| English
usaid banner

Issue. Articles

4(20) // 2007

 

 

1.

 

Single-stage formation of neo-pulmonary arterial bed through middle ster- notomy as a step of surgical correction of the pulmonary atresia with ven- tricular septal defect and major aorto-pulmonary collateral arteries

M.F. Zinkovsky, R.J. Lekan, A.M. Dovgan

The purpose of the research was to present the first experience of a single-stage formation of neo-pulmonary arterial bed through middle sternotomy as a step of surgical correction of the pulmonary atresia with ventricular septal defect and major aorto-pulmonary collateral arteries.

Materials and methods. 3 PA-VSD patients with pulmonary blood supply through genuine pulmonary arteries (PA) and MAPCAs underwent the correction using the suggested method at the Department of Surgery of Congenital Heart Diseases at M.M. Amosov Institute of Cardiovascular Surgery of the Academy of Medical Sciences of Ukraine during 2005–2006. The age of the patients ranged from 24 to 30 months. X-ray contrast angiography was performed for the purpose of making the diagnosis more precise and defining the anatomy of the true PA and the MAPCAs. All the patients underwent the surgical correction of PA-VSD by means of restoring the blood flow between the right ventricle and the hypoplastic true PA which consisted of the creation of a conduit from a vascular artificial prosthesis (polytetrafluorineethylene) without VSD closing. The expansion of the narrow central PA was achieved due to the hydrodynamic force of the systemic arterial pressure. The communicative MAPCAs, connected with the true PA, were closed by means of surgery in all the cases, in one case the MAPCA was made uni-focal with the left branch of P.

Results and discussion. The mean time period of the aorta cross-clamping was (55 ± 6.2) min., and the mean time period of the artificial blood flow – (95 ± 7.9) min. After the artificial blood flow all the patients, against the background of mean doses of sympathomimetics (dopamine 5–7 µkg·kg- 1·min.- 1), had stable hemodynamics. All the patients who underwent extubation within the first 6 hours after the operation were discharged from hospital in satisfactory condition on day 10–12 after the operation. Two main approaches to the treatment of VSD- MAPCAs are being used in the leading cardiosurgical clinics depending on the anatomy of the lesion. According to the first approach, in case of the presence of the hypoplastic true central PA, from the side thoracotomy a staging operation is performed which is based on the unifocalization of MAPCAs with the creation of the neo-pulmonary artery. The second approach is an alternative to the classical multi-stage method of treatment and presupposes a single-stage unifocalization and radical operation. We are suggesting a new method of surgical correction of PA-VSD-MAPCAs through middle sternotomy which is a «hybrid» strategy and makes it possible to perform a single-stage formation of neo-pulmonary arterial bed reducing the number of preparatory operations.

Conclusions. A single-stage formation of neo-pulmonary arterial bed through middle sternotomy by means of preparing MAPCAs in the posterior interparietal region and unifocalization procedures make it possible to reduce the number of preparatory operations before the radical correction of the lesion in patients with PA-VSD-MAPCAs.



Keywords: pulmonary atresia with ventricular septal defect, major aorto-pulmonary collateral arteries, surgical correction, unifocalization of major aorto-pulmonary collateral arteries

2.

 

Comparative evaluation of bisoprolol and metoprolol influence on the remodeling and systolic function of the left ventricle at patients with Q-wave myocardial infarction and ejection fraction less than 45 % during long observation

K.M. Amosova, A.B. Bezrodny, I.V. Prudky, V.D. Kudlay, O.B. Zaporozhets, O.M. Gerula

The purpose: a comparative estimation of the influence of early inclusion of bisoprolol and metoprolol into the therapy of patients with Q-wave myocardial infarction (MI) and ejection fraction less than 45 % on the remodeling and systolic function of the left ventricle (LV) in early and long period.

Materials that methods. 40 patients have been included in research with first Q-wave MI and LV ejection fraction (EF) < 45 %. All the patients were hospitalized within the first 24 hours since the onset of the disease, on the average (9.4 ± 2.7) h. During hospitalization the patients were randomized into 2 groups. I group included 20 patients who took metoprolol tartrate in an initial dose of 6.25 mg 2 times a day with the subsequent titration to 75 mg 2 times a day, on the average (116.7 ± 6.4) mg/day, II group included 20 patients who took bisoprolol in an initial dose of 1.25 mg/day with the subsequent titration to 10 mg a day, on the average (8.9 ± 1.2) mg/day.

