The aim of the research was to study pathomorphologic substratum of the development of restenosis in common («uncovered») stents implanted into the coronary arteries of patients with coronary artery disease.

Materials and methods.We resected and carried out pathomorphologic study of regions of vessels occluded as a result of restenosis in stents of 5 patients with chronic coronary artery disease and aortocoronary artery bypass grafting performed at M.M. Amosov Institute of Cardiovascular Surgery of the Academy of Medical Sciences of Ukraine in 2004—2005, within the period from 3 to 8 months (mean 5.6 months) after stenting of coronary arteries with the use of common metal stents.

Results and discussion. During the pathohistologic research of the biopsy material, we revealed that the branches of the stent joined the vessel walls, the elements of atherosclerotic plaque were located outside the line of the stent and the repeated narrowing of the artery aperture was caused by the proliferation of elements of the inner layer of the vessel wall. At the same time, in the regions of neointima located between the artery wall and the branches of the stent there were quite a lot of young plethoric vessels characteristic of the typical granulation tissue. Concurrently, the neointima tissue facing the aperture of the vessel and located deeper than the branches of the stent was a zone of fibrous-muscle element proliferation, free from vascular net. Atherosclerotic plaque, because of which the implantation of the stent was performed, was located outside the line of the stent in the vessel wall and represented a narrow lenticular accumulation of Sudan-positive structureless tissue which partially germinated with collagen fibres thickening in the periphery and forming capsules.

Conclusions. Restenosis in stent is a zone of fibrous-muscle element proliferation free from vascular net, which is the manifestation of the reparative reaction of the organism in response to the surgical trauma and introduction of the foreign body. Atherosclerotic plaques in the coronary arteries, which are the reason of stenting, are thickened by the stent, incapsulate with time and undergo fibrous transformation.

Keywords: stenting (endoprosthesis replacement) of coronary arteries, restenosis in stent, pathomorphologic research

The aim of the research was to determine the potential of the method of complex echocardiography in early diagnosis of dissecting aneurysm of ascending aorta.

Materials and methods. 26 cases of dissecting aneurysm of ascending aorta (DAAA) were analyzed. 19 patients were operated on. To diagnose DAAA we used the method of complex echocardiography (EchoCG) which presupposed A-mode and cross-sectional echocardiography, continuous wave Doppler EchoCG (DEchoCG) and color Doppler mapping (CDM) as well as transesophageal EchoCG (TEEchoCG). We used direct and indirect EchoCG diagnostic criteria of aortic wall dissection for DAAA diagnosis. The direct criteria were floating intima in the aortic lumen, entrance or exit lumen in the false aortic channel, blood flow or spontaneous echocontrast effect in the false channel, thrombosis of the false channel; the indirect criteria were pleural and pericardial effusion, presence and growth of aortic insufficiency (AI) degree and signs of unexpected left ventricle (LV) volume overload. The presences of these signs as well as the main indices of the morphology and systolic function of the LV and the sizes of thoracic region of aorta on different levels were found in 19 patients that had undergone the operation. Catheterization of cardiac cavities and X-ray contrast angiocardiography were performed in all patients.

Results. The patients with DAAA revealed the increase of LV end-diastolic volume by 42 % in comparison with the norm (p < 0.05) and eccentric LV hypertrophy with the increase of myocardium mass by 55 % (p < 0.05). During transthoracic echocardiography (TTEchoCG), the diagnosis of DAAA was made in 16 (84.2 %) cases and during TEEchoCG — in 18 (94.7 %). At the same time the second method made it possible to specify the topical diagnosis of dissection in 3 (15.8 %) patients. DAAA was not recognized by means of aortography in 3 (15.8 %) patients. Dissection in the ascending region of the aorta was not diagnosed. In most patients, exfoliation of the intima spread on 2/3 of the aorta diameter, both after the location of fenestration within 40 mm from the fibrous ring of the aortal valve (AV) (in 72.7 %) and in the more distal localization (in 62.5 %). Aortal insufficiency caused by the dilation of the aortal valve ring was fixed in 89.5 % cases; aortic valve replacement was necessary in 26 % cases.

