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Issue. Articles

1(17) // 2007

 

 

1.

 

Morphological changes of the stomach and duodenum mucous membranes at rats with experimental myocardial infarction

V.G. Mishalov, L.Yu. Markulan, I.M. Leschishin, P.L. Byk, .V. Fedorov

The aim of research was to develop an experimental model of myocardial infarction (MI) at rats and to estimate morphological changes in the mucous membrane of the stomach (MMS) and duodenum (DD) caused by it.

Materials and methods. The research was conducted on 60 white rats of «Vistar» line aged 12 months, with body mass (209.6 ± 4.3) g. The basic group consisted of 45 rats in which MI was modulated by diathermocoagulation of the anterior interventricular branch of the left coronal artery, the control group — 15 rats in which diathermocoagulation was not conducted. The presence of myocardium necrosis was estimated by an electrocardiogram (ECG), and according to the data of autopsy. Euthanasia was conducted on the 3rd day after MI modulation. MMS changes were estimated in a macroscopical and histological way with the calculation of the area of MMS vessels by the program of Remote Capture.

Results and discussions. After coagulation of the artery, MI of the anterolateral wall of the left ventricle occurred at all the animals: with pathological Q-wave — at 19 animals (42.2 %), without pathological Q-wave — at 26 (57.8 %). During the autopsy, the area of necrosis of about 1/3 of the area of the left ventricle was present at 7 (15.6 %) animals, 1/2 — at 16 (35.5 %), more than 2/3 — at 13 (28.9 %). At 27 (60 %) rats with a model of MI, changes of MMS and DD (in the control — at 2 or 13.3 %, p < 0.01) were marked as gastritis and duodenitis, including those with petechias and hemorrhages — at 8 (17.8 %), with petechias, hemorrhages and acute erosions — at 6 (13.3 %). There was positive correlation between the depth of MI, according to the morphological data, and the presence of acute damages of gastro-duodenal mucous membrane (r = 0.47; p = 0.001). The mean area of the veins of MMS in the basic group 1.91 times exceeded such in the control and was (1801.51 ± 40.85) mkm2, in the control — (942.04 ± 28.63) mkm2, (p = 0.001). The mean of area of the arteries in the basic group was 1.29 times smaller than in the control and constituted (551.54 ± 18.63) mkm2, in the control — (709.58 ± 28.49) mkm2, (p = 0.001). Thus, the correlation of the mean area of veins to the mean area of arteries in the control group on the 3rd day after modulation of MI was 1.32. In the basic group this correlation considerably grew and constituted 3.26, which was 2.47 times more than in the control group (p < 0.05).The causes of sharp impairment of venous outflow at experimental MI can partially be explained by cardiac insufficiency which was revealed at 26.7 % rats. The influence of other factors can not be excluded, but further research is needed for this purpose.

Conclusions. Acute lesions of MMS and DD including gastroduodenitis (60 %), multiple petechias and hemorrhages (17.8 %), abrasions (28.9 %) and erosions (13.3 %) occur at 60 % rats with a model of MI in three days. The model of MI at rats is accompanied by impairments of microvasculature of submucosal membrane of the stomach: by the reliable 1.91 times increase of the mean area of veins and 1.29 times diminishing of the mean area of arteries with the origin of sladge and microthromboses in their lumen.



Keywords: myocardial infarction, experimental model, damage of the stomach mucous membrane, condition of microcirculation

2.

 

The type of fibronectin degradation as a new additional risk factor of thrombotic and hemorrhagic complications of acute myocardial infarction with Q-wave

H.V. Dziak, .A. Koval, A.P. Ivanov, A.I. Shevtsova

The purpose of the research was to determine the sensitivity and specificity of fibronectin (FN) degradation regarding the prognosis of the risk of thrombotic and hemorrhagic complications of acute myocardial infarction (AMI) with Q-wave.

Materials and methods. 64 patients with Q-wave AMI hospitalized within the first 6 hours since the onset of the disease were examined. The mean age was (57.5 ± 1.4) years; 79.7 % were men. All the patients underwent thrombolytic therapy. Antithrombin therapy was conducted with the use of ungraded heparin (53.1 %) or enoxaparin (46.9 %). Depending on the type of the complication, the patients were divided into 4 groups. Thrombotic complications were fixed in 10 patients (15.6 %), and they occurred on average on (9.9 ± 2.8) day, hemorrhagic complications were revealed in 4 patients (6.3 %). The group with complicated AMI (acute and chronic cardiac insufficiency, rhythm and conductivity impairments) consisted of 21 persons (32.8 %). 29 patients (45.3 %) had uncomplicated course of AMI, without the above-mentioned complications. In general, the groups were matched in accordance with age, gender, other risk factors, cardiological anamnesis and frequency of the main kinds of basic anti-thrombotic and anti-ischemic therapy use. Fragmentation of FN in blood plasma was determined during the hospitalization, on the 8th day (at the end of anti-thrombin therapy), on the 21st day (at the end of hospital period) and in 1 year. Immunoblot method with the use of rabbit antibodies to FN of human blood plasma (DACO, Denmark) and conjugated with peroxidase anti-rabbit antibodies (BioRad, USA) was used. The normative values of laboratory indices were obtained during the examination of 14 practically healthy persons, age and gender matched with the AMI patients.

