Biomedical subjects

Rimantas Benetis

Publications and source records attributed to Rimantas Benetis.

At least 19 recordsLinked to original sources

PubMed2006

Evaluation of ischemic injury of the cardiac tissue by using the principal component analysis of an epicardial electrogram.

Monitoring and control of the heart tissue viability is of crucial importance during heart surgery operations. In most cases the heart tissue suffers from an ischemic injury that causes a decrease in the velocity of electrical excitation propagation in it and influences the shape of the excitation wave front that spreads over the injured area. It is reflected in a more complex shape of the registered epicardial electrogram as compared to normal. A method for quantitative evaluation of the complexity of the shape of the epicardial electrogram based on the principal component analysis is here proposed for evaluation of the ischemic injury of the cardiac tissue. A minimal, yet sufficient, number of the principal components (the optimal basis functions) for truncated expansion of the epicardial electrogram signals could be used as an estimate of signal complexity. The method for determination of such a minimal, yet sufficient, number of principal components were developed by using epicardial electrograms registered during in situ experiments on dogs in which local ischemia was evoked by ligation of a coronary vessel.

Animals↗

PubMed2006

[Successful treatment of degenerative critical aortic stenosis at stage of valvular cardiomyopathy].

Degenerative aortic stenosis and mitral annulus calcification are the most common valvular abnormalities in elderly population. The incidence of these abnormalities has increased due to increased life expectancy. In recent years, new diagnostic techniques have improved the accuracy of diagnosis of valvular heart disease, however, cases of advanced critical aortic stenosis with valvular cardiomyopathy and severe heart failure still occur. A clinical case of critical degenerative aortic stenosis and mitral annulus calcinosis, mitral stenosis and regurgitation, subsequently significantly decreased ejection fraction (15%) accompanied by valvular cardiomyopathy and severe congestive heart failure is described. Ischemic heart disease was excluded. Cardiosurgery including implantation of aortic and mitral bioprosthesis and tricuspid annuloplasty was performed after intensive medical treatment and improvement of heart failure symptoms. After follow-up of six months, a 76-year-old female patient has just symptoms of mild left-ventricular dysfunction corresponding to New York Heart Association functional class II.

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PubMed2006

The impact of unrepaired versus repaired mitral regurgitation on functional status of patients with ischemic cardiomyopathy at one year after coronary artery bypass grafting.

BACKGROUND AND AIM OF THE STUDY: The issues regarding the appropriate management of patients with ischemic mitral regurgitation (MR) and advanced left ventricular (LV) dysfunction are controversial and limited. The present study was undertaken to evaluate the mid-term dynamics of MR, LV dimensions, function and NYHA functional class in patients with ischemic cardiomyopathy (ICM) and MR who underwent coronary artery bypass grafting (CABG) either alone or combined with mitral valve (MV) repair. METHODS: A total of 199 patients with LV ejection fraction (LVEF) <35% were included in the study. Of these patients, 73 had MR grade 2+ (group 1), 66 had 0 or 1+ MR (group 2) and underwent isolated CABG, and 60 had MR > 2+ and underwent CABG with MV repair (group 3). RESULTS: At one year after surgery, the severity of MR was unchanged from preoperative grade in group 1 (2.1 +/- 0.5 vs. 1.97 +/- 0.8), and increased in group (0.76 +/- 0.43 vs. 1.44 +/- 0.77; p < 0.05), but was significantly lower in group (2.8 +/- 0.5 vs. 1.6 +/- 0.7; p <0.05). In group 1, the LV end-systolic volume index (LVESVI) tended to increase, the LV end-diastolic volume index (LVEDVI) increased from 69.6 +/- 22.6 to 79.6 +/- 23.2 ml/m2 with an increase in LVEF (from 27.9 +/- 5.9 to 31.3 +/- 9.4%), and pulmonary artery pressure (PAP) increased from 31.9 +/- 7.0 to 39.5 +/- 17.4 mmHg. In group 2, the LV volumes tended to increase, LVEF increased from 30. 3 +/- 4.1 to 34.9 +/- 9.1%, and PAP remained unchanged. In group 3, the LVESVI decreased from 55.4 +/- 16.9 to 47.1 +/- 21.7 ml/m2, LVED-VI tended to decrease, LVEF increased from 31.4 +/- 8.6 to 36.5 +/- 11.3%, and PAP decreased from 35.5 +/- 6.0 to 32.8 +/- 8.3 mmHg. CONCLUSION: Isolated CABG in patients with ICM had no favorable effect on MR reduction, and did not prevent its development. MR grade 2+ in patients with ICM at one year after isolated CABG had a deleterious effect on LV functional status, with progression of LV dilatation and increased PAP. A significant reduction or elimination of MR after combined surgery had a marked positive impact on reverse LV remodeling, including regression of LV dilatation, an increased LVEF, and decreased PAP.

