[Impairment of cognitive functions in patients with chronic thromboembolic pulmonary hypertension before and after surgical treatment]. / Kognitivnye narusheniya u patsientov s khronicheskoi tromboembolicheskoi legochnoi gipertenziei do i posle khirurgicheskogo lecheniya.

OBJECTIVE: To study cognitive functions in patients with chronic thromboembolic pulmonary hypertension (CTEPH) before and in the long-term after pulmonary thromboendarterectomy and to study factors that negatively affect cognitive status. MATERIAL AND METHODS: One hundred and twenty-four patients with CTEPH were examined before and 6 months after surgery with an assessment of cognitive impairment using the Mini-Mental State Examination (MMSE). Multivariate regression analysis was used to identify factors affecting the MMSE indicators before and in the long-term postoperative periods. RESULTS: Initially, patients with CTEPH had a total MMSE score 23.8±1.1. Six months after surgery, the score was 26.1±1.9 (p<0.001). A history of stroke, disability, stress (loss of spouse), and a high Charleson comorbidity index were independent factors affecting MMSE score before surgery. After surgery, the total MMSE score was influenced by a history of stroke, stress (loss of spouse), residual pulmonary hypertension and atrial fibrillation in the early postoperative period. CONCLUSION: Cognitive impairment in the form of mild dementia was observed in patients with CTEPH before surgery. Six months after the operation, an improvement in cognitive status was revealed, which corresponded to moderate cognitive impairment. At the same time, no complete recovery of cognitive functions was recorded. Patients with CTEPH still experienced the greatest difficulties in the following areas: concentration and counting, memory. A history of stroke, disability, stress (loss of spouse), and a high comorbidity index are associated with a decrease in MMSE scores before surgery. Six months after surgery, MMSE score was affected by a history of stroke, stress (loss of spouse), residual pulmonary hypertension and atrial fibrillation in the early postoperative period.

[Features of psychoemotional status in patients with chronic thromboembolic pulmonary hypertension after cardiac surgery during the COVID-19 pandemic]. / Osobennosti psikhoemotsional'nogo statusa u patsientov s khronicheskoi tromboembolicheskoi legochnoi gipertenziei posle kardiokhirurgicheskogo vmeshatel'stva v period pandemii COVID-19.

OBJECTIVE: To study the features of the psychoemotional status in patients with chronic thromboembolic pulmonary hypertension in the long term after pulmonary thromboendarterectomy (PTE) during the COVID-19 pandemic and to identify factors affecting the development of clinically pronounced anxiety and depressive disorders. MATERIAL AND METHODS: Psychoemotional status was analyzed in 151 patients in the long term after PTE using the Generalized Anxiety Disorder (GAD) Assessment (GAD-7) and the Beck Depression Inventory. The number of patients who underwent COVID-19 was recorded and the functional status scale of the patient who underwent COVID-19 (PCFS) was evaluated. Logistic regression analysis was used to identify predictors of clinically pronounced depression and GAD in the long-term period after surgery during the COVID-19 pandemic. RESULTS: Clinically significant GAD and depression in the long-term period after PTE during the COVID-19 pandemic were observed in 11 and 17.8% of patients, respectively. Clinically pronounced depression is associated with older age, chronic cerebral circulatory insufficiency and pronounced post COVID-19 disorders of functional status according to PCFS. The development of GAD symptoms is influenced by cardiopulmonary insufficiency in the hospital period after PTE. The combination of anxiety and depression symptoms is correlated with older age. CONCLUSION: In patients in the long term after PTE during the COVID-19 pandemic, the symptoms of GAD and depression were detected in 11 and 17.8% of cases, respectively. The complicated course of cardiac surgery has shown a negative impact on the development of GAD in the long term after surgery. The factors influencing the development of clinically pronounced depression were older age, chronic cerebral circulatory insufficiency and pronounced post COVID-19 disorders of functional status.

