[Application of dermal fibroblasts in complex treatment of patients with trophic ulcers of venous etiology].

The authors have analyzed the results of an experimental-clinical investigation devoted to studying the efficiency of local treatment of trophic ulcers at the stage of healing using transplantation of dermal allogenic fibroblasts. The method was proved to accelerate epithelization and to shorten the time of preparing to operations for correction of the venous blood flow.

[The significance of investigation of the left ventricle diastolic function in cardiosurgery].

An examination of 79 patients (main group) with congenital, acquired heart diseases and ischemic heart disease (IHD) without activity of the rheumatoid process and infectious endocarditis and 64 subjects of the same age has shown that in order to improve the assessment of the results of operative treatment of patients with the acquired heart disease and IHD it is necessary to test the diastolic function of the left ventricle (LV) in addition to the systole parameters. Cardiosurgical correction of pathological processes either causing or aggravating LV diastolic dysfunction (overloading LV with the volume or pressure, myocardium ischemia) can either eliminate or reduce its degree. A pathological monophasic filling of LV is a sign of a pronounced systole-diastolic dysfunction of LV and lung hypertension. A radical operative intervention reestablishes the biphasic filling of LV and reduces pressure in the pulmonary artery.

[Models of inter-group difference of the homeostasis system in patients with artificial heart valves and the set of laboratory parameters]. / Modeli mazhgruppovykh razlichii sostoianiia sitemy gemostaza u bol'nykh s isskustvennymi klapanami serdtsa po kopleksu laboratornykh pokazatelei.

Patients with artificial heart valves (AHV) belong to a unique multi-component model of the homeostasis system presenting an interaction of activated coagulation processes and pharmacological effects, on the one hand, and genetic peculiarities functioning homeostatic mechanisms, on the other hand. The described method was evaluated on the basis of multi-factor mathematic analysis by information-metry. The data obtained provided for isolating the most information-dense laboratory indices and some genetic polymorphisms describing the shaping of continuous intravascular coagulation of stage III in AHV patients. The clinicians and laboratory experts are offered a practical instrument for the diagnosis (prognostication) of the above condition. It was proven as necessary to examine (by the morphofunctional method) the intravascular activation of platelets and to determine the D-dimer in the remote period after prosthesis of heart valves.

[Hydrodynamic investigations of the current mechanical artificial heart valves]. / Gidrodinamicheskie issledovaniia sovremennykh mekhanicheskikh iskusstvennykh klapanov serdtsa.

The work presents results of comparative investigations of the integral hydrodynamic characteristics of the best for today domestic mechanical heart valve (MHV) Medinzh-2 (MI-2) and the turn-disk domestic MHV--LIKS-2, EMIKS (E) and foreign MHV--Medtronic-Hall, Bjork-Shiley (BS), Sorin (SO) and bicuspid valves--St. Jude Medical (SJ), Carbomedics in the stationary and in the pulsatile flows. It was found that according to the main hydrodynamic characteristics including the outlet flow structure, MHV MI-2 was substantially superior to MHV E, BS and SO, and by certain characteristics it approximated to the best foreign MHV SJ. Like all mechanical heart valves, the valve MI-2 disturbs the uniformity of the inlet flow and forms a complex non-stationary flow with detached zones, areas of great shear stresses, with vortex structures of different types, and hence the task of hydrodynamic optimization of its construction is thought to become actual. The comparison of clinical parameters of work of the valve MI-2 with its hydrodynamic characteristics confirms its high hemodynamic effectiveness and thrombo-resistance in patients at long-term periods of follow-up, taking into account the adequate correction of disbalance of hemostasis.

[Two approaches to correction of disturbed hemostasis in patients with mechanical artificial heart valves at the long-term follow-up]. / Dva podkhoda k korrektsii narushenii gemostaza u bol'nykh s mekhanicheskimi iskusstvennymi klapanami serdtsa v otdalennye sroki nabliudeniia.

The investigation of the hemostasis system performed in 47 patients with mechanical heart valves (MHV) at the terms of (3.50 +/- 0.25) years included 30 men and 17 women. There were 24 cases of aortal MHV and 23 cases of mitral MHV, I-II functional class (NYHA). The patients were given oral anticoagulants: phenylin to 35 patients (0.009 mg/day), varfarin to 12 patients (52.6 mg/a week). The primary examination of the patients has revealed insufficient anticoagulation protection and clinically asymptomatic permanent intravascular coagulation of the third degree (PIC-3), with the signs of activation of thrombocytic and/or coagulation link of hemostasis. It has been found that a complex assessment of the hemostasis system state including the vascular-thrombocytic link is an obligatory condition of the right choice and timely correction of the PIC-3 in patients with MHV. The methods of correction of impaired hemostasis depend on the primary involvement of the vascular-thrombocytic and/or coagulation link of hemostasis. The pathogenetically selected antithrombotic therapy for patients with MHV allows timely arrest of PIC-3 and less risk of the development of thrombosis and thrombo-embolic complications at long-term periods of observation.