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PubMed2005

Ischemic mitral valve repair: correlations between the mechanisms of mitral regurgitation and left ventricular function prior to and following surgery.

OBJECTIVE: To define the mechanisms of ischemic mitral regurgitation (MR) and its correlation with left ventricular (LV) function prior to and 1 year following mitral valve (MV) repair. DESIGN: Fifty-three patients (pts) underwent echocardiographic evaluation of the MR mechanism according to Carpentier's classification; quantification of MR and LV function. RESULTS: Forty-one, 5% of pts had Type I (annulus dilation), 20, 5% had Type II (commissural prolapse) and 38% had Type IIIb MR (predominant posterior leaflet restriction). Preoperative LV function was slightly better preserved in pts with Type II and IIIb MR. Despite similar MV repair efficiency intraoperatively, after 1 year Type I MR progressed vs the remaining types. LV function, including dimensions, ejection fraction and pulmonary artery pressure had a tendency to worsen in pts with Type I and markedly improved in Type II and IIIb MR. CONCLUSIONS: Ischemic MR of Type I is associated with more marked LV dysfunction preoperatively, its further deterioration and MR progression after MV repair. Type II and IIIb MR correlates with better preserved LV function preoperatively and its incremental improvement late after surgery.

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PubMed2005

Ischemic mitral valve repair: predictive significance of restrictive left ventricular diastolic filling.

AIM: The aim of the present study was to evaluate the impact of left ventricular (LV) diastolic filling impairment on postoperative results in patients with low LV ejection fraction (EF) undergoing combined coronary artery bypass grafting (CABG) and mitral valve (MV) repair. METHODS AND RESULTS: Study population consisted of 53 patients with ischemic MV incompetence and LV systolic dysfunction (mean EF-26.1 +/- 6%), who underwent CABG with MV repair. Patients were divided into three groups according to the LV diastolic filling pattern. Study protocol included evaluation of perioperative mortality (30 days inhospital mortality), NYHA functional class, and two-dimensional Doppler echocardiographic examination preoperatively, 10-14 days, and 12 months after surgery. The highest perioperative mortality rate (33.3%), unimproved functional status (in 78.5% of the patients, NYHA functional class remained unchanged late after surgery), and hemodynamic deterioration (LV dilatation, progression of mitral regurgitation (MR) was observed in the restriction group). Though early after surgery, MR reduction was significant in this group, at even one year after surgery 85.7% of patients presented with >grade 1 of MR (P < 0.05). Logistic regression analysis showed that restrictive LV diastolic filling is an important independent preoperative marker (P = 0.035) of progression of MR late after MV repair. CONCLUSION: In patients with severe LV dysfunction undergoing combined CABG and MV repair, restrictive LV diastolic filling pattern is an important preoperative marker of high perioperative mortality rate, further negative remodeling of LV, and progression of mitral regurgitation late after MV repair.

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PubMed2005

Mitral valve prolapse: diagnosis, treatment and natural course.

