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It is now an established fact that blood flow in the heart and the major vessels has normally a helical pattern. The structure of this flow is described by the exact solution of the nonstationary hydrodynamics equations for a class of self-organized tornado-like jets of viscous fluids. Our previous studies have shown that the geometry of the aortic channel corresponds to streamlines of this class throughout the cardiac cycle, which is supported by a special distribution of viscoelastic properties of the flow channel wall along the aorta. As a result of age-related pathological processes and/or their surgical correction, normal viscoelastic characteristics of vessel walls inevitably become impaired. A diversity of impairments in the structure of the cardiovascular system causes negative alterations in the normal geometrical configuration of biological flow channels. Thus, any pathological alterations in vessel channels are accompanied by deteriorations in the structural parameters of blood flow. However, a direct experimental study of all the diversity of vessel lesions is associated with considerable complications. Thus, no studies have been conducted so far to identify the regularities of alterations in the structural parameters of a swirling blood flow in different pathological conditions of the vessel channel. In this study, we have created a physical model of the flow channel of the aorta, which was based on the nonlinear distribution of transverse elasticity in the walls of the aorta along its length. Further, we created a computer simulation of the constructed model flow channel dynamics throughout the cardiac cycle in correspondence with the standard curve for blood pressure changes. The simulation results were interpreted within the semi-empirical theory of self-organized tornado-like jets of viscous fluids. This interpretation allowed us to formulate the time-dependent quantitative characteristics establishing functional relations between the structure of blood flow and the geometry of the flow channel of the aorta throughout the cardiac cycle.

Biodegradable film compositions based on natural biopolymer gelatin with immobilized colchicine were prepared and their efficiency in prevention of the adhesion process in the pericardium was evaluated on rabbit model of postoperative pericarditis. The use of gelatin-based biodegradable film compositions significantly reduced the intensity of adhesion formation in the pericardial cavity, while immobilization of anti-inflammatory drug colchicine amplified their anti-adhesion activity.

A method of invasive and non-invasive examination of epicardial motion was tested on domestic pigs (n=15). The invasive study employed a contact kinematic sensor of the epicardial wall motion, which determined the amplitude, velocity, and angular parameters of examined epicardial region. A non-invasive assessment of the epicardial kinematics based on echocardiographic 2D Velocity Vector Imaging and ECG recoding used to determine the heart electrical axis. The 4-chamber views were uses to analyze the longitudinal displacements of lateral wall of the left ventricle at the basal, mid, and apical segments. In addition, the radial displacements were determined in short axis projections at basal and apical segments as well as at the level of papillary muscles. The animals with normal or horizontal heart's electrical axis demonstrated similar displacement of the epicardium along X-axis and in longitudinal direction, while displacement along Y-axis corresponded to that in radial direction. The combined invasive and non-invasive approach in measurement of epicardium motion makes it possible to quantify the kinematic epicardial activity.

We measured the level of cardiac markers (high-sensitivity troponin T and MB fraction of creatine kinase) in children of the first year of life with congenital heart disease in the perioperative period. After cardiac surgery, plasma levels of the above markers exceed the reference limits in the examined children. The diagnosis of myocardial ischemia using biochemical markers in the postoperative period is possible only by dynamic monitoring of the cardiac marker level. The preoperative concentration of high-sensitivity troponin T in children of the first year of life with congenital heart disease can be regarded as a predictor of postoperative complications.

Analysis of the data of morphometry of aortic casts, aortography at different pressures, and multispiral computer tomography of the aorta with contrast and normal pulse pressure showed that geometric configuration of the flow channel of the aorta during the whole cardiac cycle corresponded to the conditions of self-organization of tornado-like quasipotential flow described by exact solutions of the Navier—Stokes equation and continuity of viscous fluid typical for this type of fluid flows. Increasing pressure in the aorta leads to a decrease in the degree of approximation of the channel geometry to the ratio of exact solution and increases the risk of distortions in the structure of the flow. A mechanism of evolution of tornado-like flow in the aorta was proposed.

