Clinical observations of COVID-19 infection in patients with chronic thromboembolic pulmonary hypertension.

Aim    To present clinical observations of the novel coronavirus infection (COVID-19) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) after a surgical intervention in the form of thromobendarterectomy from pulmonary artery branches.Material and methods    The Acad. E.N. Meshalkin National Medical Research Center performed 127 open surgical interventions for CTEPH in the form of thromobendarterectomy from 2016 through 2020. The present study enrolled 113 patients included into the follow-up care group and into the Center Registry who were followed up for more than 6 months after the surgery. Clinical and functional features of COVID-19 were evaluated in the studied group.Results    In the follow-up care group, 5 (4.4%) postoperative CTEPH patients had COVID-19. One patient had asymptomatic disease, and others had typical clinical symptoms and bilateral polysegmental pneumonia. There were no cases requiring artificial ventilation and no lethal outcomes. All patients with COVID-19 received anticoagulants as a basis therapy for CTEPH, and two patients who had residual pulmonary arterial hypertension (PAH) additionally received a PAH-specific therapy. During the treatment of COVID-19, no adjustment of the anticoagulant or PAH-specific therapy was required.Conclusion    The group of patients with CTEPH is a unique pathophysiological model for studying the effect of COVID-19 under the conditions of compromised pulmonary circulation. In the studied follow-up care group, the COVID-19 morbidity was 4.4 % without fatal outcomes. Evaluation of the role of chronic anticoagulant and PAH-specific therapy in COVID-19 postoperative patients as well as evaluation of the role of COVID-19 in CTEPH progression merit further investigation.

[Predictors of neurological complications after cardiac surgical interventions in oldery patients.]

To identify predictors of neurological complications in the hospital period after coronary artery bypass grafting (CABG), 92 patients with coronary heart disease aged 70 years and over were analyzed. Intraoperative monitoring of cerebral oxygenation (rSO2, %) was carried out. At the stage of induction anesthesia, the average level of rSO2 for left and right hemispheres was 64-65% without significant changes during the operation. A decrease in rSO2 during cardiopulmonary bypass (CPB) was associated with increased risk of neurological complications. The risk of neurological complications increase 7-fold and 9-fold with a decrease in rSO2 by 20% or more during CPB relative to baseline for left and right hemispheres, respectively. A history of two or more myocardial infarctions increases 3-fold the risk of neurological complications after CABG.

[The effect of spinal card stimulation on quality of life in patients with critical lower limb ischemia]. / Vliianie spinal'noi neirostimuliatsii na kachestvo zhizni bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei.

Today, there are insufficient data on the dynamics of quality of life (QoL) in patients with critical lower limb ischemia after spinal cord stimulation. OBJECTIVE: To study the dynamics of QoL in patients with critical lower limb ischemia one year after spinal cord stimulation. MATERIAL AND METHODS: QoL analysis was performed in 43 patients with critical lower limb ischemia using the SF-36 questionnaire before and one year after spinal cord stimulation. RESULTS: At baseline, we detected reduced QoL parameters corresponding to the physical function (≤30 points). The parameters of mental health corresponded to the moderate level (the score ranged between 42 and 59 points). The total score of physical well-being was reduced: 22.8 (20.2-29.3); the mean score of mental well-being was 41 (32.8-49.2) (p<0.001). One year after spinal cord stimulation, the level of all QoL parameters was increased but the total score of physical well-being remained low 33.2 (24-44.1). The mean score of mental well-being corresponded to the moderate level of QoL 56.5 (49-60.4) (p<0.001). Multivariate regression analysis showed that the physical parameters of QoL after spinal cord stimulation are adversely affected by such factors as age, the history of stroke, the ankle-brachial index (ABI), the presence of type 2 diabetes mellitus (DM), and ischemic heart disease (IHD) in combination with stenosis of brachiocephalic arteries (BCA). The mental health is affected by age and the presence of stenosis of brachiocephalic arteries. CONCLUSION: When selecting patients with critical lower limb ischemia for spinal cord stimulation, such factors as the baseline clinical status (comorbidities), age, history of stroke, and the severity of peripheral artery ischemia need to be taken into account to improve treatment effectiveness and QoL.

[Lung Diffusion Capacity and Efficiency of Pulmonary Gas Exchange in Chronic Thromboembolic Pulmonary Hypertension].

