[Full Reverse Left Ventricle Conteractility Function Remodeling and Recovery in Patient With Dilated Cardiomyopathy. Clinical Case].

The article presents a clinical case of a patient with severe chronic heart failure of ischemic origin. In 2020, the patient with a long history of ischemic heart disease, as confirmed by clinical data and instrumental examination, was diagnosed with severe cardiomegaly and NYHA class III chronic heart failure. The course of heart failure was aggravated by the presence of arrhythmia in the form of atrial fibrillation. At the first stage, a drug therapy and lifestyle modifications were recommended. In 2021, a beneficial tendency in clinical and instrumental indexes was observed, which made it possible to move on to the surgical stage of treatment. A coronary artery bypass grafting was performed with ablation of the left atrial posterior wall using the "box lesion" technique. A follow-up examination performed a year later showed normalization of the left ventricular dimension and recovery of its contractile function. The symptoms of heart failure regressed to the level of NYHA functional class I; no relapses of atrial fibrillation were detected. The patient continues to receive recommended drug therapy.

[Long-term results of clinical application of autologous mononuclear bone marrow fraction for regeneration therapy of ischemic heart disease patients].

An experience with using autologous bone marrow mononuclears for regeneration of the heart was analyzed in 97 patients in whom the intracoronary transplantation of autologous mononuclear bone marrow cells was performed. The results were estimated in terms up to 5 years and compared with a group of 37 patients who underwent only conservative treatment. A distinct positive dynamic of clinical and echocardiographic indices in the main group was noted in a subgroup of patients with a decreased ejection fraction (EF less than 50%) as compared with an analogous subgroup of patients in the control group. Substantial influence is exerted by regeneration therapy upon remote lethality. Thus, as a whole in the main group lethality over 5 years was 13.4% and in the group of control it was 21.6%. In the subgroup with a decreased ejection fraction and symptoms of heart failure lethality was 22.6% in the main group and 54.5%--in the control group. The intracoronary administration of the autologous bone marrow mononuclear fraction to inoperable patients with ischemic heart disease and a severe lesion of the coronary arteries and a decreased ejection fraction of the left ventricle is a safe and useful procedure resulting to substantially decreased lethality followed-up during 5 years against the background of conservative treatment.

[Quality of life in patients with coronary artery disease after stem cell therapy].

The main group included 17 patients with distal lesion of the coronary bed in whom the performance of complete direct myocardium revascularization was not possible. The autologous bone marrow mononuclears were administered to the main group patients at the period from 2008 to 2010. The control group consisted of 10 patients given standard medicamentous therapy. A year later in the main group patients there was a decrease of median of the functional stenocardia class, median of metabolic units by the data of loading tests, median of the number of nitroglycerin pills for a week taken by the patients as compared with the control group. By the data of OECT and PECT a year later in the main group there was an improved perfusion in all the myocardium segments. In the control group on the contrary there was negative dynamics in all the indices in question.

[Ejection fraction and sizes of the left ventricle of the heart after intracoronary administration of autologous mononuclear cells of the bone marrow in patients with coronary artery disease with low ejection fraction].

Since 2003 intracoronary administration of autologous bone marrow mononuclear cells has been performed in 119 patients with inoperable coronary artery disease, 53 of which had reduced ejection function that was gradually increased after injection of mononuclear bone marrow cells. By the 6th year the difference between the median of systolic and diastolic sizes of the left ventricle decreased by 12 and 14 mm respectively. In the control group the dynamics of changes of these indices at the same period was of negative character. The introduction of intracoronary bone marrow mononuclear cells is a safe and effective method of invasive therapy in patients with coronary artery disease to whom surgery is contraindicated.

[Direct angioplasty of the left main coronary artery with a pericardium flap].

Surgical treatment of stenosis of the left main coronary artery (LMCA) is a special problem, a number of questions of surgical strategy for this lesion still remain unsolved. The question of direct plasty dilatation of LMCA has not lost its actuality. Operations were made on 6 patients in whom direct plasty dilatation of LMCA with a flap from autopericardium was performed for local, not lengthy constriction which was located in the initial and middle part of LMCA. The operations were made under conditions of extracorporeal circulation, moderate general hypothermia (about 32 degrees C), pharmacohypothermic cardioplagia with external cooling of the heart. In all cases there was good restoration of cardiac activity and the absence of myocardium ischemia at the postoperative period. The restoration of the anatomical lumen of LMCA by this method facilitated sufficient blood flow along LMCA. Five years later all the patients are alive, one patient has external angina of the 11 functional class.

[Heart rate disturbances after mitral valve replacement].

