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Issue. Articles

2(22) // 2008





The experience of the treatment of patients with a three-atrium heart

M.F. Zinkovsky, V.P. Zakharova, V.Yu. Vashkeba, V.V. Bleyovich, O.A. Lozovy, Ya.R. Ivanov

The aim – to generalize the experience of the surgical treatment of patients with a rare congenital heart lesion – three-atrium heart – at Amosov National Institute of Cardiovascular Surgery.

Materials and methods. Within the period from 1983 to 2006, a three-atrium heart was diagnosed in 15 (0.21 %) patients, aged from 7 months to 30 years, out of 6770 congenital heart lesion patients that were consequently operated on by the same surgeon. Pulmonary hypertension according to the results of DopplerEchoCG was observed in 12 (80 %) patients. It was associated with a relatively small diameter of the orifice in the diaphragm and inside the left atrium. All the patients underwent the surgical correction of the lesion in conditions of the artificial blood circulation.

Results and discussion. The operations were successful and the patients were discharged home. All of them are of the 1st NYHA functional class. According to the EchoCG results, the pressure in the pulmonary artery normalized in all the cases irrespective of the value of the initial venous pulmonary hypertension.

Conclusions. Early diagnosing and surgical treatment of patients with a three-atrium heart provide good long-term results.

Keywords: three-atrium heart, congenital heart lesion, post-capillary pulmonary hypertension



Left ventricle myocardial function changes in patients with post-infarction cardiosclerosis according to tissue Doppler imaging after coronary arteries bypass graft combined with left ventricle aneurismectomy

M.N. Dolzhenko, A.V. Rudenko, S.V. Potashev, S.A. Rudenko, N.N. Nosenko, T.V. Simagina, M.L. Sarbash, O.A. Sharayevskiy

The aim of the study was to evaluate the changes in left ventricle (LV) myocardial function according to tissue Doppler imaging (TDI) in patients with postGinfarction cardiosclerosis and LV aneurism during one year after coronary arteries bypass graft (CABG) combined with LV aneurismectomy (AE).

Materials and methods. Doppler echocardiography (EchoCG) was performed in 40 patients at the mean age of (43.8 ± 5.1) years with postGinfarction cardiosclerosis and LV chronic aneurism with heart failure (HF) of IIGIV NYHA functional class (FC) (mean LV ejection fraction = 34.03 ± 8.65 %) using TDI and MGmode color low imaging before and 1 week, 3 and 12 months after CABG+LV AE. TDI of mitral valve (MV) annulus with velocity and time indices calculation (peak velocity of MV S annulus systolic motion and velocity of early (e?) and late (?) diastolic motion of MV annulus and also their correlation e?/a?), as well as combined indices of preGloading (correlation of transmitral LV filling and mitral annulus motion /e?) were obtained in 4 LV projections. Besides, we estimated the velocity of spread of diastolic flow according to Vp MGmode color low imaging and the correlation of the velocity of early diastolic flow and the velocity of spread of diastolic flow of LV E/Vp as a sensitive index of LV preGloading.

Results and discussion. Conventional Doppler indices of LV transmitral diastolic flow did not differ before and after CABG+AE (E/A in 12 months after the operation 1.1 ± 0.44 vs. 1.1 ± 0.5 before the operation: ( > 0.05). TDI showed the significant increase of the systolic motion velocity S: (6.1 ± 0.8) cm/s compared to (7.2 ± 1.1) cm/s in 1 week, (7.4 ± 1.2) cm/s in 3 months and (6.9 ± 1.3) cm/s in 12 months after the operation (p < 0.01); and early diastolic mitral annulus motion velocity (?): from (7.3 ± 2.1) cm/s before the operation to (8.2 ± 1.4) cm/s in one week, (8.4 ± 1.5) cm/s in three weeks and (8.9 ± 1.8) cm/s in 12 months after the operation (p < 0.01); and also the decrease of the early diastolic flow velocity () to early diastolic mitral annulus motion velocity ratio (/?): from (12.2 ± 2.4) before the operation to (8.3 ± 2.1) in one week, (8.1 ± 1.8) in three months and (7.5 ± 1,3) conventional units in 12 months after the operation (p < 0.001) and the ratio of to the diastolic propagation flow velocity (Vp): from (3.1 ± 0.45) before the operation to (2.2 ± 0.38) in 1 week, (2.0 ± 0.51) in 3 months and (1.8 ± 0.16) conventional units in 12 months after the operation (p < 0.01).