This article analyzes data obtained from the medical records of the patients with primary mitral valve prolapse. The study population was the patients admitted to Kaunas University of Medicine Heart Center (KUMHC) between 1999 and 2003. The objective of our study was to analyze the natural course of mitral valve prolapse, complications and their frequency, treatment strategy in KUMHC, as well as to review the results of surgical treatment. We gathered data from the medical records of 160 patients and analyzed their age, medical history, complications, comorbidities, functional status and echocardiographic parameters. Patients who underwent mitral valve surgery were followed 7.9+/-8.4 months after procedure. On average, 32+/-14 patients with primary mitral valve prolapse were treated at KUMHC annually. Their mean age was 48.4+/-16.5 years, 44.4% of them were male. The most frequent complications of mitral valve prolapse were > or =II degrees mitral regurgitation (78.4%), various cardiac arrhythmias (68.1%) and heart failure of > or =II NYHA class (79%). Surgical treatment was recommended for 64 (40%) KUMHC patients with primary mitral valve prolapse. Surgical treatment was applied in 44 (28.1%) of study patients. The patients, who were recommended surgical treatment, were older (mean age 53.2+/-11.9 years, p<0.05) and predominantly male (62.5%, p<0.05) as compared to medically managed patients. The heart failure (62.5% had NYHA class III or IV), severe mitral regurgitation (95.3% had mitral regurgitation of > or =III degrees ) and worse left ventricle function (15% had ejection fraction of <50%) were more frequent in this group as compared to medically managed patients (all p<0.05). During the last five years the number of hospitalized patients with primary mitral valve prolapse increased 3.2 times, the number of mitral valve surgical procedures among these patients increased 2.8 times, and the number of mitral valve repair increased 15.8 times. 56.8% of patients had uncomplicated postoperative course. The most frequent postoperative complication was new arrhythmias and/or conduction disturbances. 1 patient died in early postoperative period. There was significant decrease in left ventricle and left atrium size and the severity of mitral regurgitation 2 to 6 months after mitral valve surgery. These positive changes remained during all study period. Taking in the consideration the large number of mitral valve repair procedures and good outcomes, the low postoperative mortality of the surgical mitral valve prolapse treatment in KUMHC, we can strongly recommend surgical treatment for the patients with severe mitral regurgitation secondary to mitral valve prolapse.

Adult↗

PubMed2005

Effect of hyperosmolarity on beta2-adrenergic stimulation in human atrium.

The purpose of the present study was to determine whether extracellular osmotic pressure modulates beta2-adrenergic stimulation of the contraction force and L-type Ca2+ current in human atrial myocytes. Experiments were performed on human atrial trabeculae and myocytes isolated from the right atrium. We have studied the effect of salbutamol (SAL), a beta2-adrenoceptor agonist, on peak tension (P), time to half peak tension (tc), time to half relaxation (tr), resting tension (contracture) (C) and L-type calcium current (ICaL) under isosmotic (345 mOsm) and hyperosmotic (525 mOsm in experiments for P, and 405 mOsm for ICaL) conditions. Salbutamol (10(-8)/10(-5) M) added to the control solution increased P, with a half-stimulation constant EC50=(2.7+/-0.6)x10(-8) M (p<0.05) and the maximal stimulation of contraction force Pmax=180.6+/-45.8% (n=10). The time to half peak and time to half relaxation were reduced by salbutamol to 89.1+/-2.7% and 78.8+/-4.1% (n=8), respectively. Mannitol (180 mM) added to the Tyrode solution decreased Pmax to 34+/-5.5%; tc, tr and C were increased to 126.3+/-7.2%, 158.3+/-22.6% (n=4) and 0.54+/-0.22 (n=5) of the control level, respectively. Under these hyperosmotic conditions the same concentrations of SAL increased P with a half-stimulation constant EC50=(6.4+/-2.6)x10(-7) M and Pmax=57.2+/-12.6% (n=4). The tc and tr were reduced by 23.2+/-5.9% and 53.1+/-19.4% (n=4), respectively (as compared to mannitol). There was no significant effect of salbutamol on the resting tension induced by mannitol. Under isosmotic conditions salbutamol (10(-9)/10(-6) M) increased ICaL with an EC50 value of (2.9+/-0.9)x10(-9) M and Emax 182.3+/-19.8% (n=4). In hyperosmotic solutions the EC50 and Emax for ICaL were (1.2+/-0.5)x10(-8) M and 217.2+/-70.5%, respectively (n=5). These results indicated that hyperosmolarity reduced the effect of beta2-adrenergic stimulation on human atrial cells.

Adrenergic beta-Agonists↗

PubMed2005

[Management of patients with prosthetic heart valves].

The amount of patients with prosthetic valves is increasing and their follow up is an actual problem. The aim of this study was to estimate postoperative complications after valve replacement and to give the follow up schedule for family doctors and cardiologist. The article demonstrates late postoperative results of valve replacements performed in Heart Centre of Kaunas University of Medicine during five years (1999-2003). Hemodynamics, auscultation of patients with prosthetic valves, antithrombotic treatment, specificity of anticoagulants use before noncardiac surgery are described according to the last practical guidelines (1998). The follow up schedule after valve replacement is recommended for practical purposes. A total of 766 valves were replaced in this period: 82, 180, 167, 135 and 202, respectively per year. There were seen these late postoperative complications: thromboembolism (3.8%), valve thrombosis (2%), hypocoagulation (1.1%) and infective endocarditis (3.2%). CONCLUSION. Postoperative complications such as thromboembolism, valve thrombosis, hypocoagulation and infective endocarditis were detected more often than it is described in literature. The follow up schedule will help to identify near and late postoperative complications and to improve patients' life quality.

