[Heart failure and imbalance of chemical elements in myocardium of patients with ishemic heart disease].

Tissue content of chemical elements indirectly characterizes some metabolic processes. We have analyzed content of chemical elements in left and right ventricular myocardium of patients with ischemic heart disease with progressing heart failure and have shown that during development and progression of heart failure metabolic processes have unidirectional character in myocardium of both ventricles. Derangement of left ventricular contractile capacity is associated with lowering of content of microelements involved in antioxidant processes and energy metabolism in tissues (Cu, Mn, Cr) and elevated concentration of elements characterizing progressive of myocardial stiffness (Ca, Fe).

[Comparative characteristics of quality of life and physical status of patients with ischemic heart disease and aortic valve disease].

For comparison of physical status and quality of life of patients we analyzed 2 clinical groups: patients with ischemic heart disease (IHD) and aortic valve disease. Using original methodology of bringing results of questionnaire " Nottingham Health Profile " to functional classification we had a possibility to compare quality of life of patients with functional classes of physical working capacity and NYHA classification. Subjective component inserted into NYHA classification and quality of life questionnaire leads to substantial discrepancy with objective data on physical working capacity. In most cases patients of both clinical groups subjectively overestimate functional capacity of their organism. In patients with IHD most significant limitations manifest in psychic sphere of life, while in patients with aortic valve disease - in physical sphere of life, what demonstrates great effect of psychosomatic factor in development of IHD.

[Distribution of chemical elements in various parts of the heart of patients with acute heart failure].

By the method of autopsy in patients with ischemic heart disease (IHD) who died of acute heart failure we took samples of myocardium from 6 parts of the heart: left and right atrium, left and right ventricle, region of myocardial infarction, and scar of the left ventricle. Simultaneously we conducted histological study of these parts of myocardium. For the control we investigated content of chemical elements in myocardium of healthy victims of traffic accidents. By the method of roentgen fluorescent analysis with the use of synchrotron emission we detected content of 17 chemical elements: 4 macroelements (S, Cl, K, Ca) and 13 microelements (Cr, Mn, Fe, Ni, Cu, Zn, Se, Br, Rb, Sr, As, Mo, Hg). It was established that in patients with IHD who had died of acute heart failure content of Ca was elevated 4-8 fold in all parts of the heart. In infarction zone compared with other regions of the heart maximal quantity of Sr, Cr, Hg was contained. These elements can be looked upon as markers of infarction. In myocardium of patients with IHD especially in the zone of infarction elevation of activity of processes of lipid peroxidaton has been noted (calculated activity of malone aldehyde as example).

Anatomical variants of transposition of the main vessels and their relationship with the content of chemical elements in heart ventricles.

Cardiometrical characteristics of anatomical variants of the main vessels transposition are determined by different functional load of heart compartments and are associated with metabolic processes of different intensity, which is confirmed by the content of chemical elements in the right- and left-ventricular myocardium. It was shown that the content of chemicals was virtually the same in both cardiac ventricles in case of main vessels transposition and isolated atrial septal defect. Positive correlations between the degree of left-ventricular hypertrophy and content of S, K, Fe, and Sr in it and a negative correlation between this hypertrophy and Cu content were revealed. Transposition of the main vessels and defects of atrial and ventricular septa were associated with different levels of chemical elements in both ventricles, particularly of Zn, Mn, Fe, and Ca.

Role of chemical elements in formation of an aortic aneurysm.

The method of X-ray fluorescence employing synchronous radiation was used to study the content of chemical elements (CE) in the aortic wall in patients suffering from CAD (Group I), patients diagnosed with an ascending aortic aneurysm (Group II), and those presenting with aortic dissection (Group III). The obtained findings revealed a pronounced CE disbalance in the aortic wall in Group II and III patients as compared with Group I patients, suggesting an important role of trace and macroelements in metabolic processes related to formation of artic aneurysms. Based on the degree of the ascending aorta dilatation, we determined the coefficient of the ratio of the ascending aorta maximal diameter to the fibrous ring aortic valve diameter, equalling 1.88 +/- 0.04, above which metabolic processes in the aortic wall change over to a qualitatively another level. This point was arbitrarily termed the metabolic process reversibility point.

[Stages of compensation of circulation in acquired aortic valve disease according to data of physical working capacity].

We examined 194 men (mean age 40 +/- 1.4 years) with acquired aortic valve disease. Basing on the data of estimation of physical working capacity and reserve of cardiorespiratory system we assessed staging of development of compensatory mechanisms of circulation in patients with acquired aortic stenosis and aortic insufficiency. According to working capacity all patients were divided into 4 groups with different hemodynamic response of the organism to physical work. Staged development of mechanisms of compensation of the circulation was found to be related to pronounced left ventricular remodeling: concentric myocardial hypertrophy developed in aortic stenosis while aortic insufficiency was associated with eccentric hypertrophy of the myocardium. These differences in geometry were observed already at stage II. Parameters of systemic hemodynamics and energy expenditures of the heart during exercise practically did not differ between aortic stenosis and insufficiency of aortic valve and were characterized by progressive lowering of efficacy of circulation from stage II to stage IV despite pronounced tension of myocardial reserve. As a result significant lowering of tolerance to physical effort took place in patients of the given group.