Conclusions. The use of transthoracic and transesophageal echocardiography in dissecting aneurysm of ascending aorta allows detecting the main signs of the disease, such as rupture of the aortic intima and formation of false channel, in all cases.

Keywords: dissecting aneurysm of ascending aorta, transthoracic and transesophageal echocardiography, exfoliation of the intima, false channel

The purpose of the research was to develop guidelines concerning the treatment of specific complications basing on the determination of factors causing complications in the postoperative period after thrombendarterectomy from the pulmonary artery in patients with chronic post-embolic pulmonary hypertension.

Materials and methods.We examined 51 chronic post-embolic pulmonary hypertension patients who underwent thrombendarterectomy from the pulmonary arteries during the period from 1990 to May 2006. Among them were 21 men and 30 women aged 15—77 years, mean age (53.0 ± 5.40). All the patients had III or IV functional NYHA class; 6 of them were completely oxygen- dependent before the operation. During the operation and in the post-operative period we observed the arterial and central venous pressure, frequency and rhythm of cardiac contractions, the volume of the fluid management and diuresis, peripheral carbonation with the help of pulse-oximeter, excretions from the drainages, potassium concentration, indices of acid-base balance and hematocrit. Mean pressure in the pulmonary artery, pulmonary peripheral resistance and cardiac ejection with the use of Swan — Gants catheter were monitored in 24 patients of this group.

Results and discussion. The course of early post-perfusion and post-operative period depended primarily on the radicalism of deobliteration and the achieved decrease of the pulmonary vascular resistance. Quick regress of pulmonary hypertension during 18—24 hours after the operation which was marked in 67.8 % patients was prognostically favorable, associated with the stability of hemodynamics and absence of lethal outcomes. Repeated decrease of the lethality level in case of pulmonary thrombendarterectomy achieved in the recent years was mostly caused by the optimization of therapeutic approach in the early post-perfusion and post-operative period. Pronounced changes in the homeostasis during the conduction of thrombendarterectomy from the pulmonary arteries with deep hypothermia and stoppages of blood circulation demand the application of an integral conception of the intensive therapy, aimed at the decrease of the post-operative pulmonary hypertension, treatment of right ventricle failure, optimization of oxygenation by means of minimization of blood circulation stoppage periods in the course of the operation and the artificial ventilation of the lungs. Besides hemodynamic and respiratory impairments, the specific complications of pulmonary thrombendarterectomy are cerebral coma, choreoathetosis and delirium caused by hypoxia of the brain at the background of a short-term stoppage of blood circulation.

Conclusions. The main factors which cause complications in the post-operative period of thrombendarterectomy in patients with chronic post-embolic pulmonary hypertension are residual or vasospastic pulmonary hypertension, right ventricle failure, respiratory failure caused by reperfusion phenomena and «robbing» of the lungs and hypoxia of the brain caused by the complete stoppage of blood circulation during the operation. In order to decrease post-operative pulmonary hypertension and treat right ventricle failure, it’s advisable to use small dozes of adrenalin in combination with dopamine or dobutamine without exceeding the ratio of the mean pressure in the aorta to the mean pressure in the pulmonary artery within the limits of 2:1, to monitor diuresis and water balance with the help of diuretics. It’s advisable to conduct artificial ventilation of the lungs with the increase of ventilation parameters by 15—20 % and the use of the regime of positive exhalation end pressure with the purpose of treatment and prevention of reperfusion syndrome and «robbing» of the lungs.

Keywords: chronic post-embolic pulmonary hypertension, thrombendarterectomy, reperfusion of the lungs, postoperative complications, intensive therapy

The aim of the research. By means of studying elemental hair composition, to conduct comparative analysis of basic chemical elements balance in the organisms of patients with myocardial infarction (MI) under age 50 depending on their professional exposure to xenobiotics.

