ΡΠΈΡ ΠΎΠ±ΠΈΠΊΠ½ΠΎΠ²Π΅Π½ΠΎ Π΅ ΠΎΠ³Π½ΠΈΡΠ½ΠΎ ΠΈ Π»Π΅Π·ΠΈΡΡΠ° Π΅ ΠΏΡΠ΅Π΄ΠΈΠΌΠ½ΠΎ Π² ΠΏΡΡΠ²ΠΈΡΠ΅ 2 cm ΠΏΡΠΎΠΊΡΠΈΠΌΠ°Π»Π΅Π½ ΡΠ΅Π³ΠΌΠ΅Π½Ρ ΠΎΡ Π½Π°ΡΠ°Π»ΠΎΡΠΎ Π½Π° Π°ΠΎΡΡΠ°ΡΠ°. ΠΠ΅ΠΆΠ΄Ρ 2016-2021 Π³. Π² ΠΠ»ΠΈΠ½ΠΈΠΊΠ°ΡΠ° ΠΏΠΎ ΠΊΠ°ΡΠ΄ΠΈΠΎΠ»ΠΎΠ³ΠΈΡ ΠΈ Π°Π½Π³ΠΈΠΎΠ»ΠΎΠ³ΠΈΡ Π½ΠΈΠ΅ Π»Π΅ΠΊΡΠ²Π°Ρ
ΠΌΠ΅ Π΅Π΄Π½ΠΎΠ²Π°ΡΠΊΡΠ»Π°ΡΠ½ΠΎ 81 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ (41 ΠΌΡΠΆΠ΅ ΠΈ 40 ΠΆΠ΅Π½ΠΈ, ΡΡΠ΅Π΄Π½Π° Π²ΡΠ·ΡΠ°ΡΡ 64 Β± 11) ΡΡΠ΅Π· Π±Π°Π»ΠΎΠ½Π½Π° Π΄ΠΈΠ»Π°ΡΠ°ΡΠΈΡ ΠΈ/ΠΈΠ»ΠΈ ΠΏΡΡΠ²ΠΈΡΠ½ΠΎ ΡΡΠ΅Π½ΡΠΈΡΠ°Π½Π΅ ΠΏΠΎΡΠ»Π΅Π΄Π²Π°Π½ΠΎ ΠΎΡ Π±Π°Π»ΠΎΠ½Π½Π° ΠΏΠΎΡΡΠ΄ΠΈΠ»Π°ΡΠ°ΡΠΈΡ. ΠΠΎΡΡΠΈΠ³Π½Π°Ρ
ΠΌΠ΅ Π²ΠΈΡΠΎΠΊΠ° ΡΠ΅Ρ
Π½ΠΈΡΠ΅ΡΠΊΠ° ΡΡΠΏΠ΅Π²Π°Π΅ΠΌΠΎΡΡ (93.8%) ΠΈ Π½Π΅Π·Π°Π±Π°Π²Π΅Π½ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅Π½ ΡΡΠΏΠ΅Ρ
ΡΡΡ ΡΠ°ΠΌΠΎ Π½ΡΠΊΠΎΠ»ΠΊΠΎ ΠΌΠΈΠ½ΠΈΠΌΠ°Π»Π½ΠΈ ΡΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ. The most common localizations for upper extremity atherosclerosis are the subclavian artery and the brachiocephalic trunk. Significant stenosis of the subclavian artery occurs in 2% of the population and in 7-11% of patients with manifest cardiovascular disease. Revascularization is indicated in symptomatic or asymptomatic patients with coronary disease with planned surgical revascularization. In addition to atherosclerosis, other causes of the appearance of subclavian artery stenosis include dissection, radiation-induced inflammation of the fibromusculature, and various vasculities, especially Takayasu arteritis. The left subclavian artery is about four times more commonly affected than the right. It usually occurs over the age of 50 years and in 1.5-2 times more common in men than in women. Disease of the subclavian artery is usually focal and the lesion is predominantly in the first 2 cm proximal to the origin of the aorta. Between 2016-2021 in the clinic of cardiology and angiology we treated endovascularly 81 patients (41 men and 40 females, median age 64 Β± 11) with either intraluminal balloon dilatation and/or primary stent implantation followed by balloon post dilatation. We achieved a high technical success rate (93.8%) and immediate clinical success, with only a few minor complications.