AIM: to study lung diffusion capacity and efficiency of pulmonary ventilation in patients with chronic thromboembolic pulmonary hypertension (CTEPH) depending on the severity of pulmonary hypertension. MATERIALS AND METHODS: The study included 139 patients with CTEPH. The parameters of body plethysmography, lung diffusion capacity, efficiency of pulmonary ventilation and their interrelation with results of angiopulmonography were assessed. RESULTS: Patients were divided according to systolic pulmonary artery pressure (SPAP): group 1 - < 50, group 2 - 50-80, group 3 - > 80 mm Hg. The lung diffusion capacity and the efficiency of pulmonary ventilation in patients with CTEPH were reduced against the background of normal spirometric parameters, most pronouncedly in group 3. Regression analysis revealed an inverse relationship between severity of pulmonary hypertension and lung diffusion capacity (regression coefficient -13.7 [-19.1; -8.3], p 80 mm Hg. The results of the study demonstrate the close relationship between pulmonary hypertension and respiratory ventilation-diffusion disorders in patients with CTEPH.

[Long-term outcomes of spinal neurostimulation in patients with critical lower limb ischemia]. / Otdalennye rezul'taty primeneniia spinal'noi neirostimuliatsii u bol'nykh kriticheskoi ishemiei nizhnikh konechnostei.

AIM: To evaluate long-term outcomes of spinal neurostimulation (SNS) in patients with critical lower limb ischemia (CLI). MATERIAL AND METHODS: Long-term outcomes of SNS were assessed in 52 CLI patients. Changes of clinical status were considered by using of Rutherford R.B. et al. scale. Before and in 12 months after SNS percutaneous oxygen partial pressure (TO2, mm Hg) was measured at the affected lower limb at rest and in orthostatic test. Ankle-brachial index (ABI) was also determined. RESULTS: SNS improved clinical status in most cases through following effects: 1) reduced pain syndrome and increased motor activity; 2) skin ulcers healing due to increased TO2 and improved functional state of microcirculation. No augmentation of TO2 during orthostatic test at TO2 <10 mm Hg was associated with negative clinical dynamics after SNS (OR 3.2, CI 2.2-54.1, p=0.002). Coronary artery disease with supra-aortic vessels lesion was associated with reduced ABI after SNS (OR 2.1, CI 1.4-3.8, p=0.001).

Advanced consumable-free morphological analysis of intact red blood cells by a compact scanning flow cytometer.

Whereas modern automated blood cell analyzers measure the volume of individual red blood cells (RBCs), leading to four RBC indices (mean corpuscular volume, MCV; mean corpuscular hemoglobin, MCH; mean corpuscular hemoglobin concentration, MCHC; red cell distribution width, and RDW), the RBC shape has not been assessed by clinical screening tools. We applied the scanning flow cytometer (SFC) for complete characterization of intact RBC morphology in terms of diameter, maximal and minimal thicknesses, volume, surface area, sphericity index, spontaneous curvature, hemoglobin concentration, and content. The above-mentioned individual RBC characteristics were measured without fluorescent markers and other chemicals by a SFC equipped only with 660 nm laser for RBC illumination and single detector for measurement of angle-resolved light scattering. The distributions over all RBC characteristics were constructed and processed statistically to form the novel 31 RBC indices for 22 donor samples. Our results confirm the possibility of precise, label-free, enhanced morphological analysis of individual intact RBCs with compact single-detector flow cytometer. Detailed characterization of RBCs with high statistics and precision can be used to increase the value of screening examinations and to reveal pathologies accompanied by abnormality of RBC shape. © 2017 International Society for Advancement of Cytometry.

[Predictors of Cardiorespiratory Complications in Patients With Ischemic Heart Disease After Coronary Artery Bypass Grafting].

PURPOSE: to elucidate predictors of cardiorespiratory complications during the early postoperative period after coronary artery bypass grafting (CABG) in patients with ischemic heart disease (IHD). MATERIAL AND METHODS: We examined 180 patients with IHD (mean age 59.3+/-1.23years). Prior to surgery we assessed their clinical and functional status including state of respiratory function. Predictors of complications were determined by univariate logistic regression analysis. RESULT AND CONCLUSIONS: Early postoperative complications in this group of patients were atrial fibrillation, prolonged mechanical ventilation, and cognitive disorders. Main predictors of these complications were preoperative abnormalities of respiratory function (presence of chronic obstructive pulmonary disease, decreased efficiency of pulmonary ventilation), and concomitant diseases such as type 2 diabetes and multifocal atherosclerosis.