Material and methods. Multi-elemental hair analysis with the use of the method of roentgen-fluorescent spectrometry was performed in patients with acute MI under age 50 including 28 patients whose professions were connected with the influence of xenobiotics (I group), 11 patients having no professional contact with these substances (II group) and 23 healthy persons of the same age without professional exposure to xenobiotics. Concentration of 28 elements was assessed: essential (calcium, potassium, iodine, selenium, brome, sulfur, zinc, silver, iron, manganese, copper, molybdenum, cobalt, chrome, vanadium, nickel) and toxic ones (barium, chlorine, lead, arsenic, mercury, cadmium, antimony, rubidium, strontium, zirconium, titan, tin).

Results and discussion. The concentration of heavy metals in the hair of MI patients of the I group was substantially higher than in the controls and in patients of the II group. The hair concentration of three toxic elements — chlorine, lead, mercury — was substantially higher in the MI patients of the II group than in the controls. It may be the result of smoking. The decrease of the average level of the protective element selenium was observed in the hair of 82.1 % MI patients of the I group and 72.7 % patients of the II group, where it didn't reach the minimal possible value.

Conclusions. MI patients under age 50 whose professions are connected with the influence of xenobiotics have in their hair substantially higher concentrations of heavy metals (copper, manganese, chrome, cadmium, lead), toxic light metals (strontium and rubidium), as well as potassium, brome and chlorine than patients and healthy persons who have no professional contacts with these substances. Irrespective of the profession, MI patients under age 50 demonstrate higher incidence of the decreased concentration of the protective element selenium.

Keywords: elemental hair composition, xenobiotics, myocardial infarction

The aim of our research was to compare the efficiency of different thrombolytics at patients with pulmonary artery branches thrombectomy (PABTE) without serious hemodynamics disorders.

Materials and methods. Under our supervision there were 56 patients with submassive PABTE without serious hemodynamics disorders and prescription from a few hours to 12 days confirmed by angiopulmanography (APG). Thrombolytic therapy by means of intravenous infusion of tissue plasminogen activator (TPA) was received by 30 patients (1st group), urokinase — by 26 (2nd group). Control angiography was conducted 2, 8, 12, 24 hours after the beginning of thrombolysis. The improvement of pulmonary perfusion in percentage from the initial units in Miller index in each of these groups was estimated in each of the above mentioned terms. Depending on the time of conducting thrombolysis since the onset of the disease (from 1 to 12 days), the dynamics of changes of systolic pressure in the pulmonary artery measured by Doppler EchoGCG and changes of Miller index were estimated.

Results and discussion. According to the results of the analysis of the dynamics in Miller index, its change in 2 and 8 hours was more expressed in the 1st group than in the 2nd (30.2 % versus 12.3 % and 49.6 % versus 25.7 %, respectively, p < 0.05), which is the evidence of greater efficiency of TPA in comparison with urokinase in early terms. In 12 hours, however, the improvement of pulmonary perfusion was the same in the patients of both groups. While conducting the thrombolysis on the 1st—2nd days, the efficiency of both thrombolytic agents was equal and constituted 73.8 % on the average. From the 2nd to the 5th day the index of thrombolysis efficiency decreased by 4.8 % on the average in the 1st group and by 7.2 % in the 2nd, reaching 62.5 and 54.5 % accordingly. From the 5th to the 8th day inclusive, this index went down on the average by 8.9 % and 6.8 %, respectively, per day. To the 10th day the efficiency of urokinase was close to zero and TPA remained at 27 % level. No distinctions in hospital lethality and frequency of the serious hemorrhages after the administration of both thrombolytic agents were revealed (3.3 % against 3.8 % and 6.7 % against 7.7 %, accordingly, all p < 0.05).

Conclusions. According to X-ray contrast APG, TPA promotes more expressed improvement of lung perfusion at patients with PABTE without substantial hemodynamic changes than in urokinase group in early terms (6—8 h) after the beginning of therapy but the angiography results are identical by 12 h. The decrease of thrombolysis efficiency with the increase of the period of its conducting since the onset of PABTE was less expressed in case of TPA administration than in case of urokinase use.