Results and discussions. Patients of the 1st and the 2nd groups were comparable by age (64.7 ± 1.2) and (63.1 ± 1.1) years accordingly), gender, arterial hypertension occurrence (65 % and 60 % patients) and diabetes mellitus (20 % and 20 %) in the anamnesis, MI localization (anterior at 65 % and 60 %), frequency of Killip class II heart failure at the moment of inclusion into the research (40 % and 35 %, all p > 0.05), and also the therapy in hospital and at out-patient stage. The control group consisted of 20 practically healthy persons. The study included doppler-EchoCG with calculation of the standard indicators of the systolic function of the LV (by Simpson) on the 1st, 5–7th, 28th days and in 6 months. Heart rate (HR) in both groups decreased by the 5–7th days (on the 1st day from (87.2 ± 1.5) to (67.3 ± 1.2) beats/min, on the 2nd – from (86.4 ± 1.2) to (66.1 ± 1.3) beats/min, as compared with the 1st day; < 0.01,) and did not change authentically in the future, being identical at patients of the 1st and the 2nd groups in all terms of research ( > 0.05). The systolic arterial pressure had similar character of the dynamics; by the 5–7th days, in the 1st group it decreased from (140.3 ± 2.6) to (129.2 ± 2.7) mmHg, and in the 2nd group – from (140.8 ± 2.7) to (127.8 ± 2.8) mmHg ( < 0.01) and did not change in the future. Side-effects included 1 case of passing atrio-ventricular blockade of grade in the 1st group and 1 case of HR decrease to 44 beats/min in 2nd group which disappeared at reduction of the dose of preparations to previous well tolerated one on a titration scale. In 1st group, 3 (15 %) patients died in the course of hospital treatment: 1 patient – from myocardium rupture, 2 patients – from true cardiogenic shock. In the 2nd group no lethal cases were registered during the research. At the beginning of the research, the groups did not differ essentially in all the indicators of the systolic function of LV and its hypertrophy (all p > 0.05). In comparison with the control group, the end diastolic index (EDI) was elevated: in the 1st group – (72.9 ± 1.5) ml/m2 and in the 2nd group – (72.2 ± 1.4) ml/m2 ( < 0.05). At equally expressed increase of EDI from the 1st to the 5–7th days (on the average by 6.8 % and 6.2 %, < 0.05), on day28 this indicator became lower in the 2nd group than in the 1st one, (76.4 ± 1.5) and (81.5 ± 1.4) ml/m2, accordingly, ( < 0.05). That tendency remained up to the 6th month ((74.1 ± 1.6) and (82.3 ± 1.6) ml/m2, accordingly, < 0.01) due to EDI returning to the initial level in the 2nd group and its increase by 12.9 % from initial level ( < 0.01) in the 1st group, which is the evidence of the positive influence of bisoprolol on the processes of LV remodeling in long-term therapy. The dynamics of the end systolic index was different: by the 6th month it increased from (45.6 ± 1.2) to (50.2 ± 0.9) ml/m2 in the 1st group, and decreased from (45.9 ± 1.2) to (39.7 ± 1.2) ml/m2, ( < 0.01) in the 2nd group. This indicator in the 2nd group became smaller than in the 1st group on day 28 ((42.4 ± 1.2) against (48.6 ± 1.3) ml/m2, < 0.01), and in 6 months ((39.7 ± 1.2) against (50.2 ± 0.9) ml/m2, < 0.01). The EF in 1st group did not change essentially throughout all research (on the 1st day – (38.9 ± 1.8) %, through 6 months – (40.3 ± 1.8 )%, p > 0.05). Bisoprolol, unlike metoprolol, had positive influence on the LV systolic function, as evidenced by the increase of EF from (38.1 ± 1.4) % to (45.2 ± 1.3) %, ( < 0.01) by day 28 and to (47.1 ± 1.6 %, < 0.01) in 6 months. As a result, the EF in the 2nd group elevated by 5.8 % ( < 0.05), as compared to the 1st group, on day 28 and by 6.8 % ( < 0.01) through 6 months. The dynamics of wall motion score index had similar character, which did not change in the 1st group, (on day 1 (1.95 ± 0.06) conventional units, through 6 months – (1.92 ± 0.06) conventional units, p > 0.05), and decreased in the 2nd group – from (1.94 ± 0.05) to (1.70 ± 0.06) conventional units ( < 0.01) on day 28, and to (1.64 ± 0.06) conventional units ( < 0.01) in 6 months. No deviations from the norm concerning the thickness of the posterior wall of the LV and the interventricular septum or their changes in the dynamics of the supervision have been revealed in both groups.

Conclusions. The treatment of patients with Q-wave MI and LV systolic dysfunction with the use of bisoprolol in an average dose of (8.9 ± 1.2) mg/day prevents the development of early (by day 28) and late (by the 6th month) dilation of LV which is observed in therapy by metoprolol tartrate in an average dose of (116.7 ± 6.4) mg/day, at identical expressiveness of the negative chronotropic effect, as a criterion of the blockade of β1-adrenoreceptors. The therapy of such patients with bisoprolol promotes stable improvement of LV systolic function, since day 28. Such improvement is not marked in the therapy with the use of metoprolol.



