[Perfusion, Metabolism and Regional Myocardial Contractility in Patients With Valvular Heart Disease: a Long-Term Follow-Up After Valve Replacement].

AIM: To perform complex assessment of myocardial perfusion, metabolism, and regional contractility in patients with valvular heart disease (VHD) in remote period after surgical correction of heart defects. MATERIAL AND METHODS: We examined 30 patients with VHD in 1-8 years after heart valve replacement because of mitral (n=13) or aortic (n=17) valve defects of the following etiology: rheumatic heart disease (n=10), degeneration of connective tissue (n=13), infective endocarditis (n=7). For assessment of myocardial perfusion, metabolism, and regional contractility, we used single photon emission computed tomography (SPECT). RESULTS: Myocardium of patients who had undergone surgical correction of heart valve defects was characterized by dominating diffuse sclerotic changes localized mostly in basal segments. Hibernating myocardium was a less frequent finding. There were segments of borderline state with normal parameters of metabolism but slight impairment of perfusion without pronounced disturbances of kinetics. Patients with infectious etiology of valvular defects had combined perfusion and metabolic changes in multiple myocardial segments. Extensive derangements of perfusion and metabolism were characteristic for patients with connective tissue degeneration. CONCLUSION: Signs of cardiac failure caused by disturbances of myocardial perfusion and metabolism in patients with valvular heart disease can persist even after successful correction of valvular defect with normalization of intracardiac hemodynamics.

[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.

[Effects of long-term therapy with losartan on baroreflex regulation of cardiovascular system]. / Vliianie dlitel'noi terapii lozartanom na sostoianie baroreflektornoi reguliatsii serdechno-sosudistoi sistemy.

To assess dynamics of structural-functional parameters of the circulatory system including the state of the cardiopulmonary baroreflex (CPBR) in patients with ischemic heart disease (IHD) and cardiac failure (CF) on losartan treatment, we studied 14 IHD men with CF (NYHA functional class II-III), mean age 54.6 +/- 7.1 years. Before and after losartan treatment the patients were examined using echocardiography, radiocardiography with 131-I albumin, occlusion plethysmography, 131-I hippuran clearance. CPBP was estimated by the change in circulation flow rate in the forearm in low body rarefaction by means of low pressure camera. Losartan was given in maximal tolerance dose (25-100 mg/day). Examination in the end of the treatment demonstrated diminished venous tone, increased blood flow in the forearm, reduced volume of circulating plasm, elevated hematocrit, higher ratio of early to late filling peaks of the left ventricle, progression of baroreflex dysfunction. Thus, long-term losartan treatment promoted improvement in peripheral vascular tonicity, diastolic function of left-ventricular myocardium, reduction in circulating plasm volume, progression of baroreflex dysfunction.

[The effect of tropoxin on the neurogenic and vasogenic inflammation of the dura mater vessels]. / Vliianie tropoksina na neirogennoe i vazogennoe vospalenie sosudov tverdoi mozgovoi obolochki.

Subchronic administration of tropoxin (in doses of 7.5 and 10 mg/kg) caused dose-dependent blocking of 131I-albumin plasma transudation from the dura mater vessels, induced by electrical stimulation of the trigeminal ganglion and intravenous infusion of the agonist of 5-HT2B/2C receptors metachlorophenylpiperazine. The antimigraine agent metisergid produced a similar effect. A single injection of metisergid and tropoxin did not block albumin transudation. A 3 mg/kg dose of mianserin prevented the blocking effect of tropoxin and metisergid on plasma exudation into the dura mater. It is suggested that the mechanism of the tropoxin antimigraine effect is realized through the presynaptic 5-HT1 receptors of afferent endings of the trigeminal nerve and the postsynaptic 5-HT2B/2C receptors of the dura mater vessels.

[The effect of clofelin on the transudation of plasma proteins into the dura mater induced by stimulation of the trigeminal ganglion]. / Vliianie klofelina na propotevanie belkov plazmy v tverduiu mozgovuiu obolochku, vyzvannoe stimuliatsiei troinichnogo gangliia.

Intravenous administration of clofelin blocks transudation of 131I-albumin into the dura mater of rats in electrical stimulation of the trigeminal ganglion. Preliminary injection of the alpha-adrenoblocker yohimbine and the antagonist of serotonin receptors 5-NT1 mianserin completely removes the blocking effect of clofelin. Naloxon and the alpha 1-adrenoblocker prazosin had no effect on the degree of expression of albumin transudation and the clophelin effect. The role of the adrenergic system, the presynaptic alpha 2-adrenoceptors in particular, in functioning of the trigeminovascular system and the development of neurogenic inflammation in the dura mater is discussed.

