[Comparative trial of efficacy of trimethasidine MB and 3-(2,2,2-trimethylhydrasine) propionate dihydrate in chronic heart failure].

AIM: To study efficacy of the myocardial cytoprotector trimethasidine MB and metabolic drug 3-(2,2,2-trimethylhydrasine) propionate dihydrate (3-TMHP) in the treatment of chronic cardiac failure (CCF). MATERIAL AND METHODS: Sixty-five patients with CCF after myocardial infarction (> 6 months) with left ventricular ejection fraction (LV EF) <40% were randomized into 3 groups: group 1 (n=28) received basic therapy plus trimethasidine in a daily dose 70 mg; group 2 (n=25)--basic therapy plus 3-TMHP in a daily dose 1000 mg; control group (n=12) received basic therapy with ACE inhibitors, beta-blockers and diuretics. Before and after 6-month treatment all the patients have undergone stress echocardiography with dobutamine. Perfusion and myocardial metabolism were determined in 34 patients with single photon emission computed tomography of the myocardium (SPECT) with 99m-Tc-technetril and positron-emission tomography of the myocardium (PET) with F-18-fluorodesoxyglucose. RESULTS: Groups 1 and 2 significantly reduced functional class of CCF and prolonged the distance of a 6-min walk. Significant improvement of life quality was observed only in the treatment with trimethasidine. According to PET, treatment with trimethasidine MB and 3-TMHP has an anti-ischemic action manifesting with a significant attenuation of glucose hypermetabolism in the ischemic segment to normal values. However, significant improvement of systolic thickening in hybernated segments by SPECT as well as a significant rise of LV EF were recorded only in the treatment with trimethasidine MB. Stress echocardiography with dobutamine had high specificity (85.7%) but low sensitivity (50.4%) in detection of hybernated myocardium. CONCLUSION: Trimethasidine MB (preductal MB) has advantages over 3-TMHP, so it is preferable in ischemic CHF.

[Possibilities of myocardial cytoprotection in complex treatment of patients with chronic heart failure].

Efficacy of metabolic therapy with trimetazidine MR and 3-(2,2,2-trimethylhydrazyn) propionatodihydratum (3-TMHP) was compared in patients with chronic heart failure (CHF) of ischemic genesis. Clinico-functional examination included dobutamine stress echocardiography single photon emission computer tomography (SPECT) with 99mTc-technetril, and positron emission tomography (PET) with 18F-Fluoro-2-deoxyglucose. Clinical course of CHF improved during therapy with both trimetazidine MR, and 3-TMHP. According to PET data therapy with trimetazidine MR and 3-TMHP exerted antiischemic action which appeared as significant diminishment of glucose hypermetabolism in ischemic segments down to normal values. However significant improvement of regional systolic thickening in hibernating segments according to SPECT data, significant increase of left ventricular ejection fraction at rest and peak load according to data of stress-echocardiography took place only during therapy with trimetazidine.

Use of human VEGF(165) gene for therapeutic angiogenesis in coronary patients: first results.

The paper presents the first results of therapeutic angiogenesis in clinical cardiosurgery: human VEGF(165) gene transplantation to coronary patients. The use of this therapeutic method is particularly effective in patients with inoperable cardiovascular injuries, i.e. patients with the most severe condition, in whom treatment remains little effective at the modern level of cardiosurgery development.

[ECG-gated single-photon emission computed tomography with 99mTC-tetraphosmin in diagnostics of short-term myocardium stunning under the condition of stress-induced ischemia in CHD patients with multivascular lesions of coronary vessels].

The authors analyzed the efficiency of ECG-gated single-photon emission computed tomography (SPECT) with 99mTc-tetraphosmin in diagnostics of short-term myocardium stunning in CAD patients with transient ischemia. The technique was applied to 16 CAD patients. Combined evaluation of perfusion was based on the analysis of radiotracer uptake level in left ventricle (LV) myocardium. In order to evaluate myocardium function the authors measured LV systolic thickening index, using 20-segment pattern. 8 out of 16 patients (50%) displayed the phenomenon of stress-induced stunning. The volume of stunned myocardium in individual patients was 2 to 7 LV segments. In general, up to 37% (29/78) of reversible perfusion defects are subjected to short-term stunning under the condition of transient ischemia. After surgical treatment, 84% of segments with signs of stunning normalized their functioning both under stress and at rest.

