LEFT VENTRICLE REARRANGEMENT IN PATIENTS WITH CRITICAL OSTIAL STENOSIS OF THE LEFT MAIN TRUNK COMPLICATED WITH ISCHEMIC MITRAL REGURGITATION

Abstract

In this work, we studied the possibility of stenting the left coronary artery trunk in patients with subacute myocardial infarction on a background of critical stenosis of the left coronary artery trunk, reduced left ventricular ejection fraction and surgically significant mitral regurgitation. We analyzed treatment outcomes of 97 patients who underwent stenting of left main trunk for subacute stage of myocardial infarction. All patients had mitral insufficiency of II–III degree. The echocardiography data were analyzed before surgery, 7 days, 30 days and 12 months after surgical treatment. Direct stenting of the left coronary artery trunk was performed in 38 (39.2%) patients. 59 (60.8%) patients underwent Culotte bifurcation stenting. A good treatment effect was achieved in 89 (91.2%) patients. As a result of the LV myocardial remodeling, EF increased by 1.44 times (p < 0.05). There was a significant decrease in the degree of mitral insufficiency by 39% to surgically insignificant from 5.9 to 3.6 mm (p < 0.05). Stent placement as an initial treatment in elderly patients with more than 24 hours after the onset of acute myocardial infarction (AMI) originated from a critical lesion of the left coronary artery trunk and concomitant pronounced mitral insufficiency proved as fully justified and safe. We assume that this treatment enables to improve ejection fraction and reduce severity of mitral regurgitation in elderly AMI patients.