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.

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.

[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.

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.

Nitrogen Oxide-Added Extracorporeal Membrane Oxygenation for Treating Critical Acute Heart Failure after Cardiac Surgery.

The aim of the study was to test the use of gaseous nitric oxide added to the extracorporeal membrane oxygenation (ECMO) system for treating critical acute heart failure after cardiac surgery. MATERIALS AND METHODS: Venoarterial ECMO with addition of nitric oxide into the extracorporeal circuit was used for treating a 52-year-old patient after two-step cardiac surgery for acute dissection of the thoracic aorta and aortic valve insufficiency. After the Bentall-de Bono procedure, a technical error was revealed: that was a non-functioning anastomosis to the right coronary artery, which caused massive ischemic myocardial injury. An emergency myocardial revascularization was performed with the help of the cardiopulmonary bypass converted into ECMO; the patient's condition improved and he was transferred to the ICU. RESULTS: Considering the sharp decrease in heart contractility and the extremely high level of myocardial damage markers, it was decided to supply nitric oxide (40 ppm) to the ECMO circuit. A positive effect was noted within 8 h from the start of the procedure: the concentration of creatine phosphokinase-MB decreased almost 4 times and the concentration of troponin I decreased twofold. The most pronounced changes were observed by the end of day 1: a significant decrease in the concentration of myocardial damage markers, a decrease in the VIS indicator by 7.5 times; an improvement in the contractile function. Further on, the patient's condition gradually stabilized: the manifestations of acute heart failure and multiple organ failure stopped, and then ECMO was discontinued after 82 h of work. The patient was decannulated and he continued to show stable hemodynamic parameters. He was discharged from the clinic on day 18 after surgery. CONCLUSION: For the first time, venoarterial ECMO with supply of gaseous nitric oxide into the extracorporeal circuit was used to support blood circulation after cardiac surgery. This made it possible to ensure the survival of the patient with critical ischemia-reperfusion injury developed after the surgery.

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.

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.

[First experience in using cardiocytoprotector mexicor in operations of myocardial revascularization under conditions of extracorporeal circulation].

We examined a total of forty-four patients diagnosed with coronary artery disease who were subjected to coronary artery bypass graft surgery under conditions of extracorporeal circula tion. In the examined group (15 patients) during anaesthesia and perfusion, we additionally administered the cardiocytoprotector mexicor at a total dose of 1,500 mg. It was revealed that administering mexicor in a complex of anaesthesiological-and-resuscitation support considerably increased the indices of myocardial contractility and oxygen-transporting function of blood in the postperfusion period, also decreasing both the amount and duration of inotropic stimulation, and favourably contributing to early recovery and restoration of spontaneous respiration in the immediate postoperative period.

[Role of collateral coronary circulation in the compensation of regional disorders of energy metabolism in the myocardium in experimental myocardial ischemia]. / O roli kollateral'nogo koronarnogo krovotoka v kompensatsii regionarnykh narushenii energeticheskogo obmena serdechnoi myshtsy pri éksperimental'noi ishemii miokarda.

Patterns of glucose, pyruvate and lactate consumption by the ischemized myocardium were studied in dog experiments with reference to the leve of retrograde inflow to the network of the ligated coronary artery. For this purpose, blood samples were taken from distal portion of ligated anterior descending coronary artery and the great cardiac vein accompanying the branches of the former. The increase of the lactate level, "excessive" lactate, the redox potential of the lactate/pyruvate system (E), delta E was shown to be less pronounced in those experiments where collateral coronary flow volumetric rate was above 1.5 ml/min, whereas pH and pO2 values dropped more steeply following coronary ligation in the experiments with small retrograde inflow to the ischemized area. The differences between glucose and pyruvate consumption by the ischemized myocardium were not significant.

[Evaluation of the therapeutic action of hexosephosphate as an energy-supplying agent in acute coronary insufficiency]. / Otsenka lechebnogo deistviia geksozofosfata kak énergoobespechivaiushchego sredstva pri ostroi koronarnoi nedostatochnosti.