[The role of integrated assessment of the indicators of external respiration function in cardiac surgical patients]. / Rol' kompleksnoi otsenki pokazatelei funktsii vneshnego dykhaniia u patsientov s kardiokhirurgicheskoi patologiei.

This literature review dedicated to the importance of an integrated assessment of external respiratory function in cardiovascular diseases (CVDs), including an analysis of up-to-date techniques, such as spirometry, body plethysmography, examination of the diffusing capacity of the lung, determination of O2 consumption with evaluation of the effectiveness of pulmonary ventilation. It considers the pathogenetic components of impairments in pulmonary ventilation and gas exchange, which develop in different CVDs, as well as during and after cardiac surgery. The authors analyze the results of international investigations and their own experience, which emphasize the prognostic value of lung function tests and suggest that there is a need for a comprehensive functional assessment of the respiratory system in cardiac surgical patients for their effective preoperative preparation, assessment and reduction of operational risks, and improvement of the prognosis of surgical treatment.

Risk of development of neurological complications in prosthetic repair of the aortic ascending portion and arch. / Risk razvitiia nevrologicheskikh oslozhnenii pri protezirovanii voskhodiashchego otdela i dugi aorty.

The study comprised a total of 68 patients (presenting) with chronic dissection of the aortic ascending portion and arch, undergoing surgery and subjected to measuring at various stages of the operation the level of cerebral oxygenation (rSO2) of the right and left hemispheres by means of bilateral transcranial spectroscopy. The aim of the study was to examine the risk for the development of neurological complications in patients with chronic dissection of the aortic ascending portion and arch in various methods of cerebral protection during aortic prosthetic reconstruction. Group One consisted of thirty-one 40-to-61-year-old (mean age 51 years) patients who during circulatory arrest (CA) were as cerebral protection subjected to antegrade cerebral perfusion (ACP) on the background of moderate hypothermia (23-24°C). Group Two included thirty-seven 40-to-58-year-old (mean age 48 years) patients who during CA were subjected to cerebral protection consisting in craniocerebral hypothermia on the background of total deep hypothermia (18°C). Prior to surgery and in the immediate period thereafter, all patients underwent clinical and instrumental examination of the neurological status. During CA while aortic arch repair in Group One patients at the expense of maintaining cerebral perfusion a decrease in rSO2 registered in the right and left hemispheres amounted to only 11.8 and 8.7%, respectively, compared with the baseline values. In Group Two patients during CA a decrease in rSO2 along the right and left hemispheres amounted to 29.6 and 30.9% compared with the initial values, which was statistically significantly more than in Group One (p=0.002 and p=0.003). Thus, in Group Two patients during CA cerebral hypoperfusion resulted in a considerable decrease in oxygen supply of the brain, in spite of systemic deep hypothermia and craniocerebral hypothermia, promoting reduction of cerebral metabolism. Using ACP during CA in Group One patients maintained the oxygen status of the brain at an optimal level. In Group One patients, in the early postoperative period neurological complications were registered in 12.9% of cases. In Group Two, neurological complications were noted in 35.1% of cases. The univariate logistic regression analysis demonstrated that the risk for the development of any neurological complications depended on the degree of a decrease in rSO2 during CA while prosthetic repair of the aortic arch relative to the previous values - OR 1.25; 95% CI 1.11-1.65; p=0.02. Hence, deep hypothermia and craniocerebral hypothermia used as cerebral protection during CA turned out to be less effective compared with ACP, because despite reduction of metabolic requirements of the brain, cerebral hypoperfusion substantially of neurological status impairments in the early postoperative period.

Biochemical markers in blood serum of patients undergoing various methods of carotid endarterectomy. / Biokhimicheskie markery syvorotki krovi pri razlichnykh metodakh karotidnoi éndarteréktomii.