Adolescent↗

PubMed2005

[Coronary reoperations: recurrence of angina and clinical outcome].

OBJECTIVE: To evaluate the features of coronary artery bypass reoperations and to reduce the influence of the factors affecting postoperative morbidity and mortality. MATERIAL AND METHODS: The records of 53 consecutive patients (88.7% of men, 11.3% of women; mean age 67.1+/-7.5 years) who underwent coronary artery bypass reoperations were reviewed retrospectively. Coronary artery bypass reoperations comprised 2.98% of all coronary artery bypass grafting operations during that period. Coronary artery bypass reoperations performed within 4-week period after the last operation and complex procedures were excluded. RESULTS: Postoperative mortality after 53 reoperations and 1775 primary coronary artery bypass grafting operations was 7.5 and 2.52%, respectively, and the results are comparable with the results from other clinics of cardiac surgery. Mean time interval between primary coronary artery bypass grafting and reoperation was 90.7+/-49.9 months. Angiography at that period showed patency of venous and arterial conduits--34.6 and 76.5%, respectively. Twenty-nine patients (54.7%) received only venous conduits during reoperation. There were 2.4+/-1.1 anastomoses constructed during reoperation comparing to 3.5+/-0.9 anastomoses per patient during primary coronary artery bypass grafting. CONCLUSIONS: According to our data mortality after coronary reoperations remains higher comparing to primary coronary artery bypass grafting, however, it does not differ significantly. We observed an increasing number of elderly patients in coronary reoperations. We think that it is related to the demographical changes within our country and increased use of arterial conduits during primary coronary artery bypass grafting operations. Arterial conduits are patent at least 10 years; it means that the time period until recurrent angina and reoperation is delayed. However, progression of arterial atherosclerosis remains the main reason for coronary artery bypass grafting reoperation.

Age Factors↗

PubMed2004

Blood serum apolipoproteins B and A-I in females suffering from rheumatic heart valve disease.

OBJECTIVE: With the aim to check whether the atherogenic factors are involved in the mechanisms of valve fibrosis, we have studied the blood serum concentrations of apolipoproteins (apo) A-I and B concentration in patients suffering from rheumatic heart valve fibrosis. METHOD: The quantities of apoA-I and apoB in the blood serum were tested by the ELISA method. Concentration of apoA-I and B in the blood serum was determined in rheumatic females with replacement of the damaged valves: after aortic valve operation (n=11; mean age 43.3+/-3.6 years) and after mitral valve operation (n=29; 41.3+/-4.1). The results obtained for rheumatic patients were compared with the data on age-matched healthy females (n=43; 39.5+/-5.2 years). RESULTS: Significantly lower apoA-I level in the blood serum of all patients suffering from rheumatic heart valve disease was determined as compared with controls: in the pooled group of patients (1.02+/-0.22 vs 1.23+/-0.23 g/l, P<0.001), in women after aortic valve replacement (0.98+/-0.21 vs. 1.23+/-0.23 g/l, P<0.005), and in women after mitral valve surgery (1.03+/-0.23 g/l vs 1.23+/-0.23 g/l, P<0.005). The apoB level in patients suffering from rheumatic heart valve disease did not differ from that of controls. The apoB/apoA-I ratio for patients with valve fibrotic damage was significantly higher as compared to controls in all groups (P<0.02). The increase of apoB/apoA-I ratio in patients with rheumatic valve fibrosis was caused by lower apoA-I levels in blood serum. CONCLUSION: The obtained results indicate that decreased apoA-I levels in blood serum can be indicative of valve fibrosis in rheumatic heart valve disease patients.

Adult↗

PubMed2004

[Late results of minimally invasive operations of myocardial revascularization in patients with acute coronary syndrome].

