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Issue. Articles

4(24) // 2008

 

 

1.

 

Transcatheter treatment experience of critical congenital cardiac failures

Yu.V. Panychkyn, I.O. Dytkovskyj, B.V. Cherpak, V.M. Beshlyaga, S.M. Fanta, Ya.P. Truba, V.V. Lazoryshynets

The object of this study is analysis of the transcatheter treatment efficacy in multistage radical treatment of the congenital heart diseases (critical aortic stenos, pulmonary artery stenos, transposition of main vessels with intra ventricle septum, total pulmonary veins derange with obstruction) in patients operated in the National Amosov institute of cardio-vascular surgery Academy of Medical Sciences of Ukraine starting from 1990 till the June of 2008.

Methods and subjects. Balloon dilation and balloon atrioseptostomy are the basic endovascular manipulations that are carried out in children who suffer from congenital heart disease. In the clinic 669 endovascular operations were carried out in patients with congenital heart disease; 45 balloon valvuloplasty of the aortic stenos, 29 balloon dilation of the aortic coarctation, 121 balloon valvuloplasty of the pulmonary artery, 474 balloon atrioseptostomies among them.

Results and discussion. As the result of the balloon valvuloplasty of the critical aortic stenos systolic pressure gradient value on the valve was reduced from 49.2 ± 8.1 till 17.9 ± 6.3 mm Hg, ejection fraction was increased from 41.4 ± 10.8 % till 62.6 ± 8.9 % approximately. After the aortic coarctation angioplasty, approximate systolic pressure gradient value between aorta ascendens and aorta descendens was equal to 10.2 ± 4.8 mm Hg (initial 35.2 ± 9.7 mm Hg), ejection fraction was increased on average from 48.1 ± 13.4 % till 63.4 ± 6.9 %. Valvuloplasty of the pulmonary artery had good immediate and long-term results: systolic pressure gradient was decreased significantly ( 77.3 ± 14.2 mm Hg 17.2 ± 9.8 mm Hg), tricuspid insufficiency was reduced, decrease in the heart size and normalization of the contractive activity of the myocardium were registered. After carrying out of balloon atrioseptostomy in children with TGA, saturation of the arterial blood with oxygen was increased from 42.3 ± 7.5 % till 83.2 ± 10.1 %. Rashkind procedure in children with atrioventricular valve atresia or hypoplasia, or pulmonary artery atresia resulted in the increase ASD sizes (from 4.1 ± 2.3 mm till 7.4 ± 1.9 mm), and decrease of the pressure gradient between atriums (from 11.2 ± 6.6 mm Hg. to 3.1 ± 1.8 mm Hg). Lethal outcomes after balloon valvuloplasty were notified in 8.9 % (4 patients), after aortic coarctation – 6 % (2 patients), after other kinds of therapy there were no fatal outcomes. Insufficient results were detected in 4.4 % patients with aortic stenos (2), 7 % (4 patients) coarctation of aorta, 3 % with pulmonary aortic stenos. All these patients required surgery on the open heart.

Conclusions. Transcatheter interventions allow to stabilize very hard condition of patients and to improve forecast of the further surgical treatment. Though not all of the endovascular operations could be considered as radical, their importance can hardly be overestimated as they save even lives of the insufficient patients with the most difficult congenital heart disease. It should be mentioned, that some of the congenital heart disease after the endovascular intervention do not need further surgical treatment in future. In such a way, 86 % of the pulmonary artery valve stenos, 38 % of the aorta coarctation, 14 % of the aortic valve stenos after the balloon dilation do not need further surgical treatment.



Keywords: ongenital heart disease, balloon dilation, balloon atrioseptostomy

2.

 

Risk scale of unfavorable long-term outcomes after myocardial infarction

O.M. Parkhomenko, O.S. Gurjeva, .. Irkyn, S.P. Kushnyr, .V. Shumakov, S.. Khozhukhov, .. Skarzhevskiy

Object of study: to develop risk scale for evaluation of 5-years risk of cardiovascular death (CVD) after myocardial infarction (MI) using data of hospital registry of AMI patients.

