NON-INVASIVE CORONARY ARTERIES ATHEROSCLEROSIS CT-VISUALIZATION: UP-TO-DATE STANDARDS AND OWN CLINICAL EXPERIENCE STUDY. / NEINVAZYVNA KT-VIZUALIZATsIIa ATEROSKLEROTYChNYKh URAZhEN' KORONARNYKh ARTERII: SUChASNYI STAN PROBLEMY TA REZUL'TATY VLASNOGO DOSVIDU ZASTOSUVANNIa.

Non-invasive coronary arteries (CA) visualization experiences fast progress recently. Existing evidence-based dataand trials show that there is a great need in non-invasive technologies able to trustworthy and accurately identifyCA high risk atherosclerotic plaques (AP) and provide more insights into atherosclerosis pathophysiology in individ-ual patents, being accurate qualitative and quantitative methods of primary diagnosis and answer to therapeuticintervention indicators in patients with coronary artery (CAD). Until now in Ukraine there were no studies evaluat-ing accuracy of last generation 640-sliced computed tomography coronary angiography (CTCA) in diagnosing of dif-ferent CAD forms.Objective of the study was to study diagnostic accuracy of CTCA compared to invasive coronary angiography (iCAG)in the patients with different forms of chronic CAD before surgeon revascularization.Materials and methods. From I.2019 to V.2021 we prospectively studied 201 patients with different chronic CADforms (76.6 % men and 23.4 % women) aged (61.8 ± 9.2) years hospitalized to our center for diagnostic work-upand decision about primary or secondary revascularization (coronary aortic bypass (CABG) or percutaneous (PCI)intervention). All patients underwent planned CTCA and iCAG.Results and conclusions. There were no significant complication duing procedures performed. Totally 2412 coro-nary segments were visualized and studied. Coronary calcium index (CI) highly significantly correlated with overallburden and severity of atherosclerotic process (r = 0,73, р < 0.0001). CTCA compared to iCAG showed no false-nega-tive results and only 6 (2.99 %) false positive results in cases of insignificant lesions. There was no significant dif-ference in diagnostic accuracy for significant stenoses with very high accuracy for overall vessels lesions quantityand burden (r = 0.95, р < 0.0001) with very high prognostic method accuracy (AUC 0.99; OR >>1000, р < 0.0001),making high multi-sliced CTCA safe and extremely accurate method for qualitative and quantitative diagnosis of ath-erosclerotic CA lesions absolutely comparable to iCAG, including hemodynamic significance evaluation.

THE PLACE OF CARDIAC COMPUTED TOMOGRAPHY IN PREOPERATIVE PLANNING OF EXTENDED SEPTAL MYECTOMY IN PATIENTS WITH OBSTRUCTIVE FORM OF HYPERTROPHIC CARDIOMYOMATHY. / MISTsE SERTsEVOÏ KOMP'IuTERNOÏ TOMOGRAFIÏ V PEREDOPERATsIINOMU PLANUVANNI ROZShYRENOÏ SEPTAL'NOÏ MIEKTOMIÏ U PATsIIeNTIV Z OBSTRUKTYVNOIu FORMOIu GIPERTROFIChNOÏ KARDIOMIOPATIÏ.

