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INTERVENTIONAL PRACTICE IN PATIENTS WHO UNDERWENT
AORTOCORONARY SHUNTING
Toʻychiyev Sh.M., Saydaliyev R.S., Allayorov S.A.
Tashkent medical academy, Tashkent, Uzbekistan
The invasiveness of coronary angiography is that a vein is punctured to insert
a special thin tube, a catheter, which will be advanced toward the heart during the
procedure. The doctor controls the catheter advancement using equipment. During
coronary angiography, a radiopaque substance is injected, one that can absorb X-
rays.
Coronary angiography of the heart vessels rarely requires general anesthesia;
in the vast majority of cases, local anesthesia is sufficient. The study does not require
long-term hospitalization and has high diagnostic value for determining the patient's
health, the method of his treatment and the volume of necessary surgical
manipulations.
Key words:
coronary angiography, ischemic heart disease, coronary heart
disease, coronary artery bypass grafting
ИНТЕРВЕНЦИОННАЯ ПРАКТИКА У БОЛЬНЫХБ
ПЕРЕНЕСШИХ АОРТОКОРОНАРНОЕ ШУНТИРОВАНИЕ.
Туйчиев Ш.М., Сайдалиев Р.С., Аллаеров С.А.
Ташкентская медицинская академия, Ташкент, Узбекистан.
Инвазивность коронарографии заключается в том, что в вену
прокалывается специальная тонкая трубка — катетер, который в ходе
процедуры будет продвигаться по направлению к сердцу. Продвижение
катетера контролируется врачом с помощью аппаратуры. Во время
коронарографии вводится рентгеноконтрастное вещество, способное
поглощать рентгеновские лучи. Коронарография сосудов сердца редко
требует проведения общего наркоза, в подавляющем большинстве случаев
достаточно местной анестезии. Исследование не требует длительной
госпитализации и имеет высокую диагностическую ценность для определения
состояния здоровья пациента, метода его лечения и объема необходимых
хирургических манипуляций.
Ключевые слова:
коронарография, ишемическая болезнь сердца,
ишемическая болезнь сердца, аортокоронарное шунтирование.
AORTOKORONAR SHUNTLASH O`TKAZGAN BEMORLARDA
INTERVENTSION AMALIYOT O
‘
TQAZISH.
Toʻychiyev Sh.M., Saydaliyev R.S., Allayorov S.A.
Toshkent tibbiyot akademiyasi, Toshkent, O`zbekiston
“JOURNAL OF SCIENCE-INNOVATIVE RESEARCH IN
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ResearchBib Impact Factor: 9.654/2024 ISSN 2992-8869
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Koronar angiografiyaning aortokoronar shuntlash amaliyotidan farqli ravishda
invazivligi shundaki, tomir ichiga maxsus yupqa naycha, kateter kiritiladi, bu
jarayon davomida yurakka qarab harakatlanadi. Kateterning rivojlanishi asbob
yordamida shifokor tomonidan nazorat qilinadi. Koronar angiografiya paytida
rentgen nurlarini o'zlashtira oladigan modda AOK qilinadi. Yurak tomirlarining
koronar angiografiyasi kamdan-kam hollarda umumiy narkoz talab qiladi, aksariyat
hollarda lokal og’riqsizlantirish yetarli. Tadqiqot uzoq muddatli kasalxonaga
yotqizishni talab qilmaydi va bemorning sog'lig'i holatini, davolash usulini va zarur
jarrohlik muolajalar hajmini aniqlash uchun yuqori diagnostik ahamiyatga ega.
The cause of death of every second person is cardiovascular disease. The main
danger is ischemic heart disease (IHD).
Coronary heart disease (CHD) is a chronic
disease caused by insufficient blood supply to the heart muscle. In the vast majority
of cases, this is a consequence of coronary artery atherosclerosis. Coronary artery
atherosclerosis is a gradual narrowing (stenosis) or complete closure (occlusion) of
the coronary arteries.
At first, ischemic heart disease manifests itself during physical and emotional
stress. As a rule, sharp pains occur in the center of the chest (retrosternal pain) -
angina. They can be burning, squeezing, sometimes causing a feeling of lack of air.
This is a signal that the heart muscle in the ischemic zone is experiencing an acute
lack of blood supply.
An atherosclerotic plaque narrowing the lumen can suddenly
rupture, then a blood clot forms on it - a thrombus. This clot can quickly and
completely block the lumen of the artery. In this case, the blood supply to the area
of the heart supplied by this artery completely stops.
Within 15 minutes after the
blood flow stops, the heart muscle cells in the ischemic zone begin to die, and after
6-8 hours this entire zone dies completely - myocardial infarction develops.
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There are two methods of surgical treatment of ischemic heart disease: coronary
artery bypass grafting (CABG) and intravascular surgery (balloon angioplasty,
stenting). Both methods have their indications and contraindications. Therefore, the
question of choosing one of them is always decided individually.
