The purpose – to examine markers of cellular and humoral immunity compared with the dynamics of dilatation and systolic left ventricular function in patients with acute diffuse myocarditis according to the results of one year follow-up.

Materials and methods.We examined 38 patients with acute diffuse myocarditis (25 men and 13 women) at 1, 6 and 12 months of onset. In all patients we studied venous peripheral blood with detection of the number of lymphocytes with antigenic determinants of CD8+ (cytotoxic T cells), CD16+ (T killer cells), CD19+ (B lymphocytes) and the expected value of titers of antibodies to myocardium. The intensity of the proliferative response of lymphocytes to the specific antigen of myocardial tissue was evaluated by the reaction of blast-cell transformation of lymphocytes. Additionally, the levels of cytokines were determined in the supernatants of mononuclear cells: tumor necrosis factor α, interleukin-1β, interleukin-10 and interferon-γ. Echocardiography was performed with the assessment of the indexes of LV end-diastolic and end-systolic volume, LV ejection fraction. Cardiothoracic index was measured by chest roentgen.

Results and discussion. The concentrations of proinflammatory cytokines at 1 and 6 months from the onset of acute diffuse myocarditis were as follows: for interleukin-1β – (156.8 ± 16.3) and (91.8 ± 13.4) pg/ml (p < 0.05), respectively, for tumor necrosis factor α – (214.2 ± 28.1) and (163.3 ± 20.1) pg/ml (p < 0.05), respectively, the content of CD8+, CD16+ at 1 and 6 months of onset – (0.66 ± 0.04) and (0.56 ± 0.04) 109/l (p < 0.05), respectively, and (0.34 ± 0.02) and (0.27 ± 0.02) 109/l (p < 0.01), respectively, the activity of blast-cell transformation reaction of lymphocytes – (6.9 ± 0.52) and (4.9 ± 0.51) % (p < 0.01), respectively, the ejection fraction of left ventricle in the 1st month of onset compared with the 6th month – (32.3 ± 2.7) and (39.2 ± 2.8) % (p < 0.05), respectively, the value of end-diastolic volume index in the 1st month versus the 12th month – (116.2 ± 9.8) and (90.2 ± 9.6) ml/m2 (p < 0.05), respectively. After 6 months from the onset of acute diffuse myocarditis, median titer of antibodies to attack and content of CD19+ compared with the 1st month raised – (15.6 ± 1.5) and (20.6 ± 1.7) conv. units. (p < 0.05) vs. (0.17 ± 0.01) and (0.22 ± 0.01) 109/l (p < 0.05), respectively. We identified the direct correlation between the value of LV end-diastolic volume index measured after 12 months of observation and the levels of interleukin-1β (r = 0.43; p < 0.05), tumor necrosis factor α (r = 0.43; p < 0.05), interferon-γ (r = 0.36; p < 0.05) and titer of antibodies to attack (r = 0.39; p < 0.05) in the first month of the disease, while for the anti-inflammatory interleukin-10 this correlation had an opposite direction (r = –0.46; p < 0.05). We observed an inverse correlation between left ventricular ejection fraction and concentration of interleukin-1β (r = –0.56; p < 0.05), tumor necrosis factor α (r = –0.62; p < 0.01) and activity of blast-cell transformation of lymphocyte reaction (r = –0.76; p < 0.01) and a direct relationship with the concentration of interleukin-10 (r = 0.64; p < 0.01).

Conclusions. Acute diffuse myocarditis accompanied by early dilatation and left ventricular systolic dysfunction is characterized by distinct activation of systemic immunoinflammatory reactions (high concentrations of interleukin-1β, tumor necrosis factor α, interferon-γ) and the reaction of cellular immunity (high content of CD8+, CD16+ and high activity of blast-cell transformation of lymphocyte reaction). Reduced activity of immunoinflammatory responses and cellular immunity occurs after 6 months of debut of diffuse myocarditis, accompanied by activation of humoral immunity (increased frequency of detection of antibody titer to the myocardium and their mean titer, concentration of CD19+), and is associated with increased left ventricular ejection fraction. Indicators of activity of immunoinflammatory response in acute diffuse myocarditis are in direct correlation with the value of left ventricular end-diastolic volume indices and the value of cardiothoracic index; they are in reverse correlation with left ventricular ejection fraction, whereas for the anti-inflammatory cytokine interleukin-10 the correlations have the opposite direction.

