The generally accepted theory of the interaction between the left ventricle (LV) of the heart and the arterial system (AS) is based on the analytical model suggested by D. Burkhoff and K. Sagawa (1986), which is characterized by the LV contractility (E_es) and effective elasticity of the AS (E_a). This model involves a number of significant simplifications.

Purpose. To study the relations of the mechanical efficiency and the LV external work (SW) vs. the arterial load for the more realistic models of cardiovascular system (CVS), where the pulse dynamics, CVS closing, shortening deactivation (ShD) and autoregulation of the LV pumping function are taken into account.

Materials and methods. Experimental material: data obtained by E.Baan and T.Van Der Velde (1989,1991) in experiments on anes-thetized dogs for studying the afterload influence on the Ees and the end-systolic pressure-volume relation (ESPVR) of the LV. The mathematical model includes right heart ventricle, pulmonary arteries and venae, LV, aorta, systemic arteries and venae and venae cavae. The LV is described as a pressure source with an internal resistance (E(t)—R model); a homeometric autoregulation (HOMA) mechanism is considered.

Results. As in D.Burkhoff and K.Sagawa's model, the LV efficiency in our model is also a maximum when the E_a/E_es ratio is close to 0.50. At the same time, the efficiency changes within a physiologically reasonable E_a range are inconsiderable. Unlike the D.Burkhoff and K.Sagawa's model, where the SW is a maximum when E_a/E_es = 1.0, in a closed CVS the SW does not reach its maximum within the actual afterload range. The model version with the ShD but without the HOMA showed the ESPVRs' to be nonlinear and to shift left and up with the afterload, which meets the experimental results of T. Van Der Velde et al. The E_es was greater under high then under reduced af-terload. This, however, did not mean the contractility increase because the max dp/dt vs. end-diastolic volume (EDV) relations were the same for all TPR (total pulmonary resistance) levels, while in experiments they showed behavior similar to the ESPVRs'. An agreement with the experimental data was obtained in the model taking into account the HOMA: both max dp/dt vs. EDV relations and the ESPVRs formed a family, shifting left and up with the afterload, which is indicative of the LV inotropic state increase.

Conclusions. The heart autoregulation system maintains the LV efficiency close to the maximum in all the physiologically reasonable afterload ranges. The shortening deactivation affects the ESPVR with the afterload change, which, however, cannot be considered as the LV contractility changes. The latter takes place according to the homeometric autoregulation scheme.

Keywords: сardiovascular system, shortening deactivation, heart autoregulation, mathematical modeling.

Objective. Retrospective influence of concomitant AH on the clinical course and the nearest outcomes of acute Q-wave myocardial infarction (Q-AMI) and cardiohemodynamics in such patients in widespread use of modern methods with proved efficacy in comparison with earlier period was evaluated.

Materials and methods. The retrospective analysis of medical cards in two patients' cohorts with Q-AMI was conducted. All of them were treated in Central Kiev Clinic Hospital in January—December 1986 (period I, n=636) and in January—December 1998 (period II, n=885). The mean age was 66,5±3,2 and 68,3±3,9, respectively (p>0,05). ACE inhibitors and β-blockers were used more frequently in the II period in comparison with the I (by 6,4 and 2,2 times, respectively, p<0,01), thrombolysis (by 70,1 times, p<0,01) and heparin (by 26,2 %, p<0,01) as well. The use of calcium channel blockers decreased (by 71,3 %, p<0,01). Dopmin and dobutamin were more and digoxin less frequent in acute left ventricle failure (ALVF). The significant deficiency is inadequate use of thrombolysis (9,2 % during period II and 1,3 % — period I). It is connected with economical problems and reflects the situation with thrombolysis in Ukraine. Concomitant AH was registered in 271 patients in the period I (42,6 %) and in 324 patients in the period II (36,6 %, p>0,05). The generally accepted echocardiographic left ventricle systolic function data were included into the examination (II period).

