CLINICAL CASE
 

Surgical treatment of pseudoaneurysm of the free left ventricle wall: a clinical case
O. Kiziukevich, S. Spiridonov, A. Zhyhalkovich, D. Isachkin
Today diseases of the cardiovascular system are the leading cause of death in many countries. The key role in this pathology is played by ischemic heart disease. An extreme manifestation of ischemic heart disease – myocardial infarction is one of the main causes of complications and mortality in patients with ischemic heart disease. One of the most formidable complications of acute myocardial infarction is heart rupture, which most often leads to death, more than 60% of cases occurring in the prehospital stage. Many studies of similar groups of patients show a wide spread in assessing the incidence and mortality of this pathology. The development of myocardial ruptures has two frequency peaks: the first day and 5–7 days from the onset of AMI. The most common case is acute rupture of the free wall of the left ventricle with extensive hemorrhage in the pericardium leading to a fulminant death. The development of a pseudoaneurysm of the left ventricle is a very rare outcome of the myocardial rupture.
2021 Том 5, №1
Some aspects of clinical and laboratory parameters in newborns from mothers with coronavirus infection SARS-CoV-2 (COVID-19), infected at different times of perinatal period
I. Loginova, A. Ustinovich, E. Alferovich, I. Payuk, V. Shnitko
The problem of coronavirus infection has been the world’s concern since 2019. At the same time, the issues of infection of newborn children remain unclear, the issue of vertical transmission of the virus from mother to child is being discussed. The aim of our study was to study the features of the period of postnatal adaptation of newborns born to mothers with coronavirus infection SARS-CoV-2 (COVID-19), taking into account the time of infection occurrence. We analyzed the features of the neonatal course in children from the mothers with confirmed Covid-19 infection (PCR RNA of SARS-Cov 2) revealed in the mothers either during pregnancy or in the postpartum period. When examining children, we used clinical, laboratory, and biochemical research methods. It was found that children whose mothers contracted coronavirus infection COVID-19 immediately before childbirth had an aggravated course of the neonatal period compared with children from mothers who had recovered in the middle of pregnancy, and the manifestations of infection and post-hypoxic syndrome were more pronounced in the former. Laboratory investigations proved that newborns from the mothers who fell ill shortly before childbirth had acute viral inflammation.
2021 Том 5, №1
Tetralogy of Fallot – «Old» congenital heart defect in the xxi century – unresolved questions of stage-by-stage surgical correction
P.F. Charnahlaz
Despite the fact that the defect has been known for a long time and methods of surgical correction have been developed that allow achieving excellent immediate and long-term results, the tactical issues of stage-by-stage correction of the defect in situations where primary radical correction is impossible due to such reasons as a severe initial condition, low weight of the patient, underdevelopment of the branches of the pulmonary artery (PA) have not yet been fully resolved. In addition to classical Blalock-Taussig intersystem anastomoses, such endovascular techniques of maintaining pulmonary blood flow as stenting of the right ventricular outflow tract (RVOT) and stenting of the patent ductus arteriosus (PDA) are being introduced into clinical practice. These techniques, with all the advantages of minimally invasive technologies in certain clinical and anatomical situations, are not inferior, and in most cases surpass classical surgical techniques.
2021 Том 5, №1
Atrial fibrillation and adherence to oral anticoagulation: review of clinical cases
M.S. Dzeshka, S.L. Boyko, N.V. Shpak, V.A. Snezhitskiy
Prevalence of atrial fibrillation (AF) is continuously increasing. Stroke in AF patients is the most unfavorable complication of arrhythmia, clinical course being severer, neurological deficit pronounced, and mortality higher compared to stroke patients without AF. Oral anticoagulation (OAC) results in significant reduction of stroke and systemic embolism but at the same time is compromised by haemorrhagic complications. High adherence to treatment is essential for effectiveness and safety of OAC. Nonetheless, poor adherence to treatment in case of chronic diseases requiring drug regimen remains unresolved. Social, economic and demographic factors, patient’s psychological markers, inertia of the healthcare system, formalism in the implementation of recommendations in routine clinical practice, violation of the continuity between inpatient and outpatient care, limited resources and other factors lead to low adherence among patients with AF. Refusal of OAC, intermittent treatment, delayed medication with OAC, failure to follow recommendations for the control of modifiable risk factors associated with anticoagulant therapy, are transformed into a high level of cardiovascular and cerebrovascular events in patients with AF. This article presents an analysis of three clinical cases of patients with complicated AF, discusses treatment from the standpoint of evidence-based medicine, the role of low adherence in the development of complications, and obstacles to increasing adherence.
2020 Том 4, №2
Clinical case of treatment of a patient with portal hypertension developed as a result of portal vein thrombosis
E.V. Mahiliavets
Abstract. Non-cirrhotic causes of the development of portal hypertension make upabout 10%. The factors leading to its development are the development of thrombosis in the portal vein system, occlusion due to pancreatitis, pancreatic tumors, and other causes. Acute bleeding from esophageal varices is a formidable complication of portal hypertension, regardless of its etiology. The tactics of treatment and prevention of bleeding from esophageal varices in patients with portal vein thrombosis generally corresponds to that for intrahepatic portal hypertension in liver cirrhosis with some additions. Aim. Presentation of the results of clinical observation of an open Hassab operation (esophagogastric devascularization without esophageal transection + splenectomy) in a patient with portal vein thrombosis complicated by portal hypertension and esophageal varices, as well as a short literary excursion on this issue.
