[Vasculopathy of the grafted heart: the synergism of proinflammatory and proatherogenous factors and viral infection].

The authors analyze the pathogenetic significance of hyperhomocysteinemia, antiphospholipid syndrome, the hyperexpression of cell adhesion molecules, inflammation, and oxidative disorders for, as well as the role of viral infections in the development of coronary artery disease of the grafted heart. The paper shows that viral infections in recipients lead to the development of proinflammatory, proatherogenous, and prothrombogenous status, expressing themselves in an increase in the corresponding laboratory markers in recipients' blood plasma, and points out the role of viral infection in the pathogenesis of coronary artery disease of the transplanted heart. Control and treatment of viral infections, as well as pharmacocorrection of proinflammatory, proatherogenous, and prothrombogenous status would made it possible to influence the development of coronary artery disease of the grafted heart.

[The peculiarities of bone exchange disorder and its regulation in men after long terms following orthotopic heart transplantation and cadaveric kidney transplantation].

The study found bone exchange disorder manifested by accelerated bone resorption, retarded bone formation, and the loss of the bone mineral density (BMD) of the axial and peripheral skeleton in 19 men (39 observations) 66 +/- 44 months following orthotopic heart transplantation (OTHT) and in 92 men 45 +/- 28 months after cadaveric kidney transplantation. An accelerated bone resorption, more pronounced in cadaveric kidney (CK) recipients, is associated with hyperparathyroidism (HPT) and renal dysfunction, while bone formation retardation is associated with a decrease in insulin-like growth factor-1 level. An increase in osteoprotegerin level is of compensatory character. The prominence of HPT depends on the degree of renal dysfunction; in CK recipients it also depends on the degree of the reduction in the levels of biologically active testosterone and estradiol. Reduction in BMD of the peripheral skeleton after OTHT are associated with the degree of renal dysfunction and a decrease in free testosterone index; after CK transplantation it is associated with HPT, the cumulative dose of glucocorticoids, reduction in the levels of biologically active testosterone and estradiol, as well as sex-hormone binding globulin (SHBG); reduction in spine BMD is only associated with SHBG.

[Experimental autotransplantation of the heart]. / Autotransplantatsiia v eksperimente.

The paper analyses the results of 15 heart autotransplantations undertaken in puppies under deep hypothermia. The employed method of autotransplantation without division of the atrial septum is described. The characteristics of a adaptation of the cardiac autotransplant in the recipient body are presented along with the principles of correction of the changes observed in the early postoperative period.

[Morphohistochemical characteristics of heart myocardiocytes under profound donor hypothermia]. / Morfogistokhimicheskaia kharakteristika miokardiotsitov serdtsa pri glubokoi gipotermii donora.

Hearts of 52 pups were studied histochemically and electron-microscopically at various stages of total-body hypothermia. The dependence of the myocardiocyte metabolic alterations on the factors acting in the myocardium during different stages of hypothermia and during subsequent warming is shown. The vitality of the cooled heart is largely determined by retaining not only of its function, but by its anatomo-physiological links with the organism. The method of the profound hypothermia of the donor organism is, according to the authors, one of the ways to sustain the donor heart vitality before transplantation.

[Extracorporeal methods of blood purification in cardiovascular diseases]. / Ekstrakorporal'nye metody ochishcheniia krovi pri serdechno-sosudistykh zabolevaniiakh.

Increasing sensitivity to drugs, elimination of endotoxicosis, recovery of normal homeostatic control after hemocarboperfusion help to break off the vicious circles associated with severe cardiovascular disorders, and improve the effect of subsequent medication. Hemocarboperfusion added to combined intensive care and resuscitation procedures was associated with a 82.9% success rate.

[Maintenance of the circulation and the restoration of heart function in the donor body by means of direct mechanical heart massage for subsequent transplantation (an experimental study)]. / Podderzhanie tsirkuliatsii i vosstanovlenie funktsii serdtsa v organizme donora s pomoshch'iu priamogo mekhanicheskogo kardiomassazha dlia posleduiushchei transplantatsii (éksperimental'noe issledovanie).