Results. Patients in both periods with or without AH were at the same age. But there was the predominance of women and patients with diabetes mellitus type 2 in both periods in AH group (I — 20,2 % and 12,4 %; II — 20,1 % and 16,2 %, respectively, p<0,05). Probability of anterior-posterior Q-AMI was higher during the II period in comparison with the I among the AH group (24,1 % and 13,8 %, <0,05). II class ALVF was more frequent in hypertensive patients as peculiarity of MI vs non-hypertensive ones in both periods (I — 30,9 % and 24,7 %; II — 32,4 % and 27,8 %, p<0,05). Other serious complications (cardiogenic shock, arrhythmia and block) were the same in both periods. The incidence of re-MI decreased in hypertensive patients (4,6 % vs 9,7 %, p<0,05). In-hospital mortality during the I period was higher in patients with AH in contrast to non-AH ones (25,7 % vs 19,8 %, p<0,05). It decreased by 21,0 % (p<0,05) in the II period. All survivers and non-survivers of the II period with or without AH had the same levels of the LV ejection fraction (EF) — 50,2±2,3 % and 48,7±0,8 %, p>0,05; 42,6±1,8 % and 38,6±1,2 %, p>0,05, respectively. Patients with AH had the increased right ventricle (RV) diameter (28,0±1,0 mm and 18,0±1,0 mm, p<0,05, respectively, for survivers; 29,0±1,0 mm and 20,0±1,0 mm, p<0,05, respectively, for non-survivers).

Conclusions. The increase in use of ACE inhibitors, aspirin, β-blockers, thrombolytics and heparin led to decrease in previously elevated (by 77,0 % vs non-AH patients) in-hospital mortality in Q-AMI (by 14,8 %) to the level of the non-hypertensive ones. In both outcomes of AMI there are the same LV systolic function data (1—3th day), but the RV is dilated in patients with concomitant AH.

Keywords: acute Q-wave myocardial infarction, arterial hypertension, ACE inhibitors.

Objective. To study the main causes of death in patients with postinfarction rupture of ventricular septum (RVS) and to determine the ways of improvement of surgical treatment's results of this complication.

Materials and methods. 31 patients (21 men and 10 women) with acute myocardial infarction (AMI) and RVS were examined. They were treated in cardiological departments of 7 hospitals in Kyiv and other regions of Ukraine from 1997 till 2002, at the age of 43—67 y.o. (mean 49,0 ± 5,3 years). RVS has arisen on 3—12 day from the moment of AMI, (mean 4,8 ± 1,2 day). They were delivered to the Institute of cardiovascular surgery named after N.M.Amosov and surgical treatment was performed in 15 patients (I group); 16 — have died in clinic within the next few days after RVS due to heart failure progressing (II group). Operation was made with use of artificial blood circulation, moderate hypothermia and with cardioplegic myocardial protection. Plastics of RVS defect by a synthetic patch and coronary artery bypass was performed in all patients. Aneurysmography of left ventricular wall was made in 9 cases additionally. Operations were carried out in time from 12 to 120 day from RVS (mean 55,9±31,9 days).

Results. RVS in 15 patients was located in its forward part (forward RVS), in — 16 patients — in back (back RVS) according to AMI localization. The sizes of forward and back RVS defects were practically identical — mean diameter was 2,8±1,4 cm and did not depend on quantity of occlused coronary arteries (p > 0,05). Patients of II group have died in terms from 1 to 28 day of RVS (mean 9,4 ± 7,1). The main cause of their death was acute and congestive heart failure — 14 (87,5 %) patients. Five patients of group I have died (33,3 %). Their operations were performed in 1,5 months period after RVS. In cases when surgical treatment was performed more then 45 days after RVS there was no registered lethal outcomes (p < 0,05). The main cause of lethal outcomes in patients of group I was acute heart failure. Surgical treatment efficiency of RVS in late terms in many respects is connected with the growth of compact fibrous tissue on edges of VS defect and its zones after 1,5—2 months that allows to close defect by patch without the risk of it's break or rupture.

Conclusions. The main cause of patients' with RVS death is acute or congestive heart failure in 87,5 % of cases. For the improvement of surgical treatment's results of such patients it is expedient with the help of active drug therapy of heart failure to aspire to delay the performance of operation before 6 weeks and more after RVS for improvement and proof stabilization of patients' condition and completion of fibrous tissue formation on the edges of defect.

Keywords: acute myocardial infarction, ventricular septum rupture, therapeutical strategy, surgical treatment, results.

