Dynamics of Metabolic and Oxidative Parameters of Erythrocytes during Treatment of Chronic Heart Failure with Molecular Hydrogen.

We studied the effect of molecular hydrogen (H2) on the content of 2,3-diphosphoglyceric acid (2,3-DPG), ATP, malondialdehyde, and catalase activity in erythrocytes in chronic heart failure. Inhalation of 2% molecular hydrogen H2 was carried out for 40 min repeatedly (5 days) or once. Inhalation of H2 caused an increase in ATP concentration in both research groups, but was more pronounced after repeated inhalation. The content of 2,3-DPG increased after repeated exposure to H2. The increase in metabolic activity under the effect of H2 was accompanied by a decrease in malondialdehyde concentration and an increase in catalase activity. Thus, the application of H2 in chronic heart failure reduced oxidative stress and improved metabolism of erythrocytes, which contributes to improvement of microcirculation. This allows us to recommend H2 for protection against ischemic and reperfusion damage to the myocardium.

Infrared Spectroscopy in Differential Diagnosis of Pulmonary Embolism.

The aim of the study was to assess the effectiveness of infrared spectroscopy for verification of pulmonary embolism (PE) and a number of similar diseases. MATERIALS AND METHODS: Infrared spectroscopy was used to investigate blood serum of 19 healthy volunteers and 30 patients with intraoperatively confirmed PE as well as with chronic obstructive pulmonary disease (COPD) (n=10), pneumonia (n=10), tuberculosis (n=10), lung abscess (n=10) and lung cancer (n=10), acute disorder of cerebral circulation (ADCC) (n=10), ischemic heart disease (IHD) (n=10). Peak height ratios of absorption band were taken as diagnostic parameters (cm-1/сm-1): P1 - 1160/1165; P2 - 1165/1070; P3 - 1165/1150; P4 - 1165/1050; P5 - 1100/1050; P6 - 1025/1165. These parameters of IR spectrum are significant for the given nosology. RESULTS: The calculated indicators have demonstrated statistically significant difference of IR spectra parameters for the studied nosologies (p<0.001) even on the small samples supplementing each other and enabling step-by-step exclusion of lung abscess and pulmonary tuberculosis, COPD and pneumonia, cancer, IHD, ADCC, and PE.The presented radar charts, built with consideration of the values of all peak height ratios of the absorption bands with diagnostically significant maxima, provided the possibility to visualize the IR profiles making the differentiation of PE and its clinical analogs not only more objective and reliable but also more explicit and compelling. CONCLUSION: Infrared spectroscopy is a potentially effective method of PE differential diagnosis. Sample expansion will allow researchers to evaluate the sensitivity and specificity of this technique compared to the existing standard schemes of PE verification.

New Technology for the Use of Inhaled Nitric Oxide to Protect the Heart and Lungs during Operations with Cardiopulmonary Bypass.

The aim of the study was to evaluate the effectiveness of a new technology for the use of inhaled nitric oxide (NO) for the heart and lung protection during operations with cardiopulmonary bypass (СРВ). MATERIALS AND METHODS: The study included 90 patients who underwent heart valve surgery and combined procedures under CPB and pharmacological cardioplegia. Three groups were created: group 1 (control, n=30); group 2 (n=30) - NO inhalation (20 ppm) was conducted traditionally, that is, before and after CPB; group 3 (n=30) - NO inhalation was performed using a new technology - during the entire operation, with pulmonary artery perfusion and lung ventilation performed during CPB. Troponin I (cTn I) level, changes in the pulmonary function parameters, and clinical indicators were studied. RESULTS: Statistically significant lower levels of postoperative cTn I were registered in the patients of groups 2 and 3, at the same time, the levels were significantly lower in group 3 compared to group 2. The patients in group 1 (standardized anesthesia protocol) demonstrated an increase in the alveolar-arterial oxygen difference, an increase in intrapulmonary shunting, a decrease in blood oxygenation, and static lung compliance after СРВ. In both cases, NO inhalation retained the values of lung compliance and pulmonary oxygenating function after CPB, and in the patients of group 3, it also significantly reduced intrapulmonary shunting and alveolar-arterial difference after CPB. NO inhalation allowed a statistically significant decrease in the incidence of pulmonary dysfunction, acute respiratory failure, as well as the time of respiratory support in the ICU. CONCLUSION: The developed technology for the use of inhaled NO in surgery with CPB provides a clinically marked protective effect on the heart and lungs. The effectiveness of the protective action of NO depends on the duration of its administration and is most pronounced when used during the entire operation, including CPB time.