Methods and subjects. History, clinical and laboratory data of 940 patients hospitalized on the first day of AMI were assessed. Length of follow-up comprised 4.16 ± 0.07 years. Most significant risk factors of 3-years post-MI CVD were elucidated using stepwise Cox-regressions and those risk factors were grouped into scale components. Validity of risk scale for 5-years CVD prediction was assessed using receiver operating curves analyses. Statistical software SPSS 11.0 was used for data analyses.

Results and discussion. Risk scale of CVD in post-MI patients included data on age of patients, CHF history, presence of acute LV failure symptoms, heart rate on admission > 90 bpm, urgent revascularization, estimated glomerular filtration rate, prolonged elevation of cardiac enzymes (> 46 hrs for CK-MB and > 75 hrs for CK) or elevated white blood cells counts (> 10.2·109/l on the 1st day or > 7.5·109/l on 10th day of MI ( < 0.05). Developed scale was informative for CD prediction during 5-year follow-up in general group (area under ROC [95 % C] = 0.77 (0.67–0.86), < 0.0001) and in subgroup divided by revascularization : in patients with and without reperfusion areas under ROC-curve [95 % CI] = 0.79 [0.69–0.89], < 0.0001 and 0.77 [0.64–0.95], < 0.001 respectively). Score from 0 to 4 corresponds to low risk (HR [95 % C] = 0.46 [0.28–0.77], p = 0.003), from 5 to 7-moderate risk, from 8 to 10-high risk (HR [95 % C] = 2.04 [1.28–3.25], p < 0.0001) and higher or equal to 11-very high risk to develop CD during 5 years follow-up (HR [95 % C] = 4.23 [2.47–7.25], p < 0.0001).

Conclusions. Newly developed scale is a precise instrument for risk assessment of 5-years CD after MI and it is informative regardless reperfusion therapy.



Keywords: acute myocardial infarction, risk assessment, risk scale

3.

 

Variants of endarterectomy technique from pulmonary arteries in chronic postembolic pulmonary hypertension

L.V. Kulyk

Object: to compare application possibilities and advantages of different methods of endarteractomy from pulmonary arteries in the process of one surgery.

Methods and subjects. Types of thrombendarterectomy from pulmonary arteries within 1987–2007 were analyzed. 67 patients were operated: 34 males and 31 female at the age from 16 till 77 – on average 51, 6years. The third functional class according to NYHA included 34 patients, the fourth class included 31 patients. The main methods of pre-operative diagnosis amplification and operability definition were selective angiopulmonography and probing of fight heart parts, tomography with angiography of pulmonary arteries. The blood cardioplegia was used to protect myocardium. The duration of aorta compression was from 84 till 168 min, (135 ± 31.3) min on average. The duration of complete blood circulation collapse was (42 ± 11.5) min on average. general duration of artificial blood circulation was (180 ± 39.1)min on average. 61 patients were operated, urgent surgeries were performed to 4 patients (due to rapid hypoxemia development). thrombendarterectomy was followed by right pulmonary artery dezobstruction.

Results and discussion. 65 thrombendarterectomies were performed with 13.8% of lethal outcomes. Within 1986–1996 the traditional methods of P. Daily were used during which the complete blood circulation collapse was performed under the deep (to 20 °) hypothermia. 56 patients underwent this surgery, 48 survived. According to technical conditions the restoration of pulmonary arteries passages was performed according to three methods. 1. Traditional method with right pulmonary artery dezobstruction with complete blood circulation collapse was performed under the deep (to 20 ° and below) hypothermia (56 patients, 8 died). 2. Endarterectomy under the condition of moderate (28 °) hypothermia without blood circulation collapse with periods of circulation reduction till 500–300 ml/min. This methods application was initiated in 2004. 7 patients underwent this surgery, 6 of them survived. 3. Relatively «dry» operative field can be obtained under the derange of descending thoracic aorta to avoid bleeding through bronchial arteries.

Conclusions. The main method of thrombendarterectomy is surgery with complete blood circulation collapse under the deep hypothermia. Patients with dense thrombosis material in pulmonary arteries may have thrombendarterectomy without deep hypothermia and blood circulation collapse with or without aorta compression.



Keywords: pulmonary artery thromboembolism, chronic post embolic pulmonary hypertension, thrombendarterectomy, surgery, treatment

4.