Keywords: bisoprolol, myocardial infarction, remodeling of the left ventricle

3.

 

Variants of the small saphenous vein topography

A.A. Guch, L.M. Chernukha, .. Bobrova

The purpose of the research was the selection of the small saphenous vein and its femoral branch topographical variants according to the data of ultrasonic scanning with estimation of their occurrence in general population.

Materials and methods. The results of the study of the small saphenous vein (SSV) and saphenopopliteal fistula (SPF) topographical variants according to the data of ultrasonic duplex scanning of 474 patients that underwent examination and treatment at National Institut of Surgery nad Transplantology named after O.O. Shalimov during 2003—2007 years. 203 (42.8 %) of them were men, 271 (57.2 %) – women, mean age of the patients was (45.8 ± 16.6) years (from 18 to 68 years). The variants of SPF location with regard to the popliteal fold were singled out according to D. Creton classification.

Results and discussions. 6 topografical variants of SSV were revealed during the ultrasonic study: the inflow of SSV into the popliteal vein by an isolated trunk – in 223 (47.1 %) patients; the inflow of SSV into the popliteal vein and it’s connection to the deep veins of the thigh with a thinner proximal branch – in 109 (23.0 %) patients; the distribution of SSV on the thigh as a single trunk, it’s connection to the popliteal vein with a thin anastomotic branch – in 57 (12.0 %) patients; the inflow of SSV into gastrocnemis veins – in 43 (9.1 %) patients; the inflow of SSV into the tributaries of the large saphenous vein (LSV) without direct connection to the deep system — in 14 (2.9 %) patients; continuation of SSV in the upper direction as femoral branch (FB) or vein of Giacomini – in 28 (5.9 %) patients. 5 variants of topography of the SSV FB were selected: FB connects with the deep veins of the thigh – in 75 (38.7 %); FB divided into muscle and/or hypodermic branches, uniting with tributaries of LSV and/or with the deep system – in 19 (9.8 %) patients; FB spread to the buttock region as one trunk or as many deep and superficial branches – in 10 (5.2 %) patients; FB connected with the posterior accessory saphenous vein, passing to the vein of Giacomini – in 84 (43.3 %) patients; FB flew into LSV at the level of middle or upper third part of the thigh – in 6 (3.0 %) patients. SSV and its tributaries have variable anatomy connecting with LSV deep main and muscular veins at different levels. The variability of the SSV topography is caused by its complex embryogenesis. When planning the surgery on account of varicose disease, patients must be examined with the use of ultrasonic scanning which has up to 98 % accuracy and permits developing individual approaches to selecting SSV and its branches.

Conclusions. The ultrasonic scanning permits selecting 6 variants of SSV topography differing by the level of its connection with the deep and/or hypodermic veins of the lower extremity. The most widespread variant which is present at 47.1 % patients is the inflow of SSV into the popliteal vein as an isolated trunk. Among these patients, the formation of SPF at the distance of 7cm from the popliteal fold occurs in 70.0 % cases. Among all the patients, SSV had the continuation on the thigh as FB in 40.9 % patients, had no junction with the popliteal vein in 17.9 % cases.

Key words:



Keywords: small saphenous vein, saphenopopliteal anastomosis, ultrasonic duplex scanning

4.

 

Therapeutic efficiency of bisoprolol and its influence on the systolic function of the left ventricle and heart rhythm variability in patients with early stage of acute myocardial infarction during long-term observation

A.N. Bilovol, I.I. Knyazkova, A.I. Tsyhankov

The purpose of the research was to evaluate the long-term bisoprolol therapy regarding its clinical efficiency, tolerance and influence on the systolic function of the left ventricle (LV), hibernating myocardium and heart rhythm variability (HRV) in patients with acute myocardial infarction (MI) complicated with cardiac insufficiency (CI) at early stages of the disease.

Materials and methods. 25 patients (22 men and 3 women) aged 43–71 years (mean 54.8 ± 6.3 years) with acute Q MI, complicated with Killip – Kimball class II acute CI were enrolled in the open controlled study. The control group consisted of 12 healthy men, mean age – (52.4 ± 2.8) years. All the patients underwent clinical study, ECG registration, EchoCG with evaluation of the transmitral Doppler blood flow, stress- EchoCG with small doses of dobutamine and daily monitoring (DM) of ECG. The research was conducted during hospitalization, on day 2, on day 27–30, in 6 and 12 months since the onset of the disease. The tolerance to physical load was estimated by 6-minute walk test on day 27–30, in 6 and 12 months of observation. Initial examination and prescription of bisoprolol (Bisoprolol-ratiopharm, ratiopharm, Germany) in individual doses of 5–10 mg/day (mean daily dose of 7.5 ± 0.5 mg) as addition to the conventional therapy was conducted on day 2–3 of MI. The duration of the therapy and observation was 12 months.