Keywords: pulmonary artery branches thrombectomy, improvement of pulmonary hemodynamics, therapeutic window, thrombolysis, tissue plasminogen activator, urokinase

The aim of the study is to analyze the reasons why it is impossible to use great saphenous vein (GSV) as autograft and to estimate short-term effectiveness of differentiated use of various methods of femoro-popliteal arterial segment reconstruction depending on the type of GSV lesion.

Materials and methods.We analyzed the results of treatment of 138 patients with lesions of femoro-popliteal segment and GSV unsuitable for being used as autograft. The causes and types of GSV lesion were analyzed. Differentiated approach to arterial reconstructions was used depending on the type of GSV structure and lesion, type of lesion of lower extremity main arteries and the degree of their ischemia.

Results and discussion. Several basic causes of GSV unsuitability for reconstruction were singled out. Depending on the type of GSV, differentiated approach was used to applying different methods of femoro-popliteal arterial segment reconstruction, which allowed receiving positive short-term results in 85 % of operative interventions.

Conclusions. In case of insufficient diameter of great saphenous vein, repeated dilations allowed using it as autograft for femoropopliteal reconstructions with positive short-term results in 69.2 % patients. In case of absence of great saphenous vein, impossibility of its repeated dilations and «loose» type of anatomical structure, the use of great saphenous vein from the contralateral limb for femoro-popliteal reconstructions provided positive short-term results in 80.0 % patients, performance of open or reversed endarterectomy — in 88.9 % and the use of synthetic prosthetic devices G in 80.0 % patients.

Keywords: great saphenous vein, femoro-popliteal segment, arterial reconstruction

The aim of the study was to estimate the effectiveness and safety of using long-term selective beta-adrenoblocker (BA) bisoprolol for the control of the frequency of the heart contractions (FHC) in the complex treatment of patients with permanent form of atrial fibrillation (AF) accompanied by chronic heart insufficiency (CHI) on an outpatient basis.

Materials and methods. 63 patients aged 37-79 years with permanent form of AF accompanied by CHI of the II-III functional NYHA class were chosen for examination on an outpatient basis and were observed for three months after being discharged from hospital. The patients were randomized into 2 groups. The patients of the 1st group (n = 33) received additional therapy by BA bisoprolol (medication «Bisoprolol-ratiopharm», Germany) in the dose of 5 mg/day, while the patients of the 2nd group (n = 30) did not receive any additional therapy. All the patients underwent daily Holter monitoring (DHM) of ECG by medical complex «Кардиотехника КТ 4000» («Инкарт», Russia). This monitoring was performed twice - before the discharge from hospital and after three months of ambulatory observation in conditions of common everyday physical load according to the established protocol.

Results and discussion. During the second examination, the indices of the mean and maximal daily FHC of the patients in the 1st group were substantially lower than in the 2nd group (81.3 ± 16.1 and 142.1 ± 17.7 versus 107.6 ± 17.6 and 162.3 ± 15.7 respectively; all р < 0.05). The desired mean and maximal daily FHC at rest after three months of therapy was preserved more often in the 1st group of patients than in the 2nd group (in 73.5 и 69.6 % versus 42.3 и 50.1 % cases, respectively; all р < 0.05). In the course of treatment in both groups, the total number of pauses, longer than 2000 ms, didn't differ substantially during the first and second examination (all p > 0.05). Pauses, longer than 3000 ms, at the end of the examination were revealed in 3 patients (10.0 %) of the 2nd group and in 5 patients (15.2 %) of the 1st group (p > 0.05). No single case of transient bradysystole with FHC less than 40 per 1 min was fixed.

Conclusions. According to the results of DHM of ECG, the administration of bisoprolol as supplement to the therapy by digoxin in complex with graduated exercise for patients with permanent form of AF accompanied by CHI contributed to the decrease of the mean FHC by 24.4 % in the daytime and the increase of number of patients whose FHC didn't exceed 80 per 1 min. Such combined therapy does not increase the number of pauses longer than 2000 ms and the mean duration of the pauses, neither it causes transient bradysystole.