[The influence of hereditary thrombophilic mechanisms on the degree of permanent intravascular coagulation in patients with artificial heart valves]. / Vliianie nasledstvennykh trombofilicheskikh mekhanizmov na stepen' postoiannogo vnutrisosudistogo svertyvaniia u bol'nykh s iskusstvennymi klapanami serdtsa.

The genotyping of 40 patients with artificial heart valves (AHV) was performed after prosthesis of the mitral and aotic valves with bicuspid AHV (Medinzh-2 and CarboMedics). The patients took phenylin and varfarin. The patients' genotype was estimated by the thrombophylic genes: factor V Leiden (FVL), prothrombin G20210A, methylene tetrahydrofolate reductase C677T, G/A--455FGB, 4G/5G PAI-1, PI A1/A2 GPIIIa. The genes determining the thrombocytic activity or the vascular wall state substantially influence the third degree of the intensity of the permanent intravascular coagulation (PIC-3) independent of the degree of correction of hemostasis of oral anticoagulants. The addition of anti-aggregants to therapy is the only that can normalize functional activity of thrombocytes in patients with AHV having such defects. The laboratory detection of the genetic defects is of great practical importance for the determination of risk groups of formation of PIC-3 and the strategy of antithrombotic protection of patients with AHV.

[Prophylaxis of thrombosis and thromboembolic complications in patients with domestic mechanical artificial heart valves (AHV) "Medinzh-2" in remote terms of observation]. / Profilaktika trombozov i tromboémbolicheskikh oslozhnenii u bol'nykh s otechestvennymi mekhanicheskimi iskusstvennymi klapanami serdtsa "MedInzh-2" v otdalennye sroki nabliudeniia.

The observation included 40 patients (20 men and 20 women) with the rheumatic heart diseases acquired at the age of (45.9 +/- 8.7) years after isolated prostheses of the aortal (n = 25) and mitral (n = 15) valves with bicuspid constructions of AHV "MedInzh-2" in remote terms in (2.52 +/- 0.48) years, I-II functional valve (NYHA). It was shown that only a permanent control not rarer than once a month and an adequate correction by means of anticoagulation and antiaggregation therapy using standard methods for patients with the bicuspid AHV made it possible to avoid the development of thromboses and thromboembolic complications during three years of observation.

[Indices of chronic intravascular hemolysis in patients with different prosthetic heart valves in long-term follow-up]. / Pokazateli khronicheskogo vnutrisosudistogo gemoliza u bol'nykh s razlichnymi konstruktsiiami iskusstvennykh klapanov serdtsa v otdalennye sroki nabliudeniia.

An examination of 153 patients with valve replacement was performed at late stages of (6.8 +/- 0.2) years, in 84 patients the mitral valve replacement (MVR) was fulfilled, in 64--the aortic replacement (AVR) and in 5--two valve replacement were performed. Higher indices of hemolysis were noted in patients with AVR, in cases of two valve replacement and in patients with the paravascular fistula. The lowest indices of hemolysis take place in patients with bileaflet prostheses (MEDING/CarboMedics, St. Jude Medical), especially in patients with AVR. The complications of intravascular hemolysis are: cholelithiasis, anemia, hemosiderosis of the kidneys, sideropenia. The timely diagnosis, treatment and prophylactics are necessary to prevent these complications.

[Turbidimetric express method in the assessment of the hemostasis parameters in patients with prosthetic bileaflet heart valves]. / Turbidimetricheskii ékspress-metod v otsenke parametrov gemostaza u bol'nykh s iskusstvennymi dvustvorchatymi klapanami serdtsa.

Thirty patients of medium (47 +/- 3) years of age with prosthetic bileaflet heart valves without any specific complications of the I-II functional classes and with the postoperative period after mitral (11) and aortal (19) valve replacements during (2.52 +/- 0.48) years were studied. The defects of coagulation and fibrinolytic systems were found in 9 patients with high prothrombin index (93.21 +/- 9.8)% and low INR (0.9-1.7). The activation of fibrinolysis, low platelets, hypofibrinogenemia, D-dimer which are the risk factors of thrombogenic complications were found in these patients. The updated turbo-dynamic express-method which helps to activate fibrinolysis in short terms and to make its correction is proposed.

