RU2106111C1 - Method for performing revascularization of the left cardiac ventricle myocardium - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves creating tunnel in the bulk of myocardial body communicating to ventricle cavity and directed in parallel to its walls after performing aneurysmectomy. The tunnel is formed on one side of myocardial cut, athrombogenic thread and light guide are introduced into the cut and brought out through the myocardial wall on the other side of the cut. Inflammatory and thrombotic complications are prevented by exposing the tunnel to low-power helium-neon laser radiation during 3 days. Then the thread and light guide are removed. EFFECT: enhanced effectiveness of treatment.

Description

 The invention relates to medicine, namely to cardiac surgery, and can be used to treat myocardial ischemia.

 The most effective surgical treatment for coronary artery disease is coronary artery bypass grafting (CABG). However, in 2/3 of patients, CABG cannot be performed due to the pronounced multiple lesions of coronary arteriosclerosis (diffuse lesion).

 To improve myocardial nutrition in the last group of patients, another type of special intervention is used.

 The known method Ishenina Yu.M. myocardial tunneling with a tube scalpel.

 However, the known method has the following disadvantages: thrombosis of the channel and the development of purulent myocarditis of the apical region of the heart.

 The aim of the invention is to develop a method of myocardial revascularization that eliminates these disadvantages, namely, the prevention of thrombosis of the channel and the development of purulent myocarditis.

 This goal is achieved by the fact that to prevent thrombosis of the canal, an atrombogenic suture thread (siliconized fishing line-capron, fluoroplast) is introduced and left in it, and a fiber is inserted into the canal to prevent the development of purulent myocarditis in the canal for laser irradiation.

 The proposed method has the following advantages: the presence of fishing line prevents the formation of a blood clot in the channel, laser irradiation prevents the development of infectious myocarditis and thrombosis due to the bactericidal effect of laser radiation.

 The method is as follows.

 To form a channel, a tunnel in the myocardium with a tube scalpel described by Yu. M. Ishenin, a tunnel 40 mm long is made in parallel to the walls of the myocardium in the lower third of the section of the dissected myocardium by translational-rotational movements in the thickness of the myocardium. At the end of the tunnel, guided by the intracardiac anatomy, the end of the tube scalpel is brought into the cavity of the ventricle, forming a through hole. After removal of the tube scalpel together with the extracted myocardial tissue, a tunnel forms, a channel passing through the thickness of the myocardium and having one hole opening into the ventricular cavity, and the other in the ventricular wall at the incision site of the aneurysm remaining after excision. Through an opening in the left ventricle, blood from the cavity of the left ventricle enters the formed channel with a pressure equal to the pressure in the ventricle. Through the natural existing arterial and venous network, which opens into the channel (after excision of the myocardial column), blood enters these vessels and improves myocardial circulation.

 To prevent thrombosis, an atrombogenic kapron thread (fishing line) is introduced into the cavity of the channel during surgery through the entire channel and the optical fiber for laser irradiation of the channel.

 Laser irradiation (type LG-79, wavelength 633 nm, fiber diameter 0.5 mm) is performed for 3 minutes after 12 hours for three days. After three days, the line and the light guide are removed.

 Example. Patient М-в, 38 years old, and / b N 2609, was admitted to the clinic on September 23, 1991 with complaints of pain in the heart, shortness of breath during physical exertion. A history of large focal myocardial infarction was observed in 1989 and 1991. Based on a comprehensive full examination, including ECG, echocardiography, X-ray examination, cardiac sounding, coronary angiography, 10/22/1991 the patient was taken for surgery with a diagnosis of coronary heart disease, postinfarction large-focal cardiosclerosis with an outcome in left ventricular aneurysm, thrombosis, thrombosis aortic valve, angina pectoris, III functional class, circulatory failure PA.

 Operation. Intubation anesthesia. Transternal thoracotomy. The heart is enlarged. Due to the left ventricle, on the anteriofinal surface of which, with the capture of the lateral wall, the zone of the aneurysmically altered myocardium. Sites of cardiosclerosis also extend along the posterior diaphragmatic surface of the heart. When revising the coronary arteries, it was noted: along the left coronary artery there are no local narrowings, but in the distal small branches there are multiple plaques. Right coronary artery: in the area of the mouth, a section of cartilaginous density, then the artery in the form of a tight screed. A section of the right coronary artery was selected 4-5 cm from the mouth, its lumen was opened, it was found that the artery was fibrotic, there was virtually no lumen, and it was decided to refuse aorto-coronary bypass surgery.

 In the aneurysm, the lumen of the left ventricle was opened. The walls of the aneurysm are fibro-muscular, up to 5 mm thick.

 Performed tunneling of the left ventricular myocardium as follows.

 In the lower third of the dissected myocardium (after the removed aneurysm), a tunnel with a length of 40 mm was made parallel to the walls of the myocardium with a tube scalpel using rotary-translational movements in the thickness of the myocardium. At the end of the tunnel, the end of the tube scalpel is brought into the cavity of the ventricle - a through hole is formed.

 For the prevention of thrombosis and infection, an atrombogenic (siliconized) capron filament (0.9 mm fishing line) was inserted into the cavity of the entire channel and a fiber for laser irradiation was used to prevent infection. For three days, laser irradiation was performed for 3 minutes, after 12 hours, after which the fishing line and fiber were removed.

 A similar operation was performed in 9 patients, in all cases good results were obtained, there were no cases of tunnel thrombosis and septic complications. Clinical data were obtained indicating good myocardial revascularization; angina attacks in surgery patients stopped.

 Thus, the proposed method of myocardial revascularization prevents thrombosis of the myocardium and infection of the tunnel and improves myocardial nutrition, which, in turn, leads to an improvement in the condition of patients.

Claims (1)

 The method of revascularization of the myocardium of the left ventricle of the heart after an aneurysmectomy, including the creation of a tunnel in the thickness of the myocardium parallel to its walls, communicating with the cavity of the ventricle, characterized in that the tunnel is formed on one side of the myocardial incision, an atrombogenic thread and a light guide are inserted into it, and they are brought out through the wall myocardium on the other side of the incision, inflammatory and thrombotic complications are prevented by irradiating the tunnel with a low-energy helium-neon laser for three days, after which the fiber and the fiber delete.