 

Predictors of survival in patients with chronic heart failure with left ventricular systolic dysfunction for different terms followup (3-year prospective study)

L.G. Voronkov, N.A. Tkach, G.D. Dets


Object – evaluation of long-term survival predictors in patients with chronic heart failure (CHF) and left ventricular (LV) systolic dysfunction (SD) depending on prognostic terms.

Methods and subjects. The database represents 267 CHF patients with reduce LV ejection fraction (EF) ≤ 40 % (NYHA status II–IV; ischemic or/and hypertensive – 76.5 %, non-ischemic – 23.5 %, chronic atrial fibrillation – 27.3 %. General clinical examination, echocardiography, general blood count for calcium, potassium, billirubin and its fractions, creatinine, uric acid revealing, general urine test to reveal adrenaline and nonadrenaline level in urine. The insulin sensitivity was tested taking into the account index . The therapy results were analyzed. Survival was estimated by Kaplan – Meier method and the method of life tables. Calculations were performed using the Statistica. For estimation of independent predictors value the odds ratio (OR) from 95 % confidence interval was calculated.

Results and discussion. Impact each parameter for different terms of follow-up has been estimated. Parameters showing the negative impact on survival in patients with CHF and LV SD, without dependence on follow-up duration are as follows: body mass index (BMI) < 22 kg/m2, 6 min walking test distance < 350 m, end-diastolic volume index (EDVI) > 133 ml/m2;, systolic blood pressure (SBP) < 100 mm Hg, uric acid and plasma creatinine levels < 500 mkmol/l, index and lymphocyte blood content > 2,65, relative number of lymphocytes < 21 % in peripheral blood. Factors which also show the impact on survival were: EF LV< 30 %, end-systolic volume index (ESVI) > 95 ml/m2 and left atrium (LA) size > 50 mm. However, the last index didn’t demonstrate the same impact for term 6 months, and two first – for term 12 months. The dose of furosemide per week has been definite predictor of survival only within first 6–12 months. Prognostic significance of the maintenance ACE and beta-blocker doses were observed only for terms of follow-up 12–18 months and 18–24–30–36 months, respectively.

Conclusions. Survival predictors of patients with CHF and LV SD for different terms of time of their follow-up (6, 12, 18, 24, 30 and 36months) are: BMI, 6-minute walking test distance, EDVI, uric acid and plasma creatinine levels. For early terms (6–12 months) of follow-up the most negative prognostic value demonstrated following parameters: index > 2.65, SBp < 100 mm Hg., BMI < 22 kg/m2, uric acid plasma level > 500 mkmol/l and creatinine plasma level > 100 mkmol/l. For longer follow-up (18–36 months) the significant survival predictors are: average daily heart rate > 75 per min, LA size > 50 mm, and insulin blood level > 12 μIU/ml. Predictors of worse survival are the maintenance doses ACE and beta-blocker less than 20 % and less than 50 % from target, respectively.



Keywords: chronic heart failure with left ventricle systolic dysfunction, prognosis, survival, predictors

5.

 

The influence of I/D gene polymorphism on antihypertensive activity of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in patients with arterial hypertension

V.I. Tseluyko, O.V. Peletskaya

The object of the research was to study the influence of the angiotensin converting enzyme (ACE) I/D gene polymorphism on the angiotensin-converting enzyme inhibitor (Lisinopril) and angiotensin II ( ) receptor blocker (Losartan) antihypertensive activity.

Methods and subjects. The research included 100 patients (27 women and 73 men) with arterial hypertension, aged 32 – 67 years (mean 51.6 ± 0.7). All the patients underwent clinical study, ECG registration, EchoCG with calculation the left ventricular myocardium mass. The patients were randomized on 2 groups. The patients of the first group (48 patients) took Lisinopril, the patients of the second group (52 patients) took Losartan. The initial dose of Lisinopril was 10 mg; the initial dose of Losartan was 50 mg. In 1 month if the purposed arterial pressure was absent the dose of the drugs was increased to 20 and 100 mg accordingly. If the antihypertensive effect was not reached in 2 months we added the second drug (Lercanidipin). We were observing the patients during 6 months.

