[THE COMPARATIVE CHARACTERISTIC OF KAOLIN-ACTIVATED THROMBOELASTOGRAPHY IN HEALTHY NEWBORNS AND NEWBORNS WITH HEART AILMENTS].

The study was carried out to diferentiate reference values for kaolin-activated thromboelastography in newborns with congenital heart disease. The study included two groups ofpatients. The first one consisted of 62 newborns with congenital heart disease and the second one consisted of 35 healthy newborns. The results of kaolin-activated thromboelastography implemented in groups are evaluated as condition of normal coagulation. The valuable diferences of homeostasis system in healthy newborns and newborns with congenital heart disease (without severe concomitant pathology) are not established. They have similar indicators of kaolin-activated thromboelastography. The derived results can be applied as standards in full-term newborns with congenital heart disease.

[The study of markers of herpes virus infections in myocardial ischemia].

A group of patients with ischemic heart disease (IHD), who underwent surgical aorta-coronary vascular shunting, was examined in this investigation. Low titers of HSV-1 specific IgG were detected in all patients, the obtained values being consistent with similar data obtained in healthy subjects of the same age. Negative PCR of HSV-I DNA in blood and biopsy results were obtained. None of the patients demonstrated typical clinical pattern of infectious disease caused by herpes simplex virus. These data are evidence of the absence of the HSV-1 correlation with coronary atherosclerosis in patients with the IHD diagnosis. The significance of HCMV specific IgG titers and HCMV DNA detected in blood plasma in 87.7% cases is probably attributed to existence of connection of HCMV infection markers revealing in patient' blood with IHD diagnosis and coronary atherosclerosis. Besides, the HCMV DNA presence in biopsy taken from myocardium or vascular wall with lesion is revealed in 100% cases. The cytomegalovirus markers in tissue lesions with the help of specific antiserums marked to HSMV recombinant proteins are also revealed in 100% cases. This fact indicates the connection between pathological atherosclerotical process in IHD and cytomegalovirus infection.

[Prediction of the outcomes of renal replacement therapy for acute renal failure after cardiosurgical interventions].

The aim of the study was to evaluate the influence of different predictors on the outcomes of acute renal failure (ARF) in cardiosurgical patients. A hundred and five cases of ARF in January 1995 to August 2004 were retrospectively analyzed. Sixty-one patients received continuous renal replacement therapy (CRRT) and 44 patients had intermittent RRT (IRRT). Eighteen preoperative, perioperative, and postoperative risk factors were assessed. The overall hospital mortality was found to be 42%: 48.4% in the CRRT group and 33.3% in the IRRT group. A statistical analysis revealed 8 significant predictors of fatal outcomes: (1) the severity according to the APACHE II scale (25 +/- 1 scores); (2) the number of organ dysfunctions (3.6 +/- 0.2); (3) large-dose inotropic support; (4) artificial ventilation; (5) oliguria; (6) severe concomitant hepatic failure; (7) moderate-to-severe concomitant posthypoxic encephalopathy. CRRT improved survival in AFR associated with severe cardiorespiratory failure, oliguria, and cerebral dysfunctions. The paper discusses criteria for choosing the modes of renal replacement therapy.

[Study of herpes viruses in the blood of patients with cardiovascular pathology]. / Issledovanie gerpesvirusov v krovi bol'nykh s serdechno-sosudistoi patologiei.

The association between Cytomegalovirus (CMV) and Herpes simplex (HSV-1), on the one hand, and the coronary heart disease and chronic venous insufficiency (CVI), on the other hand, was studied; besides the infection rate by the above viruses in different age groups of donors was examined. The following methods--immune-enzyme analysis and detection of viral DNA by means of the polymerase chain reaction (PCR) as well as immune-fluorescence scanning of atherosclerotic plaques--were made use in the study. The pathogenesis of coronary heart disease was shown to be related with the viral contamination caused by CMV, while there was no such correlation between the former and the CVI patients. Finally, it was established that, with age, the frequency rate of seropositive reactions to CMV and HSV-1 was increasing in virtually healthy people.

[Disbiotic conditions in patients operated and reoperated for heart defects and ischemic heart disease]. / O disbioticheskikh sostoianiiakh u bol'nykh, operirovannykh i reoperirovannykh po povodu porokov serdtsa i IBS.