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiomyopathy. Extended septalmyectomy (ESM) is one of the priority methods of treatment of drug-refractory obstructive HCM. In recent years,hospital mortality during surgical correction of obstructive HCM in expert centers does not exceed 1-2 %. However,typical threatening complications of septal myectomy, such as iatrogenic ventricular septal defect (VSD) and rupture of the anterior or posterior walls of the left ventricle (LV), remain a topical issue in surgery of HCM. OBJECTIVE: to show the role of preoperative CT-planning to predict and reduce possible technical problems associated with ESM, including iatrogenic VSD. METHODS AND MATERIALS: This study includes 217 symptomatic patients with obstructive HCM, who from April 2016to October 2019 as one of the steps of preoperative planning underwent cardiac CT prior to ESM. Cardiac CT was performed to delineate the left ventricular myocardium, assess the distribution of hypertrophy and the presence ofcrypts. Special attention was also paid to the anatomy of the mitral valve (MV) and subvalvular apparatus. Coronaryartery patency was assessed by CAD-RADS, a standardized method for reporting the results of coronary CT angiography to determine tactics for further management of the patient. RESULTS AND DISCUSSION: In the study group, the average age of patients was (49 ± 15) years, 48 % - men. All patientshad a symptomatic, drug-refractory obstructive form of HCM. The mean maximum wall thickness of the interventricular septum (IVS) was (20 ± 5) mm (range 16-33). The average LV mass was (118 ± 23) g/m2. 195 patients (89.9 %)had systolic anterior motion ( SAM) of the MV. MV and subvalvular apparatus anomalies were detected in 62 patients(28.6 %). A zone of scarring and regression of IVS after alcohol septal ablation (ASA) was detected in 7 patients(0.3 %) with residual LV outflow gradient. Coronary arteries atherosclerosis was detected in 32 patients (14.7 %). CONCLUSIONS: Preoperative CT-planning of septal myectomy allows to obtain information on morphology of the LV,IVS, MV and subvalvular apparatus, and gives the surgeon the advantage to form a more accurate plan for the location and volume of septal resection, and avoid complications when correcting obstructive HCM. No iatrogenic VSDwas detected in any of the patient in the study group.

[SURGICAL TREATMENT OF THE ACQUIRED HEART FAILURES, USING BIOLOGICAL PROSTHESES].

Possibilities of application of bioprostheses for correction of acquired heart failures in condition of artificial blood circulation were studied. Examination and treatment of 235 patients, suffering failures of mitral valve (MV) and aortal valve (AV), was performed. In 89 patients a MV prosthesis was made, and in 146 ­ the AV prosthesis. In 94 patients bioprostheses were applied, and in 141 ­ mechanical prosthesis was implanted. Indices of the left heart portions morphometry and of survival, stability of good postop* erative results in remote period have witnessed high efficacy of the bioprostheses application and expediency of their application in the aged patients.

[DIAGNOSIS OF ISCHEMIC HEART DISEASE CAUSED BY TORTUOSITY OF CORONARY ARTERIES].

This article is devoted to the problems of diagnostics of coronary artery tortuosity phenomenon. Given the lack of literature about the role of phenomenon tortuosity of coronary arteries in the genesis of ischemic myocardial damage, the purpose of study was to determine the clinical relevance as well as necessity for prevention and treatment of this vascular anomaly. Therefore were analyzed medical history, laboratory and clinical database as well as data functional studies of the heart and cardiovascular system in 1404 patients which were divided into four groups on the results of coronary angiography. The results of the study indicate tortuosity of coronary arteries may be independent and additional burdening factor in the development of ischemic heart disease.

[PULMONARY COMPLICATIONS IN CHILDREN, OPERATED ON FOR INBORN HEART FAILURES IN THE ARTIFICIAL BLOOD CIRCULATION ENVIRONMENT].

The risk factors of pulmonary complications occurrence were analyzed in children, operated on for inborn heart failures in atrificial blood circulation environment. Pulmonary complications rate and the risk factors of their occurrence were analyzed.

[PLASTY OF THE INTERVENTRICLE SEPTUM DEFECT, USING A PATCH WITH A VALVE IN PATIENTS, SUFFERING HIGH PULMONARY ARTERIAL HYPERTENSION AND ENHANCED RESISTANCE OF PULMONARY ARTERIES].

Right ventricle insufficiency due to pulmonary hypertensive crysis or persisting pulmonary arterial hypertension (PAH) in patients after the interventricle septum defect (IVSD) closure with the heightened resistance of pulmonary arteries (RPA) constitutes an actual problem and associates with a high risk for a life-threatening complications and high lethality. Experience of the IVSD plasty conduction in a patient with high PAH, using a patch with a valve for right ventricle decompression while pulmonary hypertensive crysis in early postoperative period and nonreversible PAH in the remote period of observation, was presented. In the clinic 38 children were operated on for big IVSD, complicated by high PAH and heightened RPA, using a patch with a valve in 1996 - 2014 yrs. Hospital lethality have constituted 2.6%. Postoperatively a pressure in pulmonary artery (PA) have lowered trustworthy from (93.4 ? 14.9) to (49.2 ? 22.9) mm Hg. In a remote period of observation all the patients were alive. In 6 (16.2%) patients in terms from 4 mo to 18 yrs postoperatively a PAH have occurred, a pressure in PA was by 50% higher, than a systemic one. The IVSD plasty in patients with high PAH and heightened RPA may appear successful if a patch with a valve are applied.