Results and discussion. In 1 month of treatment the monotherapy provided the improvement of purposed arterial pressure in 15 % cases of the first group and in 19 % cases of the second group. When the dose was doubled, the specific weight of patients with the purposed pressure became 73 % and 75 % accordingly. The combination therapy increased these indexes to 92 % in the first group and to 96 % in the second group. There were 3 genotypes of I/D gene polymorphism: DD genotype – 16 %, ID genotype – 61 % and II genotype – 23 %. Comparative evaluation of ACE inhibitors and AT II receptor blockers influence on arterial pressure showed that ACE inhibitors were more effective in II genotype patients: systolic arterial pressure decreased on 18.9 %, diasystolic arterial pressure decreased on 16.1 %, the monotherapy was effective in 89 % cases. Angiotensin II receptor blockers were more effective in D allele carriers: systolic arterial pressure decreased on 21.5 %, diasystolic arterial pressure decreased on 18.2 %, the monotherapy was effective in 83.3 % cases.

Conclusions. 6 month therapy by angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers had similar antihypertensive activity, but angiotensin-converting enzyme inhibitors were more effective in II genotype patients while angiotensin II receptor blockers were more effective in D allele carriers. The determination of angiotensin converting enzyme I/D gene polymorphism allows to apply the antihypertensive therapy differently: ACE inhibitors in II genotype patients, AT II receptor blockers in D allele carriers.



Keywords: arterial hypertension, angiotensin converting enzyme gene polymorphism, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, left ventricular hypertrophy

6.

 

Clinical and demographical characteristic of patients with essential arterial hypertensione depending on genetic polymorphisms

L.P. Sydorchuk

Object. To evaluate clinical and demographical data in patients with essential arterial hypertension (EAH) depending on polymorphism of 1166 in the gene of the first type receptor of angiotensin II (AGTR1), Arg389Gly in the gene of β1-adrenergic receptor (ADRβ1), I/D in gene of angiotensin-converting enzyme (ACE), Pro12Ala in gene of PPAR-γ2 receptor associated with insulin resistance, T894G in the gene of endothelial NO-synthase (eNOS).

Methods and subjects. 249 patients with EAH - stages severities (EAH I – 26.5 % (66) patients; EAH – 45.8 % (114); EAH – 27.7 % (69); women – 48.2 % (120), men – 51.8 % (129), mean ages 50.5 ± 10.4 years and 50 practically healthy people were examined. All subjects were examined by genetic polymorphisms analysis for five genes associated with AH: ACE (I/D), AGTR1 (A1166C), eNOS (T894G), PPAR-γ2 receptor (Pro12Ala), ADRβ1 (Arg389Gly). Alleles of polymorphic genes were studied by the genomic DRA selection from venous blood with next amplification by PCR based method. Genes’ alleles split was performed by restriction enzymes Ddel, BanII, CseI and FaqI.

Results and discussion. The frequency of analyzed genes polymorphisms’ was: -genotype of gene – 20.1 % (50) patients, I/D-genotype – 52.2 % (130), DD-genotype – 27.7 % (69) subjects. Distribution of AGTR1 gene polymorphisms’ was: -genotype carriers – 49.4 % (123) patients, -genotype – 38.5 % (96), -genotype – 12.1 % (30). Distribution of eNOS gene polymorphisms’ was: GG-genotype carriers – 37.8 % (94) patients, TG-genotype – 53.8 % (134), -genotype – 8.4 % (21). Distribution of PPAR-γ2 receptor’s gene polymorphisms’ was: AlaAla-genotype carriers – 6.0 % (15) patients, ProAla-genotype – 28.9 % (72), ProPro-genotype – 65.1 % (162). Distribution of ADRβ1 gene polymorphisms’ was: GlyGly-genotype – 49.0 % (122) carriers, ArgGly-genotype – 41.0 % (102), ArgArg-genotype – 10.0 % (25) carriers. The EAH II-III stages severities were revealed more often in patients with D-allele of ACE gene (84.0 % (58) subjects and 76.9 % (100), respectively, < 0.01), -genotype carriers of AGTR1 gene (80.0 % (24) subjects, < 0.05), T-allele carriers of eNOS gene (76.9 % (103) patients and 85.7 % (18), accordingly, 0.001 < < 0.05), Pro-allele of PPAR-γ2 receptor’s gene (50.0 % (36) patients and 87.0 % (141), respectively, < 0.001) and Argallele of ADRβ1 gene (81.4 % (83) patients and 92.0 (23), accordingly, < 0.001). Left ventricle hypertrophy (LVH) was revealed more frequently in men-carriers of D-allele of gene ( = 0.014), women-carriers of -genotype of AGTR1 gene ( ≤ 0.007), ProPro-genotype of PPAR-γ2 receptor gene ( < 0.001). Office Systolic Blood Pressure (SBP) data reliable prevailed in EAH patients-carriers of D-allele of gene ( < 0.04), -genotype of AGTR1 gene ( < 0.05), Pro-allele of PPAR-γ2 receptor gene ( < 0.05), Arg-allele of ADRβ1 gene ( < 0.01). Office Diastolic Blood Pressure data reliable prevailed in -genotype carriers of AGTR1 gene ( < 0.05), ProPro-genotype carriers of PPAR-γ2 receptor gene ( < 0.05), ArgArg-genotype carriers of ADRβ1 gene ( < 0.02).