Keywords: myocarditis, cellular immunity, cytokines, antimyocardial antibodies, dilatation, systolic dysfunction.

The purpose – to analyze the developed surgical tactics of diagnosis and surgical treatment of pulmonary atresia, ventricular septal defect and major aortopulmonary collateral arteries.

Materials and methods. In the period from 2007 to 2013, 97 consecutive operations were performed in 62 patients with pulmonary atresia and major aortopulmonary collateral arteries. Single-stage approach with one-stage full unifocalization and total repair of the defect was used in 18 (29 %) patients. Other patients underwent multistage operations: in 23 (37 %) patients the first operation was one-stage full unifocalization with the central anastomosis, in 21 (34 %) patients – one-side unifocalization through the right or left lateral thoracotomy or central anastomosis without unifocalization for rehabilitation of hypoplastic central pulmonary arteries.

Results and discussion. Postoperative mortality was 3.1 %. Currently, 35 (56 %) of 62 patients successfully underwent the total repair. In 6 (9.7 %) patients different approaches were used at different stages of treatment. Analysis of the results showed the importance of surgical experience in reducing mortality and complications.

Conclusions. Improved surgical results are possible due to the accumulation of experience in treating this disease, the correct choice of surgical tactics and a combination of different surgical approaches in complex cases.

Keywords: pulmonary atresia, aortopulmonary collateral arteries, unifocalization.

The purpose – to study influence of non-pharmacological and pharmacological therapy on the cardiovascular risk profile and characteristics of surrogate markers of atherosclerosis in women with polycystic ovary syndrome.

Materials and methods. At the first stage of our study 90 women of reproductive age with polycystic ovary syndrome were examined. In 6 months, at the second stage of the study we formed retrospectively three groups for analysis: the 1st group consisted of 36 (40.0 %) women (mean age 29.1 ± 0.9 years) who fulfilled all treatment recommendations; the 2nd group consisted of 20 (22.3 %) women (mean age 29.0 ± 1.2 years) who fulfilled all treatment recommendations and were taking dietary fiber; the 3rd group consisted of 34 (37.7 %) women (mean age 28.2 ± 0.9 years) who did not adhere to treatment recommendations. At the first and second stages of the study in all patients we assessed the anthropometric data, lipid and carbohydrate profile, office systolic and diastolic blood pressure, 24-hour ambulatory blood pressure, estimated intima-media thickness of the common carotid artery and endothelium-dependent flow-mediated vasodilation of the brachial artery.

Results and discussion. After 6 months in the 1st and 2nd groups of women with high adherence to the therapy, there was a significant (p < 0.05) decrease in body weight (of 8.9 % and 10.5 %, respectively), body mass index (of 7.9 % and 13.6 %, respectively) and waist circumference (of 7.0 % and 7.7 %, respectively) compared to baseline. In both groups of women with high adherence to the therapy, there was a decrease in triglyceride levels (by 26.7 % and 37.5 %, respectively), and an increase in low-density lipoprotein cholesterol (by 6.7 % and 15.4 %, respectively) (p < 0.05). In the 2nd group there was a decrease of total cholesterol from (6.0 ± 0.2) to (5.3 ± 0.3) mmol/l and low-density lipoprotein cholesterol from (4.0 ± 0.3) to (3.4 ± 0.2) mmol/l (p < 0.05). Reduction in the level of fasting insulin in serum venous blood – by 25.4 % in the 1st group and by 32.7 % – in the 2nd (p < 0.05) and HOMA index by 30.5 % in the 1st group and by 40.0 % – in the 2nd (p < 0.05) was found. In the first and second groups significant and equally pronounced decline in systolic and diastolic blood pressure was revealed – office, 24-h, daytime and average 24-h heart rate. Flow-mediated dilation of the brachial artery increased from (6.7 ± 0.9) % to (9.2 ± 0.7) % in the 1st group and from (6.9 ± 1.0) % to (10.4 ± 5.5) % – in the 2nd (p < 0.05). Significant change in intima media thickness was not found (all p > 0.05). In the 1st and 2nd groups there was a reduction of the average overall risk by SCORE (43.6 % and 60.6 %, respectively), and DRS (by 26.8 % and 42.1 %, respectively) (p < 0.05) scales, while the risk in the 3rd group with low adherence to treatment increased (p < 0.05).