Results and discussions. The general group of patients with Q-wave AMI, if compared with healthy persons, manifested the increase of revealing of FN fragments (FNF) with the molecular mass (MM) 20—35 kDa (p = 0.006), 100—110 kDa (p = 0.0007), 180—190 kDa (p = 0.0005) and appearance of FNF 120 kDa (p = 0.0019) and 130—140 kDa (p < 0.00001). During the hospital period and by the end of the first year of observation, the increase of FNF frequency was preserved with MM 20—35 kDa, 100—110 kDa, 120 kDa, 180—190 kDa (p > 0.05 in comparison with the first 24 hours), and by the end of the observation the increase of revealing low-molecular FNF of < 19 kDa ( < 0.05 in comparison with the healthy persons and with the first 24 hours of the disease) was fixed. We also fixed considerable decrease of the frequency of revealing FNF with of 220 kDa during hospitalization ( = 0.0063), in hospital period up to the 21st day (p = 0.02), which remained unchanged till the end of the 1st year of observation (p = 0.009 versus the norm) without marked dynamics in comparison with the data of the 1st day ( > 0.05). FNF degradation in patients that eventually developed general complications didn't differ from that of patients with uncomplicated course of AMI on the 1st day of the disease. At the moment of anti-thrombin therapy completion (8th day), patients that later developed thrombotic complications differed from those with uncomplicated course regarding the manifestation of FNF of 90—95 kDa (p = 0.0057). Increased manifestation of low-molecular FNF compared to the norm and uncomplicated AMI course ( = 0.01 and = 0.014, respectively) was preserved in patients with hemorrhagic complications. The content of FNF 100—110 kDa normalized and the low, if compared to the healthy persons, frequency of revealing FNF 90—95 kDa ( = 0.004) was preserved by the 21st day (hospital period completion) in patients with uncomplicated course. In patients with thrombotic complications the character of the changes was quite contrary: the increase of the frequency of revealing FNF 100—110 kDa in comparison with the norm and an uncomplicated AMI course. The increase of the frequency of FNF < 15 kDa and 15—19 kDa, as compared to the healthy persons and patients with uncomplicated AMI course, was preserved in patients with hemorrhagic complications. Higher frequency of FNF 100—110 kDa (p = 0.0047), as compared to the uncomplicated AMI course, was fixed in the groups of patients with both thrombotic and hemorrhagic complications. In 1 year the spectrums of FN degradation in all the groups did not normalize in general (all p < 0.05 versus the healthy persons); the difference between the groups disappeared, though.

Conclusions. The character of FN degradation in hospital period of AMI with Q-wave undergoes qualitative changes and is an additional independent predictor of thrombotic and hemorrhagic complications of the disease. The absence of FNF of 220 kDa on the 1st day and the appearance of FNF with < 19 kDa on the 8th day are highly sensitive and specific risk factors of hemorrhagic complications of AMI with Q-wave.



Keywords: myocardial infarction with Q-wave, risk factors, thrombotic and hemorrhagic complications, fibronectin

3.

 

Dobutamine stress-echocardiography for prognosis of improvement of myocardial constriction after stenting in patients with prior Q-myocardial infarction

M.I. Lutai, .. Nemchyna, .V. Tsizh

The aim of the research was to evaluate the prognostic value of dobutamine stress-echocardiography positive result for the detection of viable myocardium in patients with prior Q-myocardial infarction (MI) after revascularization using the method of stenting.

Materials and methods. Dobutamine stress-echocardiography was performed in 15 patients (mean age 54 ± 6 years) with 5.6 ± 3 months old Q-MI in the anamnesis before conducting complete surgical revascularization of myocardium using the method of stenting. Repeated echocardiography was performed in term of 3.6 and 12 months. Global and regional systolic function of the left ventricle (LV) was estimated using 16-segment model. Analysis of changes of constriction of 113 dysfunctional at baseline segments of LV was conducted. The following parameters were evaluated – sensitivity, specificity, accuracy, positive and negative predictive value (PPV, NPV) of the test for detection of viable myocardium.