Conclusions. The calculated prognostic value of positive results of EAH II-III stages severity appearance in DD-genotype carriers of ACE gene, -genotype carriers of AGTR1 gene and ArgArg-genotype carriers of ADRβ1 gene was 80.0 %, in -genotype carriers of eNOS gene – 76.1 %, in ProPro-genotype carriers of PPAR-γ2 receptor gene – 87.0 %, and in cases of two or more «unfavourable» genotypes combinations (DD-genotype of ACE gene, -genotype of AGTR1 gene, ArgArg-genotype of ADRβ1 gene or ProPro-genotype of PPAR-γ2 receptor gene) – 100.0 %.



Keywords: arterial hypertension, genetic polymorphism

7.

 

Comparative assessment of endothelial function systemic inflammation and exercise tolerance in patients with non-significant coronary atherosclerosis depending on its spread

E.N. Amosova, O.T. Stremenyuk, E.V. Andreev, V.I. Zaharova

bjective: to analyze the condition of endothelial system according to reactive hyperemia prevention data compared to tolerance to physical exercise in patients with non significant coronary atherosclerosis depending on its spread.

Methods and subjects. 50 patients at the age 40–70 year (average age 55.4 ± 1.3) were examined, with coronary arterial stenosis 1–3 but less 50 % according to data of CG and without disorders of local constriction according to data of EhoCG. According to CG data patients were sorted into 2 groups. First group included 34 patients with single vessel non significant coronary atherosclerosis (NSCA). Second group included 16 patients multi – vessel non significant coronary atherosclerosis. All patients were tested of partly physical exercises by tredmil Woodway-15 Analiser (Germany) according to R.Bruce protocol (1969). The duration and load of exercise were measured, load was measured in metabolic units of oxygen absorption (1 M = 3.6 l/kg/min). To evaluate endothelium function the brachial artery vasomotor function was determined by means of duplex ultrasound scanning by carrying out the test from reactive hyperemia (endothelia dependent vasodilatation) and nitroglycerine (endothelia independent vasodilatation). It was done according to D.S. Celermajer and coauthors methods.

Results and discussion. Tolerance to physical exercises was significantly decreased in patients with coronary atherosclerosis (8.06 ± 0.4 MET) compared to healthy people (9.6 ± 0.5 MET, p < 0.05 it was accompanied with decreasing of double sum on the last stage 14.0 %; p < 005). Frequency of test positive result with partial physical exercises in patients with non significant coronary atherosclerosis was 68.0 % (34 patient).The patients experienced mostly the same level of physical exercises (p > 0.05). But there was significant depression of ST segment in 3 leads of ECG (100 % and 44.1 %, accordingly p < 0.05) comparing the first group to the second one. Assessment of values of endothelial function according to reactive hyperemia test shows significant depression of EZVD and ENZVD in patients with NSCA comparing to healthy people (to 29.3 % and 30.5 %, accordingly p < 0.001). During the EZVD data analysis depending on number of impaired arteries EZVD was significantly reduced in II group than in I one (4.4 ± 1.4) % and (9.5 ± 1.2) % (p < 0.001). The same process was observed for ENZVD (14.3 ± 2.0) and (17.1 ± 2, 4) % (p < 0.001).