Objective. To analyze the nearest results and follow up of surgical correction of the combined mitral-aortic heart diseases in patients with a pericardium obliteration and to define the ways of their improvement.

Materials and methods. 1002 patients with combined rheumatic mitral-aortic defects had estimated surgical treatment in Institute of cardiovascular surgery in 1981—2001, 182 pts. (18,2 %) had the pericardium obliteration (due to adhesive pericarditis — in 97 pts.; after closed mitral commissurotomy — in 84 pts., after aortic valvulotomy in conditions of artificial blood circulation (ABC) — in 1 patient). 149 (82,0 %) patients had IV NYHA class and 33 (18,0 %) — III NYHA class. Double aortic valve replacement was executed in 148 (77,0 %) patients, mitral valve replacement and aortic valvulostomy with decalcination — in 27 (14,1 %) patients, prosthetics aortic valve and mitral comissurotomia — at 6 (3,1 %) patients and both valves valvulosaving procedure — in 1 (0,5 %) patient. The heart was fully separated from adhesions (including left ventricle (LV) posterior wall) — in 66 (36,5 %) patients, in the right ventricle (RV) area and anterior-lateral LV surfaces — in 38 (20,4 %) patients, and only in the right part — in 76 (42,0 %) patients. The separation only above the aorta and cavae veins was made in 2 (1,1 %) patients due to significant density of adhesions. The remote results after 1—14 years (mean 7,8±1,2 years) were analyzed in 92 patients.

Results. Surgical mortality (before 30 days after operation) was 39,0 % (71 patients). Improvement of surgical operations and their technologies (combined cardioplegia, double-leaf artificial prosthesis) has allowed (from 01.01.1995 to 01.09.2001) to decrease consecutively hospital mortality up to 6,9 % (2 patients) among 35 operated patients. In-hospital mortality was decreased in patients, cardiolysis to whom was performed for both right and left heart (31,7 %) in comparison with separated right part only — 49,2 % (p<0,05). The good follow up result of operation was marked in 57 (61,9 %) patients, satisfactory — in 19 (20,7 %), unsatisfactory — in 5 (5,4 %). 11 (12,0 %) patients had died. The cause of death at 6 out of 9 patients was progressive heart failure.

Conclusions. The surgical treatment is expedient to carry out in patients with less expressed functional disturbances (at III or even II NYHA class), especially in concomitant adhesive pericarditis for improvement of the nearest and delayed results. Full cardiolysis of the relaxed heart had to be carry out, providing more full cooling of all myocardial surface by retrograde submission of the cardioplegic solution.

Keywords: artificial blood circulation, surgical correction of combined mitral-aortic diseases, adhesive pericarditis, pericardium obliteration, surgical treatment.

Objective. To study the abilities of echocardiography (ECHO) in the diagnosis of infectious endocarditis (IE), estimation of infectious process localization and evaluation of hemodynamic disturbances'level for determination of indications to operative treatment.

Materials and methods. Examination and surgical treatment were performed in 453 patients with IE. Preoperative diagnostics and estimation of indications for surgical treatment were based on ECHO (transthoracic one- and two-dimentional, continuous doppler examination, color doppler mapping, in unclear situations — transesophageal) at which signs of IE were determined, and the degree of hemodynamic disturbances was defined. Diagnosis was proved during the operation.

Results. Aortic valve was involved more often in IE (62,7 %), mitral valve (19,6 %) and aortic valve together with mitral valve (12,2 %); less often — tricuspid valve (5,1 %) and pulmonary artery valve (0,4 %). The main IE criteria — vegetations were detected by preoperative transthoracic (93,2 %) and transesophageal (99,2%) ultrasound examination. Intracardiac abscess before operation was determined by ECHO only in 18 (25 %) patients from 72 (16 %) cases. Rupture of atrioventricular valves chords and their prolapse were determined in all patients, however, we concluded this sign as IE criteria, only together with clinical features. Leaflets' perforation at IE was seldom (n=8; 1,8 %) and was located as funnel-shaped leaflet defect, which protruded in a chamber with lower pressure. Destruction of valves caused their insufficiency, and it's degree was determined by doppler- ECHO and color doppler mapping.

