The aim – is the revealing of the factors determining a failure of operation at ruptured abdominal aortic aneurysm (AAA), and improvement of the results of surgical treatment of this pathology.

Materials and methods. For the period of 1992–2007, 323 patients with AAA underwent the operation, among them 160 – in the scheduled order and 163 – urgently: 131 – on account of ruptured AAA and 32 – on account of the threat of rupture. The age of the patients was from 28 to 83, the average age was 65.4 ± 7.3 years. 62.6 % of the patients suffered from hypertension, 59.5 % – from ischemic heart disease with stenocardia, 15.3 % – from pulmonary insufficiency, 44.3 % – from other serious accompanying illnesses. 72.5 % of the patients arrived in the condition of hemorrhagic shock. For the diagnosis, ultrasonic scanning and computer tomography were used – angiography mode. At 36.6 % of the patients the resection of aneurysm and linear interposition of graft were executed, at 63.4 % – bifurcation bypass.

Results and discussion. Postoperative mortality made up 44.3 % at ruptured AAA, 10.8 % – at threat of rupture, 2.1 % – at elective operations. The basic reasons of death were: massive pre- and intra-operative bleeding (26 of 58 patients died) and post-operative complications, among which the most common were acute cardiac insufficiency, pneumonia, multisystem insufficiency and complications in gastrointestinal tract.

Conclusions. The factors causing a failure of operation were: massive pre- and intra-operative loss of blood, shock at the moment of operation, previous anemia, anuria, rapture duration more than 7 days, its localization at the top pole, large size of AAA, supraand infrarenal localization of AAA, spread of AAA on iliac artery, necessity of aorto-femoral reconstruction.

Keywords: abdominal aortic aneurysm, rupture, results of operations

The aim was to summarize our own experience and to develop an optimal approach and technique of creating combinative grafts, a method of application of proximal and distal anastomoses in case of multiple, cascade stenoses of the coronary artery (CA) lumen, with serious lesion of the ascending aorta, with varicose lesion of great subcutaneous veins of the legs, the presence of obliteration in them.

Materials and methods. At the National N.M. Amosov Institute of Cardio-vascular Surgery, Academy of Medical Sciences of Ukraine, from 2000 tо 2006 inclusive, 3477 coronary arteries bypass grafting (CABG) operations were performed on the working heart at patients with isolated ischemic heart disease (IHD) and 601 CABG operations in combination with the resection of the АЛЖ at IHD patients with the course of the disease complicated with the development of post-infarction aneurism of the left ventricle. There were 41.5 % (n = 1695) patients who underwent the operation and had expressed calcinosis of the ascending aorta or multiple, on different levels, cascade stenoses of the CA lumen, great subcutaneous veins (GSV) disease, which demanded non-standard approach and methods of forming combinative venous transplants, application of proximal and distal anastomoses. The present work presents the clinical material, operations and methods of CABG on the working heart of 821 (47.2 %) «problematic» patients with IHD, out of 1739 (males – 1509, 86.8 % and females – 230, 13.2 %) patients who were successively operated on within the period of 2005–2006.

Results and discussion. The method of CABG on the working heart which we developed allowed us to use successfully the presence of collateral links in the CA system, which made it possible to decrease the risk of complication development, provided the preservation of the blood supply to the myocardium to support the pumping function of the heart. The method presupposes the following sequence of the actions: 1) Firstly, to allocate the interior thoracic artery (ITA) with the simultaneous allocation and preparation of venous transplants; 2) Firstly, to apply proximal anastomoses (except cases when the hemodynamic situation demands urgent anastomosis of ITA with the anterior inter-ventricular branch (AIVB) of the left coronary artery (LCA); 3) Firstly, to bypass the collateralized CA (those which receive blood through collaterals from the basin of another CA); 4) Collateralizing CA must be bypassed only after bypassing collateralized CA; 5) In case of equal lesions and absence of (or insufficient expression) of inter-coronary collateral links, the first thing to be done is to restore the blood flow through LCA AIVB; 6) In case of application of distal anastomosis from the functionally important CA without dangerous deterioration of the work of the heart, it is necessary to conduct ischemic test of the myocardium. After the occlusion of the artery for 1–2 minutes, the changes in electrocardiogram (ECG), heart rate (HR), arterial pressure (AP) are registered and estimated. After restoring the coronary blood flow for 2–3 minutes, arteriotomy and application of anastomosis is conducted; 7) If, in case of occlusion of one of the damaged CA, the hemodynamics worsens, ischemia on ECG, it is necessary to use big doses of dopmin and to conduct defibrillations; the best way is to connect up cardiopulmonary bypass and to apply distal anastomosis (or several ones) in the condition of parallel perfusion. Accumulation of experience of CABG at patients with IHD helped to decrease the post-operative lethality to 1–3.5 % in different centers, which decreased the urgency of this problem.

