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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.

Optimization of myocardial protection during cardiac surgery with a long period of anoxia infarction using sevoflurane postconditioning of myocardium.to develop the optimal pharmacological postconditioning protocol with sevoflurane for infarction patients ,undergoing cardiac surgery.Two groups were formedfor this study: CON] 00 (n-32) with aortic cross-clamping time 114±15 min and SEV100 group (n-34), where the myocardium anoxia was 119±22 minutes. According to previously developed in the pilot study Protocol, we added sevofturane in the circuit of extracorporeal circulation in a dose of 2.0 vol. % 20 minutes before removing the clamp from the aorta and the first 20 min of reperfusion in the group SE V100. In the group CON1 00 pharnacological postconditioning wasn't conducted. To assess the adequacy of the cardioprotection against ischemic damage in operated patients, we used the following clinical and laboratory parameters: changing the level of troponin T; the concentration of lactate and glucose as a marker of severity of anaerobic metabolism; concentration of proinflammatory cytokines IL-6, IL-8, TNF-alpha in blood serum as reperfusion injury markers. Also we used the registration of central hemodynamics data: measuring the mean invasive blood pressure; central venous pressure; Cardiac output was measured by the method of transesophageal echocardiography TEEcho-CG, calculated left ventricular ejection fraction by Simpson. We evaluated the clinical course of the perioperative period: incidence ofperioperative myocardial ischemia; the need and the duration ofuse of cardiotonic drugs in the perioperative period; the incidence of reperfusion arrhythmias; the frequency of self-recovery heart rate.According to the results of anaerobic metabolism markers, we can conclude that the period of the myocardium anoxia ofpatients in both groups experienced no significant difference. However; a completely different pattern was observed when comparing the proinflammatory cytokines, such as IL-6, IL-8, TNF-a. This confirms that the group SEV] 00 survived the reperfusion is much better than the group CON100. Instrumental examination also showed that the group ofpatients in which pharmacological postconditioning with sevofturane was held signficantly better suffered ischemia and reperfiision injury compared to control group. Self-recovery heart rate after removing the aorta clamp in the group CON100 was observed in 81%, in group SEV100 same - 93%. Similarly, the frequency of myocardial ischemia episodes on the ECG in reperfusion period was two times lower in the group SEV100 compared with group CON100 - 5.8% and 12.5% respectively. Reperfusion arrhythmia is almost 3 times more frequent in the group CON100 - 21,8%, in the group SEV100, where he conducted pharmacological postconditioning with sevoflurane is 8.8%..Combined with sevoflurane cardioprotection FPC has a much better resistance to myocardial ischemia-reperfusion injury in patients with myocardial infarction time over 100 minutes than monoprotection with cardioplegic solution "Console ". This method can be recommended as an additional method ofprotection against myocardial ischemia-reperfusion injury.

Estimated continuous cardiac output (esCCOTM) based on pulse wave transit time is one of alternative non-invasive CO measurement techniques.Randomized study included 23 scheduled patients operated upon due to cardiovascular diseases. Cardiac index (CI) was measured Comparative analyses of esCCO and others CO measurement methods used intraoperative was carried out. In the first group (n = 9) esCCO was compared with transpulmonary thermodilution (PiCCO-plus); in the second group (n = 8) - with pulmonary artery thermodilution; in the third group (n = 6) - with transoesophageal echocardiography (velocity-time integral).In the 1st group direct correlation was found (r = 0,773, p0.0001), but overestimation was found in 39% of cases; underestimation in 4%. The 2nd group showed direct correlation (r = 0.586, p0.0001). The 3d group showed direct relationship (r = 0.68, p = 0.0018), but 66.7% of the measurements were out of reference interval (more than ? 15%). Blend- Altman method showed the dispersion of results in all groups.1. Estimated continuous cardiac output measurement technique based on PWTT has a direct correla- tion with prepulmonary thermodilution and transoesophageal echocardiography, medium and high power respectively. 2. esCCO has significant differences with the referential techniques during general anesthesia in cardiac surgery pa- tients. 3. Calibration based on invasive blood pressure and outside cardiac output measurement does not increase the accuracy of measurements. 4. esCCO has a negative diagnostic value and cannot be recommendedfor the cardiac out- put evaluation during cardiac surgery. 5. This method can be useful for analyze general effectiveness of perioperative hemodynamics.

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.

evaluation of arterial and venous liver circulation during cardiopulmonary bypass (CPB) using the method of transesophageal echocardiography (TEE).62 patients undergoing reconstructive cardiac surgery with CPB were analyzed. During all the stages of treatment we performed monitoring of mean arterial pressure, heart rate and central venous pressure. TEE was performed using specialized Philips iE-33 3-D matrix multifrequency probe X7-2t in transgastral position. Ultrasonic and dopplerographic measuring of blood flow in hepatic artery and veins was performed before sternotomy, in 30 minutes after starting CPB and after stopping CPB during sternal closure. The speed of bloodflow in hepatic artery, hepatic veins, biochemical blood analysis was evaluated, i.e. lactate level, AST ALT ratio before the intervention, during CPD and in early postoperative periodCorrelation between blood flow in liver vessels and dynamics of biochemical analysis. It is considered to that this change during procedures with CPB may be linked with liver insufficiency during first hours of evaluation. In other words reduced blood flow in liver vessels may be one of the liver insufficiency early symptoms and is one of factors that require correction during operative and early postoperative period. So dynamic follow-up of hepatic circulation may be used as a method of early diagnostics of functional organ disorders.

