[Immediate results of surgical correction of combined pathology of the aortic valve and coronary arteries].

The authors analyzed an experience of surgical treatment in patients with aortic valve failure and ischemic heart disease. All patients have been operated in clinic of hospital surgery No 2 of State Pavlov Medical University. The work presented basic approaches to the management and strategy choice of the treatment of these patients. On the basis of given research, the authors suggested to perform a reconstruction of aortic valve by using original method in combination with coronary bypass surgery, which allowed avoiding a prosthetic-patient inadequacy. At the same time, it could improve an intracardiac haemodynamics and postoperative course.

[Long-term results of using mononuclear fraction of autologous bone marrow cells in complex surgical treatment of patients with heart valve failure].

The article is devoted to long-term results of pilot clinical investigation of using mononuclear fraction of autologous bone marrow cells as an additional procedure to standard surgical treatment of heart valve failure in order to improve local perfusion and contractive ability of the myocardium. The article presents results of an analysis of findings of the examination of 7 living patients within 6 years or 7 years after operation as also data of pathologicoanatomical investigation of three dead patients. The data obtained show the safety and effectiveness of this method of cell therapy in patients with heart valve failure.

[The significance of investigation of the endothelium function in diagnosis and assessment of effectiveness of treatment of infective endocarditis].

The complex state of the endothelium function was studied in 25 patients with infective endocarditis in the preoperative and early terms after surgery. A reliable elevation of all indices of endothelium dysfunction independent of the localization of the formed heart disease was detected. Against the background of operative treatment reliable changes demonstrating an improved functional state of the endothelium were noted in the early postoperative period.

[Detection of infectious agents in heart valves during endocarditis using PCR technique].

Infectious endocarditis can be caused by various microorganisms. Diagnostics of local infection by microbiological methods is not always effective. For that reason we performed a study aimed for direct detection of potential infectious agents by polymerase chain reaction in patients' heart valve tissue. DNA of infectious agents was revealed in 72% of heart valve tissue samples from patients with septic endocarditis; in studied samples, along with bacterial DNA, herpesviruses' DNA was detected. Obtained results confirm the presence of infection, which allows to perform specific diagnostics of infectious complications after implantation of prosthetic cardiac valves.

[Application of dermal fibroblasts in complex treatment of patients with trophic ulcers of venous etiology].

The authors have analyzed the results of an experimental-clinical investigation devoted to studying the efficiency of local treatment of trophic ulcers at the stage of healing using transplantation of dermal allogenic fibroblasts. The method was proved to accelerate epithelization and to shorten the time of preparing to operations for correction of the venous blood flow.

[The significance of investigation of the left ventricle diastolic function in cardiosurgery].

An examination of 79 patients (main group) with congenital, acquired heart diseases and ischemic heart disease (IHD) without activity of the rheumatoid process and infectious endocarditis and 64 subjects of the same age has shown that in order to improve the assessment of the results of operative treatment of patients with the acquired heart disease and IHD it is necessary to test the diastolic function of the left ventricle (LV) in addition to the systole parameters. Cardiosurgical correction of pathological processes either causing or aggravating LV diastolic dysfunction (overloading LV with the volume or pressure, myocardium ischemia) can either eliminate or reduce its degree. A pathological monophasic filling of LV is a sign of a pronounced systole-diastolic dysfunction of LV and lung hypertension. A radical operative intervention reestablishes the biphasic filling of LV and reduces pressure in the pulmonary artery.

[On teaching surgery at the graduation course of a medical college according to a new curriculum]. / O prepodavanii khirurgii v meditsinskom vuze na vypusknom kurse po novomu uchebnomu planu.

Teaching surgery to students of the medical college represents a complex dynamic process based on the achievements and advantages of domestic medical education. The article presents an analysis of historical aspects of teaching surgery formed under the influence of N.I.Pirogov's ideas and shows the necessity of searching for new forms of organization of teaching surgery at the up-to-date stage of reorganization of higher professional school. Special attention is given to a compulsory preservation of traditional principles of the system of teaching surgery verified by almost two centuries of experience of using it.

