[Heart failure and imbalance of chemical elements in myocardium of patients with ishemic heart disease].

Tissue content of chemical elements indirectly characterizes some metabolic processes. We have analyzed content of chemical elements in left and right ventricular myocardium of patients with ischemic heart disease with progressing heart failure and have shown that during development and progression of heart failure metabolic processes have unidirectional character in myocardium of both ventricles. Derangement of left ventricular contractile capacity is associated with lowering of content of microelements involved in antioxidant processes and energy metabolism in tissues (Cu, Mn, Cr) and elevated concentration of elements characterizing progressive of myocardial stiffness (Ca, Fe).

[Comparative characteristics of quality of life and physical status of patients with ischemic heart disease and aortic valve disease].

For comparison of physical status and quality of life of patients we analyzed 2 clinical groups: patients with ischemic heart disease (IHD) and aortic valve disease. Using original methodology of bringing results of questionnaire " Nottingham Health Profile " to functional classification we had a possibility to compare quality of life of patients with functional classes of physical working capacity and NYHA classification. Subjective component inserted into NYHA classification and quality of life questionnaire leads to substantial discrepancy with objective data on physical working capacity. In most cases patients of both clinical groups subjectively overestimate functional capacity of their organism. In patients with IHD most significant limitations manifest in psychic sphere of life, while in patients with aortic valve disease - in physical sphere of life, what demonstrates great effect of psychosomatic factor in development of IHD.

[Distribution of chemical elements in various parts of the heart of patients with acute heart failure].

By the method of autopsy in patients with ischemic heart disease (IHD) who died of acute heart failure we took samples of myocardium from 6 parts of the heart: left and right atrium, left and right ventricle, region of myocardial infarction, and scar of the left ventricle. Simultaneously we conducted histological study of these parts of myocardium. For the control we investigated content of chemical elements in myocardium of healthy victims of traffic accidents. By the method of roentgen fluorescent analysis with the use of synchrotron emission we detected content of 17 chemical elements: 4 macroelements (S, Cl, K, Ca) and 13 microelements (Cr, Mn, Fe, Ni, Cu, Zn, Se, Br, Rb, Sr, As, Mo, Hg). It was established that in patients with IHD who had died of acute heart failure content of Ca was elevated 4-8 fold in all parts of the heart. In infarction zone compared with other regions of the heart maximal quantity of Sr, Cr, Hg was contained. These elements can be looked upon as markers of infarction. In myocardium of patients with IHD especially in the zone of infarction elevation of activity of processes of lipid peroxidaton has been noted (calculated activity of malone aldehyde as example).

Role of chemical elements in formation of an aortic aneurysm.

The method of X-ray fluorescence employing synchronous radiation was used to study the content of chemical elements (CE) in the aortic wall in patients suffering from CAD (Group I), patients diagnosed with an ascending aortic aneurysm (Group II), and those presenting with aortic dissection (Group III). The obtained findings revealed a pronounced CE disbalance in the aortic wall in Group II and III patients as compared with Group I patients, suggesting an important role of trace and macroelements in metabolic processes related to formation of artic aneurysms. Based on the degree of the ascending aorta dilatation, we determined the coefficient of the ratio of the ascending aorta maximal diameter to the fibrous ring aortic valve diameter, equalling 1.88 +/- 0.04, above which metabolic processes in the aortic wall change over to a qualitatively another level. This point was arbitrarily termed the metabolic process reversibility point.

[Stages of compensation of circulation in acquired aortic valve disease according to data of physical working capacity].

We examined 194 men (mean age 40 +/- 1.4 years) with acquired aortic valve disease. Basing on the data of estimation of physical working capacity and reserve of cardiorespiratory system we assessed staging of development of compensatory mechanisms of circulation in patients with acquired aortic stenosis and aortic insufficiency. According to working capacity all patients were divided into 4 groups with different hemodynamic response of the organism to physical work. Staged development of mechanisms of compensation of the circulation was found to be related to pronounced left ventricular remodeling: concentric myocardial hypertrophy developed in aortic stenosis while aortic insufficiency was associated with eccentric hypertrophy of the myocardium. These differences in geometry were observed already at stage II. Parameters of systemic hemodynamics and energy expenditures of the heart during exercise practically did not differ between aortic stenosis and insufficiency of aortic valve and were characterized by progressive lowering of efficacy of circulation from stage II to stage IV despite pronounced tension of myocardial reserve. As a result significant lowering of tolerance to physical effort took place in patients of the given group.

[Content of microelements in left ventricular myocardium of patients with ischemic heart disease. Data of roentgenofluorescent analysis with the use of synchrotron irradiation].

Contents of 11 microelements (Se, Rb, K, Sr, Ca, Cr, Mn, Fe, Cu, Ni, Zn) in various parts (zone of infarction, of scar, periinfaction zone) of left ventricular myocardium of patients with ischemic heart disease was studied with method of rentgenofluorescent analysis with the use of synchrotron irradiation (overall 2112 analyses). Left ventricular myocardium of victims of accidents without cardiovascular pathology was studied as control. Compared with control dysbalance of various degree was noted in left ventricular myocardium of patients with ischemic heart disease. Four groups of microelements were distinguished: lowered content (Se, Rb, K); close to normal content (Mn, Cu); moderately elevated content (Cr, Sr, Fe); elevated content (Ni, Zn). Several orders of magnitude elevation of Ni and Zn was noted in all parts of left ventricle, especially in the zone of infarction and periinfarction zone.