Conclusions. The portion of «problematic» IHD patients with the deficit of veins and arterial transplants as a result of serious calcinosis of the ascending aorta, cascade stenoses of the CA and pathological changes of GSV is 41.5 % of the total number of patients that underwent the operation. The specific features of the method of CABG on the working heart is immediate application of distal anastomoses, priority bypassing of the collateralized CA, conducting a test for determination of myocardium tolerance to ischemia before bypassing, standardization of the method of application of distal anastomoses, the use of anatomical peculiarities of GSV for subsequent bypassing of several CA. These methods of CABG on the working heart of IHD patients with the deficit of venous and arterial transplants allowed bypassing of 3.6 CА with the use of 1 or 2 (1.8 grafts on the average) transplants stitched up to aorta and to increase revascularization of the myocardium up to 92.7 %.

Keywords: surgical treatment of coronary disease, venous graft deficit, aortal calcinous, coronary bypass grafting technique

The aim: evaluation of impact of renal dysfunction and comparative analysis of renal panel parameters as markers of increased risk of unfavorable in-hospital and long-term outcomes in post-acute myocardial infarction (AMI) patients and assessment of relation of renal disfunction to activation of systemic inflammation in such patients.

Materials and methods. Retrospective analyses of clinical characteristics, history and laboratory data of 826 patients hospitalized within 24-hours since AMI onset were performed. To evaluate complications’ rates and cardiac death (CD) by renal function, the patients were divided into three groups: with estimated glomerular filtration rate (eGFR) on admission ≥ 90 ml/(min·1,73 m2) – 1st group, eGFR 60 to 89.99 ml/(min · 1,73 m2) – 2nd group and with eGFR < 60 ml/(min · 1,73 m2) – 3rd group. Comparative evaluations of information value of admission and third-to-fifth day’s renal panel parameters for risk stratification of post-MI or CD patients in terms of 5-years event-free survival were performed using statistical software SPSS 11.0. Associations between tumornecrotic factor alfa (TNF-α) and leucocytosis counts with eGFR were studied using non-parametric statistical tests.

Results and discussions. Increased risk of early post-MI angina (EPMIA) in patients with eGFR < 90 ml/(min · 1,73 m2) (p < 0.05) was revealed. Increased risk of ventricular tachyarrhythmias and cardiogenic shock after the first day of AMI was observed in 3rd study group (р < 0.05). The study revealed significant impact of impaired renal function on 5-year survival and rates of new MI. In 2nd and 3rd groups, the risks of cardiac death increased two-folds as compared to first group (HR [95 % CI] = 1.84 [1.09–3.09] and HR [95 % CI] = 1.97 [1.05–3.71] respectively); risk of new AMI onset during five years after index MI-hospitalization in the 3rd group was higher than in 1st and 2nd groups (HR [95 % CI] = 1.94 [1.08–3.49]). Patients with renal dysfunction on admission had steady elevations of WBC counts and TNF-α levels as compared with the 1st group (р < 0.05).

