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The aim of the study was elucidation of hemostatic effects of low-molecular heparin Flaxiparin in patients with primary pulmonary hypertension (PPH). 10 PPH patients (mean age 39.0 (+)- 3.2 years, mean history of the disease 5.1 (+)- 0.9 years) were treated up to 6 months. For the first month Flaxiparin was injected in therapeutic doses 15,000 AXa ICU, twice a day. The next 5 months prophylactic doses were administered twice a day (7,500 AXa ICU). D-dimer, fragment 1 + 2, complex thrombin-antithrombin, beta-thromboglobulin, protein C, antithrombin III, antigen of tissue plasminogen activator and inhibitor of tissue plasminogen activator of type I, activity of the latter were measured before the treatment, after the therapeutic and prophylactic courses, 6 months after the treatment. Initially, the patients had procoagulative hemostatic disorders. i.e. activation of blood coagulation; fibrinolytic system was also affected. In the course of Flaxiparin therapy blood coagulation and fibrinolysis improved significantly. However, the effect was not persistent after the drug discontinuation. Flaxiparin can be recommended for treatment of PPH.

Techniques for noninvasive observation of heart states play an important part in experimental and therapeutic cardiology. The objective of this work is to describe a new method for intelligible pictorial representation of data acquired by an orthogonal electrocardiographic lead system and demonstration of possibilities of this method in estimating the results of longterm treatment for a cardiac disease. The method used, dipole electrocardiotopography (DECARTO), provides a set of maps (decartograms) that depict in an explicit form the instantaneous, as well as integral electrophysiological properties of the heart during the excitation cycle. The observed group of patients contained 10 females and 2 males with primary pulmonary hypertension. It was found that in all but one cases tested, the features of the maps strongly correlated with the results of the other diagnostical methods and clinical findings. The trends to improvement (6 cases), stabilization (4 cases), or deterioration (1 case) of the heart state were clearly indicated. In one case, however, the interpretation of the decartograms was ambiguous. The advantage of the DECARTO technique lays in clearness of data representation for visual analysis and facilitation of electrophysiological and anatomical interpretation of the data. (Fig. 6, Ref. 2)

VCG data (McFee--Parungao system) were obtained from 12 patients with primary pulmonary hypertension (PPH). During 2 years, VCG investigations were repeated from 2 to 5 times. Various VCG-parameters were analyzed. Space and horizontal QRS areas, projection of integra QRS vector to axis y and the sum of Rx and Sx were diagnostically most significant. Their values proved abnormal at the beginning of survey. In the course of observation, states of the right heart chambers together with VCG-parameter dynamics were investigated in every patient. States of the right cardiac chambers improved in 4 patients. In all of them the parameter turned to normal values. In two patients, during the monitoring time monotonous increase of parameters was observed, with the state of the right heart chambers declining. In 6 patients, state of right heart chambers appeared relatively stable. In these patients, values of all the parameters were either stable or insignificantly changeable around some mean values. Thus, the dynamics of VCG-parameters makes it possible to estimate adequately the states of the right cardiac chambers in PPH patients. (Tab. 1, Fig. 4, Ref. 4)

To evaluate the condition of left and right ventricular functions in patients with primary pulmonary hypertension (PPH) 21 patients (13 females and 8 males, mean age 35.4 +/- 10.0) were examined. The patients were ill for 5.7 +/- 3.5 years. Ventricular filling was characterized basing on computer data of transmitral and transtricuspid diastolic flow obtained at doppler echocardiography. Right ventricular function proved impaired in all the examinees: early in the disease the speed of early filling (Ve) was inhibited, while late filling was enhanced (Va). At terminal stages of the disease Ve increased, but Va reduced. Left ventricular function was also involved in all the patients: low Ve with the disease progression became more and more evident.

Potentialities of magnetic resonance imaging (MRI) have been studied for evaluation of patients with pulmonary hypertension. For this purpose 54 patients with primary and secondary pulmonary hypertension have been studied using resistive and superconductive MRI systems. MRI proved useful for determination of the cause of pulmonary hypertension (primary, secondary), assessment of the right heart chambers. The cine-MRI enabled detection of tricuspid and pulmonary regurgitation, paradoxical movement of the interventricular septum, thrombi in the pulmonary artery. There were some correlations between MRI parameters and indexes of pulmonary hemodynamics. As a non-invasive imaging modality MRI has a great diagnostic value in characterization of the heart and great vessels in patients with pulmonary hypertension.

Spirometry and bicycle ergometry were performed before and 3 weeks, 6 months after lomir treatment (mean dose 10.62 +/- 2.59 mg/day) of 8 patients with primary pulmonary hypertension. It was found that 3 weeks of the treatment produced a significant increase in the maximum power working capacity and performance, in 6 months of the treatment there were positive trends in gas exchange: anaerobic threshold became higher and maximum oxygen consumption rose. Thus, lomir is recommended for management of primary pulmonary hypertension as it improves exercise tolerance and gas exchange measured by means of spirometry and bicycle ergometry useful both for evaluating functional condition of the patients and the disease advance as well as its response to the therapy conducted.