UNLABELLED: The aim of the study was to compare late results of the minimally invasive operations of myocardial revascularization and conservative treatment in patients with acute ischemic syndrome. MATERIAL AND METHODS: Demographic, clinical and echocardiographic data was collected on patients with acute ischemic syndrome; data of 109 patients treated conservatively and data of 26 patients, who underwent minimal invasive operation of myocardial revascularization during acute phase of ischemic syndrome, were compared and ischemic consequences after one-year follow up period were determined in both groups. RESULTS: The patients of both groups did not differ significantly according to the most clinical characteristics. One third of the patients in the surgery group had previous myocardial infarction, also they had higher rate of paroxysmal atrial fibrillation (26.9% vs 6.4%) and acute left ventricular failure (73.1% vs 44.0%) than the patients without operation. During one-year follow up period there were no cases of lethal events or myocardial infarction in the surgical group, however 37.5% of them had mild angina pectoris. At that time lethal outcome was observed in 6.1%, myocardial infarction in 3.5% and mild-severe angina pectoris in 68.8% of patients. CONCLUSION: The functional status of the patients significantly improved during one-year period after minimally invasive operation of myocardial revascularization compared to the patients treated conservatively.

Acute Disease↗

PubMed2004

[The impact of uncorrected mitral insufficiency on left ventricle remodeling].

UNLABELLED: The aim of our study was to evaluate the influence of residual ischemic mitral insufficiency on patient's functional status and left ventricle remodeling after repair of ischemic mitral insufficiency. MATERIAL AND METHODS: The study group consisted of 95 out of 128 patients who underwent mitral valve repair for ischemic mitral insufficiency at the Department of Cardiac Surgery of the Heart Center of Kaunas University of Medicine in 1996-2002. The study protocol included general clinical data, patients NYHA functional class, pre, peri and postoperative echocardiographic data. RESULTS: In patients with residual MI (MR>or=2 grade) late postoperative left ventricle morphometric parameters, left ventricle ejection fraction and mean pulmonary artery pressure did not change. Size of left ventricle was reduced (left ventricle end diastolic diameter index decreased from 28.9+/-0.4 to 27.7+/-0.4 mm/m(2), p<0.001; left ventricle end systolic diameter index - from 22.2+/-0.6 to 19.7+/-0.7 mm/m(2), p<0.001), left ventricle ejection fraction increased (33.3+/-1.0 and 40.1+/-1.2%, p<0.0001), mean pulmonary artery pressure, NYHA functional class significantly decreased with MR<2 grade late postoperatively. CONCLUSIONS: Residual MR is important factor for further worsening of patient's functional status and progressing of left ventricle remodeling after combined surgery.

Adult↗

PubMed2004

[Early and late postoperative results after stentless aortic bioprosthesis implantation: experience of Heart Center, Kaunas University of Medicine].

UNLABELLED: The aim of our study was to evaluate the impact of stentless aortic bioprosthesis implantation on early and late postoperative results and hemodynamic changes. MATERIAL AND METHODS: Study group consisted of 66 patients, who received stentless aortic bioprosthesis in 1999-2003, and control group of 38 patients, randomly selected for data analysis out of 203 patients, who received mechanical aortic valve substitute during the same period at the Heart Center of Kaunas University of Medicine. Study protocol included clinical data, patients functional status and echocardiographic data pre and postoperatively up to 2 years. RESULTS: Within a stentless bioprosthesis group clinically more severe forms of aortic valve disease were present (NYHA f. cl. 3.47 vs 3.0), with concomitant ischemic heart disease (51.5% vs 36.8%), and mitral valve insufficiency (51.5% vs 21.1%). Subsequently coronary artery bypass grafting was performed in 50% of patients within a stentless bioprosthesis group vs 28.9% in a mechanical valve group, and mitral valve repair in 30.49% vs 10.5%. Aortic cross clamp time in a stentless bioprosthesis group was 89.1+/-21.3 min, compared to 74.6+/-39.5 min in a "mechanical" group. Data analysis of valve/body surface area match was in favor of stentless valves: patients with the same body surface area received one size larger stentless valves. Mortality in a "stentless" group was 4.54 vs 7.3% in mechanical group. Mean transvalvular gradients after 2 years were statistically significantly lower in a "stentless" group: 9.4+/-3.1 mmHg vs 11.1+/-4.1 mmHg. Also there was significant decrease of left ventricular mass and mass index in both groups, however it was more pronounced in the "stentless" valve group. CONCLUSIONS: Despite more advanced patient age, stages of aortic valve disease, complexity of operations including more demanding stentless bioprosthesis implantation techniques, early and late postoperative results are in favor of stentless bioprosthesis. Low and acceptable postoperative mortality, lower transvalvular gradients, optimal matching of valve and body surface area, could be achieved, which warrants more pronounced positive postoperative left ventricular remodeling: reduction of left ventricle mass and left ventricle mass index with improved pts survival.