Application of Molecular Hydrogen in Heart Surgery under Cardiopulmonary Bypass.

The aim of this work was to study the effect of molecular hydrogen on oxidative processes in cardiac surgery patients with acquired valve heart disease applied during surgery under cardiopulmonary bypass (CPB). Materials and Methods: The study involved 20 patients (16 men and 4 women) with acquired heart valve disease who were operated on under CPB. Two groups of patients were formed. In group 1 (n=11), anesthesia included inhalations of molecular hydrogen, which was supplied to the breathing circuit of the ventilator at a concentration of 1.5-2.0% immediately after tracheal intubation and throughout the operation. In group 2 (n=9), inhalation of molecular hydrogen was not performed. Blood sampling was taken at 4 stages: immediately after anesthesia induction, before CPB and after its termination, and also one day after the operation. The intensity of the processes of lipid peroxidation was evaluated by the level of diene (DC) and triene (TC) conjugates, Schiff bases (SB). Results: In the patients of group 1, the arterial blood samples showed a decrease in the level of TC and SB, as compared to the first stage of the study, before the initiation of CPB and one day after the operation. An increase in the level of DC and TC was detected after the termination of CPB (p<0.05). In the venous blood samples, an increase in the level of DC was noted before the initiation of CPB, which was restored by the third stage of the study (p<0.05). At the same time, after the termination of CPB, a tendency towards a decrease in TC and SB was observed, which persisted one day after the operation.In the patients of group 2, an increase in the concentration of SB in the arterial blood samples was recorded during the study as compared to the first stage. The level of TC and SB in the venous blood samples increased one day after the operation. Conclusion: Intraoperative inhalation of molecular hydrogen leads to a decrease in the oxidative stress manifestation, it being most pronounced one day after the operation. This suggests that molecular hydrogen can be used in cardiac surgery as an effective and safe antioxidant.

Modified Mitral Valve Repair with Its Insufficiency of Ischemic Genesis.

The aim of the study was to assess the effectiveness of modified mitral valve repair in comparison with traditional methods of correcting ischemic mitral regurgitation. Materials and Methods: The results of surgical treatment of 80 patients with coronary artery disease complicated by ischemic mitral regurgitation were analyzed. The mean age of the patients was 58.95±8.36 years; the ratio of men and women was 67:13. Heart failure of FC II (according to the NYHA classification) was detected in 6 patients (7.50%), FC III - in 69 (86.25%) patients, FC IV - in 5 (6.25%) patients.Echocardiographic examination was used to determine the significance and genesis of mitral regurgitation in the preoperative period. 57 patients (71.25%) were detected with grade II mitral regurgitation, 23 (28.75%) had grade III.Annuloplasty was chosen as the operation for the correction of the valve apparatus. The patients of group 1 (n=23) underwent reconstructive surgery on the mitral valve using an autopericardial strip according to the technique, which we have developed, in combination with coronary artery bypass grafting (CABG), the patients of group 2 (n=26) underwent plastic surgery using a support ring in combination with CABG, patients of group 3 (n=31) had myocardial revascularization without correction of the valve apparatus. Results: The patients of group 2 underwent restrictive mitral annuloplasty performed with rigid support rings, group 1 - with an autopericardial strip as a soft support ring, the patients of group 3 underwent CABG alone.One patient from group 2 died in the early postoperative period due to acute perioperative myocardial infarction.The most common complications were pleurisy, acute cardiovascular failure, acute respiratory failure, and cardiac arrhythmias. The smallest number of complications was noted in the group 3, where patients underwent CABG alone. After surgery, all the patients showed a decrease in mitral regurgitation, which was most pronounced in the groups with annuloplasty.When analyzing the immediate results of the operations, it was revealed that the patients of groups 1 and 2, who underwent combined interventions, had a higher percentage of complications, and the length of their stay in the ICU increased. However, these groups showed a significant improvement in mitral valve functioning. Plasty of the mitral valve with an autopericardial strip according to the technique, which we have developed, demonstrated a good hemodynamic effect, the absence of significant regurgitation in the postoperative period.