Conclusions. The patients with non significant coronary atherosclerosis experience endothelial dysfunction is more marked in case of multi-vessels non significant coronary atherosclerosis compared to single vessels non significant coronary atherosclerosis and is associated with higher induction frequency of myocardial ischemia during the load test. Marked exercises tolerance reduction in patients with NSCA doesn’t depend on number of impaired coronary arteries.



Keywords: endothelial function, coronary atherosclerosis, exercise tolerance

8.

 

Influence of the reanimation recirculation of donor blood mode on the haemodynamic shifts in early post reanimation period

V.A. Dibrova, E.V. Tsema

The object of the research was to define regularities of haemodynamic reactions system in early post reanimation period (EPP) depending on the different modes of reanimation recirculation.

Methods and subjects. The experimental studies have been carried out on 51 dogs (body weight 10.4 ± 1.7 kg). The dogs were prototyped 13–15-minute clinical death caused by asphyxia. Anesthesia methods and deprivation of life methods corresponded to «Rules of research conduction using experimental animals» approved by Ministry of Health of Ukraine. Reanimation of the animals was conducted by the method of donor artificial circulation. Depending on velocity of reanimation recirculation (VRR) the animals were divided into 4 groups: the first group (14 dogs) – VRR was 170–200 ml/(kg·min); the second group (12 animals) – 110–150 ml/(kg·min); the third group (14 dogs) – 80–100 ml/(kg·min); the fourth group (11 animals) – 50–60 ml/(kg·min). In this experimental study the following haemodynamic factors have been determined: heart index (HI) and average arterial blood pressure (AABP) by manometer method. The value of HI by numbering way using the method thermo dilution has been set. The 24-hours surviving of animals was determined in EPP.

Results and discussion. Before the clinical death the values of HI did not differ (p > 0.05) in all four groups of animals. We have noted that in the 1st, the 2nd and the 3rd groups of animals the values of HI in EPP increased (p < 0.001; with maximum on 10th minute) and hereinafter was gradually decreasing. The maximum value of HI in the animals of the first group of animals was more than initial value in 2.41 times (p < 0.001), in the second group – in 2.26 times (p < 0.001), in the third group – only in 1.47 times (p < 0.001). In the fourth group of animals we have noted the opposite trend: in each of the three measurements in EPP the value of HI did not exceed the initial level. In this group the maximum value of HI was registered in the first measurement and it is 71 % from initial level (p > 0.05). We have defined that in the 1st, the 2nd and the 3rd groups of animals the values of AABP in EPP increased (p < 0.05; with maximum on 10th minute) and hereinafter were gradually decreasing. The value of AABP in the first group of animals was more than initial value on 49.6 % (p < 0.01), in the second group – on 38.9 % (p < 0.05), in the third group – on 23.9 % (p < 0.05). In the fourth group of animals we have noted the opposite trend: in each of three measurements the value of AABP did not exceed the source level. In the fourth group the maximum value of AABP was registered in the first measurement and it is 75 % from source level (p > 0.05). In the first group 1 (7.1 %) dog died by the end of the first day of the EPP. Animals fro the second group didn’t die. In the third group 3 (21.4 %) animals died. At the same time in the fourth group 10 dogs died (90.9 %). The lethal outcome in the fourth group was significantly higher than in other groups (p < 0.05).

Conclusions. The mode of recirculation of animals after 13–15-minutes clinical death caused by asphyxia influences the nature of the haemodynamic reactions system in EPP and early animals survival. At reanimation with VRR application 100–200 ml/(kg·min) the prognosis of animals survival is favorable and hyperdynamic reactions in EPP have the same qualitative and quantitative nature, they are also expressed by HI increasing in more the 2 times and EPP – in 1.4 times after 10 min after the reanimation. This mode is suitable after 13–15 min clinical death. At VRR less than 60 ml/(kg·min) compensation hyperfunction of the cardiovascular system is not developed that proves unfavorable prognosis.



Keywords: reanimation, post reanimation period, method of artificial circulation, system haemodynamic

9.

 

Possibilities of idiopathic pulmonary arterial hypertension treatment

I.V. Krychinskaya

Object – to estimate effects of sildenafil in low doses in patients with idiopathic pulmonary arterial hypertension (IPAH).