Cardiac arrhythmia is an important cause of decrease in life quality and duration. Cardiac arrhythmias are serious medical and social problems. Success in the treatment of cardiac arrhythmia depends on the quality of diagnosis. Electrophysiological mechanism of cardiac arrhythmia and localization of arrhythmogenic substrates are very important for intervention and surgical methods of treatment of cardiac arrhythmia [2]. Invasive electrophysiological examination (EPE) of the heart is the main method of topical and electro� physiological diagnosis of cardiac arrhythmia. EPE is based on direct detection of electrocardiograms at the endocardial or epicardial surface of the heart (endocar� dial or epicardial mapping). Endocardial or epicardial mapping requires detectors to be inserted into the heart chambers or pericardial cavity. Because of invasive char� acter of endocardial or epicardial mapping, this proce� dure should be performed immediately before incision antiarrhythmia treatment of myocardium within the framework of integral surgical or intervention treatment. Development of a noninvasive method for EPE of the heart is an urgent problem. The method should pro� vide electrophysiological information of the same diag� nostic quality as endocardial or epicardial mapping. This method would significantly increase safety and availabili� ty of accurate diagnosis of cardiac arrhythmia. Noninvasive EPE of the heart should be included into the

We present the results of treatment of chronic ischemia of the lower extremities (distal form) with angiogenesis stimulators, autologous endothelioblast precursors (CD133+) and gene preparation of vascular endothelial growth factor VEGF165 (angiostimulin). Good clinical effect was attained in all patients, which was confirmed instrumentally 1, 3, and 6 months after administration of the stimulant: transcutaneous oxygen tension on the foot, index of malleolar pressure, and walking duration increased, parameters of microcirculation improved, the number of newly formed collateral arteries increased (angiography findings), quality of life improved (SF 36 questionnaire), and parameters of coagulogram also improved. The maximum positive dynamics was observed by month 3 of the study.

We analyzed changes in bioelectric impedance of the myocardium during cardiac surgery under conditions of cardioplegy. The results suggest the possibility of using bioelectric impedancemetry for evaluation of the state of the myocardium during surgery. Bioelectric impedancemetry allows evaluation of interstitium filling during infusion of the cardioplegic solution and reperfusion damage to cardiomyocytes.

The first results of the use of pH-monitoring of the myocardium with a Khuri monitor (Terumo Cardiovascular Systems Corporation) are presented. Before aorta clamping, the pH changes depended on the initial degree of damage to the examined myocardial segment. pH-Monitoring enabled urgent modification of the cardioplegia protocol, which helped to normalize pH and to prevent severe postoperative complications. The thermometric and pH-metric data were compared with the results of clinical and morphological studies. pH-monitoring made it possible to control myocardial vitality during the surgical intervention.

Inoculation of cells derived from the aorta of Wistar rats on devitalized porcine aortic walls 2-4-fold reduced their calcinosis after subcutaneous implantation to Wistar rats. Inoculation of Wistar rat bone marrow mesenchymal cells selected by adhesion activity did not reduce tissue calcinosis. The results indicate good prospects of repopulation of devitalized heart valve and vessel transplants by recipient vascular cells for reducing transplant calcinosis and improvement of their biocompatibility.