Results and discussions. The increase of ejection fraction (EF) of the LV from 48.9 ± 9.9 % to 55.3 ± 9.4 %, as well as the increase of tolerability to physical load from 72 ± 35 W to 115 ± 27 W, p < 0.05 was observed during the 6th month after stenting. The improvement of constriction was found in 59.3 % of segments of the LV. More valuable increase of constriction was observed in LV segments with blood supply from the left coronary artery (LCA) than from the right coronary artery (RCA) (63.0 % vs. 42.8 %, p < 0.05). The frequency of constriction improvement in LV segments with baseline hypokinesis was higher than in segments with akinesis (in 6 months – by 73.5 % vs. 44.7 %, in 12 months – by 70.6 % vs. 34.1 %, p < 0.05). Sensitivity and specificity of dobutamine stress-echocardiography for the improvement of LV segment constriction in the term of 6 months after revascularization was 80.6 % and 54.3 %. PPV was 72.0 % and NPV – 65.8 %. PPV of the test for the detection of viable myocardium was higher for the LCA region than for the RCA region (75.4 % vs. 50 %, p < 0.05).

Conclusion. Sensitivity and specificity of dobutamine stress-echocardiography for the improvement of LV segment constriction in patients with prior Q-MI constitutes 80.6 % and 54.3 %, respectively, in the term of 6 months after revascularization. Improvement of constriction in the term of 6–12 months after revascularization is more valuable for LV segments with base hypokinesis than for segments with akinesis. The positive predictive value of dobutamine stress-echocardiography for the detection of viable myocardium is higher in the LCA region than in the RCA region (75.4 % vs. 50 %, p < 0.05).



Keywords: ischemic heart disease, viable myocardium, dobutamine stress-echocardiography, revascularization

4.

 

The results of stenting the left coronary artery main trunk in patients with coronary artery disease

S.N. Furkalo, I.V. Khasianova

Stenosis of the left coronary artery main trunk (LCA MT) is traditionally considered the indication for the operation of aortocoronary shunting (ACS). At the same time, the possibility is widely discussed of using methods of interventional cardiology for treating this category of patients. With the introduction of stents with drug coating into clinical practice the indications for interventions have considerably widened.

The purpose of the research was to estimate the immediate and long-term (up to 5 years) results of left coronary artery main trunk stenting operations in the Clinic of Endovascular Surgery of the Institute of Surgery and Transplantation of the Academy of Medical Sciences of Ukraine.

Materials and methods. We investigated 24 patients with coronary artery disease (CAD) and LCA MT lesion who underwent stenting of the coronary arteries (CA). Isolated lesion of the LCA MT was fixed in 7 (29.2 %) patients. In the rest of the patients it was combined with the lesion of other CA. Orifice stenosis was revealed in 5 (20.8 %) patients, stenosis in the middle part of the LCA MT — in 4 (16.7 %) and bifurcational — in 15 (62.5 %). All in all, 45 stents were implanted into 24 patients (on average 1.9 stents per one patient), LCA MT, in particular, was stented with drug coated endoprostheses in 16 (66.7 %) cases. The period of the supervision of the patients was on average (14.1 ± 2.6) months.

Results and discussion. Over the supervision period, 2 cases of cardiac death were fixed. The recurrence of angina on the level of II—III Functional Class was fixed in 3 patients over the same period. Control coronography was performed in 6 patients. The need for the repeated revascularization of the myocardium because of restenosis of the uncoated stents arose in 5 (20.8 %) patients who underwent repeated CA stenting: in 3 (12.5 %) cases — because of narrowing outside the stented region of the LCA MT, and in 2 (8.3 %) — because of restenoses in the LCA MT stents implanted earlier. All the repeated interventions were performed in an endovascular way, ACS as repeated intervention was not performed. No restenosis cases were fixed in patients with implanted drug coated stents. Thus, over the supervision period, 70 % patients didn’t have any serious complications and didn’t need repeated revascularization of the myocardium.

Conclusions. The procedure of stenting the left coronary artery main trunk with drug coated stents is promising enough, though it is necessary to analyze the results of long period supervision of considerable number of patients.



Keywords: coronary artery disease, left coronary artery main trunk, stenting

5.