The authors studied the concentration of CRP, sE-selectin, sP-selectin, sICAM-1, sICAM-3, sVCAM-1, sPECAM and endothelin-1 in blood serum of patients presenting with stenotic lesions of carotid arteries and undergoing various methods of carotid endarterectomy (CEAE): eversion CEAE (Group I) and CEAE using a xenopericardium patch (Group II). Within the time frame of the study, patients in both groups were found to have an elevated CRP level in the early postoperative period, having returned to the baseline values at 6 postoperative months, as well as an increase in the concentration of endothelin-1 at six months after surgery and a decrease of the sE-selectin concentration in the early postoperative period. The level of sP-selectin in Group II patients was noted to increase considerably six months after correction of stenosis. The content of sICAM-1 and sVCAM-1 did not differ in the early postoperative and baseline periods, and was noted to decrease 6 months after the operation. Group II patients demonstrated a decrease in the sPECAM concentration during postoperative day one, followed by returning to the initial values six months after CEAE. The above-mentioned biochemical markers may be used during the postoperative follow-up period for early detection and appropriate correction of endothelial dysfunction and hyperplasia of the intima of the zone of reconstruction.

[Influence of remote ischemic preconditioning on brain injury markers dynamics during cardiopulmonary bypass].

INTRODUCTION: Remote ischemic preconditioning has gained clinicians' attention as a technique to protect the heart in patients undergoing cardiac surgery under cardiopulmonary bypass. While experimental data report neuroprotective properties of remote ischemic preconditioning, we failed to find any clinical studies investigating its effects on neurologic outcome in cardiac surgery. PURPOSE OF THE STUDY: This prospective randomized placebo-controlled study was undertaken with the aim of elucidating the role of remote ischemic preconditioning for neuroprotection in cardiac surgery. PATIENTS AND METHODS: 88 patients with coronary heart disease scheduled for on-pump coronary bypass grafting surgery were randomized to receive either remote ischemic preconditioning or control. We studied S100B peptide and neuron-specific enolase to assess neurological damage. Psychophysiological tests were employed to investigate cognitive function after surgery. RESULTS: The perioperative dynamics of S100B and neuron-specific enolase followed similar patterns in both groups throughout the observation period. At the end of surgery, level of S100B was significantly higher in the preconditioning group as compared to controls--0.58 (0.33-0.65) vs. 0.34 (0.23-0.42) mcg/l, p

[Treatment of reperfusion renal lesion after surgical management of chronic post-embolic pulmonary hypertension by means of extracorporeal membrane oxygenation (ECMO)].

Thromboendarterectomy from the branches of the pulmonary artery is a conventionally accepted approach to treatment for pulmonary hypertension in chronic pulmonary embolism. A frequently encountered complication associated with this operation is the development in the postoperative period of the reperfusion syndrome as a potential cause of fatal respiratory failure. Taking into consideration that the reperfusion syndrome is a reversible process, waiting measures of support may save the patient's life. The present article deals with a case report concerning successive surgical management of a female patient suffering from chronic recurrent pulmonary thromboembolism accompanied by high pulmonary hypertension complicated by severe respiratory insufficiency in the early postoperative period, thus requiring long-term use of veno-venous extracorporeal membrane oxygenation (ECMO). The clinical case described in the article shows that veno-venous ECMO may be employed to save patients presenting with reperfusion syndrome following thromboendarterectomy from the branches of the pulmonary artery. The method of connecting ECMO namely in the veno-venous option in this particular case was determined by fact that the patient had no cardiac insufficiency. Numerous studies conducted hitherto have also confirmed that using ECMO in the veno-venous variant is accompanied and followed by a lower incidence rate of complications as compared with that of the veno-arterial variant. The results of our case report strongly suggest that timely use of ECMO in the composition of rehabilitation measures during restoration of the compromised lungs may become an effective strategy aimed at improving survival of patients after successful thromboendarterectomy from the pulmonary artery branches.

[Remote results of surgical reconstruction of the aortic arch in patients with proximal aortic dissection].