Conclusions. CABG and LV AE in the patients with postGinfarction cardiosclerosis and chronic LV aneurism lead to LV longitudinal systolic and diastolic function improvement according to mitral annulus pulsedGwave TDI. Velocity indices improvement is already observed in a week after the operation and preserves during 1 year. Independence of myocardial kinetics parameters according to TDI and higher sensitivity of the method to LV myocardial function changes after surgical revascularization with LV aneurismectomy compared to the conventional pulsedGwave transmitral Doppler make this method a valuable instrument for LV myocardial function evaluation during followGup in patients with postGinfarction cardiosclerosis and LV chronic aneurism after surgeon treatment.

Keywords: coronary artery bypass graft, aneurismectomy, diastolic function, tissue Doppler imaging



Retrospective analysis of the effectiveness of statin use in the treatment of acute myocardial infarction accompanied by type 2 diabetes mellitus in common clinical practice

.I. Karpenko

The aim of the research was to make a retrospective analysis of the influence of early, starting with the first 24 hours, simvastatin administration on the occurrence of ischemic complications and consequences of acute myocardial infarction (AMI) in hospital and early pre-hospital periods at patients with type 2 diabetes mellitus (DM) and without any carbohydrate metabolism impairments.

Material and methods.We made a retrospective analysis of the database of patients with AMI who, as addition to the basic therapy, took simvastatin («Zokor», «MSD») in the dose of 40 mg/day, starting with the first 24 hours since the onset. All the patients were divided into two subgroups depending on the presence of concomitant type 2 DM (1st group – 107 AMI patients with DM, 2nd – 103 AMI patients without DM). To estimate the clinical effectiveness of the additional statin therapy as compared to the basic treatment we selected from the database 100 AMI patients with DM and 127 AMI patients without DM who did not take statins and were matched by age, gender, concomitant pathology and the localization of the lesion. On the 1st day of the disease and before the discharge from hospital (14 – 21st day) we evaluated the following indices in all the patients: blood lipid metabolism index – with the use of Reflatron biochemical analyzer, the blood plasma C-reactive protein (C-RP) level – with the use of DR Lange-LP 700 biochemical analyzer, as well as fibrinogen (FG) and cardio-specific enzymes levels. In 3 months after the discharge from hospital, we contacted the patients on the phone in order to find out what condition they are in. On the basis of this information we estimated the occurrence of achieving combined end point which includes death, unstable stenocardia requiring hospitalization or surgical revascularization, non-fatal relapse or recurrent MI within 3 months since AMI.

Results and discussion. The early use of statins in both subgroups led to the decrease of serum total cholesterol level (by 20 and 18.7 %; p < 0.05) and cholesterol of low-density lipoproteins level (29 and 27.2 %; p < 0.05). Under the influence of simvastatin in both subgroups, we observed the substantial decrease of the levels of C-RP (by 37 and 33 %; p < 0.05) and FG (by 22 and 17 %; p < 0.05). The occurrence of combined end point before the discharge from hospital was substantially lower in AMI patients without DM who took statins than in the same kind of AMI patients who only took the basic therapy (14.4 and 22.1 %; p < 0.05). Such results were obtained in patients with AMI and DM whose occurrence of this point was 21.6 % in comparison to 34.7 % (p < 0.05). The statin therapy also helped to decrease the occurrence of combined end point by the end of the 3rd month in AMI patients both with and without DM in comparison with the patients that did not take statins (24.6 vs. 38.6 %, and, correspondingly, 30.3 vs. 46.1 %; p < 0.05).

Conclusions. According to the retrospective analysis, early additional simvastatin administration in the dose of 40 mg to AMI patients helps to substantially decrease the frequency of death and ischemic coronary «events» by the end of the hospital period which lasts up to 3 months.

Keywords: acute myocardial infarction, diabetes mellitus, simvastatin, lipidogram



The ways of reflux distribution in the region of the small saphenous vein

A.A. Guch, L.M. Chernukha, A.O. Bobrova

The aim – to determine the ways of venous reflux distribution in the region of the small saphenous vein according to the data of ultrasonic scanning and to develop the anatomy-haemodynamic classification of varicose disease types.

