[THE COMPARATIVE CHARACTERISTIC OF KAOLIN-ACTIVATED THROMBOELASTOGRAPHY IN HEALTHY NEWBORNS AND NEWBORNS WITH HEART AILMENTS].

The study was carried out to diferentiate reference values for kaolin-activated thromboelastography in newborns with congenital heart disease. The study included two groups ofpatients. The first one consisted of 62 newborns with congenital heart disease and the second one consisted of 35 healthy newborns. The results of kaolin-activated thromboelastography implemented in groups are evaluated as condition of normal coagulation. The valuable diferences of homeostasis system in healthy newborns and newborns with congenital heart disease (without severe concomitant pathology) are not established. They have similar indicators of kaolin-activated thromboelastography. The derived results can be applied as standards in full-term newborns with congenital heart disease.

Study of Cytokine Profile of Cultured "Early" and "Late" Endothelial Progenitor Cells in Peripheral Blood of Chronic Heart Failure Patients after Mobilization Course with Granulocyte Colony-Stimulating Factor.

The effect of cell culturing protocol with various adhesion proteins and different culture time on the profile of cytokine and growth factors produced by endothelial progenitor cells harvested after mobilization with granulocyte colony-stimulating factor was examined in patients with chronic heart failure. The endothelial progenitor cells cultured on fibronectin or gelatin produced a broad and overall similar spectrum of cytokines and growth factors, the levels of which depended on the culture time. On culture day 16, the cells grown on fibronectin diminished the production of cytokines and growth factors (IL-10, IL-18, IL-8, erythropoietin, and VEGF), while the cells grown on gelatin down-regulated the synthesis of TNF-α, IL-8, and erythropoietin, although they up-regulated the production of IL-10, IL-18, and VEGF.

Oxygen provision of the brain at various stages of operation in patients with chronic pulmonary artery thromboembolism.

The authors studied cerebral oxygen supply by means of cerebral oximetry in patients presenting with chronic pulmonary artery thromboembolism (PATE) at various stages of operation. The study was aimed at assessing cerebral oxygen supply while carrying out surgical treatment in patients with chronic PATE on the background of various methods of perfusion. Thromboendarterectomy (TEA) from the pulmonary artery with the use of circulatory arrest and craniocerebral hypothermia is accompanied by more pronounced impairment of oxygen supply of the brain with a decrease in the cerebral oxygenation indices by more than 30% from the baseline values. These alterations promote increased risk for the development of neurological complications in the early postoperative period. Using the technique of antegrade cerebral perfusion ensures a minimum decrease of cerebral oxygenation during TEA and contributes to a reduction of the risk for the development of neurological complications.

[Cerebral oxygen supply in patients with chronic pulmonary artery embolism].

Aim of this study was to assess brain oxygen supply in patients with chronic pulmonary embolism (CPE) for elucidation of factors of risk of neurological complications in early postoperative period. We examined 34 patients with diagnosis of CPE. Mean duration of the disease was 3 (1.4-4.2) years. Data on baseline cerebral oxygenation, monitoring of brain oxygen during various stages of surgery, and level of cerebral oxygen supply in immediate postoperative period are presented. More than 40% lowering from initial values of parameters of cerebral oxygenation during circulatory arrest substantially increases risk of development of neurological complications in early postoperative period.

[Peripheral microcirculation in patients with lower-limb atherosclerosis on the background of metabolic syndrome].

The authors studied the peripheral microcirculatory blood flow (MCBF) by means of laser Doppler flowmetry in a total of 112 patients presenting with stage IIB-IV lower limb chronic ischaemia (LLCI) on the background of metabolic syndrome (MS). The study was aimed at assessing the state of the peripheral MCBF in LLCI patients on the background of MS. Atherosclerotic lesion of lower-limb vessels on the background of MS is characterised by more pronounced impairments of the functional state of microcirculation in the form of a decrease in the reserve of capillary blood flow during the occlusion test both before and in the early period after revascularization. Patients with LLCI combined with MS were found to have more pronounced alterations in sympathetic regulation and reactivity of the microcirculatory bed in the form of the paradoxical reaction of the blood flow during the breath-holding test.

[The mithral valve replacement with biological prostheses: early and long-term results].

442 patients underwent the mitral valve replacement (MVR) with KemCor and PeriCor stented bioprostheses. The study results justified the preference of the "totally biological" PeriCor valve in patients with active infectious endocarditis. The longest follow-up period was 11 years, the mean follow-up was 51±34 months. The risk of the structural valve disfunction was shown to be inversely proportional to the age (p=0.03). 38% of the operated women younger the 45, developed the structural valve disfunction in 79±27 months after surgery. Thus, MVR with stented bioprostheses proved to be clinically efficient early after the operation. Predictability of the results of KemCor and PeriCor valve implantation allows the theoretically substantiated approach to the rehabilitation, especially, considering the adverse event rate in different patient groups at certain follow-up periods.

[Oxygen supply to the brain in chronic disturbances of cerebral circulation in patients with pathology of brachiocephalic arteries].