[PUBLIC ADMINISTRATION OF PERSONNEL POLICY IN REFORMING OF UKRAINIAN HEALTH CARE SYSTEM USING THE EXAMPLE OF DERMATOVENEREOLOGICAL SERVICE].

The health care system, its modernization and optimization are among the most important functions of the modern Ukrainian state. The main goal of the reforms in the field of healthcare is to improve the health of the population, equal and fair access for all to health services of adequate quality. Important place in the health sector reform belongs to optimizing the structure and function of dermatovenereological service. The aim of this work is to address the issue of human resources management of dermatovenereological services during health sector reform in Ukraine, taking into account the real possibility of disengagement dermatovenereological providing care between providers of primary medical care level (general practitioners) and providers of secondary (specialized) and tertiary (high-specialized) medical care (dermatovenerologists and pediatrician dermatovenerologists), and coordinating interaction between these levels. During research has been found, that the major problems of human resources of dermatovenereological service are insufficient staffing and provision of health-care providers;,growth in the number of health workers of retirement age; sectoral and regional disparity of staffing; the problem of improving the skills of medical personnel; regulatory support personnel policy areas and create incentives for staff motivation; problems of rational use of human resources for health care; problems of personnel training for dermatovenereological service. Currently reforming health sector should primarily serve the needs of the population in a fairly effective medical care at all levels, to ensure that there must be sufficient qualitatively trained and motivated health workers. To achieve this goal directed overall work of the Ministry of Health of Uktaine, the National Academy of Medical Sciences of Ukraine, medical universities, regional health authorities, professional medical associations. Therefore Ukrainian dermatovenereological care, in particular fixed, needs a deep and objective medical and social audit. A necessary condition for the harmonious development of dermatovenereological service is adequate staffing to ensure it to reflect changes in the structure of the provision of the assistance at various levels, as well as their effective coordination throughout the natient's medical route.

[Microalbuminuria as a marker of endothelial dysfunction in the long-term follow-up patients after surgical correction of aortic coarctation].

1170 patients after surgical correction of aortic coarctation during the period from 1988 to 2002 were studied. The median period of medical supervision after coarctation repair was 13,8 years, maximum age - 24 years. For diagnostics of the Microalbuminuria (MAU) it were used the special test-strings Microalbu PHAN (PLIVA-Lachema Diagnostica). MAU were discovered in 62.6% of and 34.9% of normotesive patients. Credible decrease of MAU of hypertensive patients with corrected coarctation of the aorta were defined after 3 months-long treatment by Losartan.

[Palliative methods of surgical treatment of Ebstein anomaly]. / Paliatyvni metody khirurhichnoho likuvannia anomaliï Ebshteina.

Ebstein's anomaly--is a complex disease of the heart, the main components of which are dysplasia and tricuspid valve malposition, causing hemodynamical disorders. Principal method of correction of this anomaly is surgical one. There are many surgical methods of correction of the anomaly proposed: tricuspid valve prosthesis, plastic operation, palliative methods. Indications for surgical treatment of Ebstein's anomaly is cyanosis, the blood flow insufficiency, severe disorders of the heart rate.

[Contractility and energy metabolism in human myocardium in normal state and in various stages of cardiac insufficiency]. / Skorotlyva aktyvnist i enerhetychnyi obmin v miokardi liudyny v normi i na riznykh stadiiakh rozvytku sertsevoi nedostatnosti.

Contractile function and metabolism of byoptates of human myocardium were investigated in the control group and at early stages of heart failure development. Support of the myocardial contractile function at the early stage of the heart failure is provided by intensive use of macroergic phosphates and their insufficient resynthesis. At the late stages of myocardial failure deterioration of the heart muscle relaxation was observed as a result of disturbances in transport of high-ergic phosphates to the sites of their utilization.