It was established in experiments on 24 dogs with ligated interventricular branch of the left coronary artery that hexosophosphate (0.5 and 1 ml/kg intravenously) increases the collateral coronary blood flow and myocardial contractility against the background of a decrease in the lactate content in blood draining from the ischemic zone. Preliminary injection of hexosophosphate to rabbits increases the respiratory control in mitochondria from the ischemic myocardium. Drip intravenous hexosophosphate (100 ml) infusion to patients in the acute period of myocardial infarction reduced significantly sigma ST in precardiac leads and reduced the lactic acid content in venous blood. In 7.6% of cases hexosophosphate caused arrest or abatement of the pain syndrome.

[Prevention of myocardial damage during reperfusion of the coronary artery in dogs using dibunol combined with verapamil]. / Ogranichenie povrezhdeniia miokarda pri reperfuzii koronarnoi arterii u sobak s pomoshch'iu dibunola i ego kombinatsii s verapamilom.

An experimental study in 69 dogs examined the effect of isolated and combined use of dibunol and verapamil (isoptin) on the course of reperfusion of ischemized myocardium after 180 minutes' coronary occlusion. Verapamil alone had no protective effect on reperfused myocardium, whereas dibunol, and particularly its combination with verapamil, essentially limited the size of necrosis, reduced plasma CPK activity and animal mortality rate and maintained ultrastructural integrity of cardiomyocytes, which was accompanied by a decrease of plasma lipid peroxidation products and a stabilization of cardiomyocyte sarcolemma. The significance of membrane damage and uncontrolled calcium entrance into cardiomyocytes for the mechanism of myocardial damage at the recovery of coronary circulation is discussed.

[Effect of hexahydroubiquinone-4 (KoQ4) on the bioenergetics and functional activity of the myocardium in ischemia]. / Vliianie geksagidroubikhinona-4 (KoQ4) na bioénergetiku i funktsional'nuiu aktivnost' miokarda pri ishemii.

The effect of KoQ4 on the energetics, contractility, and electrogram of the ischemized myocardium was studied in acute experiments on dogs with induced myocardial ischemia. Intracornoary administration of KoQ4, 1.3 mg/kg, directly into the focus of ischemia for 15 min promoted a decrease in the lactate level in blood draining from the ischemic zone as compared to the control data in the absence of a difference in the dynamics of the pyruvic acid content. In distinction to the control experimental series, there was no decrease in the concentration of glucose in samples of venous blood draining from the focus of ischemia. Under the effect of KoQ4 the amplitude of left ventricular pressure and the maximum rate of its growth (dp/dt) increased moderately and the ST segment and ST/R coefficient of the epicardial electrogram from the border zone of ischemia decreased. It was shown in the rat experiments that preliminary intravenous administration of KoQ4 (14 mg/kg) increased myocardial resistance to oxygen deficiency under conditions of diacetylcholine-induced apnoe.

[The dose-dependent effects of a combination of different classes of antioxidants exemplified by dibunol and beta-carotene]. / Dozozavisimye éffekty kombinatsii antioksidantov raznykh klassov na primere dibunola i beta-karotina.

In order to enhance antioxidant protection of the organism in various pathological states, effective combinations of antioxidants have been developed that interact with various types of free radicals. On two experimental models,--acute alcohol intoxication and calcium chloride arrhythmia of rats, the prophylactic activity of antioxidant combinations was established for certain doses, rather then for monotherapy. The possibility of obtaining high protective effects at relatively low concentrations of the components in the complex preparation was shown. Am increase of antioxidant concentration in the preparation could decrease its efficiency. The highest efficiency in the complex preparations, as compared with in each component taken separately, was observed in the case of calcium chloride arrhythmia when dibunol and beta-carotene were combined at concentrations of 10 mg/kg and in the case of acute alcohol intoxication (1 and 0.25 mg/kg, respectively). Enhanced efficiency of combined antioxidant therapy opens up the way to the production of new active complex preparations with minimum toxic side toxic effects and complications.

[Specific features of performing anesthesia and artificial circulation in cardiosurgical interventions during pregnancy]. / Osobennosti provedeniia anestezii i iskusstvennogo krovoobrashcheniia pri kardiokhirurgicheskikh vmeshatel'stvakh na fone beremennosti.