 

Comparative evaluation of cardiovascular risk factors, coronary reserve, function of endothelium and signs of atherosclerosis in case of coronary syndrome X and initial atherosclerotic lesion of coronary arteries

E.N. Amosova, V.I. Zakharova, N.N. Makomela, Ye.V. Andreyev, Yu.V. Rudenko

The purpose of the research was comparative evaluation of the frequency of revealing main factors of cardiovascular (CV) risk, coronary reserve, according to the load test, function of endothelium and noninvasive signs of atherosclerosis (AS) in patients with coronary syndrome X (CS-X) and initial AS of coronary arteries (CA).

Materials and methods. 40 patients with CS-X were under our observation. The diagnosis was based on angina, depression of ST segment > 1 mm on the ECG during the treadmill exercise test, absence of CA changes during coronography (CG), negative test with hyperventilation, in the absence of other diseases of the cardiovascular system. The comparison group included 30 patients with initial CA AS, who manifested 1—2 vessel AS lesion of CA with stricture formation within 20—50 % (stenosis without signs of hemodynamic impairments) during CG. Normative indices were obtained during the examination of 30 practically healthy persons with unchanged CA during CG and according to the negative probe for coronary artery disease (CAD) by the results of the treadmill exercise test. The examination presupposed the evaluation of the spread of CV risk factors, determination of the total cholesterol level (TCL) and glucose level in the blood on an empty stomach and after glucose load, load test — treadmill exercise test, determination of endothelium dependent (EDVD) and endothelium independent (EIDVD) vasodilatation of the brachial artery, evaluation of the thickness of intima-media complex (IMC) of the common carotid artery and multi-spiral computer tomography (MSCT) of the CA.

Results and discussions. Among the factors of CV risk in patients with CS-X, as compared to patients with 1 — 2 vessel atherosclerotic lesion of CA, impairments of tolerance to glucose are more often revealed (22.5 and 10.0 %, accordingly; p < 0.05), in case of lower frequency of other factors: age > 50 years (52.5 and 80.0 %, accordingly; p < 0.05), heredity burdened with CAD (37.5 and 60.0 %, accordingly; p < 0.05), male gender (45.0 and 86.7 %, accordingly; p < 0.05), excess body mass (62.5 and 90.0 %, accordingly; p < 0.05), smoking (10.0 and 33.3 %, accordingly; p < 0.05), arterial hypertension (22.5 and 43.3 %, accordingly; p < 0.05), hypercholesterolemia (45.0 and 63.3 %, accordingly; p < 0.05). The mean thickness of IMC in the group of patients with CS-X was substantially smaller than in the group of patients with initial AS of CA: (0.65 ± 0.02) and (0.83 ± 0.03) mm, correspondingly; ( < 0.05). According to MSCT, the content of calcium in CA of patients with CS-X was substantially lower than in patients with initial CA AS: (0.04 ± 0.01) and (213.1 ± 13.6) ʲ, correspondingly; ( < 0.05). We observed the decrease of the threshold power of the loading and its duration during the treadmill exercise test in patients with CS-X in comparison to those with initial CA AS by 11.2 and by 12.6, accordingly ( < 0.05). Substantial worsening of EDVD was revealed in patients with CS-X in comparison with both the healthy persons: (4.74 ± 0.61) and (10.88 ± 0.29) %, respectively, p < 0.05; and the patients with initial CA AS: (8.9 ± 0.65) %, p < 0.05.

Conclusions. The spread of the main factors of CV risk occurs more seldom in patients with CS-X than in those with CA AS. The increase of frequency of glucose tolerance impairments in patients with CS-X in comparison to those with CA AS and healthy persons is observed in the absence of excess body mass. There is no calcium deposition in the CA and the thickness of IMC of the common carotid artery is not changed in patients with CS-X, which makes them different from patients with initial coronary atherosclerosis and prejudices the «atherosclerotic» theory of CS-X development pathogenesis. According to the test with reactive hyperemia of the brachial artery, patients with CS-X are characterized with more expressed decrease of EDVD of the brachial artery, than those with initial CA AS.



Keywords: coronary syndrome X, endothelial dysfunction, atherosclerosis of coronary arteries, multi-spiral computer tomography of coronary arteries, treadmill exercise test

6.

 

Arterial switch operation peculiarities in patients with transposition of main arteries with complex variants of origin of coronary arteries

A.M. Dovgan, A.G. Goryachev, V.N. Hrapunov, S.N. Boyko, I.G. Yakovenko, R.M. Vitovsky

Modern approaches to the treatment of children with transposition of main arteries (TMA) presuppose performing arterial switch operations. Certain variants of coronary arteries (CA) branching compose a problem for their translocation during the fulfillment of such an operation.

The purpose of the research was to present the information about our first experience of the operative treatment of transposition of main arteries with complex variants of CA origin.

