ASSESSMENT OF MYOCARDIAL REPERFUSION QUALITY IN PATIENTS WITH ACUTE CORONARY SYNDROME AND ST SEGMENT ELEVATION, BASED ON THE CRITERIA BY THE AMERICAN COLLEGE OF CARDIOLOGY/AMERICAN HEART ASSOCIATION

Aim. To use the criteria by the American College of Cardiology/American Heart Association (ACC/AHA), in order to assess the quality of myocar-dial reperfusion in Russian patients with acute coronary syndrome (ACS) and ST segment elevation (STE-ACS).Material and methods. We analysed the clinical data of 25682 patients with STE-ACS, who were treated (2010–2011) in Russian hospitals participating in the Russian ACS Registry. The following ACC/AHA indicators (2008) were used: “time to thrombolysis” — the percentage of STE-ACS patients who received thrombolysis within 30 minutes after admission; “time to primary percutaneous coronary intervention (PCI)” — the per-centage of STE-ACS patients in whom primary PCI started within 90 minutes after admission; and “reperfusion” — the percentage of STE-ACS patients who underwent any reperfusion intervention within 12 hours after the chest pain onset.Results. Among 25682 STE-ACS patients, any reperfusion intervention (PCI and/or thrombolysis, in any order) were performed in 12043 (46,9%). Among 7437 STE-ACS patients who underwent thrombolysis, 5119 (69%) met the inclusion criteria. In this group, the indicator “time to thrombolysis” was met in 3342 patients (65,3%). Among 5405 STEACS patients who underwent PCI, 3993 (73,9%) met the inclusion criteria. In these patients, the indicator “time to primary PCI” was met in 2797 (70%). Finally, among 25135 (97,9%) patients with STE-ACS who were included in the analyses, the indicator “reperfusion” was met in 9800 (38,9%).Conclusion. The main problem of the health care for Russian patients with STE-ACS is the limited reperfusion coverage. However, the reperfusion quality could be regarded as satisfactory.

Utilization of rapid-infuser devices for massive blood loss

Rapid volume replacement for severe hemorrhage continues to challenge the clinician involved in the care of the patient suffering hemorrhagic shock. We report on the development and utilization of two rapid-infuser systems for volume replacement in critically ill patients presenting in extremis. We have developed rapid-infusion circuits by using commercially available devices available at our institution. The primary pumping mechanism is either a centrifugal pump (Revolution™COBE Cardiovascular, Arvada, CO, USA), or the Myocar-dial Protection System (MPS™ - Quest Medical, Allen, TX, USA), and offers advantages over commercially available devices. Both circuits consist of a cardiotomy reservoir, a cardioplegia delivery set, assorted tubing and connectors, and a heater-cooler system. Between January and October of 2003, 15 procedures were performed which utilized one of these two devices. There were nine ruptured aneurysms, five traumas and one radical nephrectomy. The rapid infusion time averaged 228.59±105.7 min where 10.49±9.4 L of autotransfusion volume was processed, with 3.99±4.2 L of red cell volume reinfused. The allogeneic blood products that were transfused included packed red blood cells and fresh frozen plasma, as well as 5% albumin. There were no intraoperative deaths and the rapid-infuser was considered lifesaving in all instances. Mechanical rapid infusion systems may be lifesaving when severe hypovolemia or hemorrhagic shock is encountered. While both devices are able to meet the requirements of rapid fluid replacement, the MPS offers the most safety features and has become the standard of care at our institution.

Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension

Introduction. Pulmonary thromboendarterectomy (PTE) is a surgical procedure which is considered the only effective and potentially curative treatment for chronic thromboembolic pulmonary hypertension (CTEPH). CTEPH is a rare outcome from pulmonary emboli and, when left untreated, will result in right ventricular failure and death. Methods. From June 1999 to November 2003, 40 of these procedures were performed in our institution. Emphasis is placed on multidisciplinarity and cooperation between different medical and surgical disciplines. Perfusion management consists of myocar-dial and cerebral protection, deep hypothermia with multiple periods of circulatory arrest, reperfusion at hypothermia, hemofiltration and cellsaving techniques. Results. Hemodynamic improvement occurs immediately post operation. Mean pulmonary artery pressure decreased from 50±11 to 38±10 mmHg, pulmonary vascular resistance from 1246±482 to 515±294 dynes s/cm5 and cardiac index increased from 1.54±0.54 to 2.63±0.75 L/min per m2. Pump runs had an average duration of 187±29 min, circulatory arrest time was 29±11 min and crossclamp time 36±14 min. Extracorporeal membrane oxygenation can be an ultimate treatment for specific postoperative problems like persistent pulmonary hypertension and/or reperfusion pulmonary edema.

Contrast Harmonic Power Doppler Imaging of Congenital Ventricular Diverticulum

A case of an 81-year-old woman with a left ventricular diverticulum who underwent myocar dial contrast echocardiography is reported. After administration of the contrast agent, a pulsed Doppler flow measurement clearly revealed the biphasic waveform of the ejection flow in the pre-systolic and systolic phase at the ostium of the diverticular cavity. A harmonic power Doppler image showed that part of the diverticulum wall had similar acoustic proper ties to the ventricular septal wall. Intracardiac blood flow and myocardial perfusion could be clearly evaluated and a ventricular diverticulum was correctly diagnosed using contrast echocardiography.

Lack of Association between the Platelet Glycoprotein Ia C807T Gene Polymorphism and Myocardial Infarction in Japanese

SummaryThe platelet-collagen receptor, glycoprotein Ia/IIa (integrin α2β1) plays a fundamental role in the adhesion of platelets to fibrillar collagen, an event leading to platelet activation and thrombus formation and contributing to the pathogenesis of thrombotic disease. Further, glyco-protein Ia/IIa receptor density and function may be associated with two linked and silent polymorphisms (807C/T and 873G/A) within the glyco-protein Ia gene. We tested the extent to which these polymorphisms serve as genetic markers of myocardial infarction in a Japanese population. A case-control study was carried out using 210 Japanese myocar-dial infarction patients and 420 age- and sex-matched controls. Geno-typing was accomplished using PCR followed by melting curve analysis with specific fluorescent hybridization probes. The 807CC, CT, TT genotypes linked perfectly to the 873GG, GA, AA genotypes, respectively. Allele frequencies of the 807T (873A) variant were similar in the control and patient groups (0.373 vs. 0.352). The 807T and 873A variants of platelet glycoprotein Ia gene are common and in a perfect linkage in the Japanese population, but it appears unlikely that the 807T (873A) variant represents a useful marker of increased risk for myocardial infarction.

Mechanical Circulatory Support Sources of Emboli and Neurological Outcome

Long-term mechanical circulatory support devices are currently used as bridges to transplantation or myocar dial recovery and represent a major step forward in the treatment of end-stage heart failure. Examples of left ventricular assist devices/systems are Thoratec Labora tories (Berkley, CA), Baxter Novacor (Oakland, CA), and Thermo Cardiosystems Inc Heartmate (Woburn, MA). The CardioWest (Tucson, AZ) is the current total artifi cial heart device under clinical evaluation. These de vices are associated with neurological complications usually resulting from thromboembolic events to the cerebrum, cerebellum, or brainstem. The device itself is the commonest source of these emboli. Thrombus formation within the device occurs as a result of the interaction between the blood contacting surfaces of the device, the flow of blood through the device, and thrombotic tendency of the blood. There is a wide range of clinical presentation, from asymptomatic emboli detected by transcranial Doppler to devastating strokes. Strategies aimed to reduce the tendency to form throm bus are based on aggressive prevention with anticoagu lation and antiplatelet therapy and/or by design modifi cation. In particular, the use of a textured inner surface that encourages the formation of a pseudoneointima seems successful in reducing anticoagulation require ments and neurological complications.