[Content of microelements in left ventricular myocardium of patients with ischemic heart disease. Data of roentgenofluorescent analysis with the use of synchrotron irradiation].

Contents of 11 microelements (Se, Rb, K, Sr, Ca, Cr, Mn, Fe, Cu, Ni, Zn) in various parts (zone of infarction, of scar, periinfaction zone) of left ventricular myocardium of patients with ischemic heart disease was studied with method of rentgenofluorescent analysis with the use of synchrotron irradiation (overall 2112 analyses). Left ventricular myocardium of victims of accidents without cardiovascular pathology was studied as control. Compared with control dysbalance of various degree was noted in left ventricular myocardium of patients with ischemic heart disease. Four groups of microelements were distinguished: lowered content (Se, Rb, K); close to normal content (Mn, Cu); moderately elevated content (Cr, Sr, Fe); elevated content (Ni, Zn). Several orders of magnitude elevation of Ni and Zn was noted in all parts of left ventricle, especially in the zone of infarction and periinfarction zone.

[The study of cerebral oxygenation and central hemodynamics in patients with ischemic heart disease at rest and during physical effort.]. / Issledovaniia tserebral'noi oksigenatsii i tsentral'noi gemodinamiki u bol'nykh ishemicheskoi bolezn'iu serdtsa v pokoe i pri fizicheskoi nagruzke.

Cerebral oxygenation (rSO(2)) in the region of sagittal sinus and main hemodynamic parameters were measured in 112 patients with ischemic heart disease and class II-III angina. Four groups of patients were distinguished according to degree of rSO(2) lowering. Hemodynamics and oxygen transport function of the blood were proportionally related to degree of rSO(2) lowering. Normal rSO(2) (>70%) and degree lower (70-61%) was associated with predicted (desirable) cerebral blood flow. Lower rSO(2) values (60-50%) were accompanied with increased oxygen utilization (by 20-25%). Critical rSO(2) lowering (below 50%) was associated with>/=75% rise of oxygen utilization what was indicative of decreased brain blood flow and cerebral ischemia.

Laser Doppler flowmetry assessment of microcirculation in upper extremities before and in long-term period after harvesting of radial artery.

Radial artery (RA) is rather commonly used as a graft for autoarterial myocardial revascularization. Consequences of RA harvesting for the development of ischemic disturbances in distal hand segments are poorly understood. The paper presents assessment of hand microcirculation (HMC) before and in late postoperative period after RA harvesting with modern precise diagnostic method - laser Doppler flowmetry (LDF). LDF assessment of HMC was carried out in 80 patients with ischemic heart disease (160 hands) to evaluate the possibility of RA harvesting for coronary artery bypass surgery. HMC classification was developed on the base of these measurements: type 1 -normocirculatory HMC: 6.7-17 ml/min/100 g (58%); type 2 - vasospastic HMC: < or = 6.7 ml/min/100 g (20%); type 3 - hyperemic HMC: > or = 17 ml/min/100 g (22%). In 34% of cases preoperative examination revealed microcirculatory asymmetry between right and left hands. Based on preoperative examination results in 22.9% of cases the decision was made to refuse from RA excision because of positive collateral circulation test developed in our Institute (positive decision about Patent award according to appeal No2000122582/14 (023905) from 28.08.2000). In 14 patients (14 upper extremities) HMC was measured before and 1-1.5 years after RA harvesting. After RA excision baseline HMC in operated hand reduced significantly while maximal HMC reserve remained at the level close to preoperative one. Postoperative HNMC alterations evidence of adequate preoperative assessment of hand collateral circulation potential. In case of blood flow asymmetry RA must be taken from the hand with higher blood supply and adequate collateral microcirculation.

[Myocardial blood flow in different regions of the heart in patients with ischemic heart disease before and after revascularization]. / Miokardial'nyi krovotok na raznykh uchastkakh serdtsa u bol'nykh ishemicheskoi bolezn'iu serdtsa do i posle revaskuliarizatsii.

Laser doppler flowmetry was used for the intraoperative study of myocardial blood flow before and after revascularization in 116 patients with 2-3 vessel coronary artery disease and class II-IV angina. In patients without myocardial infarction, with microfocal myocardial infarction, or operated early after myocardial infarction revascularization caused no significant increase of myocardial blood flow. In patients with macrofocal infarction surgery was associated with significant increase of myocardial blood flow. Efficacy of revascularization could be assessed by lowering of flow gradients between various regions of the myocardium.

[The sequelae and late results of surgical treatment in wounds of the heart and pericardium]. / Posledstviia i otdalennye rezul'taty khirurgicheskogo lecheniia ranenii serdtsa i perikarda.

An examination of 109 patients after surgical treatment of wounds of the heart and pericardium were performed at late terms after treatment. It was found that good results had 53.2% of the patients, 12.8% of the patients had limited working capacity, 4.6% of the patients became invalids. Satisfactory and bad outcomes resulted from the development of consequences of the trauma and operation. Terms of the recovery of working capacity depended on the severity of the trauma, timeliness of treatment of complications, state of the functional reserves and adequate regimen of motor activity.