[Effectiveness of the Cox Maze-IV Procedure in Cardiac Surgery Patients With Atrial Fibrillation].

Aim Analyzing a 5-year experience of surgical treatment of cardiosurgical patients with atrial fibrillation (AF).Material and methods The study analyzed results of surgical treatment with extracorporeal circulation in 132 patients with AF who underwent the Maze-IV procedure using a radiofrequency ablator with transmurality feedback from 2013 through 2018.Results Two fatal outcomes were observed in the study group. These outcomes took place in the early postoperative period and were associated with progressive acute heart failure in patients with repeated surgery for mitral valve restenosis. 61.2% of the patients had no AF. Recurrent AF was observed during the first three years after surgery in association with withdrawal of the antiarrhythmic medication, which confirmed a need for long-term antiarrhythmic therapy. Analysis of risk factors for AF relapse identified significant predictors, including left ventricular dilatation larger than 5.5 cm at baseline and more than two-year duration of a history of arrhythmias.Conclusion The Maze-IV procedure proved an effective and safe method of surgical treatment in AF patients with acquired heart defects and ischemic heart disease, which allowed maintaining sinus rhythm in 61.2% of patients for 5 years. Preventive amiodarone saturation reduced the risk of AF relapse by 24.2 % (p=0.038) and incidence of postoperative arrhythmic complications by 34.9 % (p=0.008) in cardiosurgical patients.

[Circular Sympathetic Pulmonary Artery Denervation in Cardiac Surgery Patients With Mitral Valve Defect, Atrial Fibrillation and High Pulmonary Hypertension].

Objective Investigate the influence of the sympathetic denervation of the pulmonary trunk and the orifices of the pulmonary arteries on the degree of pulmonary hypertension (PH) and outcomes of the surgical treatment of atrial fibrillation (AF) in patients with mitral valve defects, complicated AF, and high PH.Material and methods We analyzed the surgical treatment of 140 patients with mitral valve defect, concomitant AF, and high PH - pulmonary artery systolic pressure (PASP) gradient more than 40 mm Hg. The group of interest included 51 patients (46 patients with severe mitral stenosis and five patients with grade 4 mitral valve regurgitation). All patients underwent mitral valve correction (47 valve replacement surgeries and 4 valve-sparing interventions), biatrial Maze IV procedure, and additionally, denervation of the pulmonary trunk and the orifices of the pulmonary arteries. The control group included 89 patients diagnosed with mitral valve defect, AF, and PH with PASP > 40 mm Hg. However, unlike in patients of interest, denervation of the pulmonary arteries was not performed.Results Circular radiofrequency denervation of the pulmonary trunk and the orifices of the pulmonary arteries using a clamp-destructor is an effective and safe method, significantly reduces secondary PH (p=0.018), promotes reverse remodeling of the heart chambers, left atrium in particular (p=0.01), and improves outcomes of the Maze IV procedure (p=0.022) by restoring sinus rhythm in patients with mitral valve defects, complicated AF, and high PH.Conclusion This technique must be studied further involving a more significant number of patients, analyzing long-term results, and using this technique in patients with non-valvular causes of secondary PH.

Endovascular Mechanical Thromboembolus Fragmentation in the Treatment of Critical Pulmonary Thromboembolism in Patients with Acute Hemorrhagic Stroke.