Conclusions. The results indicate that lifestyle modification and drug treatment in case of hypertension in reproductive-age polycystic ovary syndrome women with high adherence to treatment allowed to reduce the appearance of such cardiovascular risk factors as obesity, lipid metabolism (mainly due to increase in low-density lipoprotein cholesterol by 6.7 % and decrease in triglycerides by 26.7 %), hyperinsulinemia (by 25.4 %), insulin resistance (by 30.5 %), and contributed to the normalization of blood pressure. Adding medicinal dietary fiber («Guarem» 15 mg/day) to the primary therapy is associated with an additional decrease in total cholesterol by 13.4 %, low-density lipoprotein cholesterol by 15.0 %, glucose by 10.4 %. Reduction of cardiovascular risk in young women with polycystic ovary syndrome, especially by nonmedical methods was associated with improved flow-mediated dilation of the brachial artery by 27.2 % in the 1st group and by 33.7 % in 2nd group. Lifestyle modification in women with polycystic ovary syndrome and high adherence to treatment led to significant cardiovascular risk reduction by SCORE scale (43.6 % in 1st group and 60.6 % in 2nd group) and the risk of diabetes development by DRS scale (26.8 % in 1st group and 42.1 % in 2nd group). Poor adherence during 6 months led to 12 % increase of risk by SCORE scale and 21.2 % – by DRS scale.

Keywords: cardiovascular risk, insulin resistance, endothelial vasoregulating function, intima—media thickness, modification.

The purpose – to evaluate the levels of B-natriuretic peptide and galectin-3 in patients with Q-myocardial infarction (MI) of the posterior wall of the left ventricle (LV) with involvement of the right ventricle (RV) in comparison with isolated MI of the posterior wall of the LV and to compare them with the state of diastolic function of the left and right ventricles.

Materials and methods. 156 patients with acute Q-MI of the posterior wall of LV aged (64.45 ± 1.19) years were examined: 66 patients with MI of RV at the background of MI of posterior wall of LV were included in I group; 90 patients with isolated MI of posterior wall of LV composed group II. Doppler echocardiography was performed on 4–5 day of acute MI. Galectin-3 and B-natriuretic peptide levels were determined on 2 day of MI by enzymoimmunoassay using reagents Human Galectin-3 Platinum ELISA and BNP Fragment (Austria).

Results and discussion. Patients with RV MI predominantly had pseudonormal type of diastolic dysfunction of LV and RV (75.7 %), which was associated with marked dilatation of the right atrium and RV (p < 0.05), lower LV and RV contractility (p < 0.05). The levels of galectin-3 (28.38 ± 0.86 ng/ml, p < 0.05) and B-natriuretic peptide (376.3 ± 33.32 fmol/l, p < 0.01) in patients with RV MI were significantly higher than in those of II group. Concentration of galectin-3 (p < 0.05) and B-natriuretic peptide (p < 0.01) with pseudonormal type of diastolic dysfunction of the LV and RV was significantly higher than in patients with a relaxation type of diastolic dysfunction of the right and left ventricles in both groups. The level of galectin-3 in patients with RV MI (p < 0.05) significantly exceeded similar type of dysfunction of LV and RV in MI of PW of LV. With the same disorders of diastole, the level of galectin-3 was significantly higher in patients with RV MI (p < 0.05).

Conclusions. In patients with MI of LV posterior wall and involvement of RV, serum levels of B-natriuretic peptide and galectin-3 were higher on the 2nd day of the disease than in patients with isolated MI of the LV posterior wall who were matched by age, sex, frequency of MI in anamnesis, concomitant pathology, therapy, LV ejection fraction. Irrespective of presence of RV MI in patients with LV MI of posterior localization with preserved LV ejection fraction, the increased serum levels of B-natriuretic peptide and galectin-3 on the 2nd day of the disease corresponds to diastolic impairment of left and right ventricles, aggravation of which in its turn is associated with a decreased LV ejection fraction.

Keywords: galectin-3, B-natriuretic peptide, myocardial infarction, right ventricle, diastolic dysfunction.

The purpose – to study the features of the submicroscopic organization of skeletal muscle myosymplasts in patients with chronic venous insufficiency.

Materials and methods. Changes in submicroscopic architectonics of skeletal muscles of lower limbs in 65 patients with chronic venous insufficiency.

Results and discussion. The results of electron-microscopic study have shown that the ultrastructural organization of myosymplasts has degenerative changes. The mitochondria were exposed to the most severe violations, which indicates mitochondrial dysfunction. These identified changes in the ultrastructure of myosymplasts of skeletal muscles of lower limbs at patients with chronic venous insufficiency indicate the existence of a correlation between the state of ultrastructure of myosymplasts and the degree of venous insufficiency.

