Cardiovascular disease and associated comorbid conditions as determinants of adverse perinatal outcomes in pregnancy - an analysis of the results of the register of pregnant BEREG.

AIM: the Aim of the BEREG Registry was to analyze the prevalence and structure of cardiovascular diseases, associated comorbid conditions and assess their effects on pregnancy and perinatal outcomes in real clinical practice. MATERIALS AND METHODS: In Tula city regional perinatal center the observation study named "Assessment of the clinical condition of the pregnant women with cardiovascular disease during gestation, at child delivery, at the early postpartum period and at twelve months after childbirth and assesment of perinatal outcomes, condition of the fetus and the newborn and the quality of treatment of these patients groups.  All eligibly pregnant women hospitalized in 2014 to "Tula regional perinatal center" have been recruited in the Registry. Clinical and demographic data at admission, obstetric history, laboratory and instrumental examination data, previous medical history have been investigated. The following endpoints were evaluated: maternal mortality, death of the fetus and newborn baby; preeclampsia or/and eclampsia, heart failure, arrhythmia, thromboembolism events.  Statistical processing of obtained data was carried out using the software package STATISTICA 10.0 (StatSoft, USA). RESULTS: The study included 3214 women delivered babies in the perinatal center in 2014, of which 691 (21,4%) were diagnosed with cardiovascular disease (CVD) in most cases (451 women, 65,9%) - these were different clinical variants of arterial hypertension (AH). Five women (0.7%) had acquired and 23 women ( 3.3%,) congenital heart defect, non-significant heart development abnormities were found in 80 subjects, (11.6%). and Cardiac arrhythmias and conductivity disturbance have been revealed in 116 and 16 cases (16.8% and 2.3%) correspondingly. Patients with CVD were significantly older than women without CVD and more often had a variety of disorders of carbohydrate metabolism, overweight, obesity and chronic varicose disease of the lower extremities. Pregnancy in women with CVD significantly more often was complicated by the threat of interruption, placental insufficiency, preterm and operative babies delivery. Arterial hypertension as well as obesity, placental insufficiency and threatened miscarriage became prognostically unfavorable conditions that contributed of premature birth and fetal death. Fetal death or newborn babies death took place in 1,3% of all the subjects enrolled. In this cohort antenatal death have been registered in 43,2%, intrapartum one in 2.3% and neonatal death in 54.5%. CONCLUSION: Negative prognostic factors for low birth-weight babies were: placental insufficiency, various clinical variants of AH, obesity and infectious diseases; less input had endocrine diseases and risk of abortion. Adverse factors for the fetus death or newborn death were different clinical variants of arterial hypertension and the risk of abortion in any trimestre of pregnancy.

[Successful correction of congenital heart defects: multiple defects and atrial septal aneurysm].

A case of congenital cardiac disorder with multiple defects in the secondary interventricular septum and atrial septum aneurysm in a young serviceman is reported. Plastic surgery of the atrial septum with a good clinical outcome included closure of the defect with a flap harvested from the autopericardium under conditions of artificial blood circulation and warm blood cardioplegia.

[Successful correction of arterial fistula between coronary arteries and pulmonary trunk].

A case of congenital heart disease (fistula between left coronary artery and right pulmonary artery, right coronary artery and pulmonary trunk) diagnosed accidentally during planned medical examination is reported. Corrective surgery included disconnection of left coronary and right pulmonay arteries, right coronary artery and pulmonary trunk under artificial circulation and warm blood cardioplegia.

[Surgical treatment of coronary heart disease in elderly patients].

Current approaches to the provision of effective medical aid to elderly patients with cardiovascular diseases are discussed. Clinical characteristics of such patients, concomitant pathologies, the strategy and extent of cardiosurgical treatment and postoperative therapy are described The original observations are compared with literature data concerning the immediate postoperative outcomes, clinical features, and peculiarities ofsurgical intervention in the patients of this age group.

[Plastic surgery of the mitral valve in patients with coronary heart disease].