[New approaches to the treatment of ischemic heart disease: therapeutic angiogenesis in combination with surgical revascularization of the myocardium]. / Novye podkhody k lecheniiu ishemicheskoi bolezni serdtsa: terapevticheskii angiogenez v sochetanii s khirurgicheskoi revaskuliarizatsiei miokarda.

AIM: To evaluate the results of surgical treatment of patients with ischemic heart disease in combination with intraoperative intramyocardial introduction of the human gene VEGF165 (angiostimulin). MATERIAL AND METHODS: Twenty four patients enrolled in the study were examined using 12-lead ECG, echocardiography, treadmill exercise test, single-photon emission computed tomography of the myocardium with Tc-99m-tetrophosmine, fluorodesoxyglucose (FDG) positron-emission tomography of the myocardium, selective coronarography. Out of 24 patients, 10 patients have been reexamined so far. The effect of the treatment was assessed by the data obtained at the treadmill test, transthoracic echocardiography, myocardial scintigraphy and FDG. RESULTS: All the patients demonstrated a clinical response. The class of effort angina improved, the dose of the prescribed nitric drugs was decreased, exercise tolerance and total stress time rose, quality of life improved. Myocardial scintigraphy registered reduction of the total area and better accumulation of the radiopharmaceutical under load and at rest 3 and 6 months after the operation including myocardial areas which had not been revacularised at coronary artery bypass grafting but had been treated with the preparation of the human gene VEGF165. CONCLUSION: The results of the study suggest that therapeutic angiogenesis may be an alternative impact on those myocardial areas which are supplied by the affected but ineligible for bypass grafting coronary arteries.

[Abnormal branching of the left coronary artery from the pulmonary artery]. / Anomal'noe otkhozhdenie levoi koronarnoi arterii ot legochnoi arterii.

13 hearts with the above congenital disturbance are studied. The disturbance of the space orientation of the anterior and posterior interventricular septa is found. The aortal and pulmonary valves are found to be oriented at an angle to each other, and the route of the left coronary artery is changed. These features allow to suggest that the anomalous issue of the left coronary artery from the pulmonary artery originates from the alterations of the interaction between the arterial valves and peritruncal ring. The choice of surgery depends on the heart anatomy in each individual case.

[Ebstein's anomaly (morphologic and morphometric study]. / Anomalia Ebshteina (morfologicheskoe i morfometricheskoe issledovanie).

12 hearts with Ebstein's anomaly were studied. This disease is a combined anomaly of heart formation with dysplasia of the folds of the tricuspid valve (TV), its tendinous chordas and papillary muscles, dysplasia of the trabecular part of the right ventricle and dysplastic interrelationships between TV and the right ventricle: attachment by short chordas of posterior and septal folds of TV with the right ventricle walls, anomalous distal attachment of the anterior fold of TV. "Atrialisation" of the right ventricle is the reflection of the folds dysplasia the extreme form of which is the loss of communication between TV and trabecular part and formation of the direct communication between TV and the infundibular part of the right ventricle.

[Classification of ventricular septal defects]. / Klassifikatsiia defektov mezhzheludochkovoi peregorodki.

The hearts were examined from 125 patients with isolated ventricular septal defects (VSD) who had died at the age of 0-14 years before or without operation. One hundred twenty five heart showed 178 defects: 103 with isolated, 22 with multiple VSD. Five major defect types were identified: (1) perimembranous; (2) sinus; (3) central trabecular; (4) boundary muscular trabecular; (5) infundibular. According to the relevance of fibrous skeleton and cardiac conduction system, the defects of various sites are divided into 2 large groups: 1) unadjacent to them (muscular) and 2) adjacent. In terms of septal geometry, there are also two large groups: 1) those located in the inflow portion of the septum and 2) those located in the outflow portion.

[Surgical anatomy of subaortic conus of the normal heart]. / Khirurgicheskaia anatomiia podaortal'nogo konusa normal'nogo serdtsa.

