Patient D., 62 years old entered the clinic Kyiv City Heart Center with a diagnosis of coronary art

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Progress in the field of interventional cardiology has currently led to a significant increase in the number of percutaneous interventions for the treatment of coronary heart disease. This fact has changed the clinical profile of patients point to coronary zinga artery bypass graft. Thus, surgeons are increasingly exposed to diffuse running zinga of coronary atherosclerosis. In this situation, the classical coronary bypass surgery may not be sufficient to achieve complete revascularization. Coronary endarterectomy (CE) is the additional surgical method to be successful in treating the most severe group of patients with end-stage atherosclerosis and aterokaltsynozu, occlusion of coronary arteries [1,2].
Patient D., 62 years old entered the clinic Kyiv City Heart Center with a diagnosis of coronary artery disease, stable angina pectoris, NYHA class III. Postinfarction (from 11.2008) and atherosclerotic infarction (case 0209/09). In history revealed hypertension, hypercholesterolemia, smoking as risk factors for coronary disease. When echocardiography - systolic and diastolic dysfunction of the left ventricle (LV). LV ejection fraction - 44%.
Coronary angiography revealed three main lesions of coronary vascular zinga system of the heart. This envelope branch (CO) and anterior interventricular branch (PMSHH) left coronary artery (LKA) had stenosis of 80%. PKA was totally oklyuzovana in the proximal segment (Fig. 1).
Operation coronary artery bypass grafting (CABG) was performed zinga under artificial circulation with moderate hypothermia (27 - 32 C), standard heparynizatsiyeyu (300 U / kg) elektroplehiyeyu (artificial heart fibrillation) and intermittent (up to 10 minutes) peretysnennyam aorta. When you try to bypass PKA in the lumen was found expressed atherosclerotic process vessels with a diameter less than 1 mm. In this regard, it was inappropriate to perform anastomosis that the following conditions are unable to provide effective blood flow in the distal direction zinga PKA. The decision on the methodology of KE Mills NL [3].
For this arteriotomiyu on PKA extended to 10 - 12 mm along. Then, using a special tool vidseparuvaly ateromatychnyy cord from the inner wall of coronary arteries in the most distal and proximal directions. Further, due to the moderate traction using tweezers ateromatychnyy vascular cast was removed from the vessel lumen (Fig. 2).
The operation was finished zipper in section PKA autovenous shunt. The postoperative period was smooth. The patient zinga was ekstubovano 10 hours. Transferred from the intensive care unit after 2 days. After 10 days issued for the rehabilitation to the cardiology department of residence. Coronary angiography, which was performed in the early postoperative period, showed complete recanalization PKA (Fig. 3).
Coronary endarterectomy (CE) as a method of revascularization was first used in the practice of cardiac surgery Bailey CP et al [4] in 1956, the hospital Haneman, in Philadelphia. Longmire WP et al [5] KE performed zinga in conjunction with CABG. Since it was suggested many surgical techniques to perform CE, including indoor and methods detachment atheromatous casts using carbon dioxide laser, ultrasound, infusion kardioplehichnoho solution [2,6]. Frequency CE implementation according to the literature ranges from 3.7% to 14% [2-4].
Gradually, surgeons began to avoid this procedure, since the mortality and incidence of