Material and methods. During 2000 — 2005 we performed arterial switch in 25 children at M.M. Amosov department of surgery of Institutions of Cardiovascular Diseases congenital from the heart. 6 of the children were very complex from the point of view of surgical correction, variants of CA branching. In 3 cases, the right and the anterior descending branch of the left CA originated from the I aortal sinus, and the circumflex artery originated from the II sinus and passed behind the pulmonary trunk. Still in another case the right CA originated from the I sinus of the aorta, and the anterior descending and the circumflex branch of the left CA — from the II sinus and they passed behind the pulmonary trunk. In 1 patient all the CA originated in the form of one trunk from the II sinus. In 1 patient with Tausig-Bing syndrome, CA originated in a typical way, however, the main arteries located «side-by-side».

Results and discussion. None of the 6 patients with the complex anatomy of the coronary vessels had problems connected with myocardial ischemia. One patient died of multi-organ failure caused by sepsis. The condition of the 5 patients who survived corresponds to the I functional class in 12—40 months after an operation. Arterial switch in case of TMA with the complex anatomy of the CA is possible provided all the rules which permit decreasing the risk of coronary insufficiency development are observed. The methods of CA implantation which we used made it possible to prevent bends so that no case of worsening of the coronary blood flow was fixed after the operation of TMA arterial switch.

Conclusions. Successful surgical treatment of TMA with complex anatomy of the CA is possible provided a number of surgical techniques aimed at preserving the topographical integrity and geometry of the reimplanted coronary arteries and thus decreasing the risk of myocardial ischemia development are observed during the operation of arterial switch.



Keywords: transposition of main arteries, arterial switch, coronary arteries

7.

 

The dynamics of the serum level of cytokines and C-reactive protein in patients with chronic heart failure under the influence of therapy with angiotensin converting enzyme inhibitors and

V.K. Serkova, .V. Maiko

The purpose of the research was to determine the influence of the therapy with inhibitors of the neurohumoral activation (isolated enalapril and in combination with carvedilol) on the level of pro-inflammatory cytokines and C-reactive protein (C-RP) in patients with chronic heart failure (CHF).

Material and methods. 77 patients with CHF aged 31—60 years (64.9 % men and 35.1 % women) and 18 healthy persons, age and gender matched, were under our observation. According to New York Association of Cardiologists classification (NYHA), the II functional class of CHF was fixed in 22 patients and the III — in 55. The cause of CHF in 48 patients (62.3 %) was coronary artery disease and in 29 (37.7 %) — idiopathic dilated cardiomyopathy. In 89 (78.1 %) patients, systolic dysfunction of the left ventricle (LV) was observed; LV ejection fraction, according to EchoCG, did not exceed 45 %. Group I (n = 14) included patients who, for some reason, were administered only diuretics and digoxin. All the patients of group II (n = 34) additionally took enalapril (Enap of KRKA Company; Slovenia), group III consisted of 29 patients, whose therapy was supplemented with carvedilol (Koriol; of KRKA Company; Slovenia). The mean dose of enalapril was (41.2 ± 3.8) mg/day. The mean dose of enalapril in patients of group II was (17.4 ± 1.3) mg, and in patients of group III — (17.1 ± 2.1) mg ( > 0.05). The level of pro-inflammatory cytokines — tumornecrotic factor-a (TNF-α) and interleukin-6 (IL-6) of the blood serum — was determined using the method of immune-enzyme analysis, the content of C-RP — by semiquantitative nephelometric method. The structural and functional parameters of the heart in patients and healthy persons were estimated according to the data of Doppler EchoCG on the scanner «SIM 7000 CFM Challenge» (Italy). Laboratory and instrumental study was performed twice: before the administration of the neurohumoral activation inhibitors and after 3 months of therapy.

Results. At the beginning of the observation the level of TNF-a exceeded 6.7 pg/ml in 33 (42.8 %) patients with CHF, IL-6 — 7 pg/ml in 36 (46.8 %), C-RP- 3.1 mg /ml in 41 (53.2 %) patients. At the beginning of the observation the mean values of the indices in patients of all the groups didn’t differ fundamentally (all p > 0.05) and they substantially exceeded these indices in comparison with the controls. The therapy was accompanied by the positive dynamics of the level of pro-inflammatory cytokines and C-RP in patients of groups II and III (p < 0.001—0.05), such dynamics being absent in patients of group I, though the degree of its expressiveness differed substantially in different groups. Thus, TNF-a, IL-6 and C-RP levels before the treatment constituted (16.1 ± 2.6) pg/ml; (14.9 ± 2.2) pg/ml and (8.0 ± 1.2) mg /ml in patients of group II and (16.1 ± 3.1) pg/ml; (15.6 ± 2.7) pg/ml and (8.5 ± 1.6) mg /ml in patients of group III, respectively, and after the treatment (8.2 ± 2.3) pg/ml, (5.9 ± 1.4) pg/ml, (3.0 ± 0.8) mg /ml and (5.9 ± 1.8) pg/ml, (3.8 ± 1.7) pg/ml and (1.5 ± 0.7) mg /ml, respectively, (all p < 0.001—0.05).