Conclusions. Transthoracic ECHO is the basic method of preoperative IE diagnostics. The main indications for operative treatment are determined on data ECHO. For revealing small vegetations, intracardiac abscesses, fistulas and perforations of the leaflets it is necessary to apply transesophageal ECHO more widely. Analyzing ECHO picture of vegetations and other signs of IE (leaflets' and subvalve structures' destruction, ruptures of atrioventricular valves chords, leaflets perforation, intracardiac abscesses, fistulas) it is possible to make conclusion about duration of disease.

Keywords: infectious endocarditis, echocardiography, vegetations, intracardiac abscess, fistulas, perforation of the leaflet, rupture of the chords.

Objective. To evaluate the serum Angiotensine-converting enzyme (ACE) activity in patients with metabolic syndrome (MS) in comparison with clinical peculiarities and expression of metabolic disturbances.

Materials and methods. 94 pts. with MS were observed. Mean age 54±1,5 years. Control group consisted of the patients with arterial hypertension and obesity. Arterial blood pressure (BP), ECG, EchoCG, antropometric examination were performed for 24-hours in all patients. The level of cholesterine, triglyceride, high density lypoproteids were determined in patient's serum. The level of immuneresistant insulin and glucose were determined on en empty stomach and in 120 min. after glucose load. ACE activity in blood serum was evaluated by spectrophotometry.

Results. The level of ACE was reliably higher (38,2±2,4 mkmol × min-1 × l-1, p<0,001) in observed patients in comparison with control group (20,52±1,9 mkmol × min-1 × l-1) and healthy people (18,1±1,6 mkmol × min-1 × l-1). Reliably increasing ACE activity (p<0,001) was found out in patients with MS and high BP (II degree of BP — up to 1,4 times higher, III degree — 1,6 times higher in comparison with I degree, p<0,001). The highest ACE activity was marked in patients with high BP (50,3±4,6 mkmol × min-1 × l-1) in comparison with "dippers" (32,62±4,6 mkmol × min-1 × l-1) and "non-dippers" (33,7±2,4 mkmol × min-1 × l-1) (p<0,01). Patients with MS and LV hypertrophy (LVH) had 26% (p<0,5) higher ACE activity vs. patients with LVH absence. Higher (p<0,05) ACE activity was found out in patients with MS and disturb glucose tolerance vs. patients with diabetes mellitus type 2 (42,5±4,0 mkmol x × min-1 × l-1 and 33,1±1,3 mkmol × min-1 × l-1, respectively). In patients with MS and stabile angina pectoris of IV—III functional class ACE activity was up to 116,5% (p<0,05) and 94,4% (p<0,01) respectively higher in comparison with patients with stabile angina pectoris of I functional class.

Conclusions. ACE activity in patients with MS depended on the BP level, duration of BP elevation, peculiarities of 24-hour monitoring BP, expression of LVH, accompanied stabile angina pectoris and expression of carbohydrate metabolism disturbances.

Keywords: metabolic syndrome X, arterial hypertension, Angiotensin converting enzyme, renine-angiotenzine-aldosterone system.

Objective. To study the influence of Q use in acute MI on patient's survival and functional condition of myocardium during the first year after MI.

Materials and methods. 110 patients (99 men, 52,2+9,1 y.o.) after first uncomplicated (63 % anterior) MI in 3, 6 and 12 months after MI were examined. 30 patients (group I) received Q in addition to the basic therapy (β-blockers, nitrates, ACE inhibitors, aspirin, heparin) during 5 days at special scheme. 80 patients treated with the basic therapy served as control group (group II). Groups had comparable sex, age and MI localization. Almost all patients of both groups were treated with β-blockers and ACE inhibitors in tolerated doses during the period of observation. The main tasks of functional investigations were evaluation of left ventricle (LV) systolic and diastolic functions, determination of residual myocardial ischemia and electrical instability of myocardium, evaluation of vegetative balance.

