[Features of cardiomyocytes structural changes in patients with postinfarction aneurism and reduced myocardial contractility of the left ventricle of the heart].

Cardiomyocytes (CMC) of 18 patients with both ischemic heart disease, aneurism of the front wall and reduced myocardial contractility of the left ventricle (LV) were hypertrophied and in state of chronic hibernation, which was characterized by weakening of tissue-specific signs. Widening of lack myofibrils' zones and in part gap junction of intercalated disk transfer on the side of cells was found The hypertrophy of CMC had positive correlation, but chronic hibernation - negative one with the volume of LV. The worse prognosis of clinical course was degenerative changes of hibernate CMC with accumulation of autophagosomes that correlated with increasing of LV sphericity index.

[Surgical remodeling of the left ventricle in ischemic cardiomyopathy].

The paper covers early and long-term results of left ventricle geometric reconstruction and myocardial revascularization in 44 patients with ischemic cardiomyopathy. The authors have established clinical and hemodynamic criteria of ischemic cardiomyopathy, indications for surgical treatment and a surgical technique. The article presents a new approach to correction of mitral insufficiency in the given category of patients. According to the results of the study, the necessary conditions for a surgical intervention to be successful are: intraoperative monitoring of central hemodynamics using Swan-Ganz catheter, evaluation of myocardial contractile function by means of transoesophageal echocardiography and wide use of preoperative intraaortic balloon pumping. Geometric reconstruction results in normalization of left ventricle shape and its end-systolic and end-diastolic volumes, marked increase of ejection fraction and improvement of central hemodynamics. The stability of the long-term results has been confirmed in a 4-year follow-up.