Clinical observations of COVID-19 infection in patients with chronic thromboembolic pulmonary hypertension.

Aim    To present clinical observations of the novel coronavirus infection (COVID-19) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) after a surgical intervention in the form of thromobendarterectomy from pulmonary artery branches.Material and methods    The Acad. E.N. Meshalkin National Medical Research Center performed 127 open surgical interventions for CTEPH in the form of thromobendarterectomy from 2016 through 2020. The present study enrolled 113 patients included into the follow-up care group and into the Center Registry who were followed up for more than 6 months after the surgery. Clinical and functional features of COVID-19 were evaluated in the studied group.Results    In the follow-up care group, 5 (4.4%) postoperative CTEPH patients had COVID-19. One patient had asymptomatic disease, and others had typical clinical symptoms and bilateral polysegmental pneumonia. There were no cases requiring artificial ventilation and no lethal outcomes. All patients with COVID-19 received anticoagulants as a basis therapy for CTEPH, and two patients who had residual pulmonary arterial hypertension (PAH) additionally received a PAH-specific therapy. During the treatment of COVID-19, no adjustment of the anticoagulant or PAH-specific therapy was required.Conclusion    The group of patients with CTEPH is a unique pathophysiological model for studying the effect of COVID-19 under the conditions of compromised pulmonary circulation. In the studied follow-up care group, the COVID-19 morbidity was 4.4 % without fatal outcomes. Evaluation of the role of chronic anticoagulant and PAH-specific therapy in COVID-19 postoperative patients as well as evaluation of the role of COVID-19 in CTEPH progression merit further investigation.

[Predictors of neurological complications after cardiac surgical interventions in oldery patients.]

To identify predictors of neurological complications in the hospital period after coronary artery bypass grafting (CABG), 92 patients with coronary heart disease aged 70 years and over were analyzed. Intraoperative monitoring of cerebral oxygenation (rSO2, %) was carried out. At the stage of induction anesthesia, the average level of rSO2 for left and right hemispheres was 64-65% without significant changes during the operation. A decrease in rSO2 during cardiopulmonary bypass (CPB) was associated with increased risk of neurological complications. The risk of neurological complications increase 7-fold and 9-fold with a decrease in rSO2 by 20% or more during CPB relative to baseline for left and right hemispheres, respectively. A history of two or more myocardial infarctions increases 3-fold the risk of neurological complications after CABG.

[Factors of adverse prediction of application of spinal cord stimulation with chronic pain syndrome in patients with critical lower limb ischemia]. / Faktory neblagopriiatnogo prognoza primeneniia spinal'noi neirostimuliatsii pri khronicheskom bolevom sindrome na fone kriticheskoi ishemii nizhnikh konechnostei.

AIM: To study the clinical dynamics in the long-term period after spinal cord stimulation (SCS) in patients with chronic pain syndrome and critical lower limb ischemia (CLLI) and to identify factors affecting the prognosis of SCS. MATERIAL AND METHODS: The clinical dynamics was analyzed in 48 patients with pain syndrome and CLLI 1 year after SCS. Microcirculatory blood flow (MBF) was studied in the affected foot by laser-doppler flowmetry (LDF) (Perfusion Units (PU)) and transcutaneous oximetry (TcpO2, mmHg.) using an occlusive test before and after SCS. The factors associated with negative clinical dynamics 1 year after SCS were determined. RESULTS: In 74% of cases, SCS contributes to the improvement of clinical status (reduction of pain syndrome, increase in motor activity, healing of ulcers). After SCS, according to LDF and TcpO2, the authors observed an increase in MBF and tissue metabolism - from 1.3 (0.7-2.8) to 6.2 (3.8-8.7) PU and from 14.5 (7.5-22.1) to 41.1 (26.4-57.6) mmHg, respectively with normalization of the MBF reserve during the occlusion test. Negative clinical dynamics after SCS is associated with high comorbidity, TcO2 <10 mmHg and the duration of pain. CONCLUSION: SCS contributes to the improvement of the clinical status of patients with chronic pain syndrome and CLLI. The negative dynamics is associated with high comorbidity, TcrO2 <10 mmHg and the duration of pain.