Methods and subjects. 22 patients with IPAH NYHA class II or III were examined. After examination in addition to symptomatic therapy patients received sildenafil. Its dosage was 25 mg 2 times/day. Control examination was conducted in 24 weeks. The dyspnea dynamics was estimated by Borg Dyspnea Index (changes in 6-minute-walk distance). We also estimated the change of pulmonary artery systolic pressure (PASP), diameter of right ventricle (RV), faction of shortening (FS) of RV, eventual-diastole and eventual-systole volumes of the left ventricle (EDV, ESV of LV), diameter of vena porta (VP) and percent of its slump on inhalation were estimated by Doppler-EchoCG.

Results and discussion.Treatment with sildenafil during 24 weeks proved the decreasing of Borg Dyspnea Index for 31 % (p < 0.05). Exercise capacity was increased significantly, as evidenced by a 19.5 % according to 6-minute walk distance test (p < 0.05). At the end of the 24 week NYHA class was improved in 50 % patients. The decrease in PASP was statistically significant. Decline of PASP more than 10 % from initial marked in 50 % patients, and diminishing of diameter of RV more than 10 % from initial – in 36 % patients. Treatment with sildenafil 50 mg /day is endured well, without causing serious side effects, requiring abolition of sildenafil.

Conclusions. For the patients of IPAH NYHA class II or III treatment with sildenafil 50 mg/day during 24 weeks furthers the tolerance to the physical loading on a 1 class of NYHA development in 50 % patients and increases the distance of the 6-minute walking in the average for 19.5 %, reduces PASP and diminishes the diameter of RV more than 10 % in 50 % patients.



Keywords: idiopathic pulmonary arterial hypertension, phosphodiesterase type 5 inhibitors, sildenafil

10.

 

The treatment of vestibular dysfunction in patients with essential arterial hypertension after cerebral hypertensive crisis, by caloric vestibular stimulation

Ya.Yu. Gomza

In case of essential arterial hypertension after cerebral hypertensive crisis 69.5 % of patients were diagnosed dysfunction of peripherals level vestibular analyzer, which hasn’t been treated. Caloric vestibular stimulation could be a solution of this problem.

The object of research is to reveal treatment efficacy of different methods of caloric vestibular stimulation applied to patients with peripherals vestibular dysfunction accompanied with essential arterial hypertension II after cerebral hypertensive crisis with hyporeflexion of labyrinths.

Methods and subjects. 120 patients with essential arterial hypertension II stage after cerebral hypertensive crisis with hyporeflexion of labyrinths, who underwent different methods of caloric vestibular stimulation,were examined. 30 patients, who did not undergo caloric vestibular stimulation and 30 patients of a control group without any disorders.

Results and discussion. Combined vestibular syndrome – central and peripheral – was revealed in 40.0 % patients with essential arterial hypertension II stage after cerebral hypertensive crisis with hyporeflexion of labyrinths who underwent cold calorisation of injured labyrinth; 33.3 % patients who underwent warm calorisation of injured labyrinth; 26.7 % patients who underwent warm calorisation of injured labyrinth and warm calorisation of opposite labyrinth, and in 20.0 % patients who underwent warm calorisation of injured labyrinth and cold calorisation of opposite labyrinth. Combined vestibular syndrome remained in 86.7 % patients who were applied medical treatment of cerebral hypertensive crisis and did not undergo caloric vestibular stimulation. Comparative analysis of vestibulometry results showed decreasing of quantity of patients with cerebral hypertensive crisis with vestibular dysfunction after the treatment in basic groups comparing to control groups from 20.0 % to 93.3 %.

Conclusions. Caloric vestibular stimulation application improves treatment efficacy of peripherals vestibular dysfunction in patients with essential arterial hypertension II stage after cerebral hypertensive crisis by simultaneous application of cerebral hypertensive crisis medicine treatment. Application of warm calorisation of injured labyrinth with cold calorisation of opposite labyrinth is more effective method of caloric vestibular stimulation in patients with essential arterial hypertension II stage after cerebral hypertensive crisis with hyporeflexion of labyrinths, than application of cold calorisation of injured labyrinth. And it decreases quantity of labyrinth dysfunction cases by 4.7 times.