Keywords: atrial fibrillation, chronic heart insufficiency, Holter monitoring of ECG, beta-adrenoblocker, bisoprolol, digoxin, control of FHC

Objective. To estimate features of the connective tissue metabolism according to the indices of serum concentration and oxyproline (OP) excretion in patients with varix of the lower extremities depending on the expressiveness of the connective tissue dysplasia (CTD).

Materials and methods. 50 patients with varix of the lower extremities aged 20—68 years (mean 48.9 ± 2.13 years) were examined. The patients were divided into two age and gender matched groups: the 1st one — patients with pronounced manifestations of CTD (from 6 to 22 features); the 2nd one — patients with slightly pronounced manifestations of CTD (from 1 to 5 features). OP content in the blood was measured according to the calibration curve and expressed in micromoles per 1 litre of blood serum using P.N. Sharayev method. OP urine excretion was determined by spectrophotometric method. The concentration of total glycosaminoglycans in daily urine was determined using P.N. Sharayev method. Regulatory values of biochemical indices were achieved in the process of examination of 15 practically healthy persons, without varix and CTD, age and gender matched.

Results and discussion. Substantial (p < 0.01) elevation of total OP serum content (27.4 ± 1.0 versus 17.5 ± 1.5), mostly due to free OP, was fixed in the patients of the 1st group in comparison with the 2nd. Substantial increase of daily excretion of total OP with urine was observed in the 1st group in comparison with the 2nd (666.7 ± 150.92 versus 167.1 ± 41.35; р < 0.05), no changes being fixed in glycosaminoglycans excretion. At the same time, the total OP excretion exceeded the indices of the control group by 101.9 % and remained within the range of the norm in the 2nd group. In the process of the analysis of the connective tissue metabolism depending on degree of chronic venous insufficiency, substantial increase of content of all blood serum OP fractions (р < 0.05; r = 0.33) was fixed, as well as the increase of its excretion with the urine (р < 0.05; r = 0.40) along with the aggravation of the disease.

Conclusions. As evidenced by the elevated free OP content in the blood serum and the increased OP excretion with the urine, patients with varix of the lower extremities and pronounced clinical manifestations of CTD reveal more intensive degradation of the collagenous fibrils than those without such manifestations.

Keywords: connective tissue dysplasia, varix of the lower extremities, oxyproline

The purpose of the research was to determine and compare the influence of the first administration of angiotensin converting enzyme inhibitor (ACEi) captopril and fosinopril in combination with hydrochlorthiazide (HCT) on the daily profile of arterial pressure (AP) and volumetric cerebral blood flow (CBF) in patients with arterial hypertension (AH).

Materials and methods. 72 patients with AH of the II stage aged 32—65 years, with the disease duration of 3 to 24 years were examined. All the patients took HCT in the dose of 12.5 mg once a day in the morning together with one of ACEi. The patients of the 1st group (n = 35) were prescribed captopril (C) — 50 mg per day in two doses, the 2nd group (n = 37) — fosinopril (F) in the dose of 10 mg once a day. The patients were divided into groups using the randomization method. The condition of CBF autoregulation was estimated by the reaction of the volumetric CBF to the decrease of AP with the help of duplex color Doppler cardiography on the apparatus «Аloka-5000» (Japan). Subgroup A consisted of AH patients with the preserved CBF autoregulation, subgroup B — of patients whose volumetric CBF decreased by more than 5 %. 24-hour monitoring of AP (DMAP) using the apparatus ABPM-2 («Meditech», Hungary) was also conducted.

