[Assessment of the results of left ventricular reconstruction in combination of coronary atherosclerosis and diabetes mellitus]. / Otsenka rezul'tatov rekonstruktsii levogo zheludochka pri sochetanii koronarnogo ateroskleroza i sakharnogo diabeta.

AIM: To study the effect of type 2 diabetes mellitus on changes of intracardiac haemodynamics and myocardial morphology in patients with ischaemic heart disease and a postinfarction aneurysm of the left ventricle before and after corrective operations on the heart. PATIENTS AND METHODS: The study included 79 patients with ischaemic heart disease and a chronic aneurysm of the left ventricle (Group I - patients with type 2 diabetes mellitus (n=27), mean age 57.5±3.9 years, average number of shunts 2.9±0.6; Group II - patients without diabetes mellitus (n=52), mean age 55,3 ±7.1 years, average number of shunts - 2.7±0.3). In the preoperative period all patients were examined taking into account the functional class of angina pectoris, with the assessment of the left ventricular ejection fraction, end-diastolic index, end-systolic index, sphericity index. All patients underwent coronary artery bypass grafting and surgical restoration of the normal geometry of the left ventricle according to the Menicanty technique with the target end-systolic index of 60 ml/m2, during which 39 patients from both groups were subjected to intraoperative biopsy of the left ventricular myocardium and right atrial auricle. RESULTS: The intergroup analysis revealed no statistically significant differences in age, angina pectoris class, level of arterial pressure between the groups. Neither were there statistically significant differences in the echocardiographic parameters at the preoperative stage. In the postoperative period, we detected a significant decrease in the end-systolic and end-diastolic volumes of the left ventricle in both groups, with a statistically significant increase of the left ventricular ejection fraction observed only in non-diabetic patients. One year after the operation, such patients still continued to demonstrate more favourable parameters of the systolic and diastolic functions of the left ventricle. A detailed analysis with determining the delta of the alterations in the parameters revealed more significant positive dynamics in the postoperative period in patients with ischaemic heart disease not associated with type 2 diabetes mellitus. CONCLUSION: The obtained findings are indicative of negative dynamics of the course of chronic ischaemic heart disease aggravated by type 2 diabetes mellitus after reconstruction of the left ventricle. Macro- and microangiopathy in type 2 diabetes mellitus significantly deteriorated the myocardial trophism. Subsequent bleedings draw phagocytic cells into the myocardial stroma, thus adversely affecting the further prognosis and course of the disease, since we demonstrated that the presence of inflammatory infiltrate in the myocardial stroma is a key factor of unfavourable outcomes of surgical treatment of patients with ischaemic cardiomyopathy.

[Typical errors pulmonary artery verification on the example of a clinical case].

The difficulties of verification of pulmonary embolism (PE) are well known and have not been overcome to date, despite significant progress in approaches to managing patients with this pathology over the past 1015 years. Due to the nonspecific clinical picture, cases of a long and difficult journey to this diagnosis are not exclusive. In large studies have shown that the most frequent symptom of pulmonary embolism shortness of breath. However, it is not always associated with doctors of different specialties with the need to exclude this diagnosis, purposefully collect anamnesis, identify risk factors. Modern low-dose oral contraceptives are considered quite prosperous in terms of the development of thrombotic complications and cause a slight (1020%) increase in fibrinogen concentration, factors VII, VIII and X, as well as a decrease in the content of active protein S by 1020%. But in the case of the presence of diseases and conditions that increase the risk of venous embolism, this effect may be sufficient for the realization of life-threatening pulmonary embolism. In this regard, it is important to provide a combined effect on the prognosis of the pathology of the patients and the chosen method of contraception.

[Ultrasonographic control of cerebral blood flow in patients with stenosis of brachiocephalic arteries before and after carotid endarterectomy]. / Ul'trazvukovoi kontrol' mozgovogo krovotoka u bol'nykh so stenozom brakhiotsefal'nykh arterii do i posle karotidnoi éndarteréktomii.

The authors studied the parameters of arterial and venous blood flow in patients presenting with haemodynamically significant atherosclerosis of the carotid arteries before and after carotid endarterectomy, as well as while carrying out functional tests. Comparing the indices of arterial blood flow in the Study Group consisting of 52 patients and the Control Group comprising 15 apparently healthy volunteers at rest prior to the operation revealed statistically significant differences of volumetric parameters of blood flow in the internal carotid artery. The obtained results showed that the breath-holding test was accompanied and followed by increased velocity of blood flow in the middle cerebral artery (MCA) on the side contralateral to stenosis, with the reactivity index (RI) amounting to 0.98±0.20, which statistically significantly differed from the RI in the Control Group patients (1.28±0.13). The forced respiration test demonstrated a decrease in the volumetric indices of blood flow in the MCA on the side of stenosis, as well as an increase of the maximum end-diastolic velocity of blood flow on the side contralateral to stenosis. The test with sublingual administration of nitroglycerin appeared to result in reduced blood flow in the MCA. The supratrochlear test demonstrated decreased velocity of blood flow in the supratrochlear artery. Studying the venous link of cerebral vessels after the operation showed that statistically significant differences were revealed only on the side contralateral to stenosis as compared with the values prior to revascularization. An increase of blood flow in the internal jugular veins after the operation on the side contralateral to the operation was apparently suggestive of an adequate distribution of blood flow through the main vessels of the brain.

[Simultaneous magnetic resonance angiographic and tomographic assessment of atherosclerotic plaques of carotid arteries with paramagnetic contrasting by cyclomang].

The authors studied a possibility of simultaneously performing magnetic resonance (MR) angiography of carotid arteries and contrast-enhanced MR tomography of atherosclerotic plaques of carotid arteries. We examined a total of 16 patients presenting with disseminated atherosclerosis and 8 patients of the control group. Quadrature coils for examination of the head were used in order to sequentially perform MR tomography of the brain, MR angiography of carotid arteries and MR tomography of atherosclerotic plaques of carotid arteries with contrasting by 0.5M cyclomang. Angiography was carried out by means of the technique of 3D GR FFE of rapid gradient echo (TR/TE/FA/ST=10 ms/2.7 ms/20°/1.5 mm). MR tomography of the carotid arteries bifurcation was performed in the T1-weighted spin-echo mode: TR=500-900 ms, TE=10 ms, slice sickness 1-3 mm into the matrix 256x256 voxels, with the voxel size measuring 0.2x0.2x2 mm. The average time of passing of the paramagnetic through the blood vessels of the cerebral hemispheres in the control group amounted to 4.23±0.14 s for the left hemisphere and to 4.27±0.15 s for the right one. The mean time of bolus passing in patients with predominantly unilateral stenosis of the internal carotid artery amounted to 4.89±0.23 on the affected side, equalling 4.56±0.19 s on the unaffected side (p>0.05). In bilateral lesions these indices for the left and right hemispheres amounted to 4.98±0.21 s and 5.01±0.16 s (p>0.05), respectively. Contrast-enhanced MR angiography with cyclomang made it possible in all cases to visualize the localization and character of stenosis. The index of stenosis degree calculated for MR-angiogram highly significantly correlated with the indices of the ultrasonographic examination performed according to the ECST technique both for cases of unilateral (r=0.87, p<0.05) and cases of bilateral stenotic lesion (r=0.85, p<0.05). Inhomogeneous soft plaques with high content of lipids had high values of the enhancement index on contrasting--1.26±0.07, whereas hard fibrous avascular plaques--1.09±0.04 (p<0.05). The total time of the examination amounted to 41±5 min while performing time-fly MR-angiography and to 29±5 min without it. A conclusion was made that simultaneous MR angiography and contrast-enhanced (with Mn-paramagnetic) MR tomography of carotid arteries is possible and appropriate within the framework of a single study using quadratic coil for the head.

[Cardiovascular effects of D-ALA2, LEU5, ARG6-enkephalin (dalargin) are mediated by peripheral mu-opioid receptor activation].

It has been established that intravenous administration of dalargin at a dose of 0.1 mg/kg induced hypotensive, positive inotropic, and positive chronotropic response in patients with myocardial infarction, while not producing the "steal syndrome." The positive chronotropic effect of dalargin was mediated by peripheral mu-opioid receptors. Increase in the heart rate induced by dalargin had a reflex nature. Direct action of dalargin on the heart was accompanied by a decrease in the heart rate and a delay in the cardiac conductance in the atrioventricular junction region.

[Effect of antiischemic therapy in immediate period after mammary coronary bypass surgery on left ventricular contractility and conduit blood flow. Randomized controlled study]. / Vliianie antiishemicheskoi terapii v blizhaishem periode posle mammarno-koronarnogo shuntirovaniia na sokratitel'nuiu funktsiiu levogo zheludochka i krovotok po mammarno-koronarnym shuntam: randomizirovannoe platsebo-kontroliruemoe issledovanie.

AIM: To assess influence of 2-week course therapy with atenolol, nebivolol, and verapamil on systolic and diastolic left ventricular function and mammary coronary blood flow in early period after revascularization. MATERIAL: Patients (n=113) after mammary coronary bypass grafting. METHODS: Echocardiographic characteristics of systolic and diastolic left ventricular function, and blood flow through mammary coronary grafts were measured before and after treatment with study drugs. RESULTS: In placebo treated patients isovolumic relaxation time (IVRT) and late diastolic filling phase (A) increased, while velocity characteristics of mammary-coronary blood flow decreased. Administration of atenolol, nebivolol, and verapamil was associated with significant increases of left ventricular ejection fraction, stroke volume, cardiac output, IVRT, peak diastolic velocity, flow through mammary coronary grafts and their lumen diameter, and decrease of E/A ratio. CONCLUSION: Administration of atenolol, nebivolol, and verapamil in early postoperative period after mammary coronary bypass grafting improved systolic and diastolic function of the left ventricle, and blood flow through mammary coronary grafts. None of the studied drugs had significant advantage over others.

[Prognostication of hemodynamic efficacy of surgical correction of chronic coronary insufficiency based on stress test with nitroglycerine]. / Prognozirovanie gemodinamicheskoi éffektivnosti khirurgicheskoi korrektsii khronicheskoi koronarnoi nedostatochnosti na osnovanii dannykh nagruzochnogo testirovaniia s nitroglitserinom.

In our previous studies we demonstrated possibility of the use of stress echocardiography with sublingual administration of nitroglycerine for detection of viable myocardium. Basing on data about myocardial and cerebrovascular reserves obtained during nitroglycerine tests we created mathematical model for prediction of hemodynamic effectiveness of coronary bypass surgery. Stress echocardiography, Doppler echography of middle cerebral and internal carotid arteries with nitroglycerine were carried out in 80 patients with coronary artery disease before myocardial revascularization. Quantitative equivalent characterizing degree of myocardial reserve preservation in early postoperative period was used as basis for discrimination of patients into groups with positive and negative result of surgery, and coefficients and constants of discriminant function were calculated for these groups. According to results of clinical testing sensitivity, specificity and diagnostic effectiveness of the model were 76.9, 75 and 76%, respectively.