Age Factors↗

PubMed2004

[Neuropsychological outcomes after coronary artery bypass grafting].

OBJECTIVE: Neuropsychological (cognitive) dysfunction has been described as an important complication, affecting up to 80% of patients early after cardiac surgery. Also it has been shown that cognitive abnormalities persist in a later postoperative follow up. The aim of our study was to determine incidence of cognitive complications early after isolated coronary artery bypass grafting using cardiopulmonary bypass, and to identify predictive factors, associated with perioperative cerebral dysfunction. MATERIAL AND METHODS: Eighty-six patients (63 men and 23 women; mean age 66.1+/-6.7 year) with identified isolated coronary artery disease were enrolled into prospective study using Case Report data collection document. Neuropsychological status was examined using Symbol Digit Modalities Test with additional Euro QOL test. All tests were performed at baseline (1 day before operation), at the 5(th) to 7(th) postoperative day and one month after operation. RESULTS: Neuropsychological dysfunction (as compared with baseline) occurred in 59 patients (68.6%) at the 5(th)-7(th) postoperative day and persisted in 19 patients (22.1%) after one month. Patients who suffered postoperative cerebral dysfunction more often had history of prior cerebrovascular morbidity (p<0.05), poor left ventricular ejection fraction (<or=35%) (p<0.05) and higher incidence of left main coronary artery disease (p<0.05). CONCLUSIONS: Cognitive dysfunction is still important complication after coronary artery bypass grafting persisting during the early follow-up in some patients. Symbol Digit Modalities Test was sensitive instrument for diagnostics of postoperative neuropsychological complications reasons.

Age Factors↗

PubMed2004

[Early complications and changes of left ventricular geometry and volume following two types of ventricular reconstruction: compression of scar zone and modified Dor aneurysmectomy].

UNLABELLED: The aim of the study was to evaluate early complication rate and changes of left ventricular geometry and function after two types of left ventricular reconstruction surgery. METHODS: The study included 54 patients with ischemic heart disease and left ventricular aneurysm, who underwent coronary artery bypass grafting and left ventricular reconstruction surgery: I group (31 patients) underwent modified Dor aneurysmectomy and II group (23 patients) underwent infarcted wall compression. The study protocol included operative data, early postoperative complications and evaluation of left ventricular function 10(th)-14(th) day after surgery. RESULTS: Early complication rate had tendency to be higher in I group. Among patients with left ventricular ejection fraction <20%, in I group all 6 patients died, including 5 patients who underwent aneurysmectomy combined with mitral and tricuspid anuloplasty and 2 patients who underwent both apical aneurysmectomy and posterior wall compression, in II group - 1 of 3 patients died. Early changes of left ventricular geometry in I group included decrease in left ventricular diameter, volume, mass, as well as reduction of short axis of left atrium, in II group - decrease in left ventricular diameter, mass and both axis of left atrium. Left ventricular ejection fraction had tendency to increase in both groups: in 41.9% of patients in I group and in 56.5% in II group. CONCLUSIONS: Following different types of left ventricular reconstruction surgery early postoperative complications rate did not differ, except higher mortality rate in patients with left ventricular ejection fraction <20%, who underwent modified Dor aneurysmectomy combined with other surgical procedures. Early changes of left ventricular geometry and volume differed between patients who underwent different types of left ventricular reconstruction.

Aged↗

PubMed2004

[Late changes of the left ventricular function following non-ischemic mitral valve reconstructive surgery].

