The coronary arteries shunting was performed in four elderly men with severe coronary heart disease, complicated by stagnant heart insufficiency and right ventriculus insufficiency (RVI). One patient could not be disconnected from the artificial blood circulation (ABC) apparatus till the venous shunting (VS) to atherosclerotically strictured right ventriculus anterior branch of right coronary artery was not accomplished. Other three patients, to whom VS to this branch was already conducted, were disconnected from the ABC without complications. In three patients echocardiography trusted RV disorders existence before this branch shunting conduction with improvement after shunting. While coronary arteries shunting conduction the anastomosis ought to be done to anterior branches of RVI when they are affected.
The relapse of ischemia was detected in 127 patients in clinical series after coronary bypass surgery. It was noted in terms from 1 month till 204 months. The basic clinical manifestation or the relapse of ischemia was the recurrence of heart stroke in 74.8%. According to the data of coronary bypass angiography, the main cause of the ischemia relapse appears to be the dysfunction of early formed shunts in 64.6% patients. The development of early thrombosis of autografts is substantially determined by the pool and degree of stenosis of shunt coronary arteries.
AIM: To evaluate diagnostic and prognostic significance of the levels of proinflammatory cytokines (IL-1, IL-6, TNF-alpha) in improvement of stratification, i.e. determination of coronary restenosis risk in patients with ischemic heart disease 18 months after coronary artery (CA) stenting. The patients were divided into two groups: group 1 consisted of 30 patients with ischemic heart disease and symptoms of anginal recurrence, 38 patients of group 2 had no recurrent coronary insufficiency. Baseline examination of 68 patients with ischemic heart disease and their examination 6-24 months (18.1 +/- 1.9 months) after CA stenting were performed. RESULTS: High activation of the proinflammatory cytokines in patients with postinfarction cardiac dysfunction and after CA stenting is associated with a high rate of recurrent angina, deterioration of myocardial perfusion, progression of atherosclerosis in CA native bed. Restenosis of CA stents in patients after endovascular myocardial revascularization significantly more frequently correlates with elevated blood levels of IL-6 by 56.8% (p = 0.031). Patients with anginal recurrence caused by stent restenosis, progression of atherosclerosis in native CA developed high expression (10.2-58.1%) of TNF-alpha (p = 0.038) 18 months after endovascular revascularization. Repeated angioplasty is associated with multiple CA affection (k = 0.56, p = 0.004) and predilation before stenting (k = 0.3; p = 0.001). CONCLUSION: Dynamics of proinflammatory cytokines (IL-1, IL-6 and TNF-alpha) is efficient to use in complex diagnosis for better stratification of CA restenosis risk in endovascular stenting of patients with coronary artery disease.