The aim of the study was to evaluate the effectiveness of endovascular mechanical thromboembolus fragmentation in the treatment of critical pulmonary thromboembolism in patients with acute hemorrhagic stroke. MATERIALS AND METHODS: The study included 47 patients with acute hemorrhagic stroke complicated by massive high-risk pulmonary thromboembolism with critical manifestations of the right ventricular failure. All patients were divided into two groups depending on the treatment method: the examined group (n=17) undergone endovascular mechanical thromboembolus fragmentation and the control group (n=30) received only basic intensive therapy. RESULTS: Thromboembolus fragmentation was performed on patients of the examined group in order to transfer embolism of the trunk and main branches to the smaller branches of the pulmonary artery. The technical success of the procedure (destruction of the central thromboembolus) was achieved in 100% of cases. 14 patients (82.4%) showed positive clinical dynamics: improvement of general condition, reduction of pulmonary artery pressure, decreased volume of pulmonary bed damage according to CT angiography. Three patients (17.6%) died in the early postoperative period. Twenty five patients from the control group died, hospital mortality rate was 83.3%. There were no deaths in the examined group after 6-9 months of follow-up, signs of pulmonary hypertension persisted in 11 patients (64.7%). CONCLUSION: Endovascular mechanical thromboembolus fragmentation in the treatment of critical pulmonary thromboembolism in patients with acute hemorrhagic stroke results in fast and safe decrease in pulmonary artery pressure. Fragmentation of central thromboembolus and its displacement into the peripheral vascular bed with a modified pigtail catheter is a minimally invasive surgical procedure which may be used as an alternative to surgical embolectomy in cases of an extremely high risk of surgery and absolute contraindications to thrombolytic therapy.

[Threatened paradoxical embolism, massive occlusion of pulmonary artery: risk stratification, treatment policy]. / Ugrozhaiushchaia paradoksal'naia émboliia, massivnaia okkliuziia legochnoi arterii: stratifikatsiia riska, taktika lecheniia.

Described in the article is a clinical case report regarding a male patient presenting with pulmonary thromboembolism, with a floating thrombus in the common femoral vein, in the right atrium, prolapsing into the right ventricle and propagating through a patent foramen ovale to the left atrium, thus being a threat of paradoxical embolism. The echocardiography findings demonstrated the following: mean pressure in the pulmonary artery amounting to 56 mm Hg, dilatation of the right atrium and right ventricle. The patient was subjected to simultaneous thrombectomy from the common femoral artery, from the right, left atria and pulmonary artery in conditions of cardioplegia, as well as ligation of the superficial femoral artery. The postoperative period proved uneventful. The patient was discharged on postoperative day 15, with pressure in the pulmonary artery amounting to 38 mm Hg. Besides, analysed herein are the contemporary literature data, clinical guidelines, and opinions of experts concerning treatment policy in this complex pathology.

[Optimization of postoperative medical therapy of infective endocarditis in patients with congenital valvular heart disease].

The purpose of this study was to evaluate the effectiveness of combined surgical and medical treatment of infective endocarditis in patients with congenital valvular heart disease when included in a regimen of the drug Reamberin. In this regard, the analysis of the effectiveness of a combination regimen of 74 patients with valvular congenital heart diseases complicated with infective endocarditis. Given the indications for surgical correction operative technique features and possible technical difficulties in carrying out such operations, due to the inflammatory changes and tissue destruction, and ways to overcome them. For the correction of metabolic disorders in the postoperative period, 47 patients (main group) was appointed Reamberin: once, intravenous drip 400 ml/day during the first 5 days after surgery. 27 patients (control group) was conducted infusion therapy depending on the severity of the condition according to the classical scheme. In addition to standard clinical and laboratory examination, to assess the effectiveness of Reamberin was investigated catalase activity of CPK in blood serum in the dynamics of observation (1, 3 and 5 days after surgery). It is revealed that surgical approach, used in complex treatment of patients with valvular congenital heart diseases, including reorganization of the cavities of the heart, increasing the frequency of joints and the use of reinforcing strips of synthetic material that prevents the cutting of sutures through the inflamed tissue has achieved good short-and long-term results. Infective endocarditis and destruction of the valvular annulus fibrosus the use of a frame of strips of polytetrafluoroethylene allows you to restore its integrity and to implant a mechanical prosthesis. The inclusion in the regimen of patients with infective endocarditis complicated by cardiac insufficiency in the early postoperative period the drug Reamberin improves the efficiency of treatment by a more rapid restoration of the normal metabolism of cardiomyocytes and accelerates elimination of signs of heart failure.

