RESUMEN
Cardiomyocytes (CMC) of 18 patients with both ischemic heart disease, aneurism of the front wall and reduced myocardial contractility of the left ventricle (LV) were hypertrophied and in state of chronic hibernation, which was characterized by weakening of tissue-specific signs. Widening of lack myofibrils' zones and in part gap junction of intercalated disk transfer on the side of cells was found The hypertrophy of CMC had positive correlation, but chronic hibernation - negative one with the volume of LV. The worse prognosis of clinical course was degenerative changes of hibernate CMC with accumulation of autophagosomes that correlated with increasing of LV sphericity index.
Asunto(s)
Aneurisma Cardíaco , Contracción Miocárdica , Infarto del Miocardio , Miocitos Cardíacos/ultraestructura , Disfunción Ventricular Izquierda , Adulto , Aneurisma Cardíaco/etiología , Aneurisma Cardíaco/patología , Aneurisma Cardíaco/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Infarto del Miocardio/patología , Infarto del Miocardio/fisiopatología , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/patología , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
The incidence of atherosclerotic lesions in coronary arteries combined with other vascular problems has been increasing during the last years. Hence, a rise in the number of patients with coronary heart disease, candidates for surgical myocardial revascularization. This paper reviews the history of surgical treatment of combined lesions of coronary and peripheral arteries and presents original criteria developed in A N Bakulev Research Centre of Cardiovascular Surgery for the choice of surgical strategy to treat multifocal atherosclerosis and postinfarction left ventricular aneurysm.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Procedimientos Quirúrgicos Cardíacos/tendencias , Enfermedad de la Arteria Coronaria/cirugía , Aneurisma Cardíaco/cirugía , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/etiología , Humanos , Resultado del TratamientoRESUMEN
The paper covers early and long-term results of left ventricle geometric reconstruction and myocardial revascularization in 44 patients with ischemic cardiomyopathy. The authors have established clinical and hemodynamic criteria of ischemic cardiomyopathy, indications for surgical treatment and a surgical technique. The article presents a new approach to correction of mitral insufficiency in the given category of patients. According to the results of the study, the necessary conditions for a surgical intervention to be successful are: intraoperative monitoring of central hemodynamics using Swan-Ganz catheter, evaluation of myocardial contractile function by means of transoesophageal echocardiography and wide use of preoperative intraaortic balloon pumping. Geometric reconstruction results in normalization of left ventricle shape and its end-systolic and end-diastolic volumes, marked increase of ejection fraction and improvement of central hemodynamics. The stability of the long-term results has been confirmed in a 4-year follow-up.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Cardiomiopatías/cirugía , Ventrículos Cardíacos/cirugía , Isquemia Miocárdica/cirugía , Cardiomiopatías/diagnóstico por imagen , Cardiomiopatías/fisiopatología , Ecocardiografía Transesofágica , Ventrículos Cardíacos/fisiopatología , Humanos , Monitoreo Intraoperatorio , Isquemia Miocárdica/diagnóstico por imagen , Estudios Retrospectivos , Volumen Sistólico/fisiología , Resultado del TratamientoRESUMEN
Personality disorders (PD) are recognized among key maladaptive factors in postoperative period of coronary artery bypass surgery (CABS). However studies on PD among CABS patients are predominantly under psychological approach and information on clinical features is very limited. A present investigation aimed at assessing clinical features and prognostic value of PD in late post operative period of CABS (from 1 to 3 years). Using psychiatric, cardiological and psychological methods, 48 patients (42 male, mean age 61.3 +/- 8.2 years) with diagnosis of PD and favorable cardiological status after CABS have been assessed. PD in post operative period is an important predictor of unfavorable social and occupational outcome of CABS. Three types of clinical course of PD were singled out: 1) hypohondric personality development; 2) "second life" personality development; 3) "denial of illness" reactions. Pronounced maladaptation was observed in type 1, most severe one--in type 2 and minimal maladaptation or its absence--in type 3. These types were differentiated by different repertoires of psychological defense mechanisms (PMD): type 1 was characterized by a limited number of them with a drift to mature mechanisms; PD of type 2 are featured by a narrow and rigid repertoire of defenses with predomination of immature mechanisms and in type 3 a maximum number of PMD with balanced involvement of mature and immature mechanisms was observed.