Conclusions. Impaired renal function is associated with greater rates of in-hospital early post-infarction angina, ventricular arrhythmias and is an independent predictor of new MI and cardiac death during 5-year follow-up after MI. Activation of systemic inflammation may contribute in adverse post-MI outcomes of patients with impaired renal function.

Keywords: acute myocardial infarction, renal function, cardiac death, risk assessment

The aim of the research was to evaluate the influence of self-control education and active out-patient observation on mortality, necessity for hospitalisation, functional status and hemodynamics characteristics of patients with chronic heart failure (CHF) in general practice.

Materials and methods. 80 patients with II—IV class of CHF (NYHA) caused by coronary artery disease in combination with arterial hypertension were under our supervision. They were divided into two groups: the 1st – intervention group and the 2nd – control group. At the beginning of the research, the patients of both groups were age, gender, functional condition, hemodynamics and treatment indices matched. At the beginning of the research,the patients of the intervention group had a course of individual therapeutic education, during which they aquired information about CHF, peculiarities of treatment. The duration of the research was 12 months. At the beginning and at the end of the research, CHF functional class, hemodynamics characteristics, necessity for hospitalisation and enforcement of therapy were evaluated. At the end of the therapy, the general mortality rate, the number and duration of hospitalisations on account of CHF progression were determined.

Results and discussions. The number of hospitalizations on account of CHF progression in the intervention group was smaller than in the controls – 11 (27.5 %) and 20 (50.0 %) cases, respectively (р < 0.05). The total duration of the hospital treatment of the patients of the intervention group was 186 days, which was almost twice less than in the controls (337 days) (р < 0.05). During the observation period in the intervention group, 3 (7.5 %) patients died, in the controls – 7 (17.5 %) (р > 0.05). The necessity for enforcement of drug therapy for CHF, that is the increase of doses, adding preparations of other groups, administration of intravenous preparations, was matched (in 50.0 and 62.5 % cases, respectively р > 0.05) in both groups. However, the patients of the intervention group needed increasing diuretic therapy substantially more seldom than the controls (in 30 % cases vs. 57.5 %; (p < 0.05). At the end of the observation period, the intervention group revealed positive dynamics as for the functional status of the patients. In general, the clinical state of 4 (10.8 %) patients of the intervention group and 2 (6.0 %) patients of the control group improved (р > 0.05); the clinical state of 2 (5.4 %) patients and 14 (42.4 %) patients, respectively, became worse (p < 0.05).

Conclusions. Self-control education of patients with II—IV NYHA functional class of CHF in combination with active out-patient observation during 12 months allows the prevention of worsening of functional status and left ventricle ejection fraction, reducing the necessity and duration of hospitalisation, decreasing the necessity for diuretic therapy.

Keywords: heart failure, patient education, out-patient observation, nonpharmacological treatment

The aim: to make a comparative estimation of changes of heart rate variability (HRV) at rest and in the condition of an antiorthostatic test at patients after Q-wave myocardial infarction (MI) with ejection fraction (EF) less than 45 % and more than 45 % during treatment with inclusion of bisoprolol and metoprolol.

Materials and methods.We surveyed 72 patients with acute initial Q-wave MI and acute left ventricular heart failure (ALVHF) of ІІ or lower Killip class, hospitalized within the first 24 hours since the onset of the disease. The 1st group included 24 patients with LV EF < 45 % who, as a part of the standard therapy, received metoprolol tartrate; at the end of the supervision the average dose of metoprolol was 116.7 ± 6.1 mg/day. The 2nd group included 24 patients with LV EF < 45 % who received bisoprolol; at the end of the supervision the average dose of bisoprolol was 8.9 ± 0.9 mg/day. The control group included 24 patients with LV EF > 45 % which received metoprolol tartrate; at the end of the supervision the average dose of metoprolol was 124.7 ± 9.3 mg/day. Estimation of time and spectral indexes of HRV according to the analysis of 128 sinus R-R intervals at rest on an empty stomach in the morning and in condition of an anti-orthostatic test was performed on day 25 and in 6 months in all the patients. Also Doppler echocardiography with estimation of the main indexes of the LV systolic function was performed. The concentration of C-reactive protein (CRP, mg/l) and natrium-uretic factor (NT-pro-ANP pmol/l) in the venous blood serum was defined with immunoenzyme (ELISA) method.