Results and discussion. In the process of the study, we observed the decrease of the CI functional class from 2.1 ± 0.1 on day 27–30 of I to 1.6 ± 0.1 in 6 months of therapy and to 1.4 ± 0.1 – in 12 months ( < 0.001). This was accompanied by the increase of the 6-minute walk distance by 23.5 % (from (378.9 ± 15.2) to (467.9 ± 14.3) m; < 0.001) in 6 months and by 29.4 % (from (378.9 ± 15.2) to (490.3 ± 13.6) m; < 0.001) – in 12 months as compared to the data on day 27–30 of I. In comparison to the initial value ((72.4 ± 0.9) beats/min), the frequency of cardiac contractions at rest on day 27–30 ((63.8 ± 1.4) beats/min) and in 6 months ((63.2 ± 1.3) beats/min) and 12 months ((62.2 ± 1.2) beats/min) of therapy decreased by 11.9, 12.7 and 14.1 %, respectively, ( < 0.01). The decrease of the systolic and diastolic arterial pressure (AP) by 10.7 % (from (129.5 ± 5.1) to (115.6 ± 4.3) mm Hg; < 0.05) and by 8.5 % (from (82.5 ± 2.6) to (75.5 ± 2.1) mmHg; < 0.05), respectively, to the end of the hospital period was observed. The analysis of the LV ejection fraction (EF) dynamics in the process of the therapy showed that it substantially increased as compared to the initial value by 17.3 % ( < 0.05), 18.9 % ( < 0.05) and 25.7 % ( < 0.01) on day 27–30, in 6 and 12 months of therapy, respectively. End-systolic volume of LV decreased by 13.7 % ( < 0.05), 17.4 % ( < 0.05) and 21.3 % ( < 0.01), respectively. The analysis of the time characteristics of HRV revealed the decrease of the standard deviation SDNN by 46.6 % ( < 0.05) and NN50 by 37.8 % ( < 0.05) in comparison to the control group. The decrease of spectrum components was fixed during the spectrum analysis of HRV.

Conclusions. During 12-month complex therapy including bisoprolol from day 2–3 of the disease, patients with acute MI complicated with moderately expressed acute CI demonstrate the improvement of the tolerance to physical loading, according to the results of 6-minute walk test, the increase of LV EF, the improvement of the regional contractility of myocardium and the reverse development of «hibernation» of myocardium in 30.6 % of initially dissynergistic segments. This treatment is tolerated well and is associated with the increase of the initially decreased parasympathetic activity and the decrease of the increased sympathetic activity according to the results of HRV evaluation during daily ECG monitoring.



Keywords: myocardial infarction, cardiac insufficiency, bisoprolol, left ventricle remodeling, heart rhythm variability

5.

 

Indirect evaluation of probability of atrial isomerism diagnosis in the presence of different kinds of congenital heart defects and congenital extra cardiac abnormalities

M.F. Zinkovsky, A.M. Dovgan, R.R. Seydametov

The purpose of the research was the indirect evaluation of the probability of atrial isomerism diagnosis in the presence of different kinds of congenital heart defects and congenital extra cardiac abnormalities.

Materials and methods. The research is based on the study of the occurrence of different congenital heart defects (CHD) and congenital extra cardiac visceral abnormalities and their combinations with atrial isomerism (AI) in 6416 patients which were operated on at the Clinic of M.M. Amosov National Institute of Cardio-Vascular Surgery within the period from 1987 to 2007. AI diagnosis was based on the combinations of certain CHD and congenital visceral abnormalities according to autopsy data of 35 patients and life-time examination of 71 patients. The diagnostic routine included electrocardiography in 12 diversions, roentgenography, abdominal ultrasonography, echocardiography with Doppler imaging, computed tomography of visceral organs, cardiac catheterization, and ventriculoangiography.

Results and discussion. AI was registered in 106 patients with CHD, which made up 1.65 % of all patients. 13 kinds of CHD and 4 visceral anomalies were found to be associated with AI. Anomalous inferior vena cava connection was combined with AI syndrome in 91.3 % of all cases, abnormal heart position – in 82.6 %, total anomalous pulmonary vein connection – in 79.5 %, additional superior vena cava – in 68.5 %, common atrium – in 64.7 % and atrioventricular canal – in 63.5 %. A method of AI probability determination has been suggested which presupposes the evaluation of probability coefficient (C) for each CHD and congenital visceral anomaly present in a patient by means of calculating AI occurrence ratio in case of this defect to its occurrence among all patients. When C equals 1, the probability of AI occurrence is 100 %. For the anomalous inferior vena cava connection C - 0.913, for the total anomalous pulmonary vein connection – 0.7949, for the additional superior vena cava – 0.6849, for the common atrium – 0.6471 etc. The closer the C value is to 1, the higher the probability of this syndrome is in case of CHD.