[Hydrodynamic investigations of the current mechanical artificial heart valves]. / Gidrodinamicheskie issledovaniia sovremennykh mekhanicheskikh iskusstvennykh klapanov serdtsa.

The work presents results of comparative investigations of the integral hydrodynamic characteristics of the best for today domestic mechanical heart valve (MHV) Medinzh-2 (MI-2) and the turn-disk domestic MHV--LIKS-2, EMIKS (E) and foreign MHV--Medtronic-Hall, Bjork-Shiley (BS), Sorin (SO) and bicuspid valves--St. Jude Medical (SJ), Carbomedics in the stationary and in the pulsatile flows. It was found that according to the main hydrodynamic characteristics including the outlet flow structure, MHV MI-2 was substantially superior to MHV E, BS and SO, and by certain characteristics it approximated to the best foreign MHV SJ. Like all mechanical heart valves, the valve MI-2 disturbs the uniformity of the inlet flow and forms a complex non-stationary flow with detached zones, areas of great shear stresses, with vortex structures of different types, and hence the task of hydrodynamic optimization of its construction is thought to become actual. The comparison of clinical parameters of work of the valve MI-2 with its hydrodynamic characteristics confirms its high hemodynamic effectiveness and thrombo-resistance in patients at long-term periods of follow-up, taking into account the adequate correction of disbalance of hemostasis.

[Two approaches to correction of disturbed hemostasis in patients with mechanical artificial heart valves at the long-term follow-up]. / Dva podkhoda k korrektsii narushenii gemostaza u bol'nykh s mekhanicheskimi iskusstvennymi klapanami serdtsa v otdalennye sroki nabliudeniia.

The investigation of the hemostasis system performed in 47 patients with mechanical heart valves (MHV) at the terms of (3.50 +/- 0.25) years included 30 men and 17 women. There were 24 cases of aortal MHV and 23 cases of mitral MHV, I-II functional class (NYHA). The patients were given oral anticoagulants: phenylin to 35 patients (0.009 mg/day), varfarin to 12 patients (52.6 mg/a week). The primary examination of the patients has revealed insufficient anticoagulation protection and clinically asymptomatic permanent intravascular coagulation of the third degree (PIC-3), with the signs of activation of thrombocytic and/or coagulation link of hemostasis. It has been found that a complex assessment of the hemostasis system state including the vascular-thrombocytic link is an obligatory condition of the right choice and timely correction of the PIC-3 in patients with MHV. The methods of correction of impaired hemostasis depend on the primary involvement of the vascular-thrombocytic and/or coagulation link of hemostasis. The pathogenetically selected antithrombotic therapy for patients with MHV allows timely arrest of PIC-3 and less risk of the development of thrombosis and thrombo-embolic complications at long-term periods of observation.

[The influence of hereditary thrombophilic mechanisms on the degree of permanent intravascular coagulation in patients with artificial heart valves]. / Vliianie nasledstvennykh trombofilicheskikh mekhanizmov na stepen' postoiannogo vnutrisosudistogo svertyvaniia u bol'nykh s iskusstvennymi klapanami serdtsa.

The genotyping of 40 patients with artificial heart valves (AHV) was performed after prosthesis of the mitral and aotic valves with bicuspid AHV (Medinzh-2 and CarboMedics). The patients took phenylin and varfarin. The patients' genotype was estimated by the thrombophylic genes: factor V Leiden (FVL), prothrombin G20210A, methylene tetrahydrofolate reductase C677T, G/A--455FGB, 4G/5G PAI-1, PI A1/A2 GPIIIa. The genes determining the thrombocytic activity or the vascular wall state substantially influence the third degree of the intensity of the permanent intravascular coagulation (PIC-3) independent of the degree of correction of hemostasis of oral anticoagulants. The addition of anti-aggregants to therapy is the only that can normalize functional activity of thrombocytes in patients with AHV having such defects. The laboratory detection of the genetic defects is of great practical importance for the determination of risk groups of formation of PIC-3 and the strategy of antithrombotic protection of patients with AHV.

