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Second Congress of Cardiology and Angiology of Bosnia & Herzegovina

 

MYOCARDIAL REVASCULARISATION USING INTERNAL MAMMARY ARTERY
J. Selestiansky, Lj. Petrović, S. Ničin, M. Fabri, P. Kovačević, Z. Jonjev, B. Mihajlović, A. Milosavljević, M. Radovanović, M. Redžek, S. Sušak, M. Popov and N. Radovanović.
University Clinic of Cardiovascular Surgery, Novi Sad, Yugoslavia

In order to assess histological changes of the LV myocardium one-year following partial left ventricu lectomy (PLV) we compared, in semiquantitative fashion, major morphometric parameters in the LV specimens, taken during surgery and endomyocardial biopsies (EMB) one -year postoperatively. The study group consisted of 12 consecutive PLV survivors, who were predominantly male (10/12), aged 46±12 years. Surgical operative specimens were taken from the infero- and/or posterolateral wall of the LV processed routinely and stained with Masson -trichrome for better contrast. Postoperative LV EMB 3-5 per patient were taken 12 month later and processed in exactly the same number. The following morphometric parameters were assessed: (1) degree of hypertrophy and attenuation of myocardial fibres (diameter); (2) nuclear evidence of hypotrophy (diameter); (3) myofibrilar volume fraction; (4) degree of degenerative, vacuolar changes in cardiomyocites, and (5) fibrosis volume fraction. These parameters were assessed semiquantitatively and graded in usual fashion (0-none, 1-mild, 2-moderate, and 3-severe). Myofibrilar hypertrophy and attenuation, as well as fibrosis and myofibrilar volume fraction, were interexclusive (mutual score was maximum 4). Results: Both NYHA class and EF were improved 12 month following operation as compared to preoperative values ( 2,25±vs. 3,33±0,69, p<0,001, and 34±10% vs. 21±9%, p<0,001, respectively). Semiquantitative morphometric analysis demonstrated postoperative values (1,50±0,52 vs. 2,42±0,64, p<0,01), as well as postoperative decrease in fibrosisvolume fraction (2,08±0,79 vs.2,67±0,49, p<0,01) and consequent increase in myofibrilar volume fraction (1,92±0,77 vs. 1,33±0,49, p<0,01). There was no difference in post and preoperative degree of myofibrilar hypertrophy, nuclear evidence of hypertrophy, and degenerative changes in myocardial fibres (1,17±0,39 vs. 1,25±0,45, 1,33±0,49 vs. 1,67±0,65 and 1,50±0,52 vs. 1,83±0,83, respectively). Conclusions: One year postoperatively, PLV has favourable effects on myocardial morphology, that parallels improvement in patient's functional status and LV systolic function. Histological remodelling is manly due to the decrease of attenuation ( reduced LV dilatation), increase of the relative myofibrilar volume fraction, and decrease of the fibrosis volume fraction .

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