Results and discussions. On the 25th day of the disease, the patients with acute Q-MI in all three groups, in comparison with healthy persons, manifested significant (p < 0.01) decrease of SDNN at rest (17.4 ± 1.41, 22.5 ± 1.82 and 28.7 ± 2.2, respectively, in 1st, 2nd and control groups, in comparison with 44.3 ± 2.4 in healthy persons), and also significant (p < 0.01) decrease of DSDNN during antiorthostatic test (10.9 ± 0.88 %, 14.0 ± 1.14 %, 17.8 ± 1.32 % and 25.3 ± 2.05 %, respectively). Together with equal heart rate at rest (63.8 ± 5.17, 62.4 ± 4.97 and 64.2 ± 5.15, respectively) significant correlation was established between SDNN and NT-proANP (r = –0.67, р < 0.002), С-RP (r = –0.51, р < 0.01), LV EF (r = 0.71, р < 0.001) and also between SDNN and DSDNN (r = –0.88, р < 0.0001). After 6 months of treatment, significant increase of SDNN in all three groups was registered (by 1.3, 1.5 and 1.4 times, respectively, in 1st, 2nd and control groups, all р < 0.05). In 2nd group it was more expressed (р < 0.01) than in 1st (31.6 ± 2.3 and 23.2 ± 1.51, respectively), remaining significantly smaller (р < 0.05) than in the control group where this index was normalized. The analysis revealed significant (p < 0.01) increase of LF/HF in comparison with healthy persons on day 25 of the disease in all three groups (3.79 ± 0.27, 2.97 ± 0.24 and 2.38 ± 0.19, accordingly in 1st, 2nd and control groups as compared to 1.68 ± 0.14 in the healthy, p < 0.01) and significant (p < 0.01) decrease of DLF/HF during antiorthostatic test 6.8 ± 0.55 %, 10.8 ± 0.87 %, 18.1 ± 1.46 % and 36.9 ± 2.92 %, p < 0.01). As a result of treatment with inclusion of β-adrenoblockers, after 6 months, significant decrease of LF/HF in all groups of patients was noted (by 1.9, 1.5 and 1.3 times, accordingly, in 1st, 2nd and control groups, all р < 0.05). In 1st group this indicator was significantly (р < 0.01) smaller, than in 2nd and control groups where it normalized (2.71 ± 0.22, 1.93 ± 0.16, and 1.82 ± 0.15, accordingly, р < 0.01). Significant correlation was found between LF/HF and NT-proANP (r = 0.54, р < 0.005), CRP (r = 0.42, р < 0.01), LV EF (r = –0.68, р < 0.008).

Conclusions. On day 25 of acute Q-MI, patients with EF < 45 % and ALVHF of Killip І-ІІ class are marked with more expressed activation of the sympathetic nervous system and the decrease of activity of the parasympathetic nervous system at rest and at volume loading as compared to the patients with preserved EF. After 6 months of treatment with inclusion of β-adrenoblockers, these changes of the vegetative tone at patients with preserved systolic function practically disappear, and at patients with initially lowered EF considerably decrease. The 6 months’ treatment of patients with Q-MI and EF < 45 % with inclusion of bisoprolol associates with less expressed, than in case of metoprolol tartrate use, disorders of the vegetative tone and maintenance, according to the estimation of HRV at rest and in condition of antiorthostatic test, despite the absence of HRV difference.

Keywords: bisoprolol, myocardial infarction, heart rate variability

The aim of the research was to develop a technique of modelling miniinvasive aorto-iliac reconstructions to gain specific operating skills and to assess its effectiveness.