2020 Том 4, №2
Adult-onset Still’s disease in pregnancy complicated by macrophage activation syndrome
N.I. Artishevskaia, T.G. Rayeuneva, S.E. Aliakseitshik, E.A. Mikhnevich, A.M. Malyuta
Adult-onset Still’s disease is a rare polygenicautoinflammatory disease characterized by the classic triad of persistent high spiking fevers, joint pain (arthritis), and a distinctive salmon-colored bumpy rash. In the past decade, some pathophysiological mechanisms of the disease have been clarified and some sensitive and specific diagnostic criteria have been suggested. The disease is considered a diagnosis of exclusion. The course of the disease can be either relatively favorable or severe and disabling. Treatment is based on the use of glucocorticoids, immunosuppressive therapy and monoclonal antibodies. In the early 21 st century, descriptions of isolated cases and small series of adult-onset Still’s disease in pregnancy appeared in literature.
2020 Том 4, №1
Inherited coagulation disorders in newborns in the early neonatal period
T. N. Voitovitch, O.A. Platonova, E.N. Alferovich, I.N. Evstigneev, E.A. Sarzhevskaya, V.V. Dmitriev
The article presents a rare case of a hereditary coagulation disorder (factor VIII deficiency). Тhe reported rare case of hemophilia A manifestation in a child in the early neonatal period emphasizes the need for an accurate collection of a family history of bleeding, as well as an assessment of specific clinical and laboratory data and a differential diagnosis with other disorders of the blood coagulation system. The clinical manifestations of hemorrhagic syndrome were not specific; they allowed us to determine the direction of the laboratory search for violations of primary and secondary hemostasis. Clarification of the diagnosis and the choice of gemostatic therapy were performed after a laboratory study of blood coagulation. The presented studies reflect the most typical errors at the stages of diagnosis and correction of blood coagulation disorders, which will improve the quality of medical care for newborns in the future.
2020 Том 4, №1
Giant left ventricular aneurysm: sonographer’s view
N.V. Zatoloka, A.A. Popova, E.G. Komarovskaya
Aneurysm of the left ventricle is a well-defined area of a thin scar deprived of the muscle layer that develops after myocardial infarction with systolic akinesia or dyskinesia, which impairs its normal geometry and contractility and, as a result, reduces the ejection fraction. There are two strategies for treating left ventricular aneurysm, i.e. medication and surgery. Surgical treatment is absolutely indicated for patients with dyskinetic (akinetic) aneurysms with an increase in the endsystolic index > 80 ml/m 2 and in the end-diastolic index > 120 ml/m 2 , as well as with the threat of rupture or the development of a false aneurysm. A clinical case of a 72-year-old patient is presented. After myocardial infarction there developed a giant aneurysm of the left ventricle filled with a large thrombus. Due to the ineffectiveness of conservative treatment and the impossibility of surgical remodeling of the left ventricle using standard methods, the patient will have to undergo an orthotopic heart transplantation. This case is of interest due to the rare occurrence of such a clinical scenario of this pathology.
2020 Том 4, №1
Elimination of post-puncture arteriovenous femoral fistula
N.A. Rogovoy, V.A. Yanushko, I.P. Klimchuk, V.V. Komisarau, Y.A. Melnichuk
This article presents clinical cases of successful surgical treatment of arteriovenous fistula is formed after angiographic examination by transfemoral access. This pathology is quite rare and was identified as a random finding when we were examining patients with complaints of intermittent claudication and an angiographic exemiation in history. Treatment approaches of these patients are not completely clear. As a result, there are no generally accepted recommendations. The optimal treatment methods for these patients search for many reseachers. Surgical treatment of patients gave a positive clinical result. It is consistent with most literature data showing the advantage of surgical treatment.
2020 Том 4, №1
Double lung transplantation for primary pulmonary arterial hypertension under extracorporeal membrane oxygenation support
Sh.Z. Sharipov, E.V. Kotov, V.A. Shilo, E.A. Vilkotski, M.Ju. Gurova, V.V. Erohov, M.V. Kachuk, A.V. Sherbo, D.V. Korchemkin, A.M. Dziadzko, O.O. Rummo, N. P. Mitkovskaya, S.V. Golovinskiy
The surgical procedure of choice for treatment of patients with end stage of primary pulmonary arterial hypertension is double lung transplantation. Adequate systemic hemodynamics and gas exchange during the perioperative period of lung transplantation for such patients can be effectively and safely provided by venoarterial extracorporeal membrane oxygenation. The article presents a case report of successful lung transplantation under veno-arterial extracorporeal membrane oxygenation (central cannulation) to 22-year old patient with idiopathic pulmonary arterial hypertension complicated by right-ventricular heart failure with cardiomegalia due to expansion of the right chambers and congestive hepatopathy. This clinical case is the first one in the practice of Belarusian transplantology.
