Effect of postoperative high load long duration inspiratory muscle training on pulmonary function and functional capacity after mitral valve replacement surgery: A randomized controlled trial with follow-up.

OBJECTIVES: Although, pre-operative inspiratory muscle training has been investigated and reported to be an effective strategy to reduce postoperative pulmonary complications, the efficacy of postoperative inspiratory muscle training as well as the proper load, frequency, and duration necessary to reduce the postoperative pulmonary complications has not been fully investigated. This study was designed to investigate the effect of postoperative high-load long-duration inspiratory muscle training on pulmonary function, inspiratory muscle strength, and functional capacity after mitral valve replacement surgeries. DESIGN: Prospective randomized controlled trial. METHODS: A total of one hundred patients (mean age 38.3±3.29years) underwent mitral valve replacement surgery were randomized into experimental (n = 50) and control (n = 50) groups. The control group received conventional physiotherapy care, while experimental group received conventional care in addition to inspiratory muscle training, with 40% of the baseline maximal inspiratory pressure targeting a load of 80% by the end of the 8 weeks intervention protocol. Inspiratory muscle training started on the patient's first day in the inpatient ward. Lung functions, inspiratory muscle strength, and functional capacity were evaluated using a computer-based spirometry system, maximal inspiratory pressure measurement and 6MWT respectively at 5 time points and a follow-up assessment was performed 6 months after surgery. Repeated measure ANOVA and post-hoc analyses were used (p <0.05). RESULTS: Group-time interactions were detected for all the studied variables (p<0.001). Between-group analysis revealed statistically significant postoperative improvements in all studied variables in the experimental group compared to the control group (p <0.001) with large effect size of η2 ˃0.14. Within-group analysis indicated substantial improvements in lung function, inspiratory pressure and functional capacity in the experimental group (p <0.05) over time, and these improvements were maintained at follow-up. CONCLUSION: High intensity, long-duration postoperative inspiratory muscle training is highly effective in improving lung function, inspiratory muscle strength, and functional capacity after mitral valve replacement surgeries.

[Evaluation of the cardiovascular function in patients with chronic rheumatic heart disease in the practice of medical and social expertise].

Chronic rheumatic heart disease (HRHD) for a long time occupied a prominent position in the structure of the disability population in Ukraine. Aim of the study is to define clinical signs of cardiovascular function in patients with HRHD for disability evaluation in the practice of medical and social expertise. We examined 180 patients with HRHD aged 40-65 years. There were significant differences in patient groups, which allowed us to formulate clinical and functional diagnostic markers of dysfunction of circulation for the objective assessment of the limitations of their life, the definition of disability groups and the development of rehabilitation programs.

[Clinical and laboratory support for multiple-modality treatment of rheumatic patients with mitral valve disease]. / Kliniko-laboratorne obgruntuvannia kompleksnoho etapnoho likuvannia khvorykh na revmatyzm z mitral'nym porokom sertsia.

In 158 rheumatic patients with mitral valvular disease (MVD), clinical-and-laboratory indices were studied together with a possibility for correction of the detected disorders in a multiple-modality staged treatment involving basic drug therapy, EHF-therapy, and sanatorium-health resort stage of rehabilitation. It has been found out that EHF-therapy and sanatorium-health resort treatment have a positive effect on the clinical course of the trouble and on the laboratory indices for the inflammatory process contributing to optimization of medicamentous treatment of rheumatic patients with MVD.

[Exercise training of patients in a health resort after surgery for rheumatic heart disease]. / Fizicheskie trenirovki na terrenkure bol'nykh, operirovannykh po povodu revmaticheskikh porokov serdtsa.

We studied the effect of cardiovascular system function on the response to terrain cure in the course of rehabilitation of 88 patients after surgical correction of valvular defects in conditions of low-mountain health resort. We have found that the response to the above exercise depends on functional condition of the cardiovascular system (the degree of correction of hemodynamic disorders related to valvular disease, the degree of myocardial hypertrophy and dilation of the chambers, left ventricular contractility). Terrain cure exercise promotes improvement in regulation of cardiovascular system and mobilization of its reserves.