Conclusions. The treatment of CHF patients with enalapril and carvedilol during 3 months promotes positive dynamics of serum content of pro-inflammatory cytokines and C-RP, which is more pronounced in case of simultaneous use of these medications.



Keywords: tumornecrotic factor, interleukin-6, chronic heart failure, enalapril, carvedilol

8.

 

Defeat of peripheral veins at chronic critical ischemia of lower extremities

V.. Chernyak

The purpose: to expose the defeat of peripheral veins at patients with chronic critical ischemia of lower extremities (CCILE) and to define its nosotropic mechanisms on the basis of study of clinical indexes of the state of regional (segmental arteriotony, postocclusal venous pressure in the vessels of the staggered shins) and central venous (systolic pressure in the pulmonary artery) hemodynamics, maintenance of D-dimer in the blood, morphological changes in the vessels of the lower extremities.

Materials and methods. For period from 2003 to 2004, 90 patients were inspected with occlusal hemilesions of the arterial riverbed of lower extremities more distal than the level of inguinal copula without clinical signs of peripheral vein defeat. All the patients were divided into 3 groups according to the stage of ischemia: III-A, III-B and IV in obedience to the classification of the European Consensus on CCILE. The following indexes were the article of the study: the expressiveness of the edema of the staggered lower extremity; the permeability; the velocity of the blood stream and the value of regional pressure at the level of popliteal and posterior tibial vein in the staggered and contralateral limbs determined on the basis of positional and arterio-venous gradients; the systolic pressure (SP) in the trunk of the pulmonary artery (PA) by means of echocardiography, the indexes of clot formation with the use of the test for D-dimer presence as well as the morphological descriptions of ischemized muscles and peripheral veins.

Results and discussions. During the progress of ischemia, the patients with III-B stage had the decline of post-occlusal venous pressure (PVP) in the popliteal vein of the staggered extremity: in the horizontal position by 40.0 % ( < 0.05) in relation to III-A stage; in the vertical position, on the contrary, an unreliable tendency to the increase of PVP by 9.1 % ( > 0.05) was marked. In case of stage IV of ischemia, we marked reliable increase of PVP values to (600 ± 12) mm. of water column in the vertical position of patients and its reliable increase to (230 ± 8) mm. of water column in the horizontal position of the body. In the staggered extremities, we also marked the decline of the linear velocity of blood stream through the popliteal and posterior tibial veins: on average by 53.3 % in comparison to the norm ( < 0.05) at III- stage, by 68.2 % ( < 0.05) at III-B stage and by 76.0 % ( < 0.05) at stage IV. The analysis of the indexes of SP in PA at patients with of CCILE exposed its increase by 33.3 % in patients with clinical signs of venous thrombosis and the increase by 20.0 % in asymptomatic patients in case of III-B stage of ischemia in comparison to stage III- and the norm. At stage IV of ischemia there was further increase of SP in PA, by 53.6 % and 33.3 %, respectively. The test for D- dimer presence was positive at 11 (91.7 %) and negative at 1 (8.3 %) patient with the confirmed diagnosis of acute venous thrombosis. Among the patients with unconfirmed diagnosis of venous thrombosis, this index was negative at 59 (75.6 %) and positive at 19 (24.4 %) patients. The data of the calculations showed the direct relation between the size of edema and the degree of ischemia of the staggered extremity. Obliterations of arterial vessels, plural bulges of vein walls with their thrombosis in 98 % of tissue samples were revealed during the morphological study of the tissues of ischemized extremities.

Conclusions. Chronic critical ischemia of lower extremities is accompanied by impairments of the peripheral venous hemodynamics as gradual and reliable decrease of post-occlusal venous pressure in the deep veins of the staggered extremity, the expressiveness of which correlates with the severity of ischemia. The ischemic edema of the extremities, paresis of the arterial vessels, arterio-venous by-passing and local trichodophlebitis at patients with III-B and IV stages of ischemia are instrumental in the origin of venous thrombosis, which is exposed during the study of of D-dimer dynamics and the morphological research. Venous thrombosis associated with chronic critical ischemia of lower extremities creates conditions for thromboembolism of the shallow branches of the pulmonary artery, which is expressed by 33.3 % and 53.6 % increase of the systolic pressure in the trunk of the pulmonary artery at patients with clinical signs of venous thrombosis of III-B and IV stages of ischemia, respectively, and at asymptomatic patients — by 20.0 % and 33.3 % increase, accordingly, as compared to the respective patients with III- stage of ischemia.