2020 Том 4, №1
A rare case of focal mid-ventricular form of Takotsubo syndrome
E.A. Vertinsky, L.Yu. Ushakova, M.V. Novikova
Stress cardiomyopathy, also called Takotsubo syndrome (TTS), broken heart syndrome and stress-induced cardiomyopathy, is characterized by transient regional systolic dysfunction of the left ventricle (LV) in the absence of angiographic evidence of obstructive coronary artery disease or acute plaque rupture as well as by regional wall motion abnormalities that extend beyond a single coronary vascular bed. TTS accounted for 1,7% to 2,2% of cases presenting with suspected acute coronary syndrome (ACS) or ST-elevation infarction in a systematic review. According to the International Takotsubo Registry, of 1750 patients with TTS, 89.8% were women (mean age 66,8 years). Complete recovery of LV systolic function is necessary to confirm the diagnosis of Takotsubo cardiomyopathy and can happen over a period of days to weeks. The typical and most common description of TTS is the apical type (81,7%), evident in the characteristic abnormality of a ballooned left ventricular apex with basal segmental hyperkinesis. However, atypical variants of this syndrome with mid-ventricular (14,6%), basal (2,2%) and focal (1,5%) wall motion patterns are increasingly diagnosed. We present a patient who developed a mid-ventricular dyskinetic TTS pattern.
2019 Том 3, №2
Allergic purpura in the therapeutical practice
L. N. Romanchuk, V. M. Pyrochkin, Y. I. Karpovich, E. V. Chalaya, A. L. Belyaeva, Y. L. Karpovich, А.А. Shchetko
The article describes the clinical case of the Henoch-Schönlein disease in a patient of 53 years as an example of the relevance of the anamnestic data careful analysis, objective examination of the patient and the differential diagnosis for early detection. Polymorphism of cutaneous manifestations and visceral lesions can cause difficulties in the diagnosis of allergic purpura. Early administration of pathogenetically justified combined treatment leads to stabilization of the inflammatory process, avoidance of possible destruction of the internal organs as well as development of complications and relapses.
2019 Том 3, №2
A case of complete detachment of the conduit of the ascending aorta and aortic valve
A.P. Shket, E.V. Vasilevich, A.A. Komarovski, S.I. Kozlov, O.I. Kozlov, V.A. Tokunov, A.A. Khadanovich, Y.A. Selyn
In cardiac surgery departments, repeated operations are increasingly performed in patients who have undergone valve correction or coronary bypass surgery in the past. The operational risk in this group of patients is much higher than in the group of primary operations, and is due to the adhesive process, the risk of re-access to the heart, various anatomical and pathological scenarios of pathology. A clinical case of a 47-year-old patient is presented. Primary surgery was performed in 2006 for aortic stenosis and aneurysm of the ascending aorta. On the second operation, the separation of the conduit of the ascending aorta and aortic valve, the complete separation of both ostiums of the coronary arteries with the formation of a false aneurysm of the ascending aorta was revealed. The patient underwent a replacement of the aortic valve, ascending aorta, the left coronary artery reimplantation, CABG to RCA. This case is of great interest due to the extremely rare occurrence of such a variant of pathology.
2019 Том 3, №1
Cardiac myxoma - difficult diagnosis cases
E.L. Trisvetova, M.I. Guseva, K.M. Kaminsky, E.I. Shkrebneva
Absence of characteristic signs leads to late diagnosis of myxoma of the heart, complicated by congestive heart failure, embolism in various vascular regions, cardiac arrhythmias, sudden cardiac death. Nonspecific clinical syndromes due to the presence, localization or structural features of the tumor including systemic manifestations, congestive heart failure caused by obstructive intracardiac disorders or embolism in the vessels of the systemic and pulmonary circulation justify the performance of diagnostic methods of heart visualization. An informative noninvasive method of diagnosis is echocardiography, which, in two cases of observation, revealed myxoma of the heart.
2018 Том 2, №2
Successful surgical repair of ventricular septal defect and left ventricle aneurysm in acute myocardial infarction
A.V. Yanushko, S.L. Salauyou, Yu.T. Liutkevich, I.L. Kiziukevich
Postinfarction ventricular septal defect (VSD) is a rare, but fatal complication developing within the first two weeks from the onset of myocardial infarction (MI). Patients with VSD most frequently die of acute decompensated heart failure within several days. Nevertheless, the timing of surgical repair still remains under consideration. A more «aggressive» approach implies closing the defect in the shortest possible time period after VSD is diagnosed; whereas some surgeons advocate stabilization of patients’ hemodynamics by means of circulatory support devices with the subsequent delayed surgical treatment. We present a clinical case of the patient with acute myocardial infarction who underwent successful surgical treatment for two life-threatening complications of acute MI: VSD and posterior aneurysm of the left ventricle.
2018 Том 2, №2

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