Comparative assessment of the effectiveness of treatment of pulmonary thromboembolism in elderly patients.

We compared the efficiency of treatment of 99 patientswith pulmonary thromboembolism using thrombolytic agents, surgical intervention, and anticoagulation therapy with heparin and vitamins K. The surgical treatment proved more efficient than the two other options.

Surgical management of acute pulmonary artery thromboembolism.

We operated on a total of twenty-seven patients presenting with acute massive thromboembolism of pulmonary arteries. The patients' mean age amounted to 38.6 ± 9.17 years. The estimated pressure in the pulmonary artery averaged 54.2 ± 7.15 mm Hg. A total of twenty- two thromboembolectomic procedures were performed in the setting of assisted circulation. In five patients embolectomy was carried out from a thoracotomic approach without artificial circulation. The remote period was marked by a relapse of thromboembolism, with the female patient having completely refused to undergo treatment. All the patients remain in a satisfactory condition, with the estimated pressure in the pulmonary artery maintaining at an average level of 27.05 ± 3.11 mm Hg.

[Surgical treatment of embolism threatening formations of the right parts of the heart].

Operations were fulfilled on 42 patients with embolism threatening formations of the right parts of the heart. An episode of pulmonary arteries was in the anamnesis of 11 patients. In all cases the operations were fulfilled under conditions of extracorporeal circulation and cardioplegia. One patient died at the hospital. Lethality was 2.33%.

[Tension-free plasty in the surgery of abdominal wall hernias].

The article presents an experience with application of tension-free plasty of the anterior abdominal wall using reticular endoprostheses. New endoprostheses of Reperen are developed and applied, a method of sutureless fixation of polypropylene net in the abdominal wall tissues is proposed when performing plasty for great ventral hernias. Advantages of new methods are shown compared with analogs both in selective and in emergency surgery, in different age groups of patients. The direct and long-term postoperative results and parameters of quality of life are investigated.

[A favourable outcome of combined treatment in a patient with renal artery embolism and atrial fibrillation].

Presented herein is a clinical case report regarding a patient who was found to have embolism of the right renal artery with accompanying atrial fibrillation. Open surgery is viewed as a method of choice amongst a variety of the available treatment modalities aimed at re-establishing renal blood supply impaired due to embolism of the renal artery trunk. This clinical example demonstrates a possibility of successful renal revascularization undertaken 72 hours after renal artery embolism. The decision to simultaneously perform a combined surgical intervention consisting of embolectomy from the bifurcation of the renal artery, thrombectomy from it branches, and finally followed by radiofrequency ablation of the cava-tricuspidal isthmus, turned out an appropriate therapeutic policy which yielded a patient-friendly immediate outcome as well as favourable remote results persisting over time.

[Prognostication of the outcome of heart valve prosthesis implantation by the method of nonlinear chaos dynamics of the heart rate]. / Prognozirovanie iskhodov protezirovanii klapanov serdtsa s pomoshch'iu metoda nelineinoi khaoticheskoi dinamiki kardioritma.

An examination of 39 patients with heart diseases was performed before and after operations by the method of geometrical analysis of the nonlinear chaos (fractal) variability of the cardiac rhythm on the basis of the apparatus-programmed complex "Poly-spectrum". Five-minute-long registrations of ECG were carried on. On the basis of the data of examination of 195 healthy volunteers the reference norm of this method parameters was determined. Reliably lower parameters were found in patients with the acquired valvular disease. A dynamic investigation of the geometrical nonlinear structure of the cardiac rhythm has shown the possibility to make a prognosis of early complications after prosthetics of the heart valves.

[Strategy of treatment of aortic stenosis complicated by total calcinosis]. / Taktika lecheniia pri aortal'nom stenoze, oslozhnennom total'nym kal'tsinozom.

The authors made an analysis of problems of strategy of surgical treatment of 132 patients with aortal stenosis complicated by calcinosis. Detailed indications to surgical treatment for stenosis of the aortal valve are given depending on the stage of the disease and complications. The nuances of the technique of performing the operation of prosthesis of the aortic valve are described.