Results. During follow-up 3 (10,0 %) patients died in group I (Q) and 9 (11,3 %) in group II (control). 5 (16,6 %) cases of nonfatal re-MI in group I and 17 (21,2 %) in group II; 5 (16,6 %) and 32 (40,0 %) cases of stable angina pectoris, respectively. 4 (13,3 %) hospitalizations due to congestive heart failure in group I and 27 (33,7 %) in control group were noticed. Data validity was established only for the patients with angina pectoris (p<0,05). According to the small amount of sampling in the investigation, serious cardiac events (SCE) (death, nonfatal re-MI, hospitalization due to heart failure). There were 12 SCE in group I and 53 in group II (p<0,05). 12-month survival without SCE was higher in Q group (p<0,05). According to the data of ECHO, exercise tolerance test (ETT), 24-hours ECG monitoring, heart rate variability (HRV) analysis during follow-up we found positive influence of Q on the post-infarction remodeling and diastolic LV function, decreasing of electrical instability of myocardium. Patients of Q group had better ETT and vegetative balance in late PP.

Conclusions. The use of Q during the first 5 days of MI facilitates the decrease in angina pectoris and SCE probability. The use of Q has positive effect on LV systolic and diastolic functions and level of sympathoadrenal activation, improves working capacity and decreases electrical instability of myocardium. This effect was independent from basic treatment (β-blockers, ACE inhibitors) and revealed itself in late PP.

Keywords: quercetin, post-infarction period, functional condition of myocardium.

Objective. To carry out the analysis of the surgical treatment results, in patients with abdominal aortic aneurysm and concomitant atherosclerosis of coronary, carotid, renal, mesenteric, arteries of the lower extremities and serious concomitant diseases.

Materials and methods. Over the period from 1993 up to 2002, 203 patients with abdominal aortic aneurysm (AAA) undergone the surgical treatment including urgent manner. 83 patients (40,9 %) suffered from complicated AAA with rupture. The ratio of men to women was 5:1, mean age was 64 years old. Concomitant atherosclerotic lesions of internal carotid artery (ICA) were detected in 64 (32,0 %) patients, lesions of renal arteries — in 4, mesenteric — in 4 patients.

Results. Mortality during surgical treatment of uncomplicated AAA was 10,0 % (12 patients). The couse of death at first hours after operation was acute heart failure (5 patients). Later they had died because of renal or multiple organ failure (3 patients), myocardial infarction (2 patients), stroke (2 patients). Mortality among patients operated due to AAA rupture was 39,8 % (33 patients). The causes of death included acute cardiovascular failure (16 patients), pulmonary failure (6 patients), renal failure (5 patients), mesenteric ischaemia (2 patients), coagulopathy (4 patients).

Conclusions. Opportune diagnostics of concomitant atherosclerotic lesions of other vessels and serious heart (28,1 %), brain (15,8 %), kidneys (2,0 %) diseases and their active treatment before operation allows to perform AAA surgery widely, including old age patients, with good results. Surgical mortality in surgically treated patients with uncomplicated AAA was 10,0 %, in elderly — 10, 0 %. Use of autoblood and "Haemonetics Cell Saver" for collection and blood reinfusion in 55 (27,1 %) patients with AAA substantially helps to solve the problem of blood replacement and to avoid posttransfusion complications. Performing the one-stage operation due to AAA and stenotic lesions of extracranial, renal, mesenteric vessels leads to better postoperative outcomes. Surgical mortality in such patients is 8,3 %.

Keywords: abdominal aortic aneurysm, autoblood, blood reinfusion.

One of the reasons of unsatisfactory results of surgical treatment in patients with multifocal and bilaterial occlusive-stenotic injury of the ilio-femoral arteries is the presence of undiagnosed iliac stenosis.

Objective. To define the ultrasound diagnostic criteria of the iliac artery stenosis degree.

Materials and methods. 58 men (43—69 y.o.) were examined by colour duplex scanning ("Ultramark-9" and HDI-5000, ATL, USA). The degree of iliac stenosis was determined by contrast X-ray angiography by S. Seldinger ("Tridoros-5S", Siemens). Group I consisted of 8 patients with <20% stenosis, II — 15 patients with 20—49 % stenosis, III — 17 with 50—75 % stenosis, IV — 18 with 75 % stenosis. Such data as peak flow systolic velocity (PFSV) in stenotic area; PFSV in stenotic area (PFSV₁) to PFSV in poststenotic area (PFSV₂) ratio; end-diastolic flow velocity (EDFV) in poststenotic zone; early diastolic retrograde flow were analized.