Keywords: chronic critical ischemia of lower extremities, venous thrombosis, pathogenesis

9.

 

ongenital heart and great vessel diseases of abortuses and deadborns in Lviv region

S.A. Tomashova, V.V. Vovk, N.M. Heisa

The aim of research was to determine the percents, structure and risk factors of congenital diseases of the heart and great vessels (CD HGV) in abortuses and deadborns in Lviv region over the period of 2000—2004.

Materials and methods. The analysis of 1,196 reports of postmortem examinations of abortuses and deadborns was made. CD were revealed in 192 cases (16.1 %), including 109 fetuses (16.5 %) and 83 deadborns (15.6 %). The percentage of CD HGV constituted 16.5 % (18 cases) and 25.3 % (21), respectively.

Results and discussions. The most common among CD HGV were: ventricular septal defect (33.3 %), transposition of great vessels (12.8 %), single arterial trunk (10.2 %). CD HGV were combined with other inborn abnormalities in 55.6 % abortuses and 47.6 % deadborns. In 64.1 % women with CD HGV in abortuses and deadborns, the pregnancy was not first. In 25.6 % women reproductive anamnesis was complicated, in 69.2 % cases the current pregnancy was complicated by: intrauterine growth retardation, oligoamnios or polyhydramnios, viral infections during early gestational term, pre-eclampsia, risk of abortion. Ultrasonography during pregnancy was done in 53.8 % women; CD HGV were revealed in 14.2 % of them. The level of α-fetoprotein, measured in 15.4 % of women, was elevated.

Conclusion. According to the analysis of reports of postmortem examinations, the percentage of CD HGV among CD in Lviv region constitutes 16.5 % in abortuses and 25.3 % in deadborns. The most common among them are ventricular septal defect, transposition of great vessels and single arterial trunk. The frequency of CD HGV prenatal verification during ultrasonography in Lviv region constitutes only 14.2 %. A complex regional and national program for the prenatal diagnosing of CD HGV is necessary.



Keywords: congenital defects, heart, great vessels, abortuses, deadborns

10.

 

Dynamics of the systolic pressure in the pulmonary artery and of the functional condition of the right ventricle at patients with chronic post-embolic pulmonary hypertension during the treatment with calcium antagonists

O.Ya. Babak, E.O. Krakhmalova

The purpose of the research was to evaluate the influence of the long-term therapy with antagonists of calcium of dihydropyridine row on the systolic pressure in the pulmonary artery (SPPA), functional condition of the right ventricle (RV) and its remodeling in patients with chronic post-embolic pulmonary hypertension (CPEPH).

Materials and methods.We enrolled in the study 30 patients with CPEPH of I-III functional class (FC) according to the classification of New-York Association of Cardiologists (NYHA): 13 men and 17 women, aged 42 — 69 years (mean 53.6 ± 9.0 years), with the duration of the disease from 4 to 8years, mean duration 4.1 ± 2.0 years. According to the degree of pulmonary hypertension (PH), the patients were divided in the following way: PH of I FC was diagnosed in 11 (36.7 %) people, II FC — in 11 (36.7 %), III FC — in 6 people (20.0 %) and IV FC — in 2 (6.6 %) patients (mean FC of PH — 1.97 ± 0.93). The indices of the intracardiac hemodynamics were studied using Doppler echocardiography method on the apparatuses «Loqiq-5» (GE, USA) and «Ultramark-9» (ATL, USA). Before the beginning of the therapy with calcium antagonists all the patients had undergone the acute probe with nifedipine (henigidine, Zdorovje, Ukraine) in a single doze of 20 mg. The frequency of cardiac contractions, arterial pressure, as well as the parameters of intracardiac hemodynamics, according to the results of Doppler echocardiography, were measured before and in 30 min after the sublingual administration of the medication.