Conclusions. Such anomalies of visceral organs as bilateral atrial appendages, asplenia, polysplenia, pulmonary and bronchial symmetry, atresia of gall ducts are found in the syndrome of visceral heterotaxia in 100 % cases, so their combination with congenital heart defects indicates high probability of atrial isomerism presence. Total anomalous pulmonary vein connection, anomalous inferior vena cava connection, abnormal heart position, additional superior vena cava, common atrium, atrioventricular canal, common ventricle are most frequently associated with atrial isomerism.



Keywords: atrial isomerism, visceral heterotaxy, congenital heart lesion, diagnosis

6.

 

Apoptosis-cytokine signaling system and genetic polymorphism in patients with arterial hypertension

L.P. Sydorchuk

The purpose is to analyze the changes of indexes of lymphocyte apoptosis and cytokine profile in patients with arterial hypertension (AH) and to follow their correlation with polymorphism of 1166 in the gene of the first type receptor of angiotensin II (AGTR-1), Arg389Gly in the gene of β1-adrenergic receptor, I/D in the gene of angiotensin converting enzyme (ACE), Pro12Ala in the gene of PPAR-γ2 receptor associated with insulin resistance, T894G in the gene of endothelial NO-synthase (eNOS).

Materials and methods. The study included 96 patients with AH of — stages of severity and 20 practically healthy persons. Alleles of polymorphic genes were studied using the method of genomic DNA selection from venous blood with the following amplification by means of PCR based method. Caspases-3 and -8 activities, levels of IL-1β, TNF-α, TGF-β1 were defined by immune enzyme analysis. The groups were formed according to AH severity: 1st — 14 patients with AH ; 2nd — 27 patients with AH ; 3rd — 22 patients with AH and hypertensive encephalopathy ; 4th — 33 patients with AH and heart failure (HF) of NYHA functional class. The investigation was conducted after antihypertensive therapy cancellation.

Results and discussion. No reliable correlation was revealed between the indexes of the blood apoptosis-cytokine system in hypertensive patients and polymorphism of Pro12Ala in the gene of PPAR-γ2 receptor and T894G in the gene of NOS. The caspase-8 and -3 activities in lymphocyte lysate were more increased in patients with CC genotype of AGTR1 gene (1.684 ± 0.071 and 1.538 ± 0.146 EU/ml, < 0.05), DD genotype of ACE gene (1.587 ± 0.101 and 1.501 ± 0.097 EU/ml, < 0.05), ArgArg genotype of β1-adrenergic receptor gene (1.609 ± 0.113 and 1.497 ± 0.101 EU/ml, < 0.05), than in patients with AA genotype of AGTR1 gene, II genotype of ACE gene and Gly genotype of β1-adrenergic receptor gene. TGF-β1 level in blood plasma of patients with AH increases in proportion with target-organ damage onset. The same tendency has been revealed in pro-inflammatory cytokines IL-1β and TNF-α blood levels.

Conclusions. The correlation between the apoptosis system (caspase-8 and -3) and genes AGTR1 ( allele), ACE (D allele), β1-adrenergic receptor (Arg allele) was established. The changes of caspase-8 and -3 activities and cytokine profile depend on the target-organ damage in hypertensive patients.



Keywords: arterial hypertension, cytokines, apoptosis, genetic polymorphism

7.

 

The results of reconstructive surgery in distal atherosclerotic lesions of lower extremity arteries in patients with diabetes mellitus

V.I. Pertzov, E.V. Ermolaev

The objective of the research was to evaluate the shot- and long-term results of reconstructive surgery in treatment of distal atherosclerotic occlusions of lower extremity arteries in patients with diabetes mellitus and to determine the indication for their conducting relying on these results.

Materials and methods. We analyzed the outcomes of surgical treatment of 41 diabetic patients with distal atherosclerotic occlusions of lower extremity arteries that underwent treatment at Clinic of Hospital Surgery of Zaporozhian Medical University within the period of 1997–2006. The mean age of the patients was (56 ± 10.2) years. The examination of the patients included duplex scanning and Dopplerography of lower extremity arteries, rheoplethysmography, rheovasography with nytroglycerine test, X-ray contrast angiography, measuring brachial-tibial index, segmental pressure, and deep femoral popliteal index based on it. 10 patients underwent femoral-popliteal bypass grafting, 2 patients – femoral (popliteal)-tibial bypass grafting, 29 patients (30 operations) – profound femoral artery bypass grafting. The long-term results of 19 (79.2 %) out of 24 patients of the group that underwent profound femoral artery bypass grafting were studied. R. Rutherford scale was used to estimate the dynamics of the clinical status.