Atrial fibrillation is a typical disturbance of heart rate in patients with mitral valvular disease. Correction of the mitral valvular disease by operation of replacement (or plasty) of the mitral valve normalizes the intracardial hemodynamics resulting in clinical improvement of the patient's state and prognosis for the nearest and long-term period. Atrial fibrillation aggravates the course of the heart disease, is a substantial factor associated with thromboembolic complications.The heart rate dynamics after mitral valve replacement was assessed in 94 patients. The sinus rhythm in patients after mitral valve replacement is not changes, if there were no episodes of atrial fibrillation before the operation. The presence of chronic atrial fibrillation before operation suggests this arrhythmia to be present after correction of the mitral valvular disease if no additional operation correcting the rhythm was made. Operation of atrial fragmentation by the "labyrinth" type allows the simus rhythm to be restored in most patients with chronic form of atrial fibrillation and in long-term periods--in half of the patients.

[Effectiveness of using autologous mono-nuclears of the bone marrow in treatment of patients with ischemic heart disease].

The authors have analyzed their experiences with treatment of 50 patients with ischemic heart disease using transplantation of autologous mono-nuclears of the bone marrow. It was shown that this operation resulted in an improvement of indices of the heart functions and myocardium metabolism. Transplantation of stem cells as mononuclear fraction of the bone marrow is indicated in treatment of different groups of patients: in recurrent diseases after previous operations on the coronary arteries; in patients with distal lesions of the coronary bed; transplantation of autologous stem cells of the bone marrow is expedient simultaneously with coronary artery bypass grafting or coronary angioplasty (stenting).

[Effects of the dual chamber electrocardiostimulation on the systolic and diastolic function of the myocardium]. / Vliianie dvukhkamernoi élektrokardiostimuliatsii na sistolicheskuiu i diastolicheskuiu funktsii miokarda.

An assessment of the indicators of the systolic and diastolic functions of the left ventricle was made in 52 patients against the background of electrostimulation with a dual chamber electro-cardiostimulator with different atrioventricular delays (185, 125 and 79 ms). Different variants of the reactions to electrostimulation with a shorter atrioventricular delay were detected: the positive dynamics of the diastolic indicators was registered in the hypertrophic type of the diastolic dysfunction, aggravation of the diastolic disorders--in the restrictive type.

[Experimental and clinical research on the Russian Vitaflon blood vessel prosthesis]. / Eksperimental'no-klinicheskoe issledovanie otechestvennogo proteza krovenosnykh sosudov "Vitaflon".

The authors have performed an experimental and clinical assessment of a new graft. In 37 mongrel dogs 49 experiments were carried out with the implantation of grafts "Vitaflon" into different parts of the arterial and venous bed. It was shown that the domestic graft from modified polytetraftoroethylene had high biological inertia, good plastic properties, zero surgical porosity, strength and reliable "taking" by the recipient's organism. Following the experimental work the prosthesis "Vitaflon" (30-50 cm long and 8 mm diameter) was implanted in the femoro-popliteal-tibial position to 15 patients suffering from obliterating atherosclerosis of the lower extremity arteries. The period of follow-up observations was about 12 months. Thrombosis took place in two grafts in the early postoperative period. Other shunts were functioning well which was confirmed by the clinical picture and dopplerography.

[The surgical treatment of aneurysms of the abdominal aorta]. / Khirurgicheskoe lechenie anevrizm briushnoi aorty.

Based on an experience with treatment of 107 patients with aneurysms of the abdominal aorta subjected to planned or urgent operations the authors discuss the problems of the clinical course, diagnosis, indications for operative treatment, the technique of operative interventions and their results. In planned operations lethality was 4.1%, in ruptures of the aneurysm-64.2%. One year after the operations 90% of the patients were practically healthy, 5 years later they were 70%.

[Cardiomyoplasty--a surgical method of treatment in heart failure]. / Kardiomioplastika--khirurgicheskii sposob lecheniia serdechnoi nedostatochnosti.

Until recently heart transplantation has been the only method of surgical treatment of severe myocardial heart failure. In the recent years operations of cardiomyoplasty have been performed more and more often for treatment of patients with this disease. The article presents the literature and personal data on the operation technique, indications and contraindications for it. First clinical results of the operative interventions fulfilled since 1994 are discussed.

[A comparative study of lipid peroxidation activation after myocardial electro-destruction and in the early stages of the development of myocardial infarct in experimental studies in dogs]. / Sravnitel'noe izuchenie aktivatsii protsessov perkisnogo okisleniia lipidov posle élektrodestruktsii miokarda i v rannie sroki razvitiia ostrogo infarkta miokarda v éksperimente na sobakakh.

Electric defibrillation counter shock impulses and AMI influence on lipid peroxide activation processes were conducted. The results showed insignificant lipid peroxide activation after defibrillation counter shock (200-300 J), while the same activation in first hours of coronary artery ligation was 1.4-1.5 times greater. We concluded that lipid peroxide activation products may be an appropriate method for AMI evaluation and prognosis.