[The effect of spinal card stimulation on quality of life in patients with critical lower limb ischemia]. / Vliianie spinal'noi neirostimuliatsii na kachestvo zhizni bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei.

Today, there are insufficient data on the dynamics of quality of life (QoL) in patients with critical lower limb ischemia after spinal cord stimulation. OBJECTIVE: To study the dynamics of QoL in patients with critical lower limb ischemia one year after spinal cord stimulation. MATERIAL AND METHODS: QoL analysis was performed in 43 patients with critical lower limb ischemia using the SF-36 questionnaire before and one year after spinal cord stimulation. RESULTS: At baseline, we detected reduced QoL parameters corresponding to the physical function (≤30 points). The parameters of mental health corresponded to the moderate level (the score ranged between 42 and 59 points). The total score of physical well-being was reduced: 22.8 (20.2-29.3); the mean score of mental well-being was 41 (32.8-49.2) (p<0.001). One year after spinal cord stimulation, the level of all QoL parameters was increased but the total score of physical well-being remained low 33.2 (24-44.1). The mean score of mental well-being corresponded to the moderate level of QoL 56.5 (49-60.4) (p<0.001). Multivariate regression analysis showed that the physical parameters of QoL after spinal cord stimulation are adversely affected by such factors as age, the history of stroke, the ankle-brachial index (ABI), the presence of type 2 diabetes mellitus (DM), and ischemic heart disease (IHD) in combination with stenosis of brachiocephalic arteries (BCA). The mental health is affected by age and the presence of stenosis of brachiocephalic arteries. CONCLUSION: When selecting patients with critical lower limb ischemia for spinal cord stimulation, such factors as the baseline clinical status (comorbidities), age, history of stroke, and the severity of peripheral artery ischemia need to be taken into account to improve treatment effectiveness and QoL.

[Long-term outcomes of spinal neurostimulation in patients with critical lower limb ischemia]. / Otdalennye rezul'taty primeneniia spinal'noi neirostimuliatsii u bol'nykh kriticheskoi ishemiei nizhnikh konechnostei.

AIM: To evaluate long-term outcomes of spinal neurostimulation (SNS) in patients with critical lower limb ischemia (CLI). MATERIAL AND METHODS: Long-term outcomes of SNS were assessed in 52 CLI patients. Changes of clinical status were considered by using of Rutherford R.B. et al. scale. Before and in 12 months after SNS percutaneous oxygen partial pressure (TO2, mm Hg) was measured at the affected lower limb at rest and in orthostatic test. Ankle-brachial index (ABI) was also determined. RESULTS: SNS improved clinical status in most cases through following effects: 1) reduced pain syndrome and increased motor activity; 2) skin ulcers healing due to increased TO2 and improved functional state of microcirculation. No augmentation of TO2 during orthostatic test at TO2 <10 mm Hg was associated with negative clinical dynamics after SNS (OR 3.2, CI 2.2-54.1, p=0.002). Coronary artery disease with supra-aortic vessels lesion was associated with reduced ABI after SNS (OR 2.1, CI 1.4-3.8, p=0.001).

[Predictors of neurological complications during surgical treatment of the ascending aorta and aortic arch chronic dissection]. / Prediktory nevrologicheskikh oslozhnenii pri khirurgicheskoi korrektsii khronicheskogo rassloeniia voskhodiashchego otdela i dugi aorty.