Coronary artery bypass grafting is a cardiac surgery that creates a new path for
blood flow around the affected artery. To do this, a bypass is placed between the
aorta and the narrowed section of the artery. The following are used as a bypass: the
great saphenous vein, the internal mammary artery, the radial artery, or a synthetic
prosthesis. Access to the heart is achieved through an incision in the chest, most
often through the sternum.
Types of coronary angiography differ in the scope of the study:
General.
It is performed on all coronary arteries. This is a classic study, the
results of which can be recorded on X-ray film, removable media or a computer disk
Selective.
It is performed on several vessels. It takes little time, can be used
several times to obtain images in different projections.
Depending on the method of implementation, coronary angiography of the
heart can be of the following types:
Interventional.
Is the most common method, involves the introduction of a
catheter to fill the vessels of the heart with a radiopaque substance.
CT coronary angiography
. Does not require the introduction of a catheter,
since the radiopaque substance is injected into the vein.
Ultrasound.
Used mainly in scientific research, the technique itself is similar
to interventional coronary angiography, the difference is that the catheter is equipped
with an ultrasound sensor to assess the condition of the vascular wall.
Depending on the conditions of the intervention, this may be:
femoral artery
brachial artery
radial artery
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Then, through a special device (introducer), thin catheters are inserted one by
one. With their help, a contrast agent is introduced into the lumen of the coronary
arteries, making the arteries visible under X-rays. Thus, the doctor gets the
opportunity to accurately detect the location of the atherosclerotic plaque, determine
the degree of narrowing of the coronary vessel and develop tactics for further action.
Next, a special stent is brought to the affected area via a special guide and installed,
which presses down on the atherosclerotic plaque. The stent is a metal frame
installed at the site of narrowing using a special tool. It strengthens the artery wall
and prevents it from narrowing again .
Currently, the treatment of patients with cardiovascular diseases is becoming
increasingly complex due to the general aging of the population and the prevalence
of comorbidities, which forces the search for alternative methods of therapy. Hybrid
revascularization strategies combine the advantages of open surgery and
transcatheter interventions.
The techniques available to both surgeons and
cardiologists can be successfully applied in the treatment of a wide range of patients
suffering from cardiovascular diseases. The results of hybrid interventions in all
areas of cardiac surgery are not inferior to the results of traditional methods and
deserve close attention. The future of cardiac surgery and interventional cardiology
is associated with the further development of "hybrid thinking".
Hybrid surgeries are a combination of coronary artery bypass grafting (open
surgery on a beating heart using a mini-access) with stenting (X-ray endovascular
intervention).
Percutaneous coronary intervention (PCI) followed by minimally invasive
coronary artery bypass grafting (MIDCABG)
The advantages of this approach include a reduced risk of myocardial
ischemia during MIDCABG.
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At the same time, traditional coronary artery bypass grafting may become an
alternative in case of suboptimal PCI results. The disadvantages of this technique
include the lack of angiographic control of the anastomosis between the left internal
thoracic artery (LIMA) and the anterior interventricular artery (AIVA), the risk of
increased blood loss during MIDCABG performed against the background of dual
antiplatelet therapy, and the possibility of stent thrombosis.
Minimally invasive coronary artery bypass grafting (MIDCABG)
followed by percutaneous coronary intervention (PCI)
Advantages of this approach: initiation of aggressive antiplatelet therapy after
PCI performed as a second stage, myocardial protection with a functioning bypass
graft to the LAD during high-risk PCI. Disadvantages include the following:
Simultaneous MIDCABG and PCI (simultaneous)
The schematic heart shows the areas of surgical intervention. The positive
aspects of this strategy include simultaneous angiographic control of the
anastomosis of the LVGA with the LAA and PCI of the affected coronary arteries.
The negative aspects include the risk of bleeding against the background of dual
antiplatelet therapy, as well as economic and logistical difficulties.
Conclution:
According to the results of the research conducted on the practice
of coronary artery bypass grafting despite the restoration of the patency of the
coronary blood vessels, after a certain period of time, restenosis, i.e. re-clotting of
the vessels for certain reasons, was observed. To date, efforts are being made to carry
out interventional procedures in patients who have undergone US surgery. The main
goal of this is to reduce the complications arising from the practice and to improve
the patient's future quality of life by preventing the recurrence of the disease.
References
1.
Mandeep Singh ,,Twenty-Five–Year Trends in In-Hospital and Long-Term
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Unterberg C ,Buchwald A, Wiegand V ,Kreuzer H.,,Coronary
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Angiology.1992;43:653±660.
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4. Gade S. V. Miguel, MD, PhD,1 Alexandre G. Sousa, MD,2 Gilmara S. Silva,
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,,Does Prior Percutaneous Coronary Intervention Influence the Outcomes of
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