One hundred and fourty-three normal hearts have been studied. The conoid septum, supraventricular crest, bulboventricular fold, area of the fibrous tissue between the aortal and mitral valves and the anterior interventricular septum make the walls (frontal view, in the direction of the hour hand) of the left ventricular cone. In the normal heart there is no real contact between the fibrous rings of the aortal and mitral valves. They are connected by means of a strip of the fibrous tissue, its size varies. The subaortal cone and deferent part of the left ventricular axes make an obtuse angle; the axes of the subpulmonary and subaortal cones have a cross direction. The geometrically definitive left ventricular cone is seen as obliquely-sectioned overturned isosceles cone, with its big base directed upward, right and back, and the small one forward and left.

[Classification of aortic and pulmonary artery origin from right ventricle]. / Klassifikatsia otkhozhdenia aorty i legochnoi arterii ot pravogo zheludochka.

An original systematics of origin of the aorta and pulmonary artery from the right ventricle (OAPA RV) is suggested on the basis of examination of 63 heart specimens with the anomaly. Two main variants of OAPA RV are distinguished: (1) with and (2) without a formed infundibular septum (IS). Types A and DA belong to the first variant, types B, C, D, and DC to the second variant. Type A is characterized by drainage of the left ventricular (LV) outflow tract (OT) into the subaortic conus. Type DA differs from type A by the existence of an auxiliary opening between the ventricles due to a deficiency of tissue of the posterior (sinus part) of the septum. Type B is characterized by the absence (or marked hypoplasia) of the septum of the conus (SC). The LV OT in this case drains under both (aortic and pulmonary) coni. In type C the LV OT opens into the subpulmonary conus. In distinction from type C, type DC has an auxiliary defect in the sinus part of the interventricular septum (IVS). Type D is characterized by complete obturation of the exit and the absence of a defect in the sinus part of the IVS (type D1: OAPA RV with an intact IVS) or with a sinus defect in the IVS-DIVS (type D2: OAPA RV with noncommitted DIVS). According to the presence or absence of stenosis of the pulmonary artery (PA) or aorta, 4 subtypes are distinguished: (1) without stenosis; (2) with stenosis of PA; (3) with aortic stenosis; (4) with combined aortic and pulmonary stenosis.

[The anatomy of the interventricular septum of the heart and the anatomical nomenclature]. / Anatomiia mezhzheludochkovoi peregorodki serdtsa i anatomicheskaia nomenklatura.

With the aim to study interrelations of the interventricular septum (IVS) and systematization of their definitions, 151 preparations of hearts of persons died from causes having no connections with cardio-vascular diseases have been studied. The IVS consists of inflow and outflow septa. The inflow septum includes the sinusal (posterior) and trabecular septa, the outflow one--the anterior and conoid septa. The distal part of the anterior and conoid septa form the infundibular septum. From the side of the right ventricle the conoid septum and bulboventricular fold form a supraventricular crest--muscular torus, separating its inflow and outflow parts. From the side of the left ventricle the supraventricular crest is seen as a muscular bar, forming the basal medial wall.

[The anatomical criteria of the origin of the aorta and pulmonary artery from the right ventricle]. / Anatomicheskie kriterii otkhozhdeniia aorty i legochnoi arterii ot pravogo zheludka.

New anatomical criteria of the above malformation are created on the basis of the study of 63 hearts with the origin of aorta and lung artery from the right ventricle: the presence of the bulboventricular fold separating the mitral and semilunar valves; complete or partial delay of the subaortal cone movement to the left ventricle; the presence of the completely or partially formed proximal cone; underdevelopment of the left ventricle due to the complete or partial absence of its cone region; the only issue from the left ventricle is the proximal cone apertures or a part of the primary bulboventricular orifice; when the primary bulboventricular orifice is obturated the left ventricle is either deprived of the opening or has it in the form of noncommitted defect in the sinusal part of the interventricular septum; the anterior margins of the bulboventricular fold and cone septum are open and supraventricular comb is not formed; the interventricular septum defect formed due to failure of fusion between bulboventricular fold and cone septum connects the aorta with the right ventricle; aorta and lung artery start completely or partially from the right ventricle.