Markers of myocardial damage in children of the first year of life with congenital heart disease in the early period after surgery with cardioplegic anoxia.

We measured the level of cardiac markers (high-sensitivity troponin T and MB fraction of creatine kinase) in children of the first year of life with congenital heart disease in the perioperative period. After cardiac surgery, plasma levels of the above markers exceed the reference limits in the examined children. The diagnosis of myocardial ischemia using biochemical markers in the postoperative period is possible only by dynamic monitoring of the cardiac marker level. The preoperative concentration of high-sensitivity troponin T in children of the first year of life with congenital heart disease can be regarded as a predictor of postoperative complications.

Experimental study of the effects of sodium ion concentrations on the function of the myocardium exposed to cardioplegic ischemia.

A new cardioplegic solution based on three natural dipeptides was developed and introduced at the Laboratory of Cardioplegia, A. N. Bakulev Research Center of Cardiovascular Surgery. The electrolyte composition of the solution corresponded to the category of intracellular cardioplegic solutions. The results of 60 experiments on isolated rat hearts were analyzed for choosing the optimal concentration of sodium ions (35, 60, or 80 mmol/liter). The composition of the studied cardioplegic solutions was selected by ion concentrations in the intra- and extracellular fluid. Earlier and most effective recovery of cardiac function with minimum rhythm and conductivity disorders was observed in the group treated with cardioplegic solution with sodium ion concentration of 60 mmol/liter.

[Diagnosis and correction of thrombohemorrhagic complications in cardiosurgical patients in the early postoperative period].

The methods of the prevention, diagnosis, and correction of hemostatic disorders are discussed in cardiosurgical patients. Prevention of hemorrhages requires hemostatic history data collection that allows identification of patients with concomitant hemophilia and those, taking antithrombotic drugs. The benefits of an extended study of blood coagulation disorders are shown in neonates and babies of the first year of life due to the physiological features of the hemostatic system and the pattern of heart disease. Algorithms are proposed for the diagnosis and treatment of hemorrhagic diathesis in the early postoperative period; a complex of minor signs of surgical hemorrhage is formulated, which makes it possible to timely perform rethoracotomy and to reduce blood transfusion. Efficiency evaluation and exclusion criteria for the use of recombinant factor VIIa are given. The efficiency of using the Russian drug tranexam versus epsilon-aminocapronic acid and aprotinin in the perioperative period was evaluated. The blood coagulative system was monitored in the treatment of disseminated intravascular coagulation in multiple organ dysfunction and sepsis, which promoted the timely use of recombinant human activated protein C and human antithrombin III. A diagnostic and treatment algorithm for replacement therapy of congenital heart disease concurrent with hemophilia A is given.

[Hematological characteristics in blood autoanalysis in children with congenital heart defects]. / Kharakteristika gematologicheskikh pokazatelei pri issledovanii krovi metodom avtomaticheskogo analiza u detei s vrozhdennymi porokami serdtsa.

Hematological status of infants with congenital heart disease (CHD) was evaluated by automated systems. Blood analyses were carried out in 40 infants with the pale type and in 20 with the blue type CHD. Increased erythrocyte count and hematocrit were detected in the blue type CHD. Evaluation of the leukocytic formula showed correlation of the results of automated analysis and microscopic analysis of a blood smear. Automated method is preferable for estimating platelet count. Platelet count was decreased and the cells were larger in patients with the blue type disease in comparison with the pale type group. Hence, automated analyzer gives a wide spectrum of blood values with high accuracy and productivity and helps evaluate hemopoiesis in patients with CHD.