Conclusions. The ultrastructural organization of skeletal muscles myosymplasts of the lower limbs in patients with chronic venous insufficiency has disturbances in 65—80 % of cases and these disturbances are more pronounced in patients with chronic venous insufficiency C4—C5. Changes in the submicroscopic architectonics of organelles show a decrease in contractile capacity of myosymplasts. That is the likely reason for the decrease of blood flow in the veins of lower limbs, which is an additional factor contributing to the development of chronic venous insufficiency.

Keywords: ultrastructure of myosymplasts, hypoxia, chronic venous insufficiency, mitochondrial dysfunction.

The purpose – to examine the efficacy and safety of a gene-therapeutic plasmid drug based on gene vegf165 in the complex treatment of patients with stage IIa–III of chronic lower limb ischemia of atherosclerotic genesis.

Materials and methods. 100 patients were enrolled in the clinical trial: 75 persons composed the clinical group, 25 – the control group. The observation period consisted of 6 months under the main protocol, and 6 months of the follow-up monitoring. We registered all cases of adverse and serious adverse events, estimated a pain-free walking distance, transcutaneous oxygen pressure, anklebrachial index, blood flow linear velocity, quality of life; in 30 % of patients X-ray contrast angiography was made.

Results and discussion. The safety of the plasmid gene construction was proved. Its application in the complex treatment of inoperable patients resulted in a statistically significant increase of pain-free walking distance by average of 167.2 %; the best result was obtained in patients with chronic lower limb ischemia of III stage – a gain of 547.5% for the year; the intergroup difference approached significance: p = 0.001 for 6 months and p = 0.004 for 1 year. Also a transcutaneous oxygen pressure increased significantly. Growth of ankle-brachial index and blood flow linear velocity reached statistical significance.

Conclusions. The use of the gene drug appreciably influences the microhemodynamics in the ischemic limb and is clinically effective in patients with chronic lower limb ischemia; it stabilizes clinical condition of patients, causes regression of pathological symptoms and improves quality of life.

Keywords: plasmid DNA, VEGF, therapeutic angiogenesis, chronic lower limb ischemia, gene therapy, clinical trial.

Jatrogenic pseudoaneurysm of ascending aorta is a sparse, but potentially life-threatening complication after cardiac surgery. We present our first experience of transcatheter device occlusion of pseudoaneurysm of ascending aorta which appeared 6 months following mitral valve replacement in a 55 year old woman.

Keywords: рseudoaneurysm of ascending aorta, device occlusion, ASD-occluder.

A 23-year-old woman with moderate hypertension during the last three years was examined to rule out renal artery stenosis. Renal artery duplex scanning and spiral computed tomography revealed saccular aneurysm on the main trunk of the right renal artery. Endovascular exclusion of the aneurysm by implantation of a stent-graft was performed. The immediate result was good. The follow-up CT scan showed that the stent-graft in the renal artery was open ended, the aneurysm was completely excluded from the circulation. The decrease in blood pressure was clinically observed.

Keywords: renal artery aneurysm, endovascular treatment, stent-graft.

In this article we have presented the latest references on the occurrence of the ventricular septal defect resulting from myocardial infarction, different methods of management of these patients according to the severity of their conditions and the period of the postinfarction ventricular septal defect. We have also presented clinical cases of effective closure of ventricular septal defect using transcatheter method in combination with percutaneus transluminal coronary angioplasty.

Keywords: ventricular septal defect, myocardial infarction, occluder.

The article presents data on the epidemiology, etiology, pathogenesis, clinical and laboratory diagnosis and treatment of antiphospholipid syndrome. A case from our own practice is described in details. The specific feature of the case is the difficulty in making a diagnosis of antiphospholipid syndrome which is probably related to a lack of awareness of this pathological condition among physicians of various specialties. In the course of systemic lupus erythematosus, recurrent venous thromboses and thrombosis of the right heart led to recurrent pulmonary embolism and persistent pulmonary hypertension, complicated by the formation of chronic pulmonary heart disease, which was provoked by therapy with hormonal contraceptives and warfarin. The physician should suspect the presence of antiphospholipid syndrome if a patient of young or middle age has had cerebral and cardiovascular events, recurrent venous and/or arterial thromboses, spontaneous abortions, skin necrosis during the reception of anticoagulants, thrombocytopenia, and prolongation of the activated partial tromboplastin time during screening.