Results and discussions. Positive short-term results in bypass surgery were obtained in 11 (91.6 %) patients, in revascularization through the system of profound femoral artery – in 24 (82.7 %) patients. The extremity was preserved in 73.0 % patients in five years in spite of the fact that the bypass patency of diabetic patients in the long-term period decreased to 58.3 % in two years and to 41.7 % in five years. The reconstruction zone was through-pass during all the period of observation (up to 5 years) in all the patients who had undergone the reconstruction of the deep artery of thigh. Cumulative analysis in 5 years showed 62.5 % positive results.

Conclusions. Femoral-popliteal bypass grafting provides good and satisfactory short- and long-term results in 91.6 and 73.0 % cases respectively and thus can be a method of choice in diabetic patients with femoral-popliteal segment occlusions and good or satisfactory distal outflow. Putch grafting of profound femoral artery which gives positive short-term results in 82.7 % cases and longterm results in 62.5 % cases is indicated for patients with poor distal outflow.



Keywords: diabetes mellitus, atherosclerosis, lesions of lower limb arteries, reconstructive surgery

8.

 

The relation of arrhythmias to peculiarities of abnormal chordas of the left ventricle in young patients without organic pathologies of the cardiovascular system

N.Yu. Osovska, V.K. Serkova

The purpose of the research was to study the peculiarities of abnormal chordas of the left ventricle (AC LV) in young patients and evaluate their arrhythmogenic effect depending on the number and location of the chordas in the LV cavity.

Materials and methods. 129 patients aged 16–24 years (29 women and 100 men) without organic pathologies of the cardiovascular system and with AC LV revealed during echocardiography were enrolled in the study. Depending on the topic and the number of AC LV, all the patients were divided into 5 groups which were compared to each other and to the control group according to the results of daily ECG monitoring.

Results and discussion. Apical localization of AC prevailed over all the rest – 24.0 % (31 patients). Diametrical middle single and multiple AC were registered in the same number of patients – each in 21.7 % cases (28 patients). Diagonal AC were fixed in 17.8 % cases (23 patients); longitudinal single AC were diagnosed the most seldom – in 14.7 % (19 patients). In general, all the groups of AC LV patients demonstrated substantial ( < 0.05) increase of the total number of both ventricular and supraventricular rhythm impairments as compared to the control in both active and passive periods. The patients with multiple and diametrical chordas of the LV demonstrated a bigger number of ventricular ectopic beats (VEB) per day than the control group, by 17.4 and 18.2 times (mean 43.5 versus 757.5 and 792.5, respectively), while in the groups with the other topic of AC it was 4–8 times smaller (mean 43.5 versus 225.5 in group I, 210 – in group III, 377.5 – in group IV). The presence of AC LV calcinosis correlated with the mean round-the-clock and day-time frequency of cardiac beats (FCB) (r - 0.46), relation between VEB in the passive and active period of the day ( SVEBpas/SVEBact) (r - 0.52), the presence of ventricular tachycardia (VT) episodes (r - 0.52), the ratio between supraventricular ectopic beats (SVEBpas/SVEBact), (r - 0.43); all < 0.05. The direction of the correlation between the thickness of AC LV and the indices of the daily ECG monitoring was analogical, but with somewhat different degree of expressiveness. Like in the group of patients with AC LV calcinosis, we observed the correlation between the AC thickness and mean round-the-clock (r - 0.48) and daily FCB (r - 0.45), the total number of VEB per day (r - 0.56), VEB in the active and passive periods of the day (r - 0.55), correlation between VEBpas/VEBact (r - 0.48), the total number of SVEB per 24 hours (r - 0.52) and in the passive period (r - 0.54), with the presence of VT episodes (r - 0.55), SVEBpas/SVEBact correlation (r - 0.49) at reliability level of < 0.05.

Conlusions. Young patients with AC LV and without organic pathologies of the cardiovascular system, according to Holter ECG monitoring, reveal the increase of the total number of VEB, SVEB and VT episodes, mostly at night, which is the evidence of the arrhythmogenic action of AC. Ventricular impairments of the rhythm are the most frequent in patients with multiple and (more rarely) diametrical middle AC LV. The least occurrence of the cardiac rhythm impairments is observed in case of apical AC LV.



Keywords: syndrome of connective tissue dysplasia, abnormal chordas of the left ventricle, arrhythmias

9.

 

Surgical management of patients with multilevel atherosclerotic lesions of lower limbs main arteries

I.V. Arbuzov, Yu.S. Spirin, V.I. Arbuzov, R.V. Ivashko

The purpose of the study was the creation of surgical tactics for treating patients with multilevel atherosclerotic lesions of the abdominal aorta and lower limbs main arteries and the estimation of its short-term results.