Keywords: vestibular dysfunction, cerebral hypertensive crisis, caloric vestibular stimulation

11.

 

Postoperative period: cardiac medications abolishing problem Part

V.G. Mishalov, N.Yu. Litvinova

 

Analyzed problems and ways of their solution connected with abolishing and restoration of medication application, including cardiac medications, anticoagulants and disaggregates during postoperative period. In pre-operative period it's important to avoid medication application that can have negative interaction with anesthesia medications. In postoperative period it's necessary to prevent the abolishing syndrome developing and possible disease relapse.



Keywords: abolishing of medication application, postoperative period, cardiovascular diseases

12.

 

Efficacy of statines application in lower extremities insufficient arterial blood circulation

E.N. Amosova, V.G. Myshalov, N.Yu. Lytvinova


The article deals with the results of randomized placebo-controlled researches of efficacy of statines application in lower extremities insufficient arterial blood circulation of atherosclerotic genesis. The data of cardio-vascular lethal outcomes, myocardial infarction and ischemia cerebral strokes frequency, requirements of revascularizing surgery have been analyzed. Also there are data concerning influence of statine application in patients with lameness on life quality and distance of painless walk. Used researches data evidence that the lethal outcomes and frequency of serious cardio-vascular diseases complication development decreased due to statine application, regardless the initial cholesterine level in blood. Short therapy with maximal doses of symvastatine increases arm-bone index and reduces manifestations of lameness. Application of sevastatine 40 gr per day reduces infarction risk and necessity in surgery on peripheral arteries and slows down the chronic insufficient blood circulation of lower extremities progressing.



Keywords: chronic insufficient blood circulation of lower extremities, lameness, treatment, symvastatine, atorvastatine

13.

 

Complications after Fontan operation

A.M. Dovgan', V.B. Demjanchuk


For last 40 years Fontan operation for pulmonary and system blood flow division has been modified many times. Nowadays it is used in alomost all forms of cardiac congenital failure with one functional ventricle. Depsite all achievements there are a lot of problems connected with the consequences of this operation. Article deals with spread complications caused by operation and specific blood flow physiology. The signs and methods of complications' treatment are proposed in the article.



Keywords: Fontan operation, complication

14.

 

The role of lipid peroxidation in pathogenesis of arterial hypertension

I.S. Chekman, N.A. Datsyuk


The article is a review of the main evidences of the experimental and clinical researches, which were conducted by the authors of different countries at studying the role of oxidative stress in pathogenesis of arterial hypertension. The summed up experience is presented on application of antioxidants for prophylaxis and treatment of patients with this disease. Studies have displayed a higher concentration of reactive oxygen species (super oxide anion, hydrogen peroxide) and secondary products of lipid peroxidation (diene conjugates and malonic dialdehyde) in plasma and a decrease in activity of antioxidant enzyme systems in individuals with arterial hypertension. These data may suggest that hypertension might develop as a result of increased oxidative stress. Reactive oxygen species, which are produced in organism, may cause chain reactions of lipid peroxidation in cell membrane. This damages entirety of phospholipids part and disturbs membrane functions, one of them is a selective permeability. -ree ionic transport (Na+, K+, Li+) through damaged membrane side of cell leads to elevated concentration of intracellular Ca2+. Hereupon arterial resistance and reactivity of sympathetic nervous system elevate. In addition, the products of lipid peroxydation may reduce the level of local vasodilatator – nitric oxide. The effect of this is the elevation of blood pressure. We present results of antioxidants application and drugs with antioxidant propreties for complex therapy arterial hypertension. Natural antioxidants (quercetin, proanthocyanidins, astaxanthin, propionyl-L-carnitine et al.) and artificial drugs (mexidol, mexicor, emoxypin, thyotriazolin, lisinopril, carvedilol, enalapril, nifedipin) are used for prevention and treatment cardiovascular diseases. Antioxidants may be able to decrease the concentration of reactive oxygen species in plasma, increase the activity of antioxidant enzyme systems and reduce the level of blood pressure compared with control subjects.



Keywords: lipid peroxidation, arterial hypertension, antioxidants, pharmacotherapia

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4(60) // 2017

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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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