[Carbonate mineral baths in the combined treatment at a piedmont health resort of patients operated on for rheumatic heart defects]. / Mineral'nye uglekislye vanny v kompleksnom lechenii na nizkogornom kurorte bol'nykh, operirovannykh po povodu revmaticheskikh porokov serdtsa.

The response of the cardiovascular system of 64 patients operated for rheumatic heart disease to mineral carbon dioxide baths was studied in the course of rehabilitation in low-mountain health resort. It was found that the above baths have a training effect on the cardiac muscle, improve myocardial metabolism. They are an essential factor in combined sanatorium treatment of patients after surgical correction of valvular defects. Baths-induced changes in the central and peripheral hemodynamics depend on cardiovascular function. Therefore, they require an individual approach. If the exposition increases to 15 minutes, mineral carbon dioxide baths have more potent training effect on the myocardium and raise effectiveness of the sanatorium treatment.

[The biological rhythms of cardiac activity based on cardiointervalography in children with rheumatism during readaptation after sanatorium treatment]. / Biologicheskie ritmy serdechnoi deiatel'nosti po dannym kardiointervalografii u detei s revmatizmom v period readaptatsii posle sanatornogo lecheniia.

Heart rate as an integral characteristic of systemic condition in rheumatism was studied in 11-13-year-old children with rheumatic heart disease. The children achieved remission by clinical and laboratory tests and were experiencing postsanatorium readaptation. Pretreatment amplitude of the fluctuations from the mean circadian values were reduced in the patients compared to healthy controls. This shows low compensatory potential of the rheumatic children. Adaptation after sanatorium treatment aggravates the above amplitude diminution, acrophases shifted to later local time.

[Anasarca caused by rheumatic carditis]. / Anasarka durch rheumatische Karditis.

Report of a 55-year-old-male patient with most serious anasarca caused by insufficiency right heart. The reason of the heart failure was probably rheumatic carditis caused by streptococcal infections which followed recurrent erysipelas both legs with phleblymphedema. The necessity of consistent antibiotic treatment of the erysipelas, that's the only possibility to avoid more difficult secondary complications like this case of rheumatic carditis showed. The treatment of insufficiency heart was followed by physical decongestive therapy of the phleblymphedema of the legs. After a treatment period of 12 weeks a water loss of 112 kg and reduction of abdominal circumference from 250 cm to 150 cm could be achieved.

[The use of the results of current instrumental methods of cardiological examination in the sociomedical expert assessment of patients with rheumatic heart defects]. / Primenenie rezul'tatov sovremennykh instrumental'nykh metodov kardiologicheskogo obsledovaniia pri mediko-sotsial'noi ékspertize bol'nykh s revmaticheskimi porokami serdtsa.

Altogether 103 patients with rheumatic heart disease were examined within different times after prosthetics of heart valves (mitral or aortal). The purpose was to elaborate the principles of applying the data of instrumental methods of cardiological examination to the improvement of disability criteria. The examination included echocardiography, tetrapolar chest rheography and ECG exercise test. The data allowed one to estimate myocardial reserves and to specify the intensity of functional disorders of the cardiovascular system. The expert medical conclusions on the working ability were revised in 47 patients, bearing in mind the data obtained. Before the examination 70 patients (68%) were considered to completely lose the working ability. However, after the examination their number dropped to 34 (33%), whereas the number of persons able to work rose from 5 to 12%.

[The physiotherapeutic correction of secondary immunodeficiency in the preoperative period in patients with rheumatic heart defects]. / Fizioterapevticheskaia korrektsiia vtorichnogo immunodefitsita v predoperatsionnom periode u bol'nykh s revmatichesmimi porokami serdtsa.

Directed correction of immunity by physiotherapeutic methods was used at the period of preoperative preparing 45 patients who needed the operation for rheumatic valvular disease of the heart. The number of purulent complications during the postoperative period in the group of patients subjected to direct correction of the immune status was found to be less than in the control group.

[The clinico-psychological correlations and work adaptation of rheumatism patients operated on for heart defects]. / Kliniko-psikhologicheskie sootnosheniia i trudovaia adaptatsiia u bol'nykh revmatizmom, operirovannykh po povodu porokov serdtsa.