AIM: To evaluate the prognostic significance of oxygen supply to the brain in the risk of neurological complications in the early post operative period of surgical treatment of the ascending aorta and aortic arch. MATERIAL AND METHODS: The level of oxygenation (rSO2) in the right and left hemispheres was measured in 68 patients with ascending aorta and aortic arch chronic dissection. Before and in the nearest period after surgery, the patients underwent a clinical/instrumental neurological study. RESULTS: The incidence of ischemic stroke in the early post operative period was 5.9%, cognitive impairment was recorded in 22% of patients. Among the parameters of oxygen supply to the brain, the dynamics of rSO2 during circulatory arrest had a significant impact on the post operative neurological status. The risk of cognitive impairment, besides the association with the oxygen status of the brain, increased with the age of patients and comorbid pathology. CONCLUSION: The decrease in rSO2 by ≥30% during surgical treatment of ascending aorta and aortic arch dissection increases the risk of ischemic stroke and cognitive impairment in the early post operative period.

[The role of integrated assessment of the indicators of external respiration function in cardiac surgical patients]. / Rol' kompleksnoi otsenki pokazatelei funktsii vneshnego dykhaniia u patsientov s kardiokhirurgicheskoi patologiei.

This literature review dedicated to the importance of an integrated assessment of external respiratory function in cardiovascular diseases (CVDs), including an analysis of up-to-date techniques, such as spirometry, body plethysmography, examination of the diffusing capacity of the lung, determination of O2 consumption with evaluation of the effectiveness of pulmonary ventilation. It considers the pathogenetic components of impairments in pulmonary ventilation and gas exchange, which develop in different CVDs, as well as during and after cardiac surgery. The authors analyze the results of international investigations and their own experience, which emphasize the prognostic value of lung function tests and suggest that there is a need for a comprehensive functional assessment of the respiratory system in cardiac surgical patients for their effective preoperative preparation, assessment and reduction of operational risks, and improvement of the prognosis of surgical treatment.

[Predictors of Cardiorespiratory Complications in Patients With Ischemic Heart Disease After Coronary Artery Bypass Grafting].

PURPOSE: to elucidate predictors of cardiorespiratory complications during the early postoperative period after coronary artery bypass grafting (CABG) in patients with ischemic heart disease (IHD). MATERIAL AND METHODS: We examined 180 patients with IHD (mean age 59.3+/-1.23years). Prior to surgery we assessed their clinical and functional status including state of respiratory function. Predictors of complications were determined by univariate logistic regression analysis. RESULT AND CONCLUSIONS: Early postoperative complications in this group of patients were atrial fibrillation, prolonged mechanical ventilation, and cognitive disorders. Main predictors of these complications were preoperative abnormalities of respiratory function (presence of chronic obstructive pulmonary disease, decreased efficiency of pulmonary ventilation), and concomitant diseases such as type 2 diabetes and multifocal atherosclerosis.

[Peripheral perfusion in CAD patients with various-stage chronic heart failure undergoing coronary artery bypass grafting]. / Perifericheskaia perfuziia u bol'nykh IBS s razlichnoi stadiei khronicheskoi serdechnoi nedostatochnosti pri koronarnom shuntirovanii.