Bacteriological examination of angiocardiac system, biocenosis of the intestine and upper respiratory tracts was made in 3473 patients who were to be operated or reoperated for congenital or acquired valvular defects in the presence of chroniosepsis and chronic septic endocarditis, complicated IHD. 375 patients with other diseases served control. 74 of them have undergone surgery for varicose veins of the legs. Preoperative contamination with opportunistic microflora was found in the heart, major vessels, veins of the majority of the patients. There was also dysbiosis of natural biotops. Patients with valvular defects to be reoperated 2-20 years after the initial operation on the heart had infection in the angiocardiac structures, severe dysbiosis of natural biotops, i.e. advanced dysbiosis--severe persistent condition with permanent source of endogenic infection complicated the underlying disease and bringing postoperative septic complications.

[State of the hypophyseal-adrenal system during surgical correction of heart defects under various anesthesiological methods and at distant periods after surgery]. / Sostoianie gipofizarno-nadpochechnikovoi sistemy pri khirurgicheskoi korrektsii porokov serdtsa v usloviiakh razlichnogo anesteziologicheskogo obespecheniia i v otdalennye sroki posle operatsii.

The concentration of 11-HOCS in the blood plasma was measured in 278 patients with heart diseases operated on under various anesthesias at different stages of surgical correction of the defects and in the immediate postoperative period. Plasma ACTH level was measured in 137 of these operated on under deep hypothermia and hypothermal perfusion. The hormonal response was the most expressed in patients operated on under normothermia, whereas in patients exposed to hypothermia the reaction was minimal. 141 patients were examined in remote periods after surgery. Blood plasma 11-HOCS level was normal in the cases with good and satisfactory results of surgical treatment, whereas in those with poor results it was higher or lower than normally.

[The suturing, plastic repair, prosthesis and autoplasty of defects in the interventricular septum without artificial circulation]. / Ushivanie, plastika, protezirovanie i autoplastika defektov mezhzheludochkovoi peregorodki bez iskusstvennogo krovoobrashcheniia.

The authors have made an analysis of 1500 operations using a unique technology of closure without perfusion of the interventricular septum defects of the heart under conditions of hypothermia. Lethality was 1.7%, frequency of recanalization of the defects was 0.9%.

[The state of the hypophyseal-adrenal system during surgical correction of heart diseases under conditions of different anesthesia and in distant periods after surgery]. / Sostoianie gipofizarno-nadpochechnikovoi sistemy pri khirurgicheskoi korrektsii porokov serdtsa v usloviiakh razlichnogo anesteziologicheskogo obespecheniia i v otdalennye sroki posle operatsii.

Blood plasma levels of 11-HOCS were measured in 278 patients with heart diseases operated on under different anesthesia at various stages of surgical correction of the diseases and during the immediate postoperative period. Blood plasma ACTH levels were measured in 137 patients operated on under deep hypothermal protection and hypothermal perfusion. The most manifest hormonal response was observed during surgery under normothermia, whereas under conditions of hypothermal perfusion the reaction to intervention was the minimal. A total of 141 patients were examined in remote periods after surgery. Blood plasma 11-HOCS levels were normal in patients with good and satisfactory results of surgical treatment and increased for decreased in those with unsatisfactory results.

[The ultrastructural characteristics of specific endothelial granules in the myocardial microvessels in congenital heart defects]. / Ul'trastrukturnaia kharakteristika spetsificheskikh éndotelial'nykh granul v mikrososudakh miokarda pri vrozhdennykh porokakh serdtsa.

Specific granules in endothelium of microvessels of the right atrium were studied in 15 patients with congenital heart diseases (Fallot tetrad, defect of interventricular septum and aortal stenosis) aged from 3 to 11 by electron microscopy 2 morphological types of granules, varying in optic density-dark and light ones, were found in all observations. Great number of the light granules young forms was also discovered. Maturity of the latter is associated with the increase of number and density of localisation of tubular structures in the granule matrix. Share of granule-containing endotheliocytes varied significantly depending on the kind of the defect (from 27% in aortal stenosis up to 44% in Fallot tetrad), with number of granules varying from 1 to 37 in profile 1. This demonstrates that granule-producing function of endotheliocytes in congenital heart diseases depends on the load exerted on the region, compensating the disturbed hemodynamics in specific pathology and either on presence or absence of hypoxemia.

[The surgical treatment of catheter-related cardiac and vascular embolisms]. / Khirurgicheskoe lechenie kateternykh émbolii serdtsa i sosudov.

Basing on the experience of the surgical treatment of 15 patients with catheteric embolism of the heart and vessels the authors concluded that septic occurrence in given patient category requires urgent operative intervention. In catheteric heart embolism in patients with heart defects surgical interventions may be performed in nonperfusing deep (28-25 degrees C) hypothermal protection, permitting simultaneous removal of heart foreign body and to correlate heart defects not requiring continuous circulation control.

[Characteristics of carbohydrate metabolism regulation during correction of congenital heart defects and hypothermic protection without perfusion]. / Osobennosti reguliatsii metabolizma uglevodov pri korrektsii vrozhdennykh porokov serdtsa v usloviiakh besperfuzionnoi gipotermicheskoi zashchity.