We assessed objective parameters of cerebral oxygen supply in 469 patients with multifocal atherosclerosis, hemodynamically significant lesions in brachiocephalic arteries in dependence on degree of severity of vascular cerebral insufficiency according to A.V. Pokrovsky classification of chronic disturbances of cerebral circulation. Comparison of clinical classification with parameters of cerebral oximetry and level of cerebral tolerance to hypoxia allowed to characterize pathophysiological mechanisms of cerebral oxygen metabolism, what was important for determination of risk of surgical treatment and postoperative prognosis.

[Cardiorespiratory abnormalities and cerebral oxygen supply in chronic thromboembolic pulmonary hypertension].

Aim of the study was assessment of severity of cardiorespiratory abnormalities and cerebral oxygen supply in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We examined 56 patients with diagnosis of chronic pulmonary thromboembolism and duration of the disease 3 (1.5-4.1) years. According to data of pulmonary angiography pulmonary artery pressure was 78 (58-92) mm Hg, pulmonary vascular resistance - 618 (450-935) dyne/sec/cm-5, Miller index - 25 (22-27). Further investigation revealed changes of anatomo-functional parameters of the heart and parameters of pulmonary ventilation. These changes were associated with insufficient oxygen supply to the brain and lowering of tolerance to hypoxia. Results of this study should be taken into consideration when brain protective measures are provided during surgical treatment of CTEPH.

[Age and sexual changes structure of genes cytokines networks in Russian population].

OBJECTIVE: To study frequencies of occurrence of the combined genetic attributes including different variants of cytokines genotypes (TNFA, IL1B, IL4, IL6, IL10, VEGF), in different on sexual and age groups in population of Siberia Caucasoid. MATERIAL AND METHODS: Frequencies of distribution of variants of structure genes cytokines networks among 500 representatives of Siberia Caucasian population, men and women of two age groups--more younger than 35 years ("young") and 55 and more years ("elderly") are investigated. In structure of investigated genes cytokines net has come 10 variants of polymorphic sites of cytokines genes and vascular endothelial growth factor gene: TNFA-863 C --> A, TNFA-308 G --> A, TNFA-238 G --> A, IL1B-31 C --> T, IL4-590 C --> T, IL6-174 G --> C, IL10-1082 G --> A, IL10-592 A --> C, VEGF-2578 C --> A and VEGF+936 C --> T. Genotyping are carried out by restriction fragment length polymorphism method. Processing of results carried out on the basis of the original methodological approach including the complex connected computer analysis of genic circuits of various dimension. RESULTS AND CONCLUSIONS: It is shown, that the significant part of variants genes cytokines networks, which widely distributed among young people is completely absent in the "elderly" age group. Such variants disappearing with age separately for men and women are established. At the program mathematical analysis it is established, that parameters of the odds ratio achieve two-place sizes (OR = 27, p = 0,0004), that testifies to high specificity of complex genetic attributes. Presence in genome such variants of genes cytokines networks, found out in the childhood or young age, as supposed, is unfavorable personalized prognostic factors of life span of the individual.

[The study of microcirculation in walls of chambers of the heart in patients with aortic stenosis in dependence on heart failure stage].

We studied microcirculatory blood flow (MBF) by laser Doppler flowmetry (LDF) in 52 patients with stage III-IV aortic stenosis (AS) and class II-IV chronic heart failure (CHF). MBF was assessed in walls of right and left cardiac chambers before and after correction of the defect. Aim of this study was to assess functional state of MBF in walls of different chambers of the heart before and after defect correction in patients with AS at various stages of CHF. We distinguished 2 groups of patients: group 1 with class II CHF, group 2 with class III-IV CHF. In group 2 compared with group 1 before and after AS correction of AS we found the lowest level of MBF in walls of left cardiac chambers and right atrium and highest parameters of the left ventricular and atrial function according to echocardiography data. Progression of anatomic-functional changes of left ventricle at the background of AS and development of CHF is characterized by lowering of MBF volume velocity in walls of left cardiac chambers.

Stimulation of angiogenesis in rat ischemic limb by intramuscular implantation of mononuclear fraction cells from autologous bone marrow.

We studied angiogenic effects of two variants of indirect revascularization (transplantation of mononuclear fraction cells from autologous bone marrow alone or in combination with laser tunneling) after modeled ischemia of the lower limbs in rats. Doppler sonography and immunofluorescence studies showed that intramuscular implantation of isolated fraction of autologous bone marrow mononuclear cells in combination with laser tunneling of the muscles is most effective and can be recommended as a method of angiogenesis stimulation in non-reconstructable distal vascular pathology of the extremities.

Morphological and molecular analysis of angiogenesis after intramyocardial transplantation of autologous bone marrow mononuclear cells.