INTRODUCTION: It is generally known that Stanford type A aortic dissection has up to now been a serious problem of cardiothoracic surgery. The current state of the art of aortic surgery, anaesthesiological support, and perfusion strategy make it possible to achieve acceptable results in the early postoperative period in various-difficulty aortic arch reconstruction. Taking into consideration that the pathological process to some extent involves the brachiocephalic arteries, of special interest are remote results of various in aggressiveness and radicality types of reconstruction of the aortic arch in its proximal dissection from the point of view of the development of delayed impairments of cerebral circulation. MATERIAL AND METHODS: Over the period from 1999 to 2011, specialists of the Novosibirsk Scientific Research Institute for Circulatory Pathology named after Academician E.N. Meshalkin under the Ministry of Public Health and Social Development operated on a total of 124 patients presenting with DeBakey type I aortic dissection. All factors supposedly influencing the development of cerebral ischaemia were subdivided into the qualitative and quantitative ones. The qualitative factors included gender, aetiology, type of dissection, type of aortic arch reconstruction, type of cerebral perfusion, type of intervention on the aortic root, previous operations on the heart, and the presence of accompanying CAD, arterial hypertension, chronic obstructive pulmonary diseases, and renal pathology. The quantitative factors were as follows: age, height, body weight, duration of assisted circulation (AC), duration of aortic occlusion (AO), duration of circulatory arrest (CA). We examined a total of 80 patients within the terms of 11-124 months (mean 48,3±26,0 months) after surgical treatment. We studied interrelationship between the factors and the development of cerebral circulation impairments in the remote postoperative period. CONCLUSION: In the remote postoperative period virtually all cases of focal impairments of cerebral circulation were associated with accompanying atherosclerosis, i. e. the already compromised brachiocephalic vascular bed. Amongst the qualitative parameters the most significant variables were: aetiology, accompanying diseases, and the type of cerebral perfusion.

[Anxiety-depressive disorders in patients before and in the long terms after aortic replacement]. / Trevozhno-depressivnye rasstroistva u patsientov do i v otdalennye sroki posle protezirovaniya aorty.

OBJECTIVE: To study the structure and dynamics of anxiety-depressive disorders in patients with dissection/aneurysm of the ascending aorta and aortic arch before and in the long term after surgical treatment and to identify factors associated with disturbances in psycho-emotional status. MATERIAL AND METHODS: We examined 124 patients with dissection/aneurysm of the ascending aorta and arch before and in the long-term period after aortic replacement, assessing anxiety and depression using the Generalized Anxiety Disorder (GAD-7) and Beck Depression Questionnaires. Multivariate regression analysis was used to identify factors associated with clinically significant anxiety and depressive disorders. RESULTS: Average scores on the GAD and the depression scale before surgery decreased from 6.5 (4.0-9.0) and 12.0 (8.0-16.0) to 3.0 (2.0-5.0) and 6.0 (3.0-10.0) (p<0.05) respectively, in the long-term postoperative period. There was no significant decrease in the proportion of patients with clinically significant levels of GAD and depression (p>0.05). Before surgery, clinically significant anxiety and depressive disorders are associated with older age, chronic cerebrovascular insufficiency (CCI) and atrial fibrillation (AF) in the hospital period. After surgery, clinically significant GAD was associated with older age, CCI, and a history of stroke. Depressive disorders were associated with older age and a history of stroke. CONCLUSION: In all patients with aortic disease, GAD and depression of varying severity are recorded; clinically significant GAD and depression are recorded in 19.2 and 23.2% of cases. In the long-term postoperative period, there is no significant decrease in the proportion of patients with clinically significant levels of GAD and depression, which amounted to 10.1 and 13.1%. Clinically significant anxiety and depressive disorders before and after surgery are associated with older age and the history of cerebrovascular disorders. In addition, the baseline clinically significant anxiety and depressive disorders showed an association with the subsequent development of AF in the early postoperative period.

[Impairment of cognitive functions in patients with chronic thromboembolic pulmonary hypertension before and after surgical treatment]. / Kognitivnye narusheniya u patsientov s khronicheskoi tromboembolicheskoi legochnoi gipertenziei do i posle khirurgicheskogo lecheniya.

OBJECTIVE: To study cognitive functions in patients with chronic thromboembolic pulmonary hypertension (CTEPH) before and in the long-term after pulmonary thromboendarterectomy and to study factors that negatively affect cognitive status. MATERIAL AND METHODS: One hundred and twenty-four patients with CTEPH were examined before and 6 months after surgery with an assessment of cognitive impairment using the Mini-Mental State Examination (MMSE). Multivariate regression analysis was used to identify factors affecting the MMSE indicators before and in the long-term postoperative periods. RESULTS: Initially, patients with CTEPH had a total MMSE score 23.8±1.1. Six months after surgery, the score was 26.1±1.9 (p<0.001). A history of stroke, disability, stress (loss of spouse), and a high Charleson comorbidity index were independent factors affecting MMSE score before surgery. After surgery, the total MMSE score was influenced by a history of stroke, stress (loss of spouse), residual pulmonary hypertension and atrial fibrillation in the early postoperative period. CONCLUSION: Cognitive impairment in the form of mild dementia was observed in patients with CTEPH before surgery. Six months after the operation, an improvement in cognitive status was revealed, which corresponded to moderate cognitive impairment. At the same time, no complete recovery of cognitive functions was recorded. Patients with CTEPH still experienced the greatest difficulties in the following areas: concentration and counting, memory. A history of stroke, disability, stress (loss of spouse), and a high comorbidity index are associated with a decrease in MMSE scores before surgery. Six months after surgery, MMSE score was affected by a history of stroke, stress (loss of spouse), residual pulmonary hypertension and atrial fibrillation in the early postoperative period.