Results. Maximal decrease of the systolic AP under the influence of C + HCT was observed in 2 hours after their oral administration and constituted 14.2 % (p < 0.05) in group 1A and 20.2 % (p < 0.05) in group 1B. Under the influence of F + HCT the decrease of the systolic AP of patients in the 2nd group reached its maximal value in 6 hours and constituted 10.7 % and 12.5 %, respectively, in patients of groups 2A and 2B (all p < 0.05). The changes of volumetric CBF under the influence of C + HCT during the first 24-hours of treatment were heterodirected. In 12 (34.3 %) patients it changed substantially, in 5 (14.3 %) patients it increased by 9.8 % (p < 0.05) on average, and in 7 (20.0 %) patients it decreased from 61.7 ± 4.2 ml/100g/min to 48.4 ± 4.1 ml/100g/min (p < 0.05). After the administration of the first dose of F + HCT, substantial differences between the mean values of the volumetric CBF were absent.

Conclusions. The abnormalities of volumetric CBF autoregulation, manifested by its decrease by more than 21.6 % from the initial value, was observed in 20 % patients with AH of the II stage after the first administration of ACEi in combination with HCT. After captopril administration the decrease of this value was more expressed than after the administration of fosinopril, which is as sociated with earlier (in 2 hours versus 8 hours) hypotensive effect. DMAP results after the administration of the first doze of captopril in combination with HCT showed the increase of the morning rise and velocity of systoloc AP which decrease after fosinopril administration.

Keywords: arterial hypertension, volumetric cerebral blood flow, angiotensin converting enzyme inhibitors, hydrochlorthiazide

The use of diuretics in chronic heart failure (CHF) presupposes: firstly, the treatment of decompensated (stagnant) CHF including urgent cases (pulmonary edema); secondly, prolonged regular administration with the purpose of control of the clinical symptoms. The mechanism of loop diuretics action, side effects and their clinical value, effects of prolonged supporting diuretic therapy in CHF patients are discussed in the survey. We provide evidential base of using the new generation loop diuretic — thоrasemid, which will not only allow improving the tolerance of diuretic therapy but also open the way to revaluation of its role in case of CHF.

Keywords: chronic heart failure, loop diuretics, prognosis

In this review the structure and functions of myoglobin as well as methods of its identification are illustrated. The diagnostic capacities of myoglobin identification in myocardial infarction and transitory myocardial ischemia, its prognostic value for patients with acute coronary syndrome, as well as advisability of its use for assessment of the effectiveness of thrombolytic therapy are described.

Keywords: myoglobin, myocardial damage

The article is dedicated to the review of literature dealing with the problems of etiology, pathogenesis, pathomorphology, diagnosing and cure of patients with fibromuscular dysplasia (FMD). The article also contains detailed discussion of FMD types depending on the affection of vascular wall layers — intimal fibroplasia, medial hyperplasia, medial fibroplasia and perymedial fibroplasia with clear determination of pathomorphological and angiographic criteria. The role of diverse etiological factors and the analysis of genetic, mechanical, ischemic, humoral and hormonal hypotheses are pointed out. Methods of diagnosing and treatment of renal and carotid FMD are presented.

Keywords: fibromuscular dysplasia, vasorenal arterial hypertension, renal fibromuscular dysplasia, carotid fibromuscular dysplasia

We analyzed a clinical case of successful treatment of a patient with initial dilated cardiomyopathy. In the postoperative period after traumatologic operation, he developed acute respiratory and heart failure whose origin was initially associated with thromboembolism of pulmonary artery branches. The staffs of physicians faced a difficult problem — to confirm or deny the diagnosis and determine if classical heparinization would be enough or if conducting aggressive thrombolysis would be necessary. The principal positions of the aetiology, pathogenesis, diagnosing, intensive therapy and prophylaxis of thromboembolism of pulmonary artery branches are pointed out. Diagnosing thromboembolism of pulmonary artery in patients with dilated cardiomyopathy is difficult because of heart failure which is manifested by pulmonary hypertension and dilation of the right parts of the heart. These patients have a high risk of thromboembolic complications and must take antithrombotic therapy with low molecular weight heparins, especially in case of cardiac rhythm disturbances.

Keywords: dilated cardiomyopathy, thromboembolism of pulmonary artery branches, anticoagulant therapy, thrombolysis