Using the orthostatic test, we examined peripheral perfusion by means of laser Doppler flowmetry (LDF) and transcutaneous oximetry in a total of 104 patients presenting with coronary artery disease and functional class II-IV chronic heart failure (CHF) prior to coronary artery bypass grafting (CABG) and in the remote terms thereafter. Volumetric velocity of the microcirculatory blood flow (MCB) of the lower limbs was measured by means of LDF in perfusion units; partial oxygen pressure (TcPO2, mmHg) was registered by means of transcutaneous oximetry. The patients with CAD were subdivided into two groups as follows: Group One comprised patients with FC II CHF and Group Two included those with FC III-IV CHF. Prior to CABG according to the findings of LDF, the lowest level of MCB of the lower limbs was revealed in Group Two, being by 57.9% (42.5-61.3) less as compared with Group One (p=0.008). In Group Two patients as compared with Group One there was a larger proportion of patients with impaired reactivity of the peripheral microcirculatory bed during the orthostatic test in the form of: 1) a paradoxical reaction of the MCB both before CABG (60.6 versus 13.9%, p=0.00001) and in the remote terms after the operation (64.3 versus 16.2%, p=0.00001); 2) lack of the reaction of the MCB prior to the operation (19.7 versus 4.7%, p=0.02) and in the remote period after CABG (16.7 versus 2.7%, p=0.04). Group Two patients both before and after CABG were found to have a decrease (compared with the norm) in the TcPO2 parameters at rest, as well as lower reactivity of tissue metabolism of peripheral tissues during the orthostatic test. An initial decrease in the left ventricular output fraction of < 42% increases the chances of preserving the post-CABG decreased values of TcPO2 of less than 24 mm Hg (OR=3.1; 95% CI 1.1-6.8; p=0.003). Lack of the reaction of the MCB during the orthostatic test prior to CABG increases the chances for the development of surgically significant atherosclerotic lesions of lower-limb arteries after myocardial revascularization (OR=4.2; 95% CI 1.3-2.3; p=0.01). Hence, the most pronounced impairments of the mechanisms of adaptation of the MCB in the orthostatic test prior to and in the remote terms after CABG were detected in CAD patients with FC III-IV CHF. A decrease in the microvascular tonicity during the test and, consequently, inhibition of the nutritive component in this cohort of patients were accompanied by low metabolic reactivity of peripheral tissues.

Risk of development of neurological complications in prosthetic repair of the aortic ascending portion and arch. / Risk razvitiia nevrologicheskikh oslozhnenii pri protezirovanii voskhodiashchego otdela i dugi aorty.

The study comprised a total of 68 patients (presenting) with chronic dissection of the aortic ascending portion and arch, undergoing surgery and subjected to measuring at various stages of the operation the level of cerebral oxygenation (rSO2) of the right and left hemispheres by means of bilateral transcranial spectroscopy. The aim of the study was to examine the risk for the development of neurological complications in patients with chronic dissection of the aortic ascending portion and arch in various methods of cerebral protection during aortic prosthetic reconstruction. Group One consisted of thirty-one 40-to-61-year-old (mean age 51 years) patients who during circulatory arrest (CA) were as cerebral protection subjected to antegrade cerebral perfusion (ACP) on the background of moderate hypothermia (23-24°C). Group Two included thirty-seven 40-to-58-year-old (mean age 48 years) patients who during CA were subjected to cerebral protection consisting in craniocerebral hypothermia on the background of total deep hypothermia (18°C). Prior to surgery and in the immediate period thereafter, all patients underwent clinical and instrumental examination of the neurological status. During CA while aortic arch repair in Group One patients at the expense of maintaining cerebral perfusion a decrease in rSO2 registered in the right and left hemispheres amounted to only 11.8 and 8.7%, respectively, compared with the baseline values. In Group Two patients during CA a decrease in rSO2 along the right and left hemispheres amounted to 29.6 and 30.9% compared with the initial values, which was statistically significantly more than in Group One (p=0.002 and p=0.003). Thus, in Group Two patients during CA cerebral hypoperfusion resulted in a considerable decrease in oxygen supply of the brain, in spite of systemic deep hypothermia and craniocerebral hypothermia, promoting reduction of cerebral metabolism. Using ACP during CA in Group One patients maintained the oxygen status of the brain at an optimal level. In Group One patients, in the early postoperative period neurological complications were registered in 12.9% of cases. In Group Two, neurological complications were noted in 35.1% of cases. The univariate logistic regression analysis demonstrated that the risk for the development of any neurological complications depended on the degree of a decrease in rSO2 during CA while prosthetic repair of the aortic arch relative to the previous values - OR 1.25; 95% CI 1.11-1.65; p=0.02. Hence, deep hypothermia and craniocerebral hypothermia used as cerebral protection during CA turned out to be less effective compared with ACP, because despite reduction of metabolic requirements of the brain, cerebral hypoperfusion substantially of neurological status impairments in the early postoperative period.

[Functional reserves of peripheral perfusion in patients with chronic lower limb ischaemia and the risk for restenosis development].