We studied the peculiarities of angiogenesis in the postinfarction period after transmyocardial laser revascularization and intramyocardial implantation of mononuclear bone marrow cells into the pericicatrical zone of the left ventricular myocardium in dogs. Morphological manifestation of angiogenesis in the myocardium after application of laser and cell technologies are angiomatosis, formation of large thin-wall vessels and sinusoids. The angiogenic effect of implanted mononuclear bone marrow cells is determined by high content (43-47%) of CD31+ cells in both adherent and nonadherent fractions. More pronounced angiogenic potential of nonadherent cells is determined by intensive expression of cytokine VEGF-B and D mRNA essential for arterial vessels growth. Immunohistochemical studies showed that about 90% cells of the nonadherent fraction are endothelial precursors expressing endothelial cell markers isolectin B4 and VEGF-R2. It was found that the use of adherent mononuclear bone marrow cells during the postinfarction period induces ossification of the epicardium and subepicardial myocardium layer, formation of cartilage plates, and focal calcification. Implantation of nonadherent mononuclear bone marrow cells into transmyocardial laser channels did not induce ectopic ossification of the myocardium.

Angiomatosis and ectopic ossification in the dog myocardium after intramyocardial implantation of autologous bone marrow mononuclears in experimental coronary disease.

Disseminated ossification of the myocardium and severe angiomatosis were detected in sites of implantation of unseparated bone marrow mononuclear fraction cells in dogs with experimental chronic coronary disease. Minor immunocytochemical differences in cells of the mononuclear fraction adhering and not adhering to plastic were found. Significant differences in the expression of mRNA of chondro-osteogenesis genes (aggrecan, lumican, and osteopontin) in adherent and nonadherent cells were detected. The expression of aggrecan gene mRNA was 3-fold lower, of lumican gene 6-fold, and of osteopontin gene 11-fold lower in nonadherent cells compared to adherent fraction.

Cardiomyocyte regeneration in pericicatricial zone of the myocardium after laser tunneling and implantation of bone marrow mononuclear cells.

Using canine model of chronic postinfarction myocardial ischemia we evaluated angiogenesis and cardiomyogenesis after combined revascularization by laser tunneling of the pericicatricial zone followed by implantation of bone marrow mononuclear cells into the channels. It was shown that the numerical density of arterioles and capillaries considerably increased 1 month after revascularization. We also observed a considerable increase in the density of cardiomyocyte nuclei in the test area, a 2-fold increase in the total area of nuclei, and an increase in the mean area of cardiomyocyte nuclei. The number of PNCA-positive cardiomyocytes significantly increased after combined revascularization. Our findings suggest that combined revascularization of the pericicatricial zone of the myocardium promoted angiogenesis and stimulates regeneration of cardiomyocytes.

[Clinical assessment of immediate results of various methods of myocardial revascularization in ischemic heart disease patients with isolated anterior descending coronary artery disease]. / Klinicheskaia otsenka neposredstvennykh rezul'tatov razlichnykh metodov revaskuliarizatsii miokarda u bol'nykh ishemicheskoi bolezn'iu serdtsa s izolirovannym porazheniem perednei niskhodiashchei arterii.

Open heart coronary artery bypass grafting (CABG), minimally invasive coronary artery surgery, transluminal balloon coronary angioplasty (TBCA) and coronary stenting were carried out in 25, 35, 12 and 38 patients with isolated anterior descending coronary artery disease, respectively. In immediate period after procedures there were 2 deaths (among patients subjected to open heart CABG and TBCA) and 2 nonfatal myocardial infarctions (among patients treated with TBCA and stenting). In 2 patients repeat interventions were performed during initial hospitalization (in 1 after TBCA and in 1 after stenting). Exercise tolerance increased by 40+/-8, 44+/-7, 45+/-8, 53+/-9 W in patients treated with open heart CABG, minimally invasive surgery, TBCA and stenting, respectively. Thus surgical and endovascular methods of treatment of patients with isolated anterior descending coronary artery lesions produced beneficial clinical effect and were associated with relatively low rate of postoperative complications.

[Endovascular treatment of subclavian arterial aneurysm using stent graft]. / Lecheniia anevrizmy podkliuchichnoi arterii s pomoshch'iu stent-grafta.

The authors describe a clinical case of successful endovascular treatment of subclavian arterial pseudoaneurysm using the stent graft JOSTENT-GRAFT 48 mm in length and 6 mm in diameter in a 49-year-old patient. The aneurysm developed over a length of 2 years as a result of polytrauma without remarkable circulatory disorders in the distal arterial bed of the upper extremity. Further existence of aneurysm was conjugated with a risk of ischemic or neurologic complications. This observation demonstrates the current potential of roentgenoendovascular surgery allowing to successfully replace the technically difficult and traumatic surgical intervention in the event of formation of pseudoaneurysms by the pulsatory hematoma type.

[Effectiveness of plasmapheresis and its modifications in the treatment of cardiosurgical patients]. / Effektivnost' plazmafereza i ego modifikatsii v lechenii kardiokhirurgicheskikh bol'nykh.

The efficiency of plasmapheresis in the treatment of infectious complications and multiple organ dysfunctions was evaluated in 66 patients after heart surgery. Early plasmapheresis attenuated the cytokine-related systemic inflammatory response and organ damage. The optimal use of plasmapheresis modifications (membrane plasma filtration, plasma carboperfusion, cryoapheresis) improved the clinical outcomes.