Materials and methods. 131 patients with multilevel atherosclerotic lesions of the abdominal aorta and lower limbs main arteries were enrolled in the study in the Department of Vascular Surgery of Kherson Regional Clinical Hospital within the period from 1999 to 2004. 130 (99.2 %) of them were men, 1 (0.8 %) – women. The age of the patients ranged from 40 to 82 years, mean age (60 ± 7.8). The algorithm of arterial reconstructions depending on the spread of atherosclerotic lesions in the aorto-iliac and femoropopliteal segments was developed. Two types of procedures were performed – isolated reconstruction of the aorto-iliac segment (I group – 60, or 45.8 % patients), simultaneous reconstruction of the aorto-iliac and femoro-popliteal segments (II group – 71, or 54.2 % patients). Disappearance of critical ischemia of lower limbs and/or improving intermittent claudication was considered as positive results of the procedures.

Results and discussion. The volume and the methods of the aorto-iliac segment reconstruction, both as an independent operation and a stage of the two-level reconstruction, were traditional. The reconstruction of the distal femoro-popliteal segment was performed according to the principles depending on the presence and spread of the lesions of the femoral deep artery, superficial femoral and popliteal arteries. Positive immediate result was achieved in 117 (89.3 %) patients, particularly, in 55 (91.6 %) cases in I group and in 62 (87.4 %) cases in II group. 4 (6.7 %) patients of I group and 6 (8.5 %) patients of II group developed the thromboses of the reconstructed arterial segments in the early postoperative course. Major amputations were made in one (1.7 %) patient of I group and in two (2.8 %) patients of II group. Postoperative mortality was 5 % (3 cases) in I group and 4.2 % (3 cases) in II group.

Conclusions. The isolated reconstruction of the aorto-iliac segment is indicated to patients with multilevel atherosclerotic lesions of the lower limbs main arteries in case when there are no lesions of the deep artery of thigh and proximal part of the superficial femoral artery and the blood flow in the popliteal artery is normal. Simultaneous two-level reconstruction of the lower limbs main arteries is indicated to patients with critical lesion of the deep artery of thigh, proximal part of the superficial femoral artery or the popliteal artery.



Keywords: atherosclerosis, multilevel lesions, major arteries of lower limbs, arterial reconstruction

10.

 

The impairment of the vestibular function in patients after cerebral hypertonic crisis

Ya.Yu. Gomza

The purpose of the research was to find and systematize the impairments of the vestibular function in patients after cerebral hypertonic crisis.

Materials and methods. 23 patients that underwent treatment at Neurological Department of the Central City Clinical Hospital of Kyiv were examined on (5.9 ± 1.3) day after cerebral hypertonic crisis. The age of the patients ranged from 29 to 58 years. Mean age – (46.9 ± 1.9). None of the patients had clinically significant stenoses of the cerebral vessels. The research of the vestibular apparatus was conducted by methods suggested by V.G. Bazarov in 1988: the research of the walking along the path; flanking walk; Fukuda writing test; Fukuda marching test; finger- finger test; cephalography; Barane rotative test; vestibular despun illusion test; electronystagmography – the research of the spontaneous position nystagmus. The Student criterion was used for the statistical processing of the results.

Results and discussion. Such walking derangement as disharmonic deviation (87.0 % patients) and derangements in Fukuda marching test (95.7 %) were revealed during the analysis of coordination tests. Spontaneous nystagmus was revealed in 95.7 % cases at electronystagmography. Visual spontaneous nystagmus was present in 52.2 %. 78.3 % patients had Nylen III degree position nystagmus. Hyperflexion of labyrinths was fixed during load tests in 65.2 % patients. Vegetative reactions in load tests were observed in 56.5 % cases. 69.6 % patients with cerebral hypertonic crisis manifest impairments of the peripheral region of the vestibular apparatus along with central vestibular derangements. Cerebral hypertonic crisis leads to the impairment of both the central and the peripheral regions of the vestibular apparatus.

Conclusions. Combined paroxysmal vestibular syndrome – central and peripheral — was registered in 69.6 % patients with cerebral hypertonic crisis which is the evidence of the dysfunction of the inner ear in most cases. Further research in this area is promising and its results must be taken into consideration when prescribing treatment to such patients.



Keywords: vestibular dysfunction, cerebral hypertonic crisis, imbalance

11.

 

The impact of associated chronic obstructive pulmonary disease on serum concentration of markers of immune inflammation in patients with chronic ischemic heart disease

K.M. Amosova, T.I. Havrylenko, D.Sh. Sichinava, O.M. Kornilina

The purpose of the research was to evaluate the serum concentration of markers of immune inflammation, like tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), interleukin-10 (IL-10) and neopterine in patients with ischemic heart disease (IHD) and associated chronic obstructive pulmonary disease (COPD) as compared to the data of patients with non-associated IHD and COPD.