Gene networks for use in metabolomic data analysis of blood plasma from patients with postoperative delirium.

Postoperative delirium (POD) is considered one of the most severe complications, resulting in impaired cognitive function, extended hospitalization, and higher treatment costs. The challenge of early POD diagnosis becomes particularly significant in cardiac surgery cases, as the incidence of this complication exceeds 50 % in certain patient categories. While it is known that neuroinflammation, neurotransmitter imbalances, disruptions in neuroendocrine regulation, and interneuronal connections contribute significantly to the development of POD, the molecular, genetic mechanisms of POD in cardiac surgery patients, along with potential metabolomic diagnostic markers, remain inadequately understood. In this study, blood plasma was collected from a group of patients over 65 years old after cardiac surgery involving artificial circulation. The collected samples were analyzed for sphingomyelin content and quantity using high-performance liquid chromatography coupled with mass spectrometry (HPLC-MS/MS) methods. The analysis revealed four significantly different sphingomyelin contents in patients with POD compared to those who did not develop POD (control group). Employing gene network reconstruction, we perceived a set of 82 regulatory enzymes affiliated with the genetic coordination of the sphingolipid metabolism pathway. Within this set, 47 are assumed to be regulators of gene expression, governing the transcription of enzymes pivotal to the metabolic cascade. Complementing this, an additional assembly of 35 regulators are considered to be regulators of activity, degradation, and translocation dynamics of enzymes integral to the aforementioned pathway. Analysis of the overrepresentation of diseases with which these regulatory proteins are associated showed that the regulators can be categorized into two groups, associated with cardiovascular pathologies (CVP) and neuropsychiatric diseases (NPD), respectively. The regulators associated with CVP are expectedly related to the effects on myocardial tissue during surgery. It is hypothesized that dysfunction of NPD-associated regulators may specifically account for the development of POD after cardiac surgery. Thus, the identified regulatory genes may provide a basis for planning further experiments, in order to study disorders at the level of expression of these genes, as well as impaired function of proteins encoded by them in patients with POD. The identified significant sphingolipids can be considered as potential markers of POD.

[Treatment of a patient with a ruptured infectious aneurysm of the aortic arch].

Described in the article is a clinical case report concerning surgical treatment of a 65-year-old male patient presenting with a ruptured infectious aortic arch aneurysm. He was subjected to an operation consisting in prosthetic repair of the ascending portion of the aorta and aortic arch with a homograft under conditions of artificial circulation, deep hypothermia, and antegrade cerebral perfusion.

[Cardioprotective effects of glutamine in patients with ischemic heart disease operated under conditions of extracorporeal blood circulation].

It was conducted a study of glutamine cardioptotective effects during perioperative use in patients with ischemic heart disease, operated under CB. Exclusion criteria were: left ventricular ejection fraction less than 50%, diabetes melitus, myocardial infarction less than 3 months ago, Patients of the study group (n=25) had glutamine (20% solution N(2)-L-alanine-L-glutamine ("Dipeptiven" Fresenius Kabi, Germany); 0.4 g/kg/day. Patients of control group (n=25) received placebo (0.9% NaCl solution). The main indicators were the dynamics of troponin I, as well as central hemodynamics parameters. On the 1-st day after operation the concentration of troponin I was significantly lower in the glutamine-group compared placebo-group (1.280 (0.840-2.230) 2.410 (1.060-6.600) ng/ml; p=0.035). 4 hours after CB in a glutamine-group also had significantly large indicators of cardiac index (2.58 (2.34-2.91) l/min/m2 vs 2.03 (1.76-2.32)) l/min/m2; p=0,002) and stroke index (32.8 (27.8-36.0.) ml/m2 vs 26.1 (22.6-31.8) ml/m2; p=0.023). Systemic vascular resistance index was significantly lower in glutamine-group (1942 (1828-2209) dyn x s/cm(-5)/m2 vs 2456 (2400-3265) dyn x s/cm(-5)/m2; p=0.001). Conclusion. Perioperative use of N(2)-L-alanine-L-glutamine during the first 24 hours ofperioperative period gives cardioprotective effect in patients with ischemic heart disease operated under CB.