[ABO and Rh blood groups in cardiovascular pathology]. / Gruppy krovi sistem ABO i Rh u bol'nykh s serdechno-sosudistoi patologiei.

A relationship between erythrocytic antigens of the ABO and Rh blood systems and cardiovascular pathology was revealed by comparing the distribution of blood groups in 13,175 patients and 7,800 donors. Prevalence of A gene and Rh+ phenotype in congenital and acquired heart diseases and ischemic heart disease was found. The frequency of B gene is increased in patients with acquired heart diseases.

[Blood oxygen saturation in various regions of the circulatory system in healthy persons]. / Nasyshchenie krovi kislorodom v razlichnykh otdelakh krovenosnoi sistemy u zdorovogo cheloveka.

The gaseous composition of the blood has been determined in cardiac cavities and major vessels in 180 practically healthy individuals aged from 1 to 30 years, during diagnostic catheterization of the heart. Physiological norms of gaseous composition of the blood in cardiac cavities and in the major blood vessels have been determined. Blood saturation with oxygen in the identical cardiac cavities and the major blood vessels are the same in men and women. The arterial blood having oxygenation below 93% is considered hypoxaemic. Normal figures of oxygenation for venous blood are from 75-84%. Exponential decrease of blood oxygenation with age (arterial and mixed venous) is roughly the same, due to this the arteriovenous difference of oxygenation at rest remains constant and is roughly equal to 20%. Minimum arterio-venous difference in oxygenation is 10%, maximum 40%.

[Evolution of lesser circulation hypertension in patients with congenital heart defects based on the example of an interventricular septal defect]. / Evoliutsiia gipertonii malogo kruga u bol'nykh vrozhdennymi porokami serdtsa na primere bol'nykh s defektom mezhzheludochkovoi peregorodki.

The results of direct pressure measurement in pulmonary circulation in 452 patients with ventricular septal defect (216 males and 236 females), whose age ranged from 12 months to 37 years, were analysed. The findings of diagnostic catheterization of the heart in 150 practically healthy persons 12 months to 40 years of age were used to elaborate the normal values of pressure in pulmonary circulation. The results of pressure measurement in pulmonary circulation repeated at intervals of 1 to 6 years in 46 patients with ventricular septal defect, 18 months to 23 years of age, were analysed. Reverse evolution of pressure in pulmonary circulation after surgical rehabilitation was followed up in 85 patients in 1, 2, 3, 5, and 7 years after the operation. At the age of 12 months to 7 years, systolic pressure in the right ventricle and pulmonary artery comes down to a possible minimum due to expenditure of the adaptational reserve. In large ventricular septal defects, however, the organism proves incapable of reducing the pressure in the early and first periods of childhood as a rule, and so the pressure increases throughout life.

[Work capacity of mitral stenosis patients before and after mitral commissurotomy]. / Trudosposobnost' bol'nykh mitral'nym stenozom do i posle mitral'npi komissurotomii.

Analysis of the working capacity of 1,000 patients who underwent mitral commissurotomy showed that 67.0% of individuals who were operated on for grade III stenosis and 27.99% of those operated on for grade IV stenosis resumed work. Frequent exacerbations of rheumatism and changes in the myocardium and valvular apparatus are among the causes of the decrease in the number of persons who resume work after the operation. Another reason is overestimation of the group of invalidity or its unjustified qualification

[Adaptive reactions of the erythrocytes in the evaluation of physical work capacity in patients with tetralogy of Fallot]. / Adaptatsionnye reaktsii eritrotsitov v otsenke fizicheskoi rabotosposobnosti bol'nykh s tetradoi Fallo

One of the leading factors affecting the functional state of the red blood system is arterial hypoxemia. Under such conditions signs of polycythemia are known to appear. At the same time, changes in the quality characteristics of the blood develop in patients with congenital heart diseases (tetralogy of Fallot including). Therefore a study of the physical rehabilitation as a total functional index may describe the adaptation of the body to hypoxemia, the variants and stages of its development. For this purpose the red blood parameters were examined (the content of hemoglobin, the erythrocyte count and their diameter) and the tolerance of physical exercises was tested by ergometry. The data were analyzed with due regard of the age of the patients and the reduction of their capacity for work, as compared to the due level. Stage 1 reduction of the capacity for work was found in patients with high red blood parameters. In groups of patients with Stage 2, 3 and especially 4 reduction of working capacity the red blood indices were significantly reduced. A distinct correlation was revealed between the erythrocyte count and their diameter, on the one hand, and the capacity for work, on the other.

[The study of cerebral oxygenation and central hemodynamics in patients with ischemic heart disease at rest and during physical effort.]. / Issledovaniia tserebral'noi oksigenatsii i tsentral'noi gemodinamiki u bol'nykh ishemicheskoi bolezn'iu serdtsa v pokoe i pri fizicheskoi nagruzke.