Materials and methods. We examined 88 patients, including 22 patients with chronic forms of IHD, 34 patients with chronic IHD and associated COPD of stage II-VI, 32 patients with COPD of stage II-III only, and 20 practically healthy people, who constituted the control group. IHD (stable angina pectoris of functional class I–II) diagnosis was detected with the help of the treadmill testing, Holter ECG Monitoring, stress echocardiography with dobutamin, esophageal pacing, spiral computer tomography of the heart. COPD detection was based on the external respiratory function indicators. None of the patients had had cardiac infarction, chronic cardiac insufficiency over IIA stage or lowered systolic function of the left ventricle of heart. The levels of -reactive protein (C-RP), TNF-α, IL-6, IL-10 and neopterine were measured in serum by immune-enzyme assay.

Results and discussion. The patients with IHD and associated COPD, as compared to the patients with IHD or COPD only, demonstrated higher concentration of neopterine in serum: respectively, (16.58 ± 1.51) against (9.44 ± 1.74) nmol/l at IHD ( < 0.001) and (12.19 ± 1.56) nmol/l at COPD ( < 0.05), while the standard is (4.5 ± 1.49) nmol/l (all < 0.05) and TNF-α – respectively (58.3 ± 7.6) against (32.5 ± 7.2) pg/ml at IHD ( < 0.05), and (47.71 ± 7.34) pg/ml at COPD ( < 0.05), while the standard is (26.79 ± 7.45) pg/ml against a background of equally decreased concentration of anti-inflammatory IL-10: respectively, (4.74 ± 0.24) pg/ml against (4.75 ± 0.24) pg/ml at IHD and (4.79 ± 0.26) pg/ml at COPD as compared to (6.94 ± 0.32) pg/ml in practically healthy people (all < 0.001). The concentration of IL-6 in patients with associated pathologies was higher than in healthy people and patients with IHD only: respectively, (18.24 ± 1.45); (7.33 ± 1.66) pg/ml ( < 0.001), and (13.97 ± 1.53) pg/ml ( < 0.05); however, it didn’t differ substantially from that of patients with COPD only – (22.45 ± 1.63) pg/ml, > 0.05). While analyzing the serum concentration of C-reactive protein, it was found out that it increased in patients with IHD and associated COPD (by 4 times, < 0.001), as compared to healthy people, and didn’t demonstrate any significant differences in patients with COPD only and IHD with associated COPD ( > 0.05). In the latter, however, the average concentration of this marker of inflammation was significantly higher than in patients with IHD only (by twice, < 0.05).

Conclusions. The patients with IHD and associated COPD, as compared to the patients with IHD only, demonstrated higher serum concentration of IL-6, TNF-α and neopterine, against the background of equally decreased concentration of anti-inflammatory IL-10. As compared to patients with COPD only, patients with IHD and COPD are distinguished with higher concentration of neopterine at equally increased concentrations of IL-6 and TNF-α, and decreased concentration of IL-10.



Keywords: ischemic heart disease, chronic obstructive pulmonary disease, tumor necrosis factor

12.

 

Tako-tsubo syndrome

E.N. Amosova, N.V. Netiazhenko

Tako-tsubo syndrome (TTS), or stress-related dysfunction of left ventricle (LV), is a transient cardiomyopathy that mimics acute coronary syndrome (ACS) with ST segment elevation without concomitant lesions of coronary arteries. H. Sato first described this syndrome in Japan in 1990. Prevalence and etiology are unknown. TTS is diagnosed retrospectively in 12 % ACS patients with ST segment elevation in Japan; in Europe and the USA this index is considerably lower. Most cases are reported in postmenopausal women. The disease generally occurs in the acute form as a result of an emotional or physiological stress and is revealed as intensive pain in the cardiac and/or substernal region which lasts more than 30 min. and is not stopped by nitroglycerine. The main diagnostic criteria are: 1) transient akinesis or dyskinesia of the LV apical segment and interventricular septum extending beyond a single vascular territory on the echocardiography and ventriculography; 2) absence of obstructive coronary artery stenosis > 50 % of the luminal diameter and angiographic evidence of acute plaque rupture; 3) new electrocardiographic abnormalities consisting of STsegment elevation or T-wave inversion; 4) absence of a recent head trauma, intracranial bleeding, pheochromocytoma, myocarditis, hypertrophic cardiomyopathy. Echocardiography and EKG have reversible abnormalities on 5–8 weeks. The diagnosis is made after ACS is excluded. In-hospital mortality is 5 % and is mostly associated with iatrogenic causes. The treatment is symptomatic.



Keywords: tako-tsubo syndrome, cardiomyopathy, dysfunction of left ventricle

13.

 

Carotid sinus syndrome

N.T. Vatutin, N.V. Kalinkina, E.V. Mykhalchenko

Anatomy, etiology, pathogenesis and epidemiology issues of carotid sinus syndrome are covered in the article. Current state and development perspectives of diagnosis and treatment methods were analyzed; data concerning their efficiency is presented.



Keywords: carotid sinus syndrome, syncopal status, diagnostics, treatment

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

Log In







Publisher


Services


Partners


Advertisers


Subscribe








© VIT-A-POL