[Rare causes of the dysfunction of mechanical bicuspid heart valves]. / Redkie prichiny disfunktsii mekhanicheskikh dvustvorchatykh klapanov serdtsa.

The authors share the observations from their cardiosurgical practice showing that one of the causes of sudden death or of rapid worsening of the state of patients with implanted bicuspid artificial valves might be their dysfunction resulting both from breakage of the hinged mechanisms of the valve with its dislocation and migration and from the disturbed mobility of the valve cusp due to a thrombus formed in the atrium. The observations show that the "ideal" construction of the valve is to be created.

[Should the presence of coiled blood flow in the left heart ventricle and aorta be taken into consideration when constructing artificial heart valves?]. / Sleduet li uchityvat' nalichie zakruchennogo potoka krovi v levom zheludochke serdtsa i aorte pri konstruirovanii iskusstvennykh klapanov?

The use of an original device developed by the authors which was introduced in the blood flow in experiments in dogs has confirmed the presence of coiled blood flow in different parts of the aorta. The rate, direction and angle of coiling were calculated. The results obtained suggest that the fact of coiling the blood flow should be taken into account when constructing new models of artificial valves of the heart in order to decrease the energy value of the cardiac output, to prevent injury of the formed elements of blood and thrombogenesis.

[Aortic valve prosthesis and the plication of a dissecting aneurysm of the ascending aorta in a patient with infectious endocarditis against a background of chronic kidney failure and its management by regular hemodialysis]. / Protezirovanie aortal'nogo klapana i plikatsiia rasslaivaiushchei anevrizmy voskhodiashchei aorty u bol'nogo infektsionnym éndokarditom na fone khronicheskoi pochechnoi nedostatochnosti i provedeniia reguliarnogo gemodializa.

Some literature data are presented on the problem of cardiac surgery in patients with chronic renal insufficiency under regular hemodialysis and on the specificity of performing operations on such patients under conditions of artificial circulation. The authors describe their first experience of a one-step prosthezing of the aortal valve and plication of the dissecting aneurysm of the ascending part of the aorta in the patient receiving the regular hemodialysis during 5 years as well as the positive results of this original operation in dynamics of the first year of observations.

[Toxicological study of materials for artificial heart valves]. / Toksikologicheskoe issledovanie materialov dlia iskusstvennykh klapanov serdtsa.

The toxicological study was performed in order to establish the optimum carbon thromboresistant coat of titanium in creating new constructions of the artificial heart valves under conditions of chronic experiments in albino rats. Fine samples of carbon coats made by different techniques were studied. The biological activity of only one coat made by the method of ionoplasmic spraying with using chemically pure carbon target was established.

[Comparative study of hemolysis in patients after implantation of Soviet-made artificial heart valves and spherical and angle-opening disc closing devices]. / Sravnite'lnoe issledovanie gemoliza u bo'lnykh posle implantatsii otechestvennykhkonstruktsii iskusstvennykh klapanov serdtsa s sharo- vym i otkryvaiushchimsia pod uglom diskovym zapiraiushchim elementom.

Intravascular hemolytic parameters were studied in 40 patients after implantation of Soviet-made cardiac values with a ball versus angle-opening disc closing device. It was found that with the angle-opening disc closing cardiac valves "LIKS" and "EMIKS", hemolysis developed considerably more infrequently and was less marked than with ball valves. A significant difference was found between the activity of lactate dehydrogenase and the levels of haptoglobin in the compared groups of patients (p less than 0.05).

[The effect of intravascular hemolysis on the body of rheumatics with heart valve prostheses]. / Vliianie vnutrisosudistogo gemoliza na organizma bol'nykh revmatizmom s protezami klapanov serdtsa.

The rate of intravascular hemolysis and associated complications was studied in 100 patients with rheumatic heart disease within 2 to 20 years after replacement of the heart valves. Hemolysis of varying intensity was recorded in 72% of patients, anemia in 5%, hemosiderinuria in 27%, cholelithiasis in 4%, and sideropenia in 36.8% of the examined. Renal failure was diagnosed in none of the patients. Thromboembolic complications were more frequently encountered in patients with hemolysis. In order to prevent anemia and sideropenia, it is recommended that control may be exercised over hemolysis and iron content in the blood of patients with prosthetic heart valves.