[Effects of jejunoileal shunting operation on the blood circulation system in patients with morbid obesity]. / Vliianie operatsii eiunoileoshuntirovaniia na sistemu krovoobrashcheniia u bol'nykh s ozhireniem krainei stepeni.

With the use of radiocardiography, the indices of central hemodynamics were studied in 22 patients with III-IV degree morbid obesity who underwent the operation of jejunoileal shunting. A special attention should be paid to the state of the patients within the first 18 months after the operation, because at this period, reformation of the cardiovascular system is most pronounced. The formulas for prediction of the state of the central hemodynamics at the late postoperative period are suggested.

[The central hemodynamic function of obese patients]. / Sostoianie tsentral'noi gemodinamiki u bol'nykh ozhireniem.

The authors substantiate the employment of radiocardiography for the examination of the cardiohemodynamics in patients with obesity of the III and IV grades. On the basis of a study of the main hemodynamic indices in patients with extreme obesity a trial is made to evaluate the pathogenesis of cardiac insufficiency in these patients.

[Determination of effective renal blood flow and the rate of glomerular filtration by sequential administration of I-131 hippuran and Yb-169 DTPA]. / Opredelenie éffektivnogo pochechnogo krovotoka i skorosti klubochkovoi fil'tratsii putem posledovatel'nogo vvedeniia 131 I-gippurana i 169 Yb-DTPK.

The authors present the results of the determination of the effective renal blood flow (ERB), the effective renal plasma flow (ERP) and the rate of glomerular filtration (GRF) by sequential administration of 131I-hippuran and 169Yb-DTPK assessing the contribution of each radionuclide in blood plasma specimens with the help of a multichannel pulse analyzer. The mean values of ERB (738.4 +/- 27.3 ml/min), ERP (391 +/- 22.4 ml/min) and GRF (128.9 ml/min) were in full accord with the literature data. The difference between GRF values calculated in the presence of 131I in plasma and after its decomposition, did not exceed 5% (6.4 +/- 1.8 ml/min), and the ratio of correlation between them was 0.948, p less than 0.01. A possibility of simultaneous determination of ERB and GRF under clinical conditions was shown.

[A comparative evaluation of methods for determining the glomerular filtration rate by 169Yb-DTPA clearance]. / Sravnitel'naia otsenka metodov opredeleniia skorosti klubochkovoi fil'tratsii po klirensu 169Yb-DTPK.

The authors present the results of comparative analysis of 7 radionuclide clearance methods for the determination of glomerular filtration rate (GFR), based on single administration of 169Yb-DTPC. A reference method was based on the determination of GFR by a curve of a decrease in plasma concentrations with subsequent biexponential analysis on a DVK-2M computer. Methods of the determination of GFR based on 2 blood drawing tests after achieving a uniform distribution of the indicator in its volume of dilution (1) and extracorporal labeling of gamma radiation by a precordial detector (2) showed the highest degree of correlation with the reference method (r = 0.918, p less than 0.001 and r = 0.920, p less than 0.001, respectively). The use of both methods based on a single-chamber model of renal clearance, led to good results, provided the measurements were to start not earlier than 1.5 h after administration of the indicator.

[Neurohumoral mechanisms regulating renal blood circulation in patients with hypertension undergoing captopril block of angiotensin-converting enzyme]. / Neirogumoral'nye mekhanizmy reguliatsii pochechnogo krovoobrashcheniia u bol'nykh gipertonicheskoi bolezn'iu pri blokade angiotenzinprevrashchaiushchego fermenta kaptoprilom.

A study was made of the effect of a single intake of captopril on the neurohumoral mechanisms of the regulation of renal circulation in 25 patients with essential hypertension (EH). Captopril induced an increase of the effective renal blood flow (ERB) and of the effective renal plasma flow along with a considerable lowering of the renal vascular resistance. No relationship was found between these changes and the time course of changes in the activity of plasma renin, aldosterone and vasopressin concentration in blood plasma. The relationship was established between the changes in the ERB and the time course of changes in baroreceptor sensitivity that significantly increased in the majority of EH patients under the effect of captopril.

[Participation of the baroreceptor reflex in the hypotensive effect of clofelin in hypertensive patients]. / Uchastie baroretseptornogo refleksa v gipotenzivnom éffekte klofelina u bol'nykh gipertonicheskoi bolezn'iu.

Involvement of the baroreceptor reflex in a hypotensive effect of clofelin was studied in 12 patients with hypertension. A close relationship of changes in the parameters of central hemodynamics with the baroreflex levels and alteration during hypotensive therapy was established.