Клінічна хірургія (Oct 2022)
Surgical treatment of mitral stenosis, complicated by massive thrombosis of the left atrium: stationary stage
Abstract
Objective. Elaboration of the correction methodology of mitral stenosis, complicated by massive thrombosis of left atrium, for improvement of immediate and late results of surgical treatment of this pathology. Materials and methods. Into the group analyzed 344 patients with mitral stenosis, complicated by massive thrombosis of left atrium, operated in Amosov National Institute of Cardiovascular Surgery in a period from 1 January 1984 yr to 1 January 2019 yr, were incorporated. In all the patients surgical correction of mitral stenosis and thrombectomy from left atrium was performed. In 161 (46.8%) patients a radical removal of thrombotic mass together with their base–lining was performed, while in 183 (53.2%) – without it. In 256 (74.4%) patients the left atrium auricle was ligated or resected, while in 88 (25.6%) – left intact. Results. The hospital lethality index have had directly proportionally raised with enhancement of degree of the left ventricle auricle: I – 0%, II – 3.9%, III – 5.1% (p<0.05). In a general group during all period of the investigation a directly proportional dependence of index of hospital lethality due to lethal thromboembolic complications on degree of massive thrombosis of the left atrium auricle was observed: I – 0.0%, II – 3.5%, III – 5.2% (p<0.05). Best indices of hospital lethality were achieved in radical removal of thrombi together with their base–lining with ligature or resection of the left atrium auricle as a possible origin of thrombi creation. Conclusion. While doing surgical correction in patients with massive thrombosis of left atrium it is important to remove the thrombotic base–lining and to ligate or resect the left atrium auricle, what significantly lowers the risk of hospital lethality, thromboembolic complications on stationary stage of treatment.
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