На государственном уровне в последние годы большое значение придается развитию реабилитационной помощи населению. Постановлением Правительства РФ от 15 апреля 2014г. №294 утверждена Государственная программа Российской Федерации «Развитие здравоохранения» с подпрограммой 5, регламентирующей развитие медицинской реабилитации и санаторно-курортного лечения, в том числе детям. Задачей подпрограммы 5 стала «поддержка развития инфраструктуры системы медицинской реабилитации».Цель. Провести анализ нормативно-правовых актов, касающихся работы реабилитационного центра для детей с врожденными пороками сердца (ВПС), и выделить основные направления совершенствования законодательства по данному направлению.Методы. Выполнен обзор основных нормативно-правовых актов, касающихся вопросов медицинской реабилитации в РФ. Представлены направления становления и развития реабилитационного центра для детей с ВПС.Результаты. Наличие в ФЗ РФ от 21 ноября 2011 г. №323 «Об основах охраны здоровья граждан в Российской Федерации» статьи 40, посвященной медицинской реабилитации и санаторно-курортному лечению, говорит о государственном приоритете в этой области. Приказ МЗ РФ №1705н от 29 декабря 2012г.«О порядке организации медицинской реабилитации» определяет понятие медицинской реабилитации, четко выводит дефиниции этапов ее оказания, регламентирует порядки медицинской реабилитации, места осуществления медицинской деятельности, включая работы (услуги) по медицинской реабилитации, ее условия, сроки оказания. В то же время приказ не является универсальным, требует рубрификации по возрасту, а вероятнее всего, и издания отдельного порядка по медицинской реабилитации детского контингента, и уже внутри подобного документа должна быть четкая дифференциация по нозологиям, в частности, медицинская реабилитация детей с заболеваниями сердечно-сосудистой системы, в том числе и после хирургического лечения.Приоритетными задачами Реабилитационного центра для детей с пороками сердца на базе кардиохирургического стационара на данном этапе становления являются:Разработка порядков оказания реабилитационной помощи детям с ВПС в зависимости от вида ВПС, срока хирургической коррекции, возраста.Разработка алгоритмов стандартизированной оценки реакции сердечно-сосудистой системы у детей с ВПС при физических нагрузках, в зависимости от вида ВПС, срока хирургической коррекции, возраста.Разработка рекомендаций по допуску к занятиям спортом детей с ВПС.Разработка рекомендаций по оценке психоэмоционального статуса у детей с ВПС, выявлению особенностей нервно-психического развития детей, которые оперированы по ВПС, влияющих на качество жизни. Разработка критериев к установлению инвалидности у детей с ВПС.Внедрение дистанционного телемониторинга пациента (частота сердечных сокращений, дыхания, сатурация, МНО, в дальнейшем - параметры электростимуляции).Заключение. Необходимо дальнейшее развитие специальности врача по медицинской реабилитации, которая включена в номенклатуру должностей медицинских работников, но квалификационные требования к таким специалистам не утверждены.

A new cardioplegic solution based on three natural dipeptides was developed and introduced at the Laboratory of Cardioplegia, A. N. Bakulev Research Center of Cardiovascular Surgery. The electrolyte composition of the solution corresponded to the category of intracellular cardioplegic solutions. The results of 60 experiments on isolated rat hearts were analyzed for choosing the optimal concentration of sodium ions (35, 60, or 80 mmol/liter). The composition of the studied cardioplegic solutions was selected by ion concentrations in the intra- and extracellular fluid. Earlier and most effective recovery of cardiac function with minimum rhythm and conductivity disorders was observed in the group treated with cardioplegic solution with sodium ion concentration of 60 mmol/liter.

The cardioprotective effect of cardioplegic solution based on histidine-containing dipeptides was evaluated on isolated rat heart under conditions of hyporthermia and long ischemia. The use of natural dipeptides in cardioplegic solutions promoted an increase in the buffer capacity of myocardial cells and creation of an additional anti-ischemic effect under conditions of long ischemia and hypothermia.

The creation of the “Automated Polyclinic” functionally-complete automated system presupposes the solution of all of the interrelated problems examined above, which requires a system approach. The proposed division of the problems into two classes (conceptual and formal) determines the importance of solving problems of a conceptual character. The selection of the conception of the structure, criteria, and design principles to a large degree predetermines the efficiency and success of further work (for example, the development of the technical and applied mathematical support).

Experience of the use of ACH in a clinic for cardiac surgery now extends over a period of 3 years. Definite reorganization of the work of virtually all services of the clinic was required for this purpose, in connection with the possibilities and the specific features of information input/output in the ACH.

The action of hyperbaric oxygenation (HBO) on the immune response was studied in mice immunized intraperitoneally with sheep's red blood cells. HBO was found to cause a decrease in the titers of hemagglutinins and hemolysins and a decrease in the number of antibody-forming cells in the spleen.

The authors investigated on 70 hearts taken from deceased subjects of either sex, aged 19 to 75 years, anatomical variants of sinoatrial (SAN) and atrioventricular node (AVN) arteries. As regards the branching of the SAN artery from the right and left coronary artery (RCA, LCA), they found altogether 14 variants of connection with the anterior atrial sulcus and the orifice of the superior vena cava. As regards the branching of the AVN from the RCA and the LCA, they identified altogether 6 variants of connection with the venous sinus orifice and the base of the interventricular septum. Problems of surgical interventions on SAN and AVN arteries and mechanisms of possible traumatization in the course of these operations are discussed. Surgical lesions can be prevented by thorough analysis of coronarograms and by taking into account anatomical variants of SAN and AVN arteries.