Results and discussions. The doses of the medications, achieved after the completion of titration, constituted: for nifedipine from 40 to 120 mg/day, on average 60±30.98 mg/day; for amlodipine from 5 to 12.5 mg/day, on average 10.71 ± 2.78 mg/day. A positive response to the therapy was fixed during the monitoring of the clinical and hemodynamic parameters in 12 out of 18 patients of group I on the 4—5 week of calcium antagonists administration. The decrease of SPPA from 53.7 ± 3.45 to 44.5±2.5 mmHg, the increase of the contraction function of the RV from 34.1 ± 2.55 to 40.7 ± 4.12 %, which was accompanied by the increase of the cardiac index (CI) from 2.2 ± 0.52 to 2.9 ± 0.41 l/min/m2 ( < 0.05—0.01) was fixed in the patients of group I on the 8—10 week of the therapy with calcium antagonists. No reliable changes of SPPA, indices of the morphofunctional condition of RV and CI were registered at the end of 6-month observation in group II which consisted of 12 CPEPH patients who didn’t respond to the acute probe with phenigidine.

Conclusions. Long-term (6 months) therapy of CPEPH patients with a positive result of pharmacological probe with nifedipine — antagonist of calcium of dihydropyridine row — promotes the decrease of SPPA by 17.7 %, the decrease of dilatation and hypertrophy of the RV, the increase of its ejection fraction by 19.4 %, the decrease of the reverse remodeling of the RV on the level of inlet and outlet tracts and expressiveness of tricuspid regurgitation. It is accompanied by the increase of CI by 29.1 %.



Keywords: chronic post-embolic pulmonary hypertension, antagonists of calcium, function of the right ventricle, Doppler echocardiography

11.

 

Fallot's tetralogy Part I

V.B. Demyanchuk

Some historical and modern concepts concerning complex congenital heart disease — Fallot's tetralogy are described in the article. The anatomy, hemodynamic features, classification, epidemiology and natural clinical course of the disease are presented.



Keywords: Fallot's tetralogy, anatomy, classification, natural history

12.

 

Arterial hypertension in women: epidemiology, pathophysiology, treatment

.I. Dyadyk, A.. Bagriy, .S. Vorobyov, V.G. Yakovenko

Despite certain differences between genders concerning the indices of hemodynamics, metabolism and hormone activity, there is no ground to talk about any sufficient differences between women and men in pathophysiology of arterial hypertension (AH) as well as in the specific features and the character of target organ lesions in AH. The report represents data about women-over-men domination among AH and coronary artery disease (CAD) patients at the age of 60 and over. A particular role in raising the risk of AH development and increasing cardiovascular risk in general in the menopause period belongs to the factors connected to 'menopausal metabolic syndrome' which is very frequent in women in this period. Antihypertensive therapy in women, irrespective of the menopause and accompanied by hormone-replacing therapy, makes the same favorable effect on cardiovascular prognosis as in men. Treatment of AH in women is to ground on the same principles as in men, using the same standards of pharmaceutical and non-pharmaceutical therapy as well as target digits of arterial blood pressure. All basic antihypertensive drug groups, sympatholytics of central action can be applied to postmenopausal female patients with AH. Antithrombotic agents and statins are also widely used.



Keywords: arterial hypertension, menopause, women, pathophysiology, therapy

13.

 

Efficacy and safety of angiotensin converting enzyme inhibitor spirapril

Yu.N. Sirenko, A.D. Radchenko

The article is a review of the main results of the experimental and clinical research, including those conducted by the author, aimed at studying the pharmacokinetics, pharmacodynamics, effectiveness and safety of angiotensin converting enzyme inhibitor spirapril, in treatment of patients with arterial hypertension (AH), heart failure (HF) and coronary artery disease. We present the results of long-term observations which inform about the ability of spirapril to inhibit the activity of angiotensin converting enzyme (ACE) by 33—86 %, to cause the regress of the left ventricle (LV) myocardium hypertrophy, to improve the diastolic function of the LV in patients with mild and moderate AH. At the same time, in patients with mild and moderate renal failure, spirapril somewhat decreases the velocity of glomerular filtration, renal plasma blood flow and doesn't influence these indices as well as the lipid spectrum and the glucose level in the blood on an empty stomach in patients with diabetic nephropathy. Spirapril in the dose of 6 mg/day and more contributes to the normalization of the arterial pressure in 29-50 % patients with mild, moderate and severe AH. In patients with HF spirapril decreases its functional class; in case of stable exertional angina pectoris it promotes the improvement of the functional condition of the endothelium.



Keywords: spirapril, pharmacokinetics, pharmacodynamics, treatment of cardio-vascular diseases

Current Issue Highlights

4(60) // 2017

Cover preview

K. M. Amosova 1, I. I. Gorda 1, A. B. Bezrodnyi 1, G. V. Mostbauer 1, Yu. V. Rudenko 1, A. V. Sablin 2, N. V. Melnychenko 2, Yu. O. Sychenko 1, I. V. Prudkiy 1&a

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