The authors summed up the main principles of performing anesthesia and artificial blood circulation in cardiosurgical interventions in 5 women with 20-27 week pregnancy. In pregnant women with progressing cardiac failure due to a heart disease, thrombosis of the cardiac valve prosthesis, acute infectious endocarditis with the altered valve, large size tumor of the heart with disturbed valve function an emergency operation must be performed under conditions of artificial circulation. Operative treatment is the only effective method for saving life of the mother and fetus. The proposed complex preoperative preparation, intra- and postoperative management of the patients are thought to be an effective method of supporting operations on the heart under conditions of artificial blood circulation in pregnant women. In order to prevent possible complications antioxidants should be included in the complex of anesthesiologic means. During operations with artificial circulation in pregnant women it is necessary to strive for performing normothermal perfusions with high volume velocities.

[New approach to correction of ventricular septal defects complicated by critical pulmonary hypertension]. / Novyi podkhod k korrektsii defekta mezhzheludochkovoi peregorodki, oslozhnennogo kriticheskoi legochnoi gipertenziei.

The authors have studied the effect of preoperative administration of Vazaprostan-20 into the pulmonary artery of patients with a defect of the interventricular septum (DIVS) and high pulmonary hypertension. By the end of the second day the patients examined had lower pressure in the pulmonary artery from 18% to 38%, higher intracardiac output in patients with the III A and III B degrees of pulmonary hypertension. In all the patients plasty of the DIVS was fulfilled under conditions of hypothermal extracorporeal circulation. The degree of residual pulmonary hypertension in the group under study was 42% at an average, and in the control group it was 50%. The preoperative administration of Vazaprostan-20 decreased the operative risk and facilitated the postoperative period. It allowed to make operations on the wider group of patients whose possibility to be operated on was doubtful. The patients of the group under study were discharged from the hospital in a satisfactory state.

[Prevention of disorders of myocardial contractile function in patients with ischemic heart disease during aortocoronary shunting]. / Profilaktika narushenii sokratitel'noi funktsii miokarda u bol'nykh ishemicheskoi bolezn'iu serdtsa pri aortokoronarnom shuntirovanii.

The efficacy of pre-, intra-, and postoperative prevention of hemodynamic disorders by creatinine phosphate, cytochrome C, and glutamic acid was evaluated in 61 coronary patients with decreased myocardial contractility. All these agents exerted a positive inotropic effect in coronary patients with ejection fraction below 0.4, increasing the stroke volume and left-ventricular ejection fraction without modifying heart rate. Glutamic acid is not recommended for preoperative treatment, because it increases oxygen consumption by the myocardium above the reserve potential of the coronary bed. Cytochrome C is the most effective drug for preoperative treatment. Intraoperative preischemic protection of the myocardium by cytochrome C in coronary patients during high risk operations prevents the development of unfavorable hemodynamic complications during induction and maintenance of anesthesia before artificial circulation, provides favorable recovery of cardiac activity, decreases the incidence of severe arrhythmias, promotes a rapid and full-value recovery of myocardial contractile function after ischemia, and decreases the incidence of acute heart failure.

[A 2-stage method for the surgical correction of calcified aortic stenosis in patients with an extreme degree of risk for an operation]. / Dvukhétapnyi metod khirurgicheskoi korrektsii kal'tsinirovannogo aortal'nogo stenoza u bol'nykh s krainei stepen'iu riska operatsii.

During the period of 1992-1998 the authors dealt with treatment of 32 patients with aortic stenosis under extreme risk of operation. All the patients were considered to be inoperable because of the severity of their state. At the first stage of operation the catheter balloon valvuloplasty (CBV) was performed for decompression of the left ventricle since it was the only possible variant at this stage of surgical treatment. Good results of CBV were obtained in 22 patients which led to the possibility to perform the prosthetizing of the aortic valve in 13 patients within two months at an average. There were no lethal outcomes. Long-term results followed-up during 6 years were estimated as satisfactory.