UNLABELLED: The aim of the study was to evaluate late changes of left ventricular geometry and function following non-ischemic mitral valve reconstructive surgery. MATERIAL AND METHODS: The study included 43 patients with non-ischemic mitral valve incompetence due to mitral valve fiber degeneration, Barlow disease, and endocarditis. Doppler echocardiography was performed prior, 10-14 days and 12 months following mitral valve anuloplasty. RESULTS: Early after surgery preload reduction resulted in reduction of left ventricular end diastolic diameter index (from 31.7+/-2.8 to 27.9+/-2.4 mm/m(2), p<0.001), end diastolic volume index (from 81.1+/-15.8 to 55.7+/-12.2 ml/m(2), p<0.001). Due to increased afterload left ventricular systolic parameters remained unchanged with decrease in left ventricular ejection fraction (from 57.7+/-7.9 to 48.5+/-3.1%, p<0.001). Late after surgery left ventricular end systolic diameter index decreased from 20.2+/-2.4 to 17.4+/-2.8 mm/m(2) (p<0.001), wall stress - from 44.1+/-10.1 to 35.4+/-7.4 dyn/cm(2) (p<0.001), ejection fraction increased from 48.5+/-3.1 to 56.4+/-4.6% (p<0.001). Reduction of left atrium diameters and systolic pulmonary artery pressure from 46.4+/-13.2 to 37.8+/-4.6 mm Hg st. (p<0.001) were also noted. CONCLUSIONS: Surgical correction of non-ischemic mitral valve incompetence and reduction of preload result in positive left ventricular remodeling in early postoperative period. At the earliest reduction of left ventricular diastolic parameters is observed and following one year - reduction of left ventricular systolic parameters, left atrium, pulmonary artery pressure, and improvement in left ventricular systolic function.

Adult↗

PubMed2004

["Off-pump" myocardial revascularization: experience in the Clinic of Cardiosurgery, Kaunas University of Medicine].

UNLABELLED: According to indications there is no difference in results of grafts patency and left ventricle function after minimal invasive myocardial revascularization in comparison to typical operation with cardiopulmonary bypass and cardioplegia. Only ranges of troponin T (TnT), CK and CK-MB are statistically significantly lower in the group of operations without cardiopulmonary bypass and cardioplegia. MATERIAL AND METHODS: According to possibilities different surgical technic of minimally invasive myocardial revascularization was used in 119 patients with chronic ischemic heart disease. Dynamic perioperative level of cardiospecific agents (TnT, CK, CK-MB) was determined in 30 cases; left ventricle function was echoscopically analyzed (ejection fraction, left ventricle wall motion index, left ventricle end diastolic diameter) for 70 patients and postoperative angiographic control was done for 46 patients. RESULTS: All operations were done in the Clinic of Cardiosurgery of Kaunas University of Medicine until July 1, 2003. An analysis of operative data of 119 cases with ischemic heart disease is presented. All patients underwent thoracic coronary and aortocoronary bypass grafting using minimal invasive cardiosurgical technique on the beating heart without cardiopulmonary bypass ("off-pump"). In most cases median sternotomy was used. Left internal thoracic artery or saphenous vein were applied as a grafts. Perioperative investigation of TnT, CK and CK-MB for 30 patients in early postoperative period showed low level of signs of myocardial injury. Postoperative angiographic control of grafts in 46 patients was done until 30(th) postoperative day and showed excellent patency rate of arterial and vein bypasses. In cases of complete revascularization marked and statistically significant improvement of the left ventricle function was found. CONCLUSIONS: According to indications minimally invasive ("off-pump") operation is alternative method to traditional myocardial revascularization with cardiopulmonary bypass and cardioplegia. In these cases lower level of perioperative myocardial injury is observed; improvement of left ventricle function and high postoperative graft patency are similar to those after traditional operations.

Adult↗

PubMed2004

[Use of hypertonic colloid solution in the treatment of heart failure in early postoperative period].

OBJECTIVE: The aim of the study was to estimate the differences in hemodynamic, metabolic and cardiovascular parameters in early postoperative period in hypertonic colloid solution and usual infusion therapy groups. MATERIAL AND METHODS: The study was blind placebo controlled. Thirty patients were randomly divided into two groups. The control group received usual Ringer solution for hypovolemia correction and the study group received 250 ml of 7.2% NaCl/6% Hydroxyethylstarch (HyperHaes, Frezenius) solution. The measurements were made before, immediately after the infusion, 60 min and 180 min after infusion. The parameters of central hemodynamics, oxygen transport, the temperature gradient, electrolyte concentration and fluid balance were evaluated. RESULTS: After infusion of HyperHaes solution cardiac index increased from 2.8+/-0.2 to 3.8+/-0.3 L/min/m(2), pulmonary vascular resistance and systemic vascular resistance decreased. Serum Na(+)and Cl (-)increase in investigative group did not exceeded normal range and returned to initial level after an hour. The total fluid balance and fluid balance during surgery in investigative group was less than that in the control group. CONCLUSIONS: HyperHaes solution in early postoperative period after coronary artery bypass grafting surgery increased preload, had the tendency of decreasing afterload, increased cardiac index, decreased total fluid balance and did not cause hypernatremia and hyperchloremia.

Aged↗