Modern approaches to cardiosurgical plastic intervention on the mitral valve in case of its ischemic insufficiency are discussed. Etiology of this condition, indications for surgery, and the history of such operations are described. It is concluded that plastic surgery of the mitral valve is the method of choice for the treatment of patients with coronary heart disease.

[The use of biological cardiac valve prostheses in modern cardiosurgery].

The present review is devoted to the problem of bioprosthetics of cardiac valves with special reference to its methodological and technological aspects including peculiarities of the most extensively used varieties of biological prostheses, current tends in the choice of indications for their application in the treatment of various congenital valvular diseases and for their implantation to the specific groups of patients. The main causes and mechanisms underlying structural degradation of bioprostheses depending on the technological processes of their manufacture and the patterns of calcium salt accumulation in the fixed tissues are considered Physiological consequences and delayed results of bioprosthetics are discussed.

[Coronary artery bypass grafting in the elderly patients: anesthesia and postoperative period].

The objective of the present work was to clarify whether the advanced age of the patients with chronic coronary heart disease may be a precipitating factor with respect to anesthesia and aortocoronary/mammarocoronary bypass grafting surgery. The study group was comprised of 34 patients at the age from 66 to 75 years. The control group consisted of 38 patients aged between 60 and 65 years. The two groups were matched for a variety of characteristics. The overall intrahospital lethality rate was estimated at 1.39% (including one patient from the control group). The patients of the study group were characterized by higher functional classes of angina and cardiac failure in conjunction with lower myocardial contractile reserve. The duration of aortic compression, artificial blood circulation, inotropic support, and artificial lung ventilation was greater in the study group than in the control one even though the total duration of the hospital stay was similar. It is concluded that the surgical treatment of elderly patients presenting with chronic coronary heart disease has beneficial outcome in the early postoperative period; for this reason, the advanced age is not a contraindication for the surgical intervention on such patients.

[Comparative analysis of community-acquired pneumonia severity in servicemen of organized military groups].

The results of the treatment of 2000 patients with community-acquired pneumonia are showed, 693 of 2000 patients were vaccinated with pneumococcal vaccine "Pneumo-23". Vaccinated patients, in comparison with non-vaccinated, didn't suffer from complications and sustained course of a disease. The regression of disease's symptoms and radiological resolution of pneumonia were faster. The length of hospital stay was shorter (18.1 +/- 1.7 and 22.41 +/- 1.30 days agreeably).

[Atrial fibrillation after coronary artery bypass grafting].

The review is focused on atrial fibrillation soon after coronary artery bypass grafting. The most popular algorithms for the prevention and management of this condition are discussed including the protocol accepted in the Cardiosurgical Centre of P. V. Martynov 2nd Central Military Hospital. Modern concepts of pharmacotherapy of atrial fibrillation, restoration, and maintenance of sinus rhythm are considered.

[Correction of mitral regurgitation in conditions of surgical treatment of coronary heart disease].

It was the purpose of this search to announce that elaborating an optimal tactics for patients with coronary heart disease (CHD), complicated with ischemic mitral regurgitation (IMR). There were operated 85 patients with CHD and IMR in the course of 2006-2008. Previously all patients were separated on 3 groups in dependence of severity of IMR, character of damage of coronary race and changing of left ventricle. In the first and the second groups was realized an aorta-coronary shunting with annuloplasty. In the third group was realized an isolated shunting. Mortality in hospital was zero percents. A rudimentary regurgitation was noted by 10% of patients of the 1st group. The maximum period of monitoring was 24 months. Freedom from mitral regurgitation for the 1st and 2nd group was 95%, for the 3rd--93%. So, adequate and mutual estimation of flap-connected factors as well as condition of coronary race by the patients with IMR reduces the risk of by-pass mitral regurgitation and shows good short-term and long-term results.

[Stenosis of the trunk of left coronary artery: state-of-the-art].