Altogether 345 patients with rheumatic fever operated on for heart disease were examined for clinicopsychological correlations and their importance for patients' adaptation to work. Cardiovascular function was estimated with the aid of clinical and instrumental methods (ECG, echocardiography, bicycle ergometry). The psychological personality traits were examined by Quetelet's 16-factorial questionnaire, the type of the attitude towards disease by a personality questionnaire developed by the V. M. Bechterew's Leningrad Research Psychoneurological Institute, work purpose by a specially made up questionnaire. Correlations between the level of adaptation to work and the sociopsychological and clinical signs were studied. The psychological characteristics, work purpose of the personality were found to be of paramount importance for restoration of work fitness, which is of significance in the design of labour prognosis of patients and in expert medical evaluation of the working capacity.

[Psychological characteristics of the personality and the attitude to work of patients subjected to surgery on account of rheumatic heart disease]. / Psikhologicheskie osobennosti lichnosti i trudovaia ustanovka bol'nykh operirovannykh po povodu revmaticheskikh porokov serdtsa.

The authors studied the psychological peculiarities of personality, attitude towards the disease and orientation for work in 124 patients operated on in connection with rheumatic heart disease. The psychological peculiarities of personality were examined by means of a 16-factor questionnaire suggested by Kettell and the type of attitude towards the disease by a questionnaire prepared by the V. M. Bechterew's Institute, orientation for work--by means of a specially compiled questionnaire. It has been established that the type of attitude towards the disease is determined by psychological peculiarities of personality, it exerts influence on orientation for work. This should be taken into consideration when conducting rehabilitation measures in patients with rheumatic heart disease after the operation on the heart.

[A new approach to the qualitative assessment of the reaction to physical loading during bicycle ergometry of patients following aortic prosthesis]. / Novyi podkhod k kachestvennoi otsenke reaktsii na fizicheskuiu nagruzku pri veloérgometrii u patsientov posle aortal'nogo protezirovaniia.

The paper is concerned with the objectivization of qualitative assessment of a response to exercise testing during rehabilitation of patients after aortic valve replacement. The authors propose methods for a study of hemodynamic provision of submaximum and threshold exercises confirming significantly a higher myocardial reserve in patients after submaximum exercises. Hemodynamic characterization of different types of threshold reactions has shown that a common feature in the majority of patients is a decrease in cardiac ejection during exercise testing, mainly as a result of ino- or chronotropic depletion. A significant increase in the number of submaximum bicycle ergometric exercises is an important criterion of the efficacy of a rehabilitation program.

Fiebre reumatica y cardiopatia reumatica en el Hospital de Clinicas / Rheumatic fever and rheumatic cardiopaty at the Hospital of Clinics

Con el objeto de estudiar la prevalencia de enfermedad reumatica en nuestro medio hospitalario, se ha tomado comomuestra los enfermos atendidos en el Pabellon Italia que tiene dos salas para cada sexo de 15 camas cada una. Se ha abarcado para esta seleccion ocho anos de 1973 a 1980. El problema de las cardiopatias reumaticas y la fiebre reumatica en el medio hospitalario se proyecta en el problema asistencial, cumplido en forma eficiente en la medida de lo posible, por las restricciones economicas el problema mediato, de la recuperacion quirurgica, tambien de aspecto economico, es de gran magnitud por el costo de esta cirugia.

Education and employability of young cardiac patients.

Between 1966-1980, 136 young cardiac patients were categorized as disabled in accordance with the National Act of Rehabilitation. To study their fate a questionnaire was circulated to them: 96 patients responded, all were 15 years of age or more at the time of the study; 31.2% attended middle or higher school education and 63.3% were employed; 45.9% were skilled and 54.1% unskilled workers; 2.2% were unemployed, which was very close to the general youth unemployment rate. Work was provided for unemployed patients in their homes but they needed additional financial support. The benefits for the young disabled cardiac patients include health insurance, vocational training, payment of boarding school fees and financial support. Nevertheless the focus of the team dealing with these patients should be their preparation for employment.