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Aim . To evaluate the efficacy of action of the calcium sensitizer levosimendan (LS) in patients with various grade of heart failure (HF) severity before cardiosurgery. Material and methods. LS was applied as a part of HF treatment while preparing patients for surgery in 2-4 days. Performed dose was 0,025 — 0,1 µg/kg/min. The drug was not administered in bolus. Preoperation group of participants included 108 patients (62% — men, 38% — women, aged 20 — 72 years (53±13)) with CHF III-IV FC by NYHA, with ejection fraction of the left ventricle (LVEF) about in average 27±8%.Mean level of natriuretic B-type peptide was 1129 (Me 854, Q 25 396, Q 75 1419) pg/mL. Main etiology of chronic HF in participants was dilation cardiomyopathy: noncoronary cardiomyopathy in 30 patients (27,7%), ischemic cardiomyopathy (ischemic heart disease, postinfarction cardiosclerosis) in 72 patients (66,7%) and acquired valve defects in 6 patients (5,6%). For assessment of efficacy of the drug in various grade of HF severity, patients were selected to subgroups according to the level of LVEF decrease (less 20%, 21-30%, 31-40%, more 40%), and pulmonary artery pressure (PAWP) (less 40 mmHg, 40-70 mmHg, more 70 mmHg). Results. Infusion of the drug led to statistically significant increase of LVEF comparing to the baseline (57%), decrease of PAWP (64%) and BNP concentration in 77% cases. Conclusion. The LS is an effective medication which can be applied with the aims to prepare HF patients to cardiosurgical operations. Most sensitive parameters of LS efficacy are PAWP, LVEF and BNP concentration. The highest efficacy of the drug was observed in subgroup with EF ≤40%, PAWP ≥40 mmHg and BNP ≥600 pg/mL. LS, applied in HF patients before cardiosurgery, can be used for assessment of reserves of myocardial capacity.

To present own experience of subclavian-carotid replacement for chronic cerebrovascular insufficiency management.For 12 years 7 subclavian-carotid reconstructions were performed that was 1.2% of all carotid repairs during this period. Great saphenous vein was always used as a graft. Carotid endarterectomy from proximal internal carotid artery was additionally performed if it was necessary. Patients had severe advanced lesion of supra-aortic vessels including bilateral carotid lesion and significant stenosis of ipsilateral proximal common carotid artery. The vast majority of them had cerebrovascular insufficiency grade 3-4.All patients underwent surgery without significant complications despite initially severe state due to advanced lesion of brachiocephalic arteries. Long-term postoperative patency of the grafts was satisfactory within the period from 12 years to 1.5 months. There were no neurological impairment and stroke.Subclavian-carotid grafting is an effective alternative for carotid endarterectomy in patients with advanced atherosclerotic lesion of common and internal carotid arteries.Введение. В настоящее время каротидная эндартерэктомия является методом выбора в лечении каротидных стенозов. Иногда эта операция может быть невыполнима из-за выраженного поражения проксимальных отделов общих сонных артерий. Использование трансторакального доступа для восстановления адекватного кровотока по внутренней сонной артерии достаточно травматично. В этих ситуациях могут быть использованы атипичные реконструкции: подключично-внутреннесонное и перекрестное общесонно-внутреннесонное протезирование. Материал и методы. За 12 лет выполнены 7 подключично-внутреннесонных реконструкций, что составило 1,2% всех операций на сонных артериях больных за этот период. В качестве протеза всегда использовали аутовену с бедра. При необходимости дополнительно выполняли каротидную эндартерэктомию из проксимальных отделов внутренней сонной артерии. У пациентов было тяжелое распространенное поражение брахицефальных ветвей, в том числе двустороннее поражение сонных артерий и гемодинамически значимые стенозы проксимальных отделов общих сонных артерий со стороны операции. У большинства больных имелась III-IV степень сосудисто-мозговой недостаточности. Результаты. Несмотря на исходное состояние, обусловленное тяжелым распространенным поражением брахицефальных артерий, все больные перенесли операцию без существенных осложнений. В отдаленном послеоперационном периоде шунты были проходимы за период наблюдения от 1,5 мес до 12 лет. Ухудшения неврологического статуса и острого нарушения мозгового кровообращения не отмечалось. Таким образом, подключично-внутреннесонное протезирование является эффективной альтернативой каротидной эндартерэктомии при распространенном значимом атеросклеротическом поражении общих и внутренних сонных артерий.

Aim. To demonstrate a clinical case of mixoma with mitral regurgitation Material and methods. The operation performed: excision of voluminous formation of the left atrium, mitral valve plastic with supporting ring Edwards Lifescience 32, interatrial septum plastic with the VAsCUTEC patch under conditions of artificial circulation and pharmacy-cold cardioplegy. Results. Complete myxoma excision, absence of mitral regurgitation after operation. Conclusion. Complete myxoma excision and mitral regurgitation correction lead to a good clinical result. Normal 0 false false false RU X-NONE X-NONE MicrosoftInternetExplorer4 A LEFT ATRIAL GIGANTIC MIXOMA ON BACKGROUND OF MITRAL VALVE DYSPLASIA Dzemeshkevitch S. L., Frolova Yu.V., Rizun L. I., Dzemeshkevitch A. S., Raskin V. V., Fedulova S. V., Dzeranova A. N., Mironovich S. A. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Обычная таблица"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Gulim","sans-serif";}

Aim. To study different ways of development and combinational abilities of pathological changes common for bicuspid aortic valvulopathy. Material and methods. Totally 207 patients included, who had during previous 5 years been operated for progression of inherited aortic valve defect. The age varied from 17 to 75 years (median 49,6±0,9 y.), men to women — 3:1. Comorbidities included rheumatic fever in 33 (15,9%) patients and infectious endocarditis in the past in 45 (21,7%). In 111 (53,6%) patients aortic stenosis dominated and distension of ascending aorta — in 82 (39,6%) patients.Results. For most of patients mechanical prostheses were used and only for 12 — biological; 13 patients underwent valvulopastic or no any operation. One third of patients (31,9%) required a prosthesis of ascending aorta. Combinations of additional procedures (as aortic valve plastic or prosthesis, tricuspid plastic, left atrium plastic, septal defects sewing, coronary bypass grafting) were not unusual — in 57. In-hospital mortality reached 2,9%.Conclusion. Bicuspid aortic valve is a specific kind of valvulopathy, commonly combined with aortopathy. The development of this pathology is probably inherited. Clinical picture of the defect develops during time and its exacerbation might be accelerated by rheumathic fever and infectious endocarditis. Surgical treatment is effective.