Materials and methods. The analysis of reflux distribution in the region of the small saphenous vein (SSV) was undertaken at 126 patients with varicose disease (VD), being diagnosed and treated at Shalimov National Institute of Surgery and Transplantology within the period from 2003 to 2007. There were 29 (23.02 %) men and 97 (76.98 %) – women, mean age of the patients was (37.7 ± 14.2) years (from 16 to 57 years). Valvular competence at the level of saphenopopliteal junction (SPJ), in the trunk of SSV and in its femoral branch (FB) was estimated by ultrasonic scanning using «EnVisor» scanner (Philips – the Netherlands). Reflux duration more than 0.5 sec was considered to be pathological.

Results and discussion. On the basis of results of ultrasonic research the following types of VD in the region of SSV were selected. Trunk type was registered at 96 (76.2 %) patients who revealed the following ways of reflux distribution: a) reflux at the level of SPJ and in the trunk of SSV up to the lower third part of the shank was registered at 88 (91.7 %) patients; b) reflux at the level of SPJ, reverse blood flow in the trunk of SSV in the proximal third part of the shank with further distribution to the branches were marked at 8 (8.3 %) patients. Branch type was marked at 22 (17.5 %) patients who revealed the following ways of reflux distribution: a) at competent SPJ, the distribution of reflux in the trunk of SSV from the incompetent Giacomini vein was registered at 7 (31.8 %) patients; b) at competent SPJ, the distribution of reflux in the trunk of SSV from the veins of the pelvis and thigh through FB of SSV was marked at 2 (9.1 %) patients; c) at competent SPJ, the distribution of reflux in the trunk of SSV from the region of varicose great saphenous vein was exposed at 8 (36.4 %) patients; d) at competent SPJ and competent valves of SSV, the distribution of reflux in Giacomini vein and its branches was registered at 3 (13.7 %) patients; e) at incompetent SPJ and competent valves of SSV and Giacomini vein, the blood stream from the popliteal vein spread on the thigh in Giacomini vein, i.e. there was ascending reflux into Giacomini vein at 2 (9.1 %) patients. Perforated type was revealed at 8 (6.3 %) patients, among them:a) at competent SPJ, the varicose expansion of SSV from the level of May perforator was marked at 2 (25.0 %) patients; b) at competent SPJ, the varicose expansion of SSV from the level of the upper third part of the shank due to the insufficiency of the perforating vein in the area of the low bound of the popliteal fossa was determined at 2 (25.0 %) patients; c) at competent SPJ, the varicose expansion of SSV from the level of the proximal third part of the shank due to the perforating veins of the lateral group and gastrocnemius muscles was diagnosed at 4 (50.0 %) patients.

Conclusions. The ultrasonic scanning allows distinguishing 3 basic types of VD and 10 variants of the reflux distribution in the region of SSV, different by the level of forming and involving of the SSV trunk and its branches in the process. The most widespread type, present at 76.2 % patients, was the reflux at the level of SPJ and its distribution in the trunk of SSV. Among them, I and III types of SPJ location were marked at 66.7 % cases. Among the total number of patients with varicose disease in the region of SSV, the «atypical» distribution of the reflux was fixed in 30 (23.8 %) cases; at 5 more patients, the SSV and its branches were competent; the varicose expansion on the posterior surface of the shank stipulated the reflux through the perforating vein of the popliteal fossa.

Keywords: small saphenous vein, reflux, ultrasonic research



Secondary arterial reconstructions in patients with multilevel atherosclerotic lesions of aorto-iliac-femoral segment

Yu.S. Spirin

The aim — estimation of immediate results of secondary arterial reconstructions in patients with multilevel atherosclerotic lesions of aorto-iliac-femoral segment.

Materials and methods. 33 patients with previously performed reconstructions (prosthesis with the use of line or bifurcational grafts) of aorto-iliac-femoral segment from one or both sides were enrolled in this study. The main reason for graft thrombosis was advanced atherosclerosis in the distal arterial ways -superficial (SFA) and/or profunda (PFA) femoral arteries (25) or at the site of distal anastomosis (8). In all the cases balloon thrombectomy from the graft and differential reconstructions of distal anastomosis (RDA) were performed. The surgical algorithm of RDA depended on the spreading of atherosclerotic lesions in the SFA and PFA or on the site of distal anastomosis. The next types of RDA were used: profundoplasty (20), endarterectomy from SFA and PFA with the formation of a new bifurcation of femoral arteries (8), autovenous SFA grafting (5). Disappearance of critical ischemia of lower limbs and saving of lower limbs were considered as positive results of the procedures.