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";}

Presented herein is a clinical case report concerning successive use of hybrid technology in secondary surgical treatment of a patient with a progressing aortic arch aneurysm and aortic insufficiency, type A chronic aortic dissection after the primary operation of plasty of the aortic valve with prosthetic repair of the ascending aortic portion for type A acute dissection. The patient underwent hybrid operation: prosthetic repair of the aortic valve with mechanical prosthesis "Carbomedics", prosthetic repair of brachiocephalic branches by means of synthetic prostheses "Vascutek" with their switching to the prosthesis of the ascending aorta, stenting of the arch and descending portion of the aorta. The duration of the postoperative hospital stay amounted to 15 days. The control multispiral computed tomography with intravenous contrasting showed that the reconstruction zone was with no deformities, with the stent graft expanded, and no leaks noted. The conclusion was made that further improvement of hybrid technique can make it a true alternative to classical surgical operations in this severely ill cohort of patients. The presented clinical example demonstrates that simultaneous hybrid surgical intervention is the most correct approach in the given situation decreasing lowering the risk of the development of complications in both immediate and remote postoperative period.

The article deals with a retrospective study devoted to the combined methods of myocardial support in cardiosurgical patients with chronic heart failure (III-IY FC according to NYHA) and low myocardial reserves capacity (LVEF 28.3 +/- 9.4%). This methods include pharmacologic (Levosimendan) and mechanical support (IABP). During the work we have analyzed data of 116 patients and measured pressure in the pulmonary artery (mmHg), end-systolic volume (ESV ml), end-diastolic volume (ED, ml), stroke volume output (SVO, ml), left ventricular ejection fraction (LVEF, %). We evaluated the level of valvular insufficiency and pulmonary hypertension (PH) and BNP concentration (pg/ml). The following indications for the usage of pharmacological and/or mechanical myocardial support were identified: I) Preventive usage of pharmacological and/or mechanical myocardial support is recommended for patients with CHF III-IY FC (NYHA) and low left ventricular EF(or = 35%), significant valvular insufficiency, PH, PICS (postinfarction cardiosclerosis); 2) The certain method of the support can be chosen with the help of Levosimendan infusion testing; 3) In case one of the above mentioned indications (point 1) or in case of mild reaction to levosimendan infusion in patients with the lesions of more than 2 coronary arteries (including the trunk of the left coronary artery) the usage of combined support is recommended; 4) In case ofor = 6 scores according to EUROSCORE scale, lesions of 2 or more coronary arteries, tricuspid insufficiency (TriI), PH, and high pressure in pulmonary artery (higher than the 2nd degree), high end-diastolic volume, end-systolic volume of LV the isolated usage of levosimendan is recommended; 5) In case of significant ischemic heart disease, PICS, lesions of more than 2 coronary arteries, (including the trunk of the left coronary artery) but without significant decrease of pressure in the pulmonary artery, end-diastolic volume, end-systolic volume and TriI the isolated usage of IABP is recommended.

21 patients were operated on the reason of postinfarctial ruptures of interventricular septum within 1989-2009 years. The mean age was 61.3 ± 7.8 years. The preoperative diagnostic means were echocardiography and magnetic resonance imaging. All patients were in critical condition, demonstrated postinfarctial left ventriculum remodeling and significant decrease of its functional reserves. Myocardial revascularization together with septal reconstruction, mitral valve and ventricular cavity reconstruction were performed. The analysis of the results proves that the active-expectant treatment tactics leads to the significant decrease of perioperative lethality. The optimal volume of surgical treatment is a liquidation of the interventricular defect together with geomentrical reconstruction of the ventricular cavity, wich is indepentant from the stage of infarction.

The paper deals with the assessment of hemodynamic parameters in the region of the circle of Willis, by using various exercise tests and transcranial Doppler study during cardiac operations under extracorporeal circulation. Some points of the timely diagnosis of air and material microembolisms are specified. There is evidence that the application of these procedures is substantiated and they may be employed in clinical practice to undertake earlier preventive measures against cervical circulatory disorders.

Twenty-five patients with coronary heart disease were examined in the preperfusion stage of myocardial revascularing operations under extracorporeal circulation. All the patients received combined anesthesia with xenon (Xe) as minimum flow anesthesia with flow of gases: oxygen, 0.4 l/min; Xe, 0.9 to 0.4 l/min. Cerebral circulation was investigated by transcranial Doppler study. The following parameters of the circulation: maximum systolic and diastolic blood flow velocities and pulsatile index were bilaterally estimated, by insonating the middle cerebral artery (MCA). When the concentration of Xe was as high as 50-60%, systolic and diastolic blood flow velocities along the MCA increase and the pulsatile index decreased. Opposite results were obtained 8 minutes after Xe feed was stopped. The findings provide evidence that Xe increases cerebral circulation and has a significant hypnotic effect. The increased systolic and diastolic blood flow velocities with the decreased peripheral resistance index in the MCA suggest that Xe diminishes peripheral vascular resistance in the pial arteries of the brain.

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.