The possibility of maintenance of circulation and subsequent restoration of the function of the heart in the organism of the donor, after 10-minute arrest of circulation, for transplantation of the heart was investigated. Study of the hemodynamic, biochemical, metabolic, and structural changes in the myocardium after 2-hour mechanical massage without and with pharmacological protection of the myocardium (glucose--insulin--potassium, hydrocortisone, dipyridamole), without and with restoration of cardiac activity in the organism of the donor and the recipient after transplantation of the second heart by the method suggested by Moory et al. in artificially created left ventricular insufficiency showed that direct mechanical massage of the heart may be used for its short-term preservation in the donor organism.

[Hemosorption as a treatment method in digitalis poisoning of heart failure patients with myocardial infarct]. / Gemosorbtsiia kak metod lecheniia digitalisnoi intoksikatsii u bol'nykh s serdechnoi nedostatochnost'iu pri infarkte miokarda.

Results of haemosorption in treating digitalis intoxication are analyzed. In 2 patients haemosorption was used for 90 min at the volume speed of 100 ml/min. Digoxin clearance at the start of haemosorption was 98.4 and 83.8 ml/min, at the end 85.7 and 70.3 ml/min. Digoxin concentration decreased by 44.8 and 13.0%. Hemosorption enabled performing electric defibrillation with restoration of the sinus rhythm.

[Echocardiographic diagnosis of acute rejection of transplanted heart]. / Ekhokardiograficheskaia diagnostika ostrogo ottorzheniia peresazhennogo serdtsa.

Comparing echocardiographic parameters with endomyocardial biopsy findings in 6 patients with acute crises of mild, moderate, and severe graft rejections and in 2 patients with persistent acute rejection crisis has shown that there are decreases in end-diastolic size and left ventricular end-diastolic ejection fraction volume, an increase in left ventricular myocardial mass, and thickening of the left ventricular posterior wall and ventricular septum, as evidenced by ultrasonic study. Such changes are detected in moderate and severe acute crises of graft rejection. Normalization of ultrasonic parameters of the grafted heart occurs 2-3 weeks after abolition of rejection crisis. A positive dynamics of echocardiographic parameters in persistent acute rejection crises suggests a good prognosis. Echocardiographic monitoring data obtained in the outpatient setting may serve an indication for unplanned endomyocardial biopsy.

[Immunopathologic study of the myocardium in dilated cardiomyopathy]. / Immunopatologicheskoe issledovanie miokarda pri diliatatsionnoi kardiomiopatii.

Myocardial tissues of patients with dilated cardiomyopathy were studied by immunofluorescence. While immunoglobulin A fixation was observed in myocardial capillary wall and cardiomyocyte sarcolemma in the majority of patients (11 of 12), immunoglobulin G and C3 complement component were a rare finding. In the vessel wall of heart allografts immunoglobulin A fixation occurred 3-6 days after transplantation. As a result of the intensive immunosuppressive therapy which was used after the operation immunoglobulin A disappeared from heart allografts within 4-5 weeks. Immunoglobulin A fixation in the heart of patients with dilated cardiomyopathy is attributed to the anti-tissue or antivirus antibodies and probably is involved in the development of this disease.

[Arrhythmia in patients after heart transplantation]. / Narusheniia ritma u bol'nykh posle transplantatsii serdtsa.

Holter monitoring was performed in 15 patients surviving over 3 months after homotopic cardiac transplantation. The frequency and types of arrhythmias occurring in the grafted innervated heart were studied according to its postoperative period duration. The follow-up lasted 3 to 29 months. Supraventricular arrhythmias were detected in 80%, whereas ventricular ones were found in 86.7%. Ventricular arrhythmias accompanied chronic graft rejection in 2 patients. It was ascertained that Holter monitoring was of greater diagnostic value than routine ECG recording. Innervation is not essential in the occurrence of cardiac arrhythmias.

[Effect of hemosorption and the separate and combined use of obsidan, trental and colpharit on rheological and hemostatic properties of the blood in patients with unstable stenocardia]. / Vliianie gemosorbtsii, razdel'nogo i cochetannogo primeneniia obzidana, trentala i kol'farita na reologicheskie i gemostaticheskie svoistva krovi u bol'nykh nestabil'noi stenokardiei.

