COVID-19 became the reason of unprecedented load of health care systems practically in all countries, with special consequences of this disease for work of offices of rentgenendovaskulyarny surgery. These consequences include change of standard practice of work with cardiological patients, patients with suspicion on COVID-19, and at those patients with COVID-19 which have or the heart diseases, or warm manifestations of this disease which are not connected with COVID-19. It is necessary to highlight that a situation with a pandemic rather dynamic and on it there are only limited data. Besides, conditions in this or that concrete clinic can differ considerably.
Though the current situation with a new koronavirusny infection for most of medical personnel is a new area, it should be noted that MERS epidemics (a Middle Eastern respiratory syndrome) and SARS (a heavy acute respiratory syndrome) within the last two decades really gave some limited information on influence of a high-contagious and serious respiratory illness for work of kateterizatsionny laboratory.
In the beginning we will discuss selection of patients for kateterizatsionny laboratory. Many institutions already entered suspension of planned procedures in kateterizatsionny laboratories in attempt to keep resources and to avoid impact on patients of the hospital environment in which COVID-19 can be more widespread. It, certainly, seems reasonable in regions of wide circulation of a disease. Under any circumstances for preservation of bed fund of hospital is reasonable to avoid holding planned procedures at patients with considerable associated diseases or patients with the expected duration have stay in a hospital more than one-two days (or which can treatment in intensive care unit is required). On the other hand, definition of a concept of truly planned procedure demands clinical judgment as in certain cases the delay of treatment of patients can have independent adverse effects. Examples of procedures which should be postponed include:
Transdermal coronary intervention concerning stable coronary heart disease;
Endovascular interventions at ileofemoralny diseases at patients with lameness;
Closing of an open oval window.
Decisions on specific cases have to be individualized taking into account risk of infection of COVID-19 in comparison with risk of a delay of diagnostics or therapy.
The following group is represented by patients with a myocardial infarction with an elevation of a ST (STEMI) segment. In many countries primary transdermal coronary intervention is the standard procedure for patients with a myocardial infarction with raising of a segment of ST. Access to express testing can be limited. However for patients with the confirmed COVID-19 and a myocardial infarction with raising of a segment of ST it is necessary to weigh carefully risk of impact on personnel and advantage for the patient. Fibrinolitic therapy can be considered as option for rather stable patients with a myocardial infarction with raising of a segment of ST with active COVID-19. At treatment of patients with active COVID-19 which it is necessary to execute primary transdermal coronary intervention it is necessary to use the appropriate means of individual protection (MIP), including a dressing gown, gloves, goggles (or masks) and N95 mask, especially considering a limited possibility of collecting the anamnesis at the patient and also potential clinical deterioration in myocardial infarction cases with raising of a segment of ST. It is important to note that overwhelming number of kateterizatsionny laboratories have either systems natural, or and are not intended to forced ventilation for isolation of infectious patients. Thus, for kateterizatsionny laboratories clear-out after such procedure that leads to delays for the subsequent interventions.
Patients with a myocardial infarction without increase in a ST segment: for most of such patients time for diagnostic testing for COVID-19 before catheterization of heart and adoption of more informed solution of rather infectious control has to be provided. The fast extract of patients with primary myocardial infarction without increase in a ST segment after revascularization will probably be important in terms of maximizing availability of beds and reduction of risk of infection of the patient in hospital. It is necessary to consider all factors when weighing risks and advantage, in comparison with infectious control. It is necessary to make efforts to try to differentiate cases to THEM 2 types in comparison with "primary" acute coronary syndromes taking into account a delay of invasive treatment in the first case, especially if the patient is hemodynamically stable. Unstable patients with a myocardial infarction without raising of a segment of ST which instability is caused by an acute coronary syndrome (but not other factors) can be considered within the section devoted to a myocardial infarction with raising of a segment of ST.