Results and discussions. Postoperative mortality was 6 % (2 cases). In remaining 31 cases positive immediate result was achieved in 25 (80.6 %) patients. In 6 (19.36 %) patients, thrombosis of the graft and critical ischemia in early postoperative period were observed. In all these patients major amputations were performed. The other complication (limphorrea) rate in the early postoperative period was 9.09 % (3 cases).

Conclusions. Good immediate results of secondary arterial reconstructions in patients with reocclusions of aorto-iliac-femoral segment were archived in 80.6 % cases. Surgical mortality was 6 %.

Keywords: atherosclerosis, reconstructions of distal anastomosis, secondary reconstructions



Peculiarities of tobacco smoking dynamics among urban and rural population of Ukraine

E.A. Kvasha

The aim – to study the TS characteristic features in urban and rural unorganized population aged 18–64 years and to estimate the present tendencies to changing these indices during a long period of observation.

Materials and methods. We received data about TS using a standard questionnaire during the examination of unorganized poplation of men and women aged 18–64 years. During 2004–2006 we examined 2175 rural residents and 1974 residents of Kyiv. The data were compared to the results of the same kind of previous research.

Results and discussions. A distinctive feature of the epidemiology of TS in Ukraine is substantial differences in the spread of this habit among urban and rural population: age standardized index of daily TS is 60.4 % among rural men and 44.2 % – among urban men. Mean daily number of cigarettes is (18.1 ± 0.3) and (15.0 ± 0.4), respectively. The monitoring of TS spread among urban population during 25 years testifies to the fact that there is expressed and stable tendency in Ukraine to decreasing the occurrence of this risk factor from 49.9 (1980) 44.2 % (2005). The most significant changes are observed in people aged 18–29 years. Among the rural population the spread of TS has remained stable for 20 years – from 58.4 to 60.4 %. The common feature is the increase of number of people who had never smoked before (in town – from 25.9 to 33.7 %, in the village – from 12.1 to 22.4 %), and the decrease of percentage of men who gave up smoking (from 26.5 to 20.3 % and from 29.5 to 15.6 %, respectively). The spread of TS among urban women is approximately 2 times bigger than that among rural women (16.4 and 6.8 %, respectively). Irrespective of the locality we revealed considerable increase of TS spread. At the same time, the tempo of the spread of this harmful habit in the village is higher than in town: the ratio of women smokers in town for the last 25 years has increased by three times in town and for the last 20 years in the village- almost by 17 times.

Conclusions. High spread of TS among the grown-up population is observed in Ukraine. For the last two decades the occurrence of this harmful habit has stabilized among men and it has substantially increased among women, especially rural.

Keywords: tobacco smoking, urban and rural population, spread, dynamics



Metabolic disorders in essential hypertension patients without diabetes mellitus and their relation to hyperinsulinemia

V.G. Lyzogub, V.N. Kramarova

The aim – to estimate the occurrence of metabolic disorders and their combinations in essential hypertension (EH) patients without type 2 diabetes mellitus (2 DM) and their relation to each other and to hyperinsulinemia.

Materials and methods. 125 patients with 1 and 2 degrees of EH, aged 23 – 59 years (mean 52.2 ± 1.5 years), without previous myocardial and cerebral infarction, rhythm disturbances, chronic cardiac failure (CHF) and DM were examined. The following parameters were analyzed: initial blood pressure (BP), waist circumference, body mass index (BMI). Blood serum concentrations of total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDLC) and low density lipoprotein cholesterol (LDLC) were measured by immunoenzyme method. Blood serum concentration of basal insulin was measured by radioimmunoassay technique. Blood glucose was measured by glycosidase method.

Results and discussions. The majority of EH patients without 2 DM had metabolic disorders: dislipoproteinemia (the increase of TC, TG, LDLC – in 88.8 %, abdominal obesity (AO) – 67.2 %, basal hyperinsulinemia (HI) — 44.8 % cases). The patients were divided into 6 groups according to metabolic disorders: 1 group – patients with isolated hypertension (7.2 %), 2 group – combination of EH with dislipidemia (14.4 %), 3 group – EH, dislipidemia, HI (11.2 %), 4 group – