[The influence of cardiosurgical intervention type and conditions of artificial blood circulation of perioperative dynamics of cardiac biomarkers].

125 patients after cardiac surgery operated on with the use of artificial blood circulation (ABC) were followed-up. Blood levels of cardiac protein, binding aliphatic acids and troponin 1 and 3 days after the operation were registered. The study showed that aorta clamping more then 90 minutes and hypothermic perfusion regimen influence cardiomyocites negatively. The state of "surgical trauma" and reperfusional myocardium damage was approximately the same during aortic surgery, myocardium revascularization with the use of aortic clamping and cardioplegia, and correction of the acquired heart disease, according to the dynamics of the studied proteins in blood. The minimal blood level of cardiac protein, binding aliphatic acids after coronary by-pass surgery on the working heart witnesses about negative influence of crystalloid hypothermic cardioplegia on coronary microcirculation.

[The characteristics of hemostasis system disorders in a female patient with syndrome of differentiated dysplasia of connective tissue].

The article discusses the data concerning the homeostasis system in patients with syndrome of differentiated dysplasia of connective tissue, in particular, under the Marfan syndrome. The description of clinical case is provided. The analysis of blood coagulation system in female patient operated on the occasion of dissecting intramural aneurysm of aorta as manifestation of Marfan syndrome is discussed.

[Conditions of artificial blood circulation and erythrocytic aggregation in cardiosurgical patients].

Normothermic artificial circulation, irrespective of its duration, enhances erythrocyte aggregation in response to noradrenaline stimulation. Short-term hypothermic perfusion reduces adrenergic aggregation of erythrocytes while in long-term hypothermic artificial circulation changes in erythrocyte adrenergic aggregation are not significant. In the course of cardiosurgical operation in conditions of artificial circulation adrenergic erythrocyte aggregation undergoes changes: a maximal rise before perfusion, linear lowering and rise to the preoperative level. If perfusion lasts longer than 90 min adrenergic aggregation of erythrocytes sharply and significantly falls. This aggregation depends little on hematocrit, but if it falls under 15% aggregation becomes significant which may be of importance in blood loss arrest in massive blood loss, hemodilution, dilution of coagulation factors and marked thrombocytopenia. In such conditions erythrocyte aggregates may seal damaged microvessels acting as hemostatic lock.

[Clinical and laboratory evaluation of 20% albumin (plasbumin) used in cardiosurgical patients].

A randomized comparative study of the effect of 20% Albumin (Plasbumin) solution and 4% succinylated gelatin (helofusin) solution on homeostasis was conducted in 36 cardiosurgical patients when the solutions were used as components to fill a pump oxygenator (PO). A comparative analysis has indicated that the use of albumin in the primary volume of PO at a concentration of 2-3% provides a higher level of total protein and better maintains colloid osmotic pressure during extracorporeal circulation than that of helofusin. At the end of an operation, the oxygen index was higher in the patients given albumin (Plasbumin). It has been also ascertained that plasbumin is well tolerated, causes no adverse reactions, and produces no dose-dependent effect.

[On the mechanism of action of recombinant activated factor VII in massive non-hemophylic bleeding in cardiosurgical patients].

Recombinant activated factor VII was used in a dose of 30 to 140 mcgr/kg in 35 cardiosurgical patients during intra- and postoperative periods complicated by massive uncontrolled (5 to 25 ml/min) bleeding of non-surgical origin. Basing on the analysis of changes in the hemostasis system parameters, the mechanism of action of the preparation may be presented as follows: recombinant fVIIa forms a complex with TF at the site of lesion; the formation of TF-fVIIa complex leads to the appearance of small amount of synthesized thrombin on the membrane of TF-containing cells, which, in turn, activates thrombocytes at the site of lesion; thrombocytes excrete phosphatidylserine, which serves as a matrix for further thrombin formation. FXIII is expressed from a granules ofthrombocytes and gets activated. FXIII binds with a specific receptor on platelets' membrane. It remains active as enzyme and participates in the formation of a firm fibrin plug at the site of lesion. Besides, substances with pro- and antifibrinolytic activity, antiheparin factor 4 and fibronectin are released from alpha granules. Factors IXa, VIIIa, and Va effectively "attach" to the surface of activated thrombocytes, and the forming of IXa-VIIIa complex leads to further activation of factor X, which, together with factor 3 expression, facilitates further local thrombin generation.

[Use of "NovoSeven" (rFVIIa) hemostatic in patients operated with extracorporeal blood circulation]. / Ispol'zovanie gemostatika "NovoSeven" (rFVIIa) u bol'nykh, operirovannykh v usloviiakh iskusstvennogo krovoobrashcheniia.

The "NovoSeven" drug was used in 25 patients (male - 18, female - 7) operated on the heart and main vessels including with artificial extracorporeal circulation (AEC). Patients did not have any clinically significant impairment in blood circulation before surgery. Perioperatively, all of them and, immediately after surgery, 4 them had uncontrollable hemorrhages at 10-25 ml/min in spite of extensive hemostatic therapy, including freshly frozen plasma, cryoprecipitate, thromboconcentrate, trasilol and ?-amine acid. Yet in 30 min after "NovoSeven" administration, hemorrhages seized virtually in all patients irrespective of a surgical intervention. It normalized the hemostasis by it differential action on an impairment depending on an activated or suppressed coagulation. Thus, the conclusion is that the "NovoSeven" (rFVIIa) is an effective hemostatic ensuring the correction of massive intra- and postoperative blood losses in cardiosurgery patients. The drug cuts the need in using the donor-blood components, thus, diminishing the risk of multi organ failure that can develop immediately after surgery.

[Effects of free oxygen radicals on impaired lung oxygenating function at aortocoronary bypass surgery]. / Vliianie svobodnykh radikalov kisloroda na narushenie oksigeniruiushchei funktsii legkikh pri operatsiiakh aortokoronarnogo shuntirovaniia.

Fifty five patients with coronary heart disease were examined. Of them 10 patients underwent multiple aortocoronary bypass surgery using intrathoracic or radial arteries under natural circulation, 45 had the same surgery under extracorporeal circulation (ECC). In the patients operated on without ECC, increases in active oxygen forms were rather moderate and practically always occurred with enhancement of antioxidative protective enzymes, the oxygen balance of arterial blood was in the normal range during and after surgery. The ECC patients displayed a considerable creatinine phosphokinase (CPK) with a lower antioxidative protection coefficient particularly when ECC was changed to natural circulation and when the lung was involved in circulation. In the postoperative period, the oxygenation index decreased from 1.7 to 1.3 in virtually all patients, the functional shunt rising from 15 to 30%. In 55% of the patients, varying arterial hypoxemia preserved in the early postoperative period. The damaging factors of ECC (hyperoxia, reperfusion syndrome, etc.) that impair the permeability of lung membranes have been shown to contribute to the activation of CPK, which causes early postoperative' arterial hypoxemia in patients operated on for coronary heart diseases.

[Hemorheology and morphofunctional characteristics of blood cells in children with congenital heart defects]. / Gemoreologiia i morfofunktsional'nye osobennosti kletok krovi u detei s vrozhdennymi porokami serdtsa.

Patients with congenital heart diseases (CHD) aged 4 months to 12 years, hospitalized for surgical treatment, were examined. Complex viscosity of the blood and the constituents of this parameter (dynamic viscosity and elastic component) were evaluated in the range of shift strain corresponding to the range of shift velocities 0.37-500 s-1 at a frequency of 2 Hz. The threshold blood fluidity was estimated for evaluating the conditions under which erythrocyte disaggregation begins. The relationship between blood rheology and morphofunctional characteristics of blood cells was evaluated. In accordance with the findings, the patients were divided into 3 groups with different suspension stability of the blood. In group 1 the threshold fluidity approximated the norm. In group 2 with normal blood rheology the shifts were compensated and regulation of rheology was in general intact. In group 3 the hematocrit values, mean erythrocyte volume, mean concentration of hemoglobin in erythrocyte, leukocyte counts, and complex viscosity of the blood were the highest, while the suspension stability was the lowest, which indicates depletion of the adaptive potential of the organism. Hence, blood rheology in patients with CHD differs by the type of regulation, mechanisms and compensation of changes, and depend largely on the mean erythrocyte volume, mean hemoglobin concentration in erythrocytes, and leukocyte counts.

[Anesthesia in surgical treatment of the ascending aorta-arch aneurysms]. / Anesteziologicheskoe obespechenie operatsii po povodu anevrizm voskhodiashchego otdela i dugi aorty.

The paper analyzes anesthesiological maintenance of infusion therapy, optimal criteria for effective brain protection, complications and mortality in 42 patients during operations on the ascending portion and arch of the aorta under deep hypothermic circulatory arrest. For this purpose, the patients were divided into 2 groups: Group 1 comprised 20 patients operated on before 1998; Group 2 included 22 patients operated on in 1998 to 2001. In both groups, circulatory arrest lasted 44 +/- 7 min. The patients were cooled to a temperature of 13.5 +/- 0.5 degrees C, to 15 +/- 0.6 degrees C in the nasopharynx. The duration of cooling was 58 +/- 5 and 73 +/- 6 min, respectively; that of warming-up was 70 +/- 8 and 83 +/- 6 min. Investigations have indicated that determination of the optimum brain cooling requires a complex assessment of central temperature values, electroencephalographic monitoring (visual estimation of a curve and quantitative characteristics), SjbO2 and cerebral metabolism. The investigations have shown that the procedure for anesthesiological maintenance and cerebral metabolism is safe and effective even in patients with arrested circulation lasting longer than 60 min. The operative mortality does not depend on the use of circulatory arrest under deep hypothermia and on its duration. Hemodynamic instability due to bleeding, as well as myocardial infarction, marked hemodilution during extracorporeal circulation are major factors that cause an increase in the rates of incidence of complications and mortality. The procedure used for anesthesiological maintenance and infusion therapy, decreased blood loss, and a reduction in the incidence of myocardial infarction could significantly reduce operative mortality. The fact that there were no neurological complications even during prolonged (80-min) circulatory arrest has shown that the brain-protective procedure including both general and regional cooling is reliable and to the extent of the indicated criteria. So is pharmacological protection.

[Free radical damage in the transplanted liver]. / Nekotorye aspekty svobodnoradikal'nogo povrezhdeniia transplantirovannoi pecheni.

The activity of lipid peroxidation (LPO), antiradical characteristics, content of sodium, potassium, magnesium, total and ionized calcium, copper, zink and iron in blood were studied in 12 patients in the course of ortotopic transplantation of the liver. The duration of the operation was on the average 11.5 +/- 1.5 hours, liver-free period 16.4 +/- 52 minutes, blood loss 7.2 +/- 2.5 l. It was discovered that in the liver-free period and in liver reperfusion there was a prominent shift of free radical and antioxidant properties, content of macro- and trace elements of blood. Because the studied parameters returned to the baseline level to the end of the operation the metabolic shifts are thought reversible.

[Changes in blood rheological properties and erythrocyte osmotic resistance in activation of free radical processes]. / Izmenenie reologicheskikh svoistv krovi i osmoticheskoi rezistentnosti éritrotsitov pri aktivatsii svobodnoradikal'nykh protsessov.

Relationship between serum oxidation of different degree and micro- and macrorheology of the blood and modification of this relationship in the presence of antioxidant alpha-tocopherol were studied. Lipid peroxidation affects blood rheology and erythrocyte osmotic resistance. Erythrocytes are the first to react to increased activity of free radical oxidation and to exhaust their compensatory potential. Plasma viscosity remains stable in serum oxidation of different degree, and therefore erythrocytes are responsible for changes in blood rheology during intensification of free radical oxidation. Moreover, erythrocytes are functionally resistant to oxidative stress in malonic dialdehyde concentrations under 3.62 +/- 0.41 nM/ml. alpha-Tocopherol increases functional resistance of erythrocytes and maybe of protein components of the plasma to damaging action of free radicals.

Effects of low-density lipoproteins on blood coagulation and fibrinolytic activity.

In vitro experiments showed that copper-oxidized low-density lipoproteins activate factors of the prothrombin complex in the whole blood and inhibit fibrin generation in both blood and plasma. Moreover, oxidized low-density lipoproteins inhibit fibrinolysis and impair the structure of fibrin clot, which results in hypercoagulation.

[Use of new respiratory technologies in solving problems of artificial one-lung ventilation in thoracic surgery in high-risk patients]. / Primenenie novykh respiratornykh tekhnologii dlia resheniia problemy iskusstvennoi odnolegochnoi ventiliatsii u patsientov vysokogo riska v torakal'noi khirurgii.

The authors proposed a separate independent (or differentiated) artificial lung ventilation as an appropriate alternative variant of artificial lung ventilation (ALV). This approach implies bulky ALV of the operated lung and high-frequency ventilation of the contralateral lung. In patients with associated respiratory diseases and stage II-III respiratory insufficiency, ALV initiates high pulmonary hypertension, intrapulmonary bypass of 50% cardiac output. The differentiated ALV on principal operation stage optimizes homeostatic parameters vs both one-lung and conventional ALV. For patients with stage II-III respiratory insufficiency and cardiovascular disease ALV is contraindicated. Differentiated ALV is the only alternative allowing surgical treatment of lung diseases in high risk patients.

[The diagnostic value of blood rheology studies in cardiac surgical interventions]. / Diagnosticheskaia znachimost' issledovanii reologii krovi pri kardiokhirurgicheskikh vmeshatel'stvakh.

The diagnostic value of routine studies of blood rheology in cardiosurgical patients was investigated. Blood rheology, hemostatic system, and acid-base balance were analyzed in 75 cardiosurgical patients during the early postoperative period. In 41 of these the postoperative period was uneventful and 34 patients developed complications. The blood fluidity conditions and estimation of the risk of thrombotic and hemorrhagic complications were assessed using the "Aggregate Status of the Blood" software. The data indicate a high diagnostic and prognostic significance of plasma viscosity, relative blood viscosity, erythrocyte aggregation and deformability indices in evaluation of the status of cardiosurgical patients in early periods after surgery. Application of hemorheological studies as routine methods for examination of patients improved the quality of treatment. Hence, rheological studies of the blood and plasma should become an obligatory component in the diagnosis of the hemostatic status in the early postoperative period after aortocoronary bypass surgery.