Materials and methods. The experience of miniinvasive aorto-iliac segment (AIS) reconstructions in experimental model was analyzed in this article. A special device which imitates an abdominal cavity with a fixed pig’s aorta was created. With laparoscopic instruments 60 vascular anastomoses (within the period of 2005 – 2006) between a pig’s aorta segment and a synthetic graft (18 and 9 mm) were performed. 20 anastomoses with «end to end» fashion and 40 anastomoses with «end to side» fashion were made.

Results and discusion. AIS reconstruction in the experimental model allowed learning the following specific skills: clamping of the abdominal aorta, opening of its lumen, preparation of the distal part of the aorta for anastomosis, creation of the vascular anastomosis. The following parameters were dynamically analyzed. At the beginning of the study, the time period necessary for the creation of intervascular anastomosis between a pig’s aorta and a synthetic graft was from 140 to 210 min (М = 160 ± 8.7) and the total time of aortic clamping was from 160 to 240 min (М = 180 ± 12.2). At the end of the study, the time period necessary for the creation of intervascular anastomosis was from 20 to 40 min (М = 25 ± 5.8) min and the total time of aortic clamping was from 35 to 60 (М = 49 ± 9.3) min.

Conclusions. Such technique of the experimental modelling of miniinvasive AIS reconstruction allowed learning the following technical skills: clamping of the abdominal aorta, opening of its lumen, preparation of the distal part of the aorta for anastomosis, creation of the vascular anastomosis. It permitted reducing the total time of aortic clamping at the end of the training stage.

Keywords: miniinvasive aorto-iliac reconstruction

The aim: to study changes of tissue fat-acid (FA) spectrum of lipids in myocardium, kidneys and liver in spontaneous hypertensive (SH) rats by gas chromatography method.

Matherials and methods. Investigations were made on 42 SH rats both male and female with weight of 180–300 g and systolic arterial pressure (SAP) – 170–180 mmHg which were kept in O.O. Bohomolets National University vivarium. The control group consisted of 28 normotensive rats with blood pressure of 100–105 mmHg, mass and gender matched. The animals were decapitated under chloride- urethane narcosis. Tissues of kidneys, liver, heart were homogenized in physiological solution. Preparation of biological material and gas chromatography analysis of tissues lipids were conducted using existing methods.

Results and discussions. In comparison with the controls, SH rats had the decreased level of palmitic FA in myocardium, from (19.3 ± 1.5) tо (13.7 ± 1.0) % and the increased level of arachidonic acid from (36.6 ± 1.8) tо (47.8 ± 1.8) % (р < 0.05). The sum of saturated FA decreased from (34.4 ± 1.6) tо (26.7 ± 1.8) %, while the sum of unsaturated FA and the sum of poly-unsaturated FA increased from (65.6 ± 1.6) tо (73.3 ± 1.8) % and from (55.8 ± 1.3) tо (65.6 ± 1.5) %, respectively (р < 0.05). FA changes of the kidney structure of SH rats were characterized by the increase of the sum of poly-unsaturated FA from (51.5 ± 1.8) tо (59.3 ± 1.6) % (p < 0.05). At the same time, the increase of the arachidonic FA level from (42.0 ± 1.0) tо (47.0 ± 1.5) % (р < 0.05) was accompanied by the decrease of stearic FA level from (11.6 ± 0.8) tо (8.2 ± 1.0) % and oleic FA from (12.9 ± 1.0) tо (10.0 ± 0.8) %, and also the increase of linoleic FA from (8.9 ± 0.9) tо (11.8 ± 1.0) % (р < 0.05). There were significant changes in the FA lipid content of the liver of SH rats as compared to the controls. The level of linoleic FA increased from (10.0 ± 1.0) tо (13.2 ± 1.0) % and of arachidonic FA from (36.7 ± 0.4) tо (42.6 ± 1.5) %, all р < 0.05. At the same time, there was decrease of stearic FA level from (11.6 ± 0.6) tо (8.9 ± 0.9) % and oleic FA from (11.5 ± 0.4) tо (8.1 ± 0.8) % (all р < 0.05).

