Effects of Mitral Valve Surgery on Ventricular Arrhythmia in Mitral Valve Prolapse Patients: Five-Year Eollow-up.

Aim      To evaluate the effect of mitral valve (MV) repair and replacement on the incidence of ventricular arrhythmias (VA) and to identify risk factors for the persistence of VA in patients with MV prolapse and severe mitral regurgitation (MR) during a mid-term follow-up.Material and methods  A single-site observational, prospective study successively enrolled 30 patients (mean age, 55.2±9.9 years, 60% men) who underwent MV repair or replacement for severe MR due to MV prolapse or chordal avulsion. Transthoracic echocardiography and Holter monitoring were performed in all patients before and annually after surgery. A pathomorphological study of MV fragments excised during surgery was performed.Results During the five-year follow-up period (144 person-years), one case of sudden cardiac death outside a health care facility was recorded. MR severity progressed in three patients after MV repair. The total number of all VAs decreased during the follow-up period, with a significant decrease in the number of paroxysms of unstable ventricular tachycardia during the first two years after surgery. The presence of VA in the postoperative period was correlated with the severity of postoperative left ventricular (LV) remodeling: end-diastolic volume (EDV) (rs=0.69; p=0.005), LV ejection fraction (EF) (rs = -0.55; p=0.004) and severity of MV myxomatous alterations according to histological study data (rτ=0.58; p=0.045). The beta-blocker treatment did not influence the VA frequency and severity (rs= -0.18; p=0.69). According to a univariate regression analysis only EDV (p = 0.001), LVEF <50% (p = 0.003), and myxomatous MV degeneration (p = 0.02) were risk factors for persistent ventricular tachycardia in the postoperative period.Conclusion      Surgical intervention on MV in patients with MV prolapse and severe MR decreased the number of cases of malignant VAs and was correlated with the postoperative changes in LV volume and function, as well as the severity of MV myxomatous alterations.

[Sclerodegenerative aortic valve lesions and hereditary connective tissue disorders].

AIM: To estimate the role of different dysplastic syndromes and phenotypes in the development of sclerodegenerative lesions and calcific stenosis of the aortic valve (AV). SUBJECTS AND METHODS: One hundred and fifty patients (82 men and 68 women) aged 42 to 83 years were examined. A study group consisted of 89 patients (mean age 60.7 +/- 8.9 years) with clinical and echocardiographic signs of sclerodegenerative AV lesions (SDAVL). A control group included 61 patients (mean age 61.3 +/- 7.6 years) who had no clinical, physical, or echocardiographic signs of SDAVL. Twenty-five patients with critical calcific aortic stenosis (CAS) underwent histological examination of removed aortic semilunar valves after prosthetic AV replacement. RESULTS: Persons with a Marfanoid habitus (18%) and mitral valve prolapse (10.7%) are most common in older age groups. An association has been found between the bone signs of dysmorphogenesis and the development of SDAVL and CAS. CONCLUSION: Three or more signs of bone dysmorphogenesis and the Marfanoid habitus should be viewed as a predictor of SDAVL.

[Diagnostic criteria and clinical evaluation of tricuspid aortic valve asymmetry].

AIM: To investigate size of the aortal root and its valves in young patients and correlation between tricuspid aortal valve (TAV) asymmetry and connective tissue dysplasia (CTD). MATERIAL AND METHODS: TAV symmetry was studied in young patients. Morphological examination consisted in phenotypic study of 34 corpses of young people who had died of noncardiological causes with a focus to internal signs of CTD signs and measurements of TAV and each cusp. Echocardiographic examination comprised phenotypic, clinical and echocardiographic studies of 144 young patients. RESULTS: Echocardiographic diagnostic criteria of TAV asymmetry were specified. They consisted in eccentricity of the line of diastolic closure of aortal cusp (M-mode echocardiography) > 1.2; distinct differences in the size of the cusps (two-dimentional study), shift of at least one of the comissures by I hour at the "clock-face". A close correlation was detected between TA V asymmetry, external and clinical manifestations of CTD. The morphological criterion of TA V asymmetry--a more than 38% increase in the ratio of cusp area to sectional area of aortal root. CONCLUSION: TAV asymmetry is detected in 20% young people. It is closely related to external signs and clinical manifestations of CTD, other minor heart anomalies and may be accompanied with aortal regurgitation.

[Comparative evaluation of the functional activity of different immunoglobulin classes in cholera]. / Sravnitel'naia otsenka funktsional'noi aktivnosti immunoglobulinov razlichnykh klassov pri kholere.

The immunological activity of specific immunoglobulins in different forms of cholera infection was studied with the use of the indirect immunofluorescent method. The forms of cholera infection were shown to be related to the physico-chemical spectrum of antibodies: patients with the pronounced clinical symptoms of cholera produced serum IgM, including antigen -- antibody complex, more actively and in a greater amount; patients with faintly pronounced and asymptomatic infection produce highly active IgG. The competitive action of immunoglobulins of different classes in their simultaneous reaction with O antigen of Vibrio cholerae is shown. The mechanism of the competitive action of different immunoglobulin classes is supposed to play some role in the process of the sanation (with highly active IgM) or detoxication (with highly active IgG) of the organism.

[The choice of optimal sensitizing dose of the antigen in the preparation of cholera erythrocytic diagnostic agent, with consideration to the avidity of antibodies under study]. / Vybor optimal'no sensibiliziruiushchei dozy antigena pri izgotovlenii kholernogo éritrotsitarnogo diagnostikuma s uchetom avidnosti issleduemykh antitel.

The authors studied the comparative antigenic activity in the indirect hemagglutination test (IHAT) of erythrocytic diagnostic agents sensitized with various doses of cholera O-antigen. A definite dependence of the IHAT results on the avidity degree of the antibodies determined in the serum was demonstrated. To ascertain the maximal levels of highly avid antibodies (in the hyperimmune cholera sera) it is possible to use antigen doses exceeding the optimal sensitizing ones. In examination of less avid antibodies (for example in the blood sera of cholera patients) the diagnostic agent in such doses displayed decreased IHAT titres. To increase the reliability of the IHAT results it is recommended to choose the sensitizing antigen doses for the preparation of the diagnostic agent to be used in the IHAT with consideration to the avidity of antibodies examined in the blood sera.

[Avidity of specific antibodies in the sera of cholera patients and vibrio carriers]. / Izuchenie avidnosti spetsificheskikh antitel v syvorotkakh krovi bol'nykh kholeroi i vibrionositelei

Avidity of specific antibodies was studied in the sera of patients suffering from cholera and vibrio-carriers by the rate of antibody binding (in the bacterial agglutination reaction) and by the completeness of their binding with O-antigen (in the passive hemagglutination test). There were revealed statistically significant higher indices of antibody avidity contained in the blood sera of the vibrio carriers, in comparison with the antibodies in the blood sera of patients with clinically manifest forms of cholera. There proved to be an increase in the antibody avidity in the dynamics of the infectious process. It is supposed that the degree of avidity of anticholera antibodies in examination of whole sera depended on the ratio of the specific macro- and microglobulins in them.