The Clinical Evolution of Diffuse Myocardial Fibrosis in Patients With Arterial Hypertension and Heart Failure With Mildly Reduced Ejection Fraction Treated by Olmesartan or Sacubitril / Valsartan.

Aim      A 12-month evaluation of the potentialities of the angiotensin II receptor inhibitor olmesartan (Olme) and the angiotensin receptor and neprilysin inhibitor (ARNI) sacubitril/valsartan in patients with arterial hypertension (AH) and dyslipidemia in the dynamics of the following indicators of chronic heart failure (CHF): N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF), LV global longitudinal strain (LV GLS) in diffuse myocardial fibrosis (MF) previously diagnosed by magnetic resonance imaging (MRI).Material and methods  Olmesartan medoxomil (n=56) and sacubitril/valsartan (n=63) were used for 12 months in patients with hypertension, dyslipidemia and NYHA functional class II-III CHF with mid-range LVEF (CHFmrEF). MF was diagnosed by the following MRI criteria: late gadolinium enhancement and an increased proportion of extracellular matrix (33% or more). The frequency of persisting late gadolinium enhancement and the increased proportion of extracellular matrix (33% or more) was evaluated at 12 months; changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), NT-proBNP, and LV GLS were evaluated after 3, 6, and 12 months of follow-up.Results Baseline parameters did not differ between groups. The late gadolinium enhancement and increased proportion of extracellular matrix were present at baseline in all patients of both groups (100%; p=1.0). Already at 3 months, statistically significant decreases in SBP and DBP were observed in both groups. In addition, the LV GLS monitoring showed LV GLS significantly increased in both groups after 3 months and continued changing after 6 and 12 months. The NT-proBNP concentration significantly decreased in both groups already after 3 months and continued to decrease after 6 and 12 months. At 6 and 12 months, sacubitril/valsartan was superior to olmesartan in reducing SBP and NT-proBNP and in restoring LV GLS. At 12 months, the incidence of persisting, abnormal late gadolinium enhancement and increased proportion of extracellular matrix was significantly less in the ARNI group.Conclusion      Olmesartan was demonstrated effective in the multi-modality therapy of CHFmrEF and MF in patients with AH and dyslipidemia. ARNI was superior to olmesartan in this regard, but further research of this issue is required.

[Surgical treatment of bilateral occlusive-stenotic lesions of carotid arteries].

The study included 136 patients with atherosclerotic lesions of carotid arteries allocated to 3 groups depending on the state of contralateral arteries. Group1: patients with stenosis and occlusion of contralateral internal carotid artery (ICA) (n = 31); group 2: patients with bilateral carotid stenosis (n = 62); group 3: patients with unilateral ICA stenosis (n = 43). 20, 54 and 34 patients of these groups respectively were operated. A total of 139 carotid endarterectomies (CA) were performed including 11 one-step CA. Overall postoperative lethality was 2.78, 5 and 3.7% in the respective groups. It is concluded that patients with multiple lesions of aortic arch are at highest risk of ischemic stroke. Step by step CA is recommended for their treatment. Intraluminal shunting is optional.

[The use of low-molecular heparins in reconstructive surgery of ascending aortic aneurysms]. / Primenenie nizkomolekuliartnykh geparinov v rekonstruktivnoi khirurgii anevrizm voskhodiashchego otdela aorty.

This paper analyzes the results of the use of enoxaparin for anticoagulant therapy in reconstructions on the ascending aorta (AA) as compared to unfractionated heparin applied previously in the control group. Between 1986 and 2003 a total of 30 patients with AA aneurysms were operated on at the clinic. Insufficiency of the aortic valve with degree II-III regurgitation was present in 25 (83.3%) cases. Chronic dissection of the AA was identified in 10 (33.3%) cases. The patient's age varied from 24 to 52 years (mean 39 years). The etiological factors of AA aneurysm were: Marfan's syndrome (46.7% of cases), Erdheim's syndrome (26.7%), atherosclerosis (10.0% of cases); previous chest traumas were recognized in 16.6% of patients. All the patients were operated on under extra-corporeal circulation and moderate hypothermia. The patients were distributed into two groups. In the control group, eighteen patients were operated on. Anticoagulant therapy was carried out using unfractionated heparin i. v. in a daily dose 10-15 thousand units. Heparin injection was initiated on the first postoperative day and continued for 6.5 days on the average, with a progressive change over to the use of indirect anticoagulants. In the basic group, twelve operated patients were administered the anticoagulant enoxaparin s.c. in a daily dose 0.7-1.0 mg/kg bw. Enoxaparin therapy was initiated from the first postoperative day and continued for 8.9 days on the average, with a progressive change over to indirect anticoagulants. The postoperative lethality in the control group accounted for 22.2% (4 patients). In two cases, it was induced by heart failure and in two cases, by hemorrhagic complications. In the basic group, the beneficial results were achieved in 91.7%; no hemorrhagic complications were recorded. The data obtained allow the conclusion that the use of enoxaparin significantly facilitates the postoperative management of patients with AA aneurysms, providing for a controllable and safe anticoagulant effect.

[Migration of the fragment of the subclavian catheter: diagnosis and surgical treatment]. / Migratsiia fragmenta podkliuchichnogo katetera: diagnostika i khirurgicheskoe lechenie.

Results of examination and surgical treatment of 68 patients after migration of foreign body (fragment of catheter) into venous bed were analyzed. Ultrasonic examination including transesophageal echocardiography was the main method of diagnosis. Various surgical approaches were used depending on localization of the foreign body. Policy of surgical treatment was developed. A case is reported.