Cerebral oxygenation (rSO(2)) in the region of sagittal sinus and main hemodynamic parameters were measured in 112 patients with ischemic heart disease and class II-III angina. Four groups of patients were distinguished according to degree of rSO(2) lowering. Hemodynamics and oxygen transport function of the blood were proportionally related to degree of rSO(2) lowering. Normal rSO(2) (>70%) and degree lower (70-61%) was associated with predicted (desirable) cerebral blood flow. Lower rSO(2) values (60-50%) were accompanied with increased oxygen utilization (by 20-25%). Critical rSO(2) lowering (below 50%) was associated with>/=75% rise of oxygen utilization what was indicative of decreased brain blood flow and cerebral ischemia.

[Myocardial blood flow in different regions of the heart in patients with ischemic heart disease before and after revascularization]. / Miokardial'nyi krovotok na raznykh uchastkakh serdtsa u bol'nykh ishemicheskoi bolezn'iu serdtsa do i posle revaskuliarizatsii.

Laser doppler flowmetry was used for the intraoperative study of myocardial blood flow before and after revascularization in 116 patients with 2-3 vessel coronary artery disease and class II-IV angina. In patients without myocardial infarction, with microfocal myocardial infarction, or operated early after myocardial infarction revascularization caused no significant increase of myocardial blood flow. In patients with macrofocal infarction surgery was associated with significant increase of myocardial blood flow. Efficacy of revascularization could be assessed by lowering of flow gradients between various regions of the myocardium.

[Clinico-physiological assessment of the mechanisms of compensation and paracompensation in patients with mitral stenosis]. / Kliniko-fiziologicheskaia otsenka mekhanizmov kompensatsii i parakompensatsii u bol'nykh mitral'nymi stenozami.

The paper presents the results of an examination of 292 patients with Stages II-V mitral stenosis. Clinical, roentgenological, and electrocardiographic characteristics of the defect were analysed. Physical fitness and gas exchange during exercise were studied in 183 patients with Stages III and IV mitral stenosis. The findings were compared with the intensity of tissue oxygen exchange and the levels of myocardial myoglobin. The patients with mitral stenosis exhibited lower exercise tolerance that was more pronounced in Stage IV. The patients also displayed characteristic profound disturbances in work energy regimen, lower reserve potentialities and functional mobility of the cardiorespiratory system. The pronounced changes in the acid-base balance and gas composition of their capillary blood in Stage IV mitral stenosis during exercise may be explained by a sharply marked arteriolar barrier in the pulmonary circulation (a paracompensatory reaction). The comparison of physiological and clinical findings has enabled the relationship of mechanisms responsible for compensation and paracompensation to be evaluated at various stages of mitral stenosis.

Laser Doppler flowmetry assessment of microcirculation in upper extremities before and in long-term period after harvesting of radial artery.

Radial artery (RA) is rather commonly used as a graft for autoarterial myocardial revascularization. Consequences of RA harvesting for the development of ischemic disturbances in distal hand segments are poorly understood. The paper presents assessment of hand microcirculation (HMC) before and in late postoperative period after RA harvesting with modern precise diagnostic method - laser Doppler flowmetry (LDF). LDF assessment of HMC was carried out in 80 patients with ischemic heart disease (160 hands) to evaluate the possibility of RA harvesting for coronary artery bypass surgery. HMC classification was developed on the base of these measurements: type 1 -normocirculatory HMC: 6.7-17 ml/min/100 g (58%); type 2 - vasospastic HMC: < or = 6.7 ml/min/100 g (20%); type 3 - hyperemic HMC: > or = 17 ml/min/100 g (22%). In 34% of cases preoperative examination revealed microcirculatory asymmetry between right and left hands. Based on preoperative examination results in 22.9% of cases the decision was made to refuse from RA excision because of positive collateral circulation test developed in our Institute (positive decision about Patent award according to appeal No2000122582/14 (023905) from 28.08.2000). In 14 patients (14 upper extremities) HMC was measured before and 1-1.5 years after RA harvesting. After RA excision baseline HMC in operated hand reduced significantly while maximal HMC reserve remained at the level close to preoperative one. Postoperative HNMC alterations evidence of adequate preoperative assessment of hand collateral circulation potential. In case of blood flow asymmetry RA must be taken from the hand with higher blood supply and adequate collateral microcirculation.

[The sequelae and late results of surgical treatment in wounds of the heart and pericardium]. / Posledstviia i otdalennye rezul'taty khirurgicheskogo lecheniia ranenii serdtsa i perikarda.

An examination of 109 patients after surgical treatment of wounds of the heart and pericardium were performed at late terms after treatment. It was found that good results had 53.2% of the patients, 12.8% of the patients had limited working capacity, 4.6% of the patients became invalids. Satisfactory and bad outcomes resulted from the development of consequences of the trauma and operation. Terms of the recovery of working capacity depended on the severity of the trauma, timeliness of treatment of complications, state of the functional reserves and adequate regimen of motor activity.