Cardiolipin antibodies (CAb) were measured in 14 patients with primary pulmonary hypertension (PPH). These included 9 females and 5 males (mean age 36.8 +/- 9.6 years) with duration of PPH 4.9 +/- 4.1 years. No rise in CAb IgG was noted, whereas CAb IgM arose to 13.0-42.5 MPI in 3 patients. 2 lethal outcomes were registered in the group of patients with normal CAb levels and 2 in the group with elevated CAb (20% against 66.7%, respectively). The deaths were caused by progressive circulatory failure and venous occlusion, pulmonary artery embolism, respectively. It is suggested that IgM CAb increase may indicate involvement of immune disorders in PPH onset and the same nature of the mechanisms underlying some PPH subtypes and autoimmune rheumatic affections.

To ascertain the role of invasive investigations in the diagnosis of primary pulmonary hypertension (PPH), 12 PPH patients underwent catheterization of the left and right heart compartments, contrast right and left ventriculography and oximetry. Compared to control values, the patients had high pressure in the pulmonary artery and right ventricle. Some of them exhibited elevated pressure in the right atrium. Pulmonary artery wedge pressure, left ventricular end-diastolic and systolic, diastolic pressure in the aorta did not differ significantly from those in the controls. Right and left ventriculography revealed an increase in the end-systolic and end-diastolic volumes of the right ventricle which diminished its stroke index and ejection fraction. The latter two were reduced in the left ventricle also. Because the procedure was well tolerated by the patients, it is recommended for PPH diagnosis and follow-up.

Morphological investigation of 12 cases of primary pulmonary hypertension (PPH) (4 males and 8 females, from 20 to 48 years old, duration of the disease from 1 to 10 years) is performed. Heart weight increase (from 390 to 640 g) and thickening of the right ventricle wall were observed. 3 groups were distinguished on the basis of histology: 1) plexigenic pulmonary arteriopathy (PPA)-2 cases, 2) recurrent pulmonary thromboembolism (RPT)-5 cases, 3) vein-occlusive disease (VOD-5 cases. The third group was divided into two subgroups: vascular-occlusive disease (VOD) with thrombotic lesions of arteries and veins and vein-occlusive disease proper (VOD-p) with thrombosis of pulmonary veins only. Morphometrically, thickening of arterial intima and media was found in PPA and RPT and in some cases of VOD-p. The thickening of the above layers in veins found in some cases of PPA and RPT was obviously secondary and indicated the development of mixed pre- and postcapillary pulmonary hypertension.

A physical and X-ray examination and echo-, electro- and phonocardiographies were performed in 29 patients with primary pulmonary hypertension. Their central hemodynamics was also conducted by introducing a Swan-Ganz flowing balloon catheter into the right cardiac cavities. With evolving chronic circulatory insufficiency, the patients showed profound hemodynamic changes both in the right (end-diastolic pressure in the right ventricle and atrium rose and ventricular stroke index dropped) and left (heart rate increased, cardiac and stroke indices decreased in the ventricle) ventricles. There were slight changes in peripheral hemodynamics. Pulmonary pressure became lower, but this fact cannot be considered to be positive as this led to significantly lower right ventricular stroke index that indicates the critical diminution in right ventricular performance, unlike cases successfully treated with peripheral vasodilators.

The authors relate the results of a clinical and post mortem examination of 12 patients who died for primary pulmonary hypertension (PPH). The clinical, x-ray, echocardiography and electrocardiography data were of the same type in all the patients. Macroscopic studies of the heart also demonstrated similar changes: the heart mass was increased because of hypertrophy of its right parts. At the same time the microscopic picture of small vessels of the lungs turned out fairly diverse. Based on these differences all the cases were divided into 3 groups: veno-occlusive disease, recurrent pulmonary thromboembolism, plexogenic pulmonary arteriopathy. However, certain differences were noted inside the groups either. It is therefore assumed that PPH is a collective notion, uniting different alterations in small pulmonary vessels, that lead to a considerable rise of pressure in the pulmonary artery.

The paper is concerned with 18 patients suffering from primary vascular pulmonary hypertension. Of these, 7 patients had the thromboembolic pattern of primary vascular pulmonary hypertension and 11 primary pulmonary hypertension. All the patients underwent comprehensive examinations including routine clinical examinations, x-raying of the chest organs, ECG, ultrasound cardiography, measurement of the pressure in the pulmonary artery by invasive and non-invasive methods. The patients were also subjected to radionuclide studies using radionuclide scintigraphy of the lungs by means of 99mTc microspheres and radionuclide phlebography. Analysis of the clinical picture and of the findings obtained with the majority of instrumental methods including radionuclide scintigraphy did not reveal any appreciable differences between the patients with the thromboembolic pattern of primary vascular pulmonary hypertension and those suffering from primary pulmonary hypertension. Radionuclide phlebography has demonstrated that the patients with the thromboembolic pattern showed the changes in the phlebogram significantly more often than those with primary pulmonary hypertension. It is advisable that radionuclide phlebography should be included into the schedule for examining patients with primary vascular pulmonary hypertension.