Results. Complex evaluation of obtained data gave an opportunity to choose the following criteria of iliac artery segments' stenosis: <20% stenosis — narrowing of iliac artery with the elevation of flow velocity, PFSV₁/PFSV₂ ratio 1,5±0,1; absence of positive diastolic phase and presence of reverse early diastolic flow (EDF); 20—49% stenosis — PFSV 1,88±0,36 m/s and/or PFSV₁/PFSV₂ ratio 2,0±0,2; 50—75% stenosis — PFSV 2,37±0,31 m/s, PFSV1/PFSV2 ratio 2,5±0,1, EDF 0,22±0,06 m/s; >75% stenosis — PFSV 3,66±0,43 m/s, PFSV₁/PFSV₂ ratio 5,0±0,25, EDF 0,38±0,08 m/s. Presence of positive diastolic phase and absence of post-stenotic reverse wave confirms the >50% stenosis.

Conclusions. Ultrasound diagnostic criteria defined by us gave an opportunity to reveal iliac artery stenosis 20—75 % and more by measuring of PFSV, PFSV₁/PFSV₂, and EDF.

Keywords: iliac artery, stenosis, colour duplex scanning.

Objective. To estimate the heart rate variability (HRV) and its correlation with left ventricule (LV) systolic and diastolic function in patients with chronic ischemic heart disease (IHD) with initial heart failure with LV ejection fraction (EF) above 45 %.

Materials and methods. 48 pts. with heart failure of I—II NYHA grades, relaxation type of LV diastolic dysfunction and LVEF>45 % by 24-hours Holter ECG monitoring with the following temporary and frequency analyzes of VHP and doplerechocardiography with estimating of systolic and diastolic LV function parameters were examined. Investigation was performed before initiating the medical treatment. Results were analyzed by variative statistics methods, correlation between intracardiac hemodynamics data and HRV was analyzed by correlative analysis. For evaluation of nonrandom character of established dependencies dispersive analysis was performed.

Results: Patients with initial heart failure with LVEF>45 % had predominant activity of sympathic vegetative nervous. It was latent in 25 % of cases due to increased influence of parasympathic part (the increase of high-frequency (HF) and low-frequency (LF) components of HRV). The activation of sympathic nervous system in patients with decreased HRV (by SDNN index — standard deviation of RR intervals) correlated with left atrium (LA) dilation and ventricular septum thickening (r=-0,47 and r=-0,38, respectively, p<0,05). The correlation between LF variation with LVEF and peak blood flow velocity in LV ejection tract (r=0,58 and r=0,56, p<0,01) in patients with preserved HRV was fined out. Correlation between SDNN and LV stiffness by enddiastolic pressure/ end-diastolic volume index r=G0,45, p<0,05) were established too.

Conclusions. The sympaticotonia is common in patients with chronic IHD with initial heart failure of I—II NYHA grades with LVEF>45 %. It is latent in 25 % of cases and is confirmed by simultaneous variation of HF and LF common capacity spectrum, probably, connected with accented antagonism of involuntary nervous system. The expression of latent activation of sympathic nervous system in patients with unchanged or increased HRV (according to the temporary analyzes) correlates with increased LV systolic function. The expression of its manifest activation, that is accompanied with decreased HRV, has direct dependence with increasing of LA diameter and LV myocardial thickening and is associated, perhaps, with LV diastolic dysfunction.

Keywords: initial heart failure, heart rate variability, systolic and diastolic left ventricular dysfunction.

The problem of right ventricle (RV) morpho-functional condition determination in cardiovascular pathology is one of the less investigated fields of cardiology. It is caused by many objective methodical and methodological difficulties. Methods of evaluation with the use of different investigational data are systematized in presented article. Positive and negative aspects of stereometric RV models are assessed, author's RV stereometric model is described. Methods of calculation based on the reach clinical material elaborated by authors are represented. They characterize the RV structural and functional condition by MRGimage results and echocardiography. Normal values are represented too.

Keywords: right ventricle, morphoGfunctional condition determination, magnetic-resonance image, echocardiography.