Coronary artery bypass grafting (CABG) is traditionally considered to be the "golden standards" of treatment for patients with the affected trunk of left coronary artery (LCA) due to its good early and late outcome, low mortality rate and frequency of repeat surgery. This fact is well documented as reflected in relevant guidelines of European and American scientific societies. However, the recent years have witnessed markedly extended application of drug-coated stents despite the fact that immediate and delayed results of such treatment need more comprehensive verification. This review is focused on the evaluation of advisability of using drug-coated stents to manage lesioned LCA based on the results of randomized studies in comparison with CABG and percutaneous transluminal coronary angioplasty. An optimal method for the treatment of the affected LCA trunk is proposed based on the available data. It is concluded that CABG remains the method of choice for the treatment of this pathology (in the absence of contraindications) ensuring good early and late outcome, low mortality rate and necessity of repeat surgery.

[Surgical treatment of post-infarction left ventricular aneurysm complicated by thromboendocarditis].

This paper reports the result of surgical treatment of a patient with hemodynamically significant post-infarction left ventricular aneurysm spreading over the apex, anterolateral wall of the left ventricle, and a major part of interventricular septum complicated by thromboendocarditis.

[Surgical tactics in treatment of osteomyelitis of long bones].

The new osteomyelitis classification was worked out on the strength of treatment results of 361 patients. Four types of long bones lesions are marked out: medullar, superficial, focal and diffuse. The kind of surgical treatment is determined according to the lesion type. Authors worked out a modification of osteoplastic trepanation--a "grip-sack" technique, which is used for medullar and focal femoral and tibial osteomyelitis. Long term follow-up results are obtained in 271 (77,7%) cases. The developed classification eases the standardization of follow-up results and permits treatment planning.

[Nutritional status of old patients on programmed hemodialysis].

AIM: To study nutritional status of old patients on programmed hemodialysis. MATERIAL AND METHODS: A total of 82 patients aged 60-88 years were divided into two groups by age: group 1 (n = 41) consisted of 60-75 year-olds, group 2 (n = 41) included 76-year-olds and older. The nutritional status (NS) was assessed by anthropometric and laboratory data, a prognostic hypotrophy index. RESULTS: In group 1 NS was normal in 65.9% patients while in group 2--only in 29.2%. Older patients had obesity in 21.9% cases. CONCLUSION: It is shown that two thirds of presenile and senile patients have abnormal nutritional status. Taking into consideration the fact that protein-energy insufficiency is an unfavourable factor affecting the patients'survival, old patients need a special control of nutritional status and its early correction.

[Revascularization of myocardium: coronary artery bypass grafting or stenting?].

The aim of the study was comparative analysis of long-term results (5 years) after coronary angioplasty and stenting (CAS) and coronary artery bypass grafting (CABG). The results of the treatment of 1100 patients with coronary heart disease, operated since 1999 to 2006 year, were analyzed. 720 (65.5%) patients had undergone CABG (group 1), 226 (20.5%) had had an implantation of stents with pharmaceutical coverage (group 2) 154 (14%) had been implanted with stents without pharmaceutical coverage (group 3). Clinical examination as a rule had occurred before operation, 29-30 days after operation and in every 12 months after discharge from the hospital. Five years survival rate in group of CABG patients was 85.9% and in groups of CAS patients it was 84.1% and 70.8% respectively. Restenosis occurred more frequently in CAS patients: in group 2 in 18.1% patients, in group 3--in 70.1% In group of CABG patients acute myocardial infarction occurred in 11.9% cases to the end of 5th year, in groups 2 and 3 this index was 10.9% and 18.3% respectively. Angina pectoris was absent in 1 year in CABG patients (62%) than in CAS patients (46.7% and 24.3% in groups 2 and 3 respectively; p < 0.05). Comparing results of CAS with use of stents with and without pharmaceutical coverage, the best clinical result was in the group with implanted stents of new generation. Relatively better clinical effect during 5 years occurred in CABG patients.