[Prophylaxis of thrombosis and thromboembolic complications in patients with domestic mechanical artificial heart valves (AHV) "Medinzh-2" in remote terms of observation]. / Profilaktika trombozov i tromboémbolicheskikh oslozhnenii u bol'nykh s otechestvennymi mekhanicheskimi iskusstvennymi klapanami serdtsa "MedInzh-2" v otdalennye sroki nabliudeniia.

The observation included 40 patients (20 men and 20 women) with the rheumatic heart diseases acquired at the age of (45.9 +/- 8.7) years after isolated prostheses of the aortal (n = 25) and mitral (n = 15) valves with bicuspid constructions of AHV "MedInzh-2" in remote terms in (2.52 +/- 0.48) years, I-II functional valve (NYHA). It was shown that only a permanent control not rarer than once a month and an adequate correction by means of anticoagulation and antiaggregation therapy using standard methods for patients with the bicuspid AHV made it possible to avoid the development of thromboses and thromboembolic complications during three years of observation.

[Socioeconomic aspects of the increased volume of cardiosurgical treatment of children with congenital heart defects]. / Sotsial'no-ékonomicheskie aspekty uvelicheniia ob"ema kardiokhirurgicheskoi pomoshchi detiam s vrozhdennymi porokami serdtsa.

The authors made an analysis of social-economical conditions limiting the possibilities of rendering cardiosurgical care to children. Possible ways are mapped out allowing to increase the amount of operations on children with congenital heart diseases.

[Microbiological monitoring of the microbic strain stability to antibacterial preparations in surgical in-patient clinics]. / Mikrobiologicheskii monitoring ustoichivosti k antibakterial'nym preparatam mikroorganizmov v khirurgicheskikh statsionarakh.

While performing of microbiological monitoring, conducted in surgical stationaries of Dnepropetrovsk, of 775 cultures, isolated during one year from patients and outer space, the S. aureus cultures were revealed, resistant to methicillin were 23.6%, to gentamycin 12.3% culture of all Gram-negative bacteria. Most effective preparation, which is recommended for the empirical antibacterial therapy conduction, is meronem, to whom the sensitivity of 87.5% for Gram-positive and 92.1% for Gram-negative cultures of conventionally pathogenic microorganism were established.

[Indices of chronic intravascular hemolysis in patients with different prosthetic heart valves in long-term follow-up]. / Pokazateli khronicheskogo vnutrisosudistogo gemoliza u bol'nykh s razlichnymi konstruktsiiami iskusstvennykh klapanov serdtsa v otdalennye sroki nabliudeniia.

An examination of 153 patients with valve replacement was performed at late stages of (6.8 +/- 0.2) years, in 84 patients the mitral valve replacement (MVR) was fulfilled, in 64--the aortic replacement (AVR) and in 5--two valve replacement were performed. Higher indices of hemolysis were noted in patients with AVR, in cases of two valve replacement and in patients with the paravascular fistula. The lowest indices of hemolysis take place in patients with bileaflet prostheses (MEDING/CarboMedics, St. Jude Medical), especially in patients with AVR. The complications of intravascular hemolysis are: cholelithiasis, anemia, hemosiderosis of the kidneys, sideropenia. The timely diagnosis, treatment and prophylactics are necessary to prevent these complications.

[Turbidimetric express method in the assessment of the hemostasis parameters in patients with prosthetic bileaflet heart valves]. / Turbidimetricheskii ékspress-metod v otsenke parametrov gemostaza u bol'nykh s iskusstvennymi dvustvorchatymi klapanami serdtsa.

Thirty patients of medium (47 +/- 3) years of age with prosthetic bileaflet heart valves without any specific complications of the I-II functional classes and with the postoperative period after mitral (11) and aortal (19) valve replacements during (2.52 +/- 0.48) years were studied. The defects of coagulation and fibrinolytic systems were found in 9 patients with high prothrombin index (93.21 +/- 9.8)% and low INR (0.9-1.7). The activation of fibrinolysis, low platelets, hypofibrinogenemia, D-dimer which are the risk factors of thrombogenic complications were found in these patients. The updated turbo-dynamic express-method which helps to activate fibrinolysis in short terms and to make its correction is proposed.