Conclusion. In the spectrum of FA lipids of myocardium, kedneys and liver of SH rats there was the increase of arachidonic acid and the sum of poly-unsaturated FA, which was accompanied by the decrease of the level of palmitic FA in the myocardium and of stearic and oleic FA in the kidney and liver. The level of linoleic FA was increased.

Keywords: lipids, fat acids, rats, spontaneous arterial hypertension

The article includes the data about the main multiGcentral randomized research of the effectiveness of statins which are used for primary and secondary prophylaxis of ischemic stroke. It also analyzes their results and metaGanalyses. Guidelines as to the secondary prophylaxis of ischemic stroke are given.

Keywords: statins, atherosclerosis, stroke, prophylaxis

Obstructive sleep apnea syndrome (OSAS) is a condition characterized by snoring, periodical upper airway collapse on the gullet level and the lung ventilation stop with preserved breathing efforts, the decrease of arterial blood oxygenation, rough sleep fragmentation and drowse. The spread of OSAS is 2–4 % in men and 1–2 % in middle-aged women. The factors that contribute to the onset of OSAS are obesity, male gender, anomalies of the structure of the visceral cranium, hyperplasia of the gullet soft tissues, the increase of the tonsils, the obstruction of the nasal passages, diseases of the endocrine system – hypothyroidism and acromegalia, family anamnesis. OSAS is associated with the increase of mortality from many cardio-vascular diseases – arterial hypertension, ischemic heart disease, chronic heart failure. It is caused by activation of sympathetic nervous system, endothelial dysfunction, hyper-coagulation, non-specific immune inflammation, oxidant stress, insulin-resistance, glucose tolerance impairment, hyper leptinemia and leptin resistance. The diagnosis of OSAS is based on the clinical signs (snoring, apnea during sleep, awakening, troubled sleep, day-time drowse, night asphyxia, nocturia, morning headache and others) and it is verified by polysomnography (PSG). PSG is a method of lasting registration of different body functions during night sleep. The treatment of OSAS by means of creating constant positive pressure in the air ways (CPAP-therapy) decreases cardiovascular disease incidence and lethality, arterial pressure, cardiac rhythm impairments and improves the quality of patients’ lives.

Keywords: obstructive sleep apnea syndrome, cardio-vascular diseases, arterial hypertension, stroke, polysomnography, CPAP-therapy

Arterial hypertension (AH) during pregnancy is observed in 8–10 % cases. In approximately 30 % cases AH is revealed before pregnancy (chronic AH), in 70 % – in gestation period (gestation AH and pre-eclampsia and eclampsia). For many decades eclampsia has been the leading factor in the structure of mother mortality and has been the main cause of perinatal complications, the most common of which are intrauterine hypoxia of the fetus and its development delay. The frequency of these complications in pregnant women with AH is 2.5 times higher than in women with normal arterial pressure (AP), and the risk of perinatal loss of the fetus increases proportionally to the AP level. The review provides meta-analysis data about the treatment of I-II degree of AH during pregnancy. We analyzed the results of experimental and clinical research into the safety and effectiveness of anti-hypertensive means in case of AH in pregnant women. The article contains data for the management of arterial hypertension in pregnancy and during the lactation in conformity with the guidelines of the European Society of Hypertension and the European Society of Cardiology (2007). According to these guidelines, the main preparations for treating mild AH in the period of pregnancy are methyldopa, α-β-adrenoblocker labetalol, calcium antagonists and β-adrenoblockers.

Keywords: arterial hypertension, pregnancy, methyldopa, nifedipine,

Left ventricular remodeling is becoming a frequent treatment for severe heart failure, but its use in combination with other surgical techniques is controversial. We report a case in which successful left ventricular remodeling was combined with coronary artery bypass grafting and mitral valve replacement to treat a patient with severe heart failure resulting from coronary artery disease and recent myocardial infarction. Cardiac function improved after the combined treatment. This case suggests that left ventricular remodeling can be used safely and effectively in combination with other surgical techniques.

Keywords: left ventricular remodeling, coronary artery bypass, heart valve replacement