The authors studied the functional state of the peripheral microcirculatory blood flow (MCBF) by means of laser Doppler flowmetry and the level of partial pressure of oxygen (TcPO(2)) in a total of 82 patients presenting with stage IIB-IV chronic lower limb ischaemia (CLLI) prior to percutaneous transluminal balloon angioplasty (PTBA) with stenting of lower limb arteries and in the remote terms following revascularization (after 12 months). The study was aimed at assessing the functional reserves of peripheral perfusion in CLLI patients and the risk for the development of restenoses in the remote period after revascularization. Group One comprised 47 patients with the compensated functional state of the peripheral MCBF by the results of the orthostatic test (changing from the lying to standing position) and Group Two was composed of 35 patients with the decompensated state of MCBF. Decompensated disorders of functional reserves of the peripheral MCBF in CLLI patients, i.e., 1) no reaction of microcirculation to the orthostatic test and 2) a substantial decrease in the oxygen pressure in peripheral tissues (TcPO(2) less than 20 mm Hg) increase the chances of restenoses development in the remote period after revascularization 1.9- and 2.4-fold, respectively. Impairments of carbohydrate and lipid metabolism in CLLI patients promote a more than two-fold increase in the risk for the development of restenoses in the postoperative period. It is necessary to determine the functional reserve of the peripheral microcirculation in patients with CLLI at the preoperative stage in order to assess the prognosis of efficacy of revascularization and determine further goal-directed correction of the MCBF.

[Risk of Cerebral Complications of Surgical Treatment of Patients With Chronic Pulmonary Embolism].

Aim of the study was to assess risk of cerebral complications at the background of various methods of brain protection during surgery in patients with chronic pulmonary embolism (PE). We examined 61 patients aged 39-54 years operated because of chronic PE. Monitoring of cerebral oxygenation (rSO2, %) was performed at various stages of surgery. Neurological status was assessed in the immediate postoperative period. We conclude that antegrade cerebral perfusion was the most effective method of cerebral protection which was associated with reduction of risk of neurological complications in the early postoperative period. Application of full cardiac arrest at the background of craniocerebral hypothermia was associated with the most significant reduction of rSO2 and increased risk of impairment of neurological status in the early postoperative period.

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.

[Efficiency of Pulmonary Ventilation in Remote Period After Surgery in Patients With Chronic Pulmonary Thromboembolism].

AIM: to assess efficiency of pulmonary ventilation in remote period after surgical treatment of chronic pulmonary thromboembolism (CPTE). MATERIAL AND METHODS: We examined 29 patients with CPTE with median age 49 (38-60) years. Pulmonary ventilation was studied by body plethysmography and its efficiency was evaluated by oxygen utilization coefficient (OUC). RESULTS: Comparison of OUCs before and in the remote period after surgery showed that after surgical treatment efficiency of pulmonary ventilation increased by 26% at the account of reduced hyperventilation but remained below normal. Patients' age and duration of the disease had a direct impact on the baseline bronchial conductivity as well as on recovery of the respiratory system reserve in the remote period after surgery.

[Efficiency of Pulmonary Ventilation in Remote Period After Surgery in Patients With Hronic Pulmonary Thromboembolism].

AIM: to assess efficiency of pulmonary ventilation in remote period after surgical treatment of chronic pulmonary thromboembolism (CPTE). MATERIAL AND METHODS: We examined 29 patients with CPTE with median age 49 (38-60) years. Pulmonary ventilation was studied by body plethysmography and its efficiency was evaluated by oxygen utilization coefficient (OUC). RESULTS: Comparison of OUCs before and in the remote period after surgery showed that after surgical treatment efficiency of pulmonary ventilation increased by 26% at the account of reduced hyperventilation but remained below normal. Patients age and duration of the disease had a direct impact on the baseline bronchial conductivity as well as on recovery of the respiratory system reserve in the remote period after surgery.

[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.

[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.