Transcatheter aortic valve implantation for severe aortic regurgitation in a patient with end-stage respiratory failure
ΠΡΠ΅Π΄ΡΡΠ°Π²ΡΠΌΠ΅ ΡΠ»ΡΡΠ°ΠΉ Π½Π° 73-Π³ΠΎΠ΄ΠΈΡΠ΅Π½ ΠΏΠ°ΡΠΈΠ΅Π½Ρ Ρ ΠΊΠΎΠΌΠ±ΠΈΠ½ΠΈΡΠ°Π½ΠΎ Π·Π°ΡΡΠ³Π°Π½Π΅ Π½Π° Π°ΠΎΡΡΠ½Π°ΡΠ° ΠΊΠ»Π°ΠΏΠ° ΠΏΡΠΈ ΠΏΡΠ΅ΠΎΠ±Π»Π°Π΄Π°Π²Π°ΡΠ° Π²ΠΈΡΠΎΠΊΠΎΡΡΠ΅ΠΏΠ΅Π½Π½Π°, ΡΠΈΠΌΠΏΡΠΎΠΌΠ°ΡΠΈΡΠ½Π° Π°ΠΎΡΡΠ½Π° ΡΠ΅Π³ΡΡΠ³ΠΈΡΠ°ΡΠΈΡ ΠΈ ΠΏΡΠΈΠ΄ΡΡΠΆΠ°Π²Π°ΡΠ° Π΄ΠΈΡ
Π°ΡΠ΅Π»Π½Π° Π½Π΅Π΄ΠΎΡΡΠ°ΡΡΡΠ½ΠΎΡΡ Π² ΡΠ΅ΡΠΌΠΈΠ½Π°Π»Π΅Π½ ΡΡΠ°Π΄ΠΈΠΉ, ΡΡΡ Π·Π°Π±ΡΠ°Π½ΠΈΡΠ΅Π»Π½ΠΎ Π²ΠΈΡΠΎΠΊ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅Π½ ΡΠΈΡΠΊ, ΠΏΡΠΈ ΠΊΠΎΠΉΡΠΎ ΠΎΡΡΡΠ΅ΡΡΠ²ΠΈΡ
ΠΌΠ΅ ΡΡΠΏΠ΅ΡΠ½ΠΎ ΠΈΠΌΠΏΠ»Π°Π½ΡΠΈΡΠ°Π½Π΅ Π½Π° off-label self-expandable Π°ΠΎΡΡΠ½Π° ΠΊΠ»Π°ΠΏΠ½Π° ΠΏΡΠΎΡΠ΅Π·Π° Medtronic Core Valve, ΠΈΠ·ΠΏΠΎΠ»Π·Π²Π°ΠΉΠΊΠΈ Ρ.Π½Π°Ρ ΠΌΠΈΠ½ΠΈΠΌΠ°Π»ΠΈΡΡΠΈΡΠ΅Π½ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄. Π’ΠΎΠ·ΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅Π½ ΡΠ»ΡΡΠ°ΠΉ ΠΏΠΎΠΊΠ°Π·Π²Π°, ΡΠ΅ ΡΠ°ΠΌΠΎΡΠ°Π·ΡΠΈΡΡΠ²Π°ΡΠ°ΡΠ° ΡΠ΅ ΠΏΡΠΎΡΠ΅Π·Π° Medtronic CoreValve Evolut R ΠΌΠΎΠΆΠ΅ Π΄Π° Π±ΡΠ΄Π΅ ΠΈΠΌΠΏΠ»Π°Π½ΡΠΈΡΠ°Π½Π° Π±Π΅Π· ΡΡΠΊΠ°Π½Π½ΠΎ ΡΠ²ΡΠ΅ΠΆΠ΄Π°Π½Π΅ ΠΈ ΠΌΠΈΠ³ΡΠ°ΡΠΈΡ Π² Π΅Π΄Π½Π° ΡΠΌΠ΅ΡΠ΅Π½ΠΎ ΠΊΠ°Π»ΡΠΈΡΠ°Π½Π° ΡΡΠΈΠΊΡΡΠΏΠΈΠ΄Π½Π° Π°ΠΎΡΡΠ½Π° ΠΊΠ»Π°ΠΏΠ° Ρ ΠΏΡΠ΅ΠΎΠ±Π»Π°Π΄Π°Π²Π°ΡΠ° ΠΈΠ½ΡΡΡΠΈΡΠΈΠ΅Π½ΡΠΈΡ ΠΏΡΠΈ Π½ΠΈΡΠΊΠΎΡΡΠ΅ΠΏΠ΅Π½Π½Π° ΡΡΠ΅Π½ΠΎΠ·Π° ΠΈ Π΄Π° Π΄ΠΎΠ²Π΅Π΄Π΅ Π΄ΠΎ Π·Π°Π΄ΠΎΠ²ΠΎΠ»ΠΈΡΠ΅Π»Π½ΠΈ Ρ
Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΡΠ½ΠΈ ΡΠ΅Π·ΡΠ»ΡΠ°ΡΠΈ Ρ ΠΏΠΎΠ΄ΠΎΠ±ΡΡΠ²Π°Π½Π΅ Π½Π° ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»Π½ΠΈΡ ΠΊΠ»Π°Ρ ΡΡΡΠ΄Π΅ΡΠ½Π° Π½Π΅Π΄ΠΎΡΡΠ°ΡΡΡΠ½ΠΎΡΡ ΠΏΡΠΈ ΠΏΠ°ΡΠΈΠ΅Π½Ρ ΡΡΡ ΡΡΠΏΡΡΡΡΠ²Π°ΡΠ° ΡΠ΅ΠΆΠΊΠ° Π΄ΠΈΡ
Π°ΡΠ΅Π»Π½Π° Π½Π΅Π΄ΠΎΡΡΠ°ΡΡΡΠ½ΠΎΡΡ. We report a case of a high-risk 73-yearβold patient with a combined aortic valve disease with predominant severe, symptomatic aortic regurgitation and a history of an end-stage respiratory failure with prohibitive surgical risk who was successfully treated using a minimalist approach to implant off-label Π° self-expandable Medtronic Evolut R prosthesis. This case report demonstrates that the self-expandable prosthesis Medtronic Evolut R might be implanted without tissue damage and migration in a moderate-calcified tricuspid aortic valve with predominant regurgitation and mild stenosis with satisfactory hemodynamic results and improvement in functional class heart failure in a patient with concomitant severe respiratory failure
Percutaneous coronary artery intervention after transcatheter aortic valve implantation
Transcatheter implantation of the aortic valve is an increasingly used method for the treatment of aortic stenosis, with a steady trend worldwide to increase the number of TAVI procedures and reduce the age of patients. In Europe, over 180,000 TAVI procedures are currently implemented annually. This review aims to evaluate the patientβs prognosis for the different approaches, the technical difο¬ culties during the procedure, and to offer useful tips for overcoming them. We publish our experience in transcatheter treatment of ischemic heart disease after TAVI implantation