Incidence and risk factors of nosocomial infections after cardiac surgery in Georgian population with congenital heart diseases.

Nosocomial infections still remain a serious problem in patients undergoing open heart surgery. The aim of the study was to determine the incidence, etiology and main risk factors of nosocomial infections (NI) following cardiac surgery in congenital heart diseases population. Retrospective case study was conducted. 387 patients with congenital heart disease (CHD), who underwent cardiac surgery from January 2007 to December 2008 were studied. The age of the most patients varied between 1 day to 15 years, 73 patients (18,8%) were older than 15 years. All 387 patients underwent cardiac surgery. The rate of NI was 16%. The most common infections were bloodstream infections (BSI) (7,75%) and respiratory tract infections (7%) respectively. The rate of NI was higher in patients under 1 year of age, after urgent surgery and urgent reoperation, long cardiopulmonary bypass (CPB) and aortic cross-clamp time, also in patients with prolonged mechanical ventilation, massive haemotransfusion, with open heart bone after surgery, reintubation, hospitalization in another hospital during last three month. It was concluded that the most common nosocomial infection after cardiac surgery congenital heart diseases in Georgian population was blood stream infection. The main risk factors of NI in the same setting were age under 1 year, urgent surgery, urgent reoperation, long CPB and aortic cross-clamp time, long duration of mechanical ventilation, massive haemotransfusion, open heart bone after surgery, reintubation, hospitalization in another hospital during last three month.

Patent ductus arteriosus endovascular closure by amplatzer duct occluder.

Transcatheter occlusion of patent ductus arteriosus (PDA) using various occluding devices and coils is a widely accepted alternative to surgical closure in most pediatric cardiology centers. In spite of these advantages in transcatheter management, the occlusion of the moderate and the large PDA remains a challenge. The Amplatzer Duct Occluder (ADO) (AGA Medical, Golden Valley, MN, USA) is a new device with easy placement. It is reported to have higher rates of occlusion than other occluders currently available for transcatheter closure of PDA. 18 patients (6 male and 12 female) underwent transcatheter closure of PDA using the ADO. The mean PDA minimal diameter (pulmonary end) was 5,4+/-2,8 mm (range 4,0 mm-12 mm). We do not use ADO for small PDA closure (

Comparison of surgical and by transcatheter methods of closure of atrial septal defect based on the two year experience.

Our study was designed to compare surgical and transcatheter methods of treatment of frequent congenital malformation: atrial septal defect. Overall, during two year period 45 patients enrolled this study. 36 where referred to surgical treatment, 9 - to interventional. In most of the cases the choice of treatment method was made pre procedurally based on malformation anatomy. Both correction methods proved to be safe and effective. As our study shows the closure success rate is identical for both methods for appropriately selected patients. Residual shunts where haemodynamically insignificant and never needed re-operation. Both procedures have approximately similar major complication prevalence. The main differences were absence of the need for blood transfusion products, morbidity, and length of hospital stay, as well as the cost of treatment. All of them are in favour of Amplatzer device closure. Based on this information we can conclude that all patients feasible for transcatheter treatment should be treated by means of this procedure.

Variation of inspired nitric oxide and nitrogen dioxide concentrations during mechanical ventilation.

Inhaled Nitric oxide is a selective and potent pulmonary vasodilator with minimal influence on systemic vascular resistance. Due to these properties NO becomes widespread treatment for pulmonary hypertension of different etiologies. However, during inhalation via inspiratory limb of breathing circuit NO reacts with oxygen, producing nitrogen dioxide (NO2) which is known to be a toxic agent. Therefore, the exact measurements of NO and NO2 concentrations is very important during NO therapy, as was previously described by several authors. The aim of this study was to measure NO and NO2 concentrations at different sites of inspiratory limb of breathing circuit. Significant changes were found between different sites of circuit: Highest NO and lowest NO2 concentrations were detected at the distal points of circuit. We conclude, that NO delivery system should be connected with inspiratory limb of breathing circuit as distally as possible, to minimize contact of NO air with oxygen and to achieve maximal NO and minimal NO2 concentrations during inspiration.

[The activity of natural killers and K cells and their interferon sensitivity in subjects inoculated against diphtheria and meningococcal infection]. / Izuchenie aktivnosti estestvennykh killerov, K-kletok, ikh chuvstvitel'nosti k interferonu u liudei, privitykh protiv difteriinoi i meningokokkovoi infektsii.

The work deals with the time course of changes in the activity of natural killers, K-cells, their sensitivity to interferon, which reflects, in our opinion, the reserve possibilities of this killer system simultaneously with the development of the specific sensitization of lymphocytes. Significant changes in the cytotoxicity of natural killers, K-cells, have been detected in persons immunized against meningococcal infection, especially in those immunized with meningococcal vaccine introduced in combination with diphtheria toxoid. In this latter group of volunteers even more pronounced sensitization of peripheral blood lymphocytes has been observed than in persons immunized with monopreparations. The results obtained in this investigation indicate that the determination of these cell reactions may be of importance in the evaluation of the effectiveness of immunization.