[Features of psychoemotional status in patients with chronic thromboembolic pulmonary hypertension after cardiac surgery during the COVID-19 pandemic]. / Osobennosti psikhoemotsional'nogo statusa u patsientov s khronicheskoi tromboembolicheskoi legochnoi gipertenziei posle kardiokhirurgicheskogo vmeshatel'stva v period pandemii COVID-19.

OBJECTIVE: To study the features of the psychoemotional status in patients with chronic thromboembolic pulmonary hypertension in the long term after pulmonary thromboendarterectomy (PTE) during the COVID-19 pandemic and to identify factors affecting the development of clinically pronounced anxiety and depressive disorders. MATERIAL AND METHODS: Psychoemotional status was analyzed in 151 patients in the long term after PTE using the Generalized Anxiety Disorder (GAD) Assessment (GAD-7) and the Beck Depression Inventory. The number of patients who underwent COVID-19 was recorded and the functional status scale of the patient who underwent COVID-19 (PCFS) was evaluated. Logistic regression analysis was used to identify predictors of clinically pronounced depression and GAD in the long-term period after surgery during the COVID-19 pandemic. RESULTS: Clinically significant GAD and depression in the long-term period after PTE during the COVID-19 pandemic were observed in 11 and 17.8% of patients, respectively. Clinically pronounced depression is associated with older age, chronic cerebral circulatory insufficiency and pronounced post COVID-19 disorders of functional status according to PCFS. The development of GAD symptoms is influenced by cardiopulmonary insufficiency in the hospital period after PTE. The combination of anxiety and depression symptoms is correlated with older age. CONCLUSION: In patients in the long term after PTE during the COVID-19 pandemic, the symptoms of GAD and depression were detected in 11 and 17.8% of cases, respectively. The complicated course of cardiac surgery has shown a negative impact on the development of GAD in the long term after surgery. The factors influencing the development of clinically pronounced depression were older age, chronic cerebral circulatory insufficiency and pronounced post COVID-19 disorders of functional status.

Oxidative stress and monooxygenase liver function in patients with coronary heart disease and multiple organ dysfunction syndrome.

BACKGROUND AND OBJECTIVE: The purpose of the study was to evaluate oxidative stress and liver monooxygenase function in patients with coronary heart disease and multiple organ dysfunction syndrome. METHODS: Twenty-seven patients with multiple organ dysfunction and 38 patients with an uneventful postoperative period were studied. Oxidative stress was quantified with malon dialdehyde, coupled trienes, hepatocuprein and catalase activity. Liver monooxygenase function was evaluated with antipyrine pharmacokinetics data. RESULTS: On the first postoperative day patients with multiple organ dysfunction were characterized by high lipid peroxidation (conjugated trienes: +84.7%) and significant decrease in liver monooxygenase function (clearance of antipyrine: -38%), whereas control patients had a mild oxidative stress and a slight depression in liver monooxygenase function. On the third to fourth postoperative day in both groups a considerable intensity of lipid peroxidation and increase in liver metabolism was seen. The major difference was observed on postoperative days 10-12. In both groups oxidative stress intensity decreased (conjugated trienes: +34.7%; +12.9%). In the main group liver monooxygenase function was markedly depressed (clearance of antipyrine: -35.6%), whereas in the control group liver metabolism did not deviate from the baseline. The correlation analysis showed a negative relationship between liver monooxygenase function and oxidative stress parameters. CONCLUSION: Patients with multiple organ dysfunction have considerably more oxidative stress and greater decrease in liver monooxygenase function (one and a half times) than those with an uneventful postoperative period. Lipid peroxidation is one of the main causes of depression of liver monooxygenase function. Slowdown of liver metabolism might change the pharmacokinetic response in patients with coronary heart disease.