Carbohydrate metabolism and insulin status have been studied in 89 patients with congenital heart valve defects operated on in conditions of profound perfusion-free hypothermic protection. It has been established that anesthesia, hypothermia, and surgical trauma are accompanied by hyperinsulinemia, which had nothing to do with the introduction of exogenic hormone. Insulin effect is attenuated and insulin resistance develops, which leads to a drop not only in glucose consumption but also in the consumption of glycolysis products. Single insulin injection during induction to anesthesia at a dose of 0.5 U/kg was insufficient for normalization of carbohydrate homeostasis. Glycolysis activation with a considerable increase in blood pyruvate level has been observed, which decreases lactate/pyruvate coefficient informative value at different stages of surgical treatment of heart valve defects.

[Hormonal regulation during cardiac surgery operations on the "dry" heart]. / Sostoianie gormonal'noi reguliatsii pri kardiokhirurgicheskikh operatsiiakh v usloviiakh "sukhogo" serdtsa.

Central and peripheral compartments of hypophyseo-adrenal regulation, the state of renin-angiotensin-aldosterone system (RAAS) and thyroid-stimulating functions of hypophysis have been assessed in 72 patients with heart valve defects operated under profound hypothermal perfusion. It has been established that cardiopulmonary bypass surgery with profound hypothermia is accompanied by moderate and reversible changes in the above parameters. The activity of hypophyseo-adrenal system and RAAS reaches the maximum during a warming-up period and then gradually decreases. TSH content considerably decreases in the early postoperative period. Cardiopulmonary bypass surgery with profound hypothermia causes more pronounced changes in neurohormonal regulation than heart valve correction under hypothermal perfusion, which might be associated with blood flow arrest in major vessels causing changes in peripheral metabolic processes.

Deep hypothermia without extracorporeal circulation in surgery of congenital cardiac defects.

Operations on the open heart under perfusionless deep hypothermia were performed in 3,141 patients with congenital cardiac defects. The patients ages ranged from 3 months to 44 years. The body was cooled to 26-24 degrees C by covering with crushed ice. Cooling was performed under conditions of not deep ether anesthesia with the use of minimum doses of narcotic analgetics (morphine 0.5 mg/kg). Lactacidemia was registered during hypothermia. In contrast to lactate, the content of fatty acids and 11-hydroxycorticosteroids during all the stages of hypothermia did not change significantly. The time of circulatory arrest ranged from 10-89 min. It took 2-7 min to restore cardiac activity. Of 3,141 patients operated on, 265 died (8.44%). The mortality pattern demonstrated that the major cause of death was cardiac insufficiency (5.9%). Neurological sequelae were observed in 110 patients (3.5%). Based on the results of tests with Luria's neuropsychological method, neurological disturbances were registered in 15.4% of patients. The frequencies of neuropsychological complications were not related to the time of circulatory arrest. Unstable hemodynamics after operation was the most contributory factor to the development of neurological complications. Perfusionless deep hypothermia is an efficient method providing conditions for performance of open heart operations, and it can be used in surgical repair of congenital cardiac defects.

Serum corticosteroid-binding globulin levels in children undergoing heart surgery.

Serum corticosteroid-binding globulin (CBG) levels were measured in children (mean age 4 years) during heart surgery. Considerable decrease in CBG level occurred between baseline examination (416 +/- 39 nM) and the day of surgery (314 +/- 30 nM). Relatively simple closed heart surgery did not influence CBG level with maximal cortisol level being 20 +/- 4 micrograms/dl. Open heart surgery under conditions of profound hypothermia (26 C, without extracorporeal circulation) caused dramatic lowering of CBG level, particularly striking after resuscitation (180 +/- 20 nM). At the same time cortisol level reached extremely high values (78 +/- 8 micrograms/dl). These data suggest that CBG is likely to play an important role in pituitary-adrenal response to surgery under severe conditions of hypothermia and cardiac arrest.

[A procedure for compensating for the blood loss in heart operations under hypothermia without perfusion]. / Taktika vozmeshcheniia krovopoteri pri operatsiiakh na serdtse v usloviiakh besperfuzionnoi gipotermii.

It was established that compensation of blood loss in patients during hypothermal occlusion facilitates more rapid restoration of cardiac activity and adequate hemodynamics, which allowed to reduce administration of alpha-adrenomimetic drugs during the postocclusive periods. Simultaneously the period of the recovery of electric activity of the brain becomes shorter, the postoperative respiration rate is slower. Cardiac insufficiency and neurological complications are rarer.

[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.