Keywords: antiphospholipid syndrome, venous and arterial tromboses, diagnosis, treatment.

The lecture presents morphologic and functional peculiarities of the myocardium in hypertensive disease and describes the mechanisms of myocardial damage with violation of systolic and diastolic function of both the left and the right ventricles. The principles of right ventricular assessment by echocardiography are described in accordance with the latest guidelines of the American and European Societies of Echocardiography. The main indices are presented of the systolic and diastolic right ventricular function which are changed in treatment: reduced trips of a fibrous ring of tricuspid valve, reduced peak systolic velocity of a fibrous ring of tricuspid valve, reduced peak early diastolic velocity, increased isovolumic relaxation time IVRTa on the fibrous ring of tricuspid valve, increased ratio of early and late diastolic velocity. The main principles of definition of these indicators are given. The emphasis is put on the role of MSCT coronary angiography and magnetic resonance imaging of the heart with contrast that allow to rule out other causes of myocardial damage and to determine the optimal treatment. A clinical case is described of myocardial damage caused by hypertension. This case shows that diastolic and systolic ventricular function may be improved at the background of optimal medical therapy.

Keywords: arterial hypertension, hypertensive cardiomyopathy, echocardiography, right ventricle, systolic and diastolic dysfunction.

The review presents an up-to-date analysis of molecular and cellular mechanisms underlying alterations of extracellular matrix and matri-cellular interactions in the dynamics of myocardial infarction. Roles of immune mechanisms, cytokines, growth factors, matricellular proteins in regulation of infarction healing and postinfarction remodeling of non-contractile elements of myocardial tissue are discussed. In particular, data about temporal and spatial distribution of activity of matrix metalloproteinases and their inhibitors are summarized and analyzed. Data about regulation of activity of different cell elements such as macrophages, fibroblasts, granulocytes and lymphocytes of different populations, participating in infarction healing and formation of postinfarction connective tissue scar are presented. Molecular mechanisms underlying dynamic changes of extracellular matrix, cellular composition of infarcted zone, mechanisms of cellular functional activity modulation by intracellular signalling pathways are discussed. Special attention is paid to the role of matricellular proteins – tenascin-С, tenascin-Х, trombospondin-1, trombospondin-2, osteonectin and osteopontin. An important role of different growth factors, with special attention to transforming growth factor b and cardiotrophin, in postinfarction tissue reparation and non-contractile myocardial structures remodelling is discussed.

Keywords: myocardial infarction, cardiac remodeling, extracellular matrix, cytokines, matricellular proteins.

Цель работы — исследовать эффективность и безопасность геннотерапевтического плазмидного препарата на основе гена vegf165 в комплексном лечении пациентов с хронической ишемией нижних конечностей атеросклеротического генеза IIа—ІІІ стадии.

Материалы и методы. В исследовании приняли участие 100 больных: 75 лиц составили клиническую группу, 25 — группу контроля. Срок наблюдения — 6 мес по основному протоколу и 6 мес в процессе отсроченного наблюдения. Регистрировали случаи нежелательных явлений и серьезных нежелательных явлений, оценивали длину дистанции безболевой ходьбы, транскутанное напряжение кислорода, лодыжечно-плечевой индекс, линейную скорость кровотока, у 30 % пациентов выполняли рентгеноконтрастную ангиографию, у всех больных оценивали качество жизни.

Результаты и обсуждение. Установлено, что генная плазмидная конструкция безопасна. Ее применение в составе комплексного лечения у неоперабельных пациентов сопровождается статистически значимым увеличением дистанции безболевой ходьбы в среднем на 167,2 %, лучший результат получен у больных хронической ишемией нижних конечностей ІІІ стадии — прирост 547,5 % за год; различия между группами достигли достоверности: p = 0,001 за 6 мес и р = 0,004 за 1 год. Так же статистически значимо увеличился показатель транскутанного напряжения кислорода. Величины прироста лодыжечноплечевого индекса и линейной скорости кровотока достигли статистической значимости.

Выводы. Генный препарат существенно влияет на микрогемодинамику в ишемизированной конечности и эффективен у больных с хронической ишемией нижних конечностей стабилизирует клиническое состояние пациентов, вызывает регресс патологической симптоматики и улучшает качество жизни.

Keywords: плазмидные ДНК, VEGF, терапевтический ангиогенез, хроническая ишемия нижних конечностей, генная терапия, клиническое исследование.