A study of the main hemorheological and hemostatic indices of the blood of 60 patients with unstable angina revealed considerable changes that required correction. The use of hemosorption (HS) produced a positive effect on a clinical course of disease as well as the patients' hemorheological status. However the HS effect maintained for 5 days and the use of drugs was required to prolong a sorption effect. The combined use of propranolol, trental and colpharit made a favorable effect on microcirculation owing to the improvement of rheological, coagulation and fibrinolytic properties of the blood.

[The dynamics of the heart contraction rate and arterial pressure during physical loading after a heart transplant]. / Dinamika chastoty serdechnykh sokrashchenii i arterial'nogo davleniia pri fizicheskoi nagruzke posle transplantatsii serdtsa.

Compared to healthy controls, patients with transplanted heart have higher baseline heart rate (HR), delayed initial HR reaction, slower changes of HR both during exercise and after it, diminished chronotropic and inotropic reserves. The data obtained contribute to better understanding of physiology of transplanted denervated heart and objective assessment of patients after heart transplantation.

[Heart transplantation. The current problems of patient selection, examination and treatment]. / Transplantatsiia serdtsa. Aktual'nye voprosy otbora, obsledovaniia i lecheniia bol'nykh.

An analysis was made of the work carried out by the Department of Coronary Surgery and Heart Transplantation as regards heart transplantations during 1988. As many as 119 patients, hypothetical heart recipients, received medical advice. The Department refused hospitalization to 42 patients because of the nonconformity to the indications and contraindications to heart transplantation. 77 patients were admitted to the Department. During examinations and treatment, 53 persons were discharged from hospital. 8 patients died before donor's hearts were received. Donor's hearts were transplanted to 10 patients. 3 persons died from severe infectious complications on days 12, 15 and 43 after the operation. Following the operation 7 patients have been surviving from 4 to 17 months. The patients' status remains satisfactory. The functional parameters of the donor's heart are within normal. Taking into consideration the lack of the treatment methods for patients with terminal heart lesions, it is necessary that the number of operations be increased. A great importance in this case is attached to the joint efforts of internists and cardiologists, aimed at the screening and examination of potential heart recipients.

[Indicators of bicycle ergometry after heart transplantation]. / Pokazateli veloérgometrii u bol'nykh posle transplantatsii serdtsa.

Exercise tolerance in postcardiac transplantation patients versus healthy controls was studied at different intervals after the surgery using bicycle ergometry. Being low after the transplantation, exercise tolerance in the patients increased throughout the rehabilitation period but still did not reach the values characteristic for healthy subjects. Initial heart rate in the above patients was higher, while chronotropic and inotropic reserves of the transplanted heart appeared lower than in the controls. The data obtained help objectively assess the condition of the patients with transplanted heart.

[Anesthesiological management in transplantation of the heart after temporary mechanical substitution of its function]. / Anesteziologicheskoe obespechenie transplantatsii serdtsa posle vremennogo mekhanicheskogo zameshcheniia ego funktsii.

The first experience of anesthesiological management of three two-step orthotopic heart transplantations is reviewed. As the first step of surgical treatment one recipient was implanted an artificial heart "POISK-IOM" (Russia), in 2 other patients left ventricular bypass was achieved using a "Biopump" ("Biomedics", USA). Anesthesia techniques, methods of infusion-transfusion therapy, and other components of intraoperative management are described. Hemodynamics, donor heart function recovery, and other homeostasis parameters have been analysed. It has been noted that high doses of fentanyl in combination with ketamine and diazepam ensured satisfactory course of general anesthesia. There were no cases of intraoperative lethality. A more complex aspect of anesthesiological management was correction of various homeostasis disturbances which progressed during surgery in patients with left ventricular bypass. In two cases the intraoperative period was characterized by the onset of multiorgan failure (heart, respiratory, renal failure, metabolic disorders, coagulopathy), which played a negative part for the postoperative period of heart transplantations. It is concluded that prediction of possible complications during temporary mechanical replacement of the cardiac function and timely determination of contraindications for the second step of two-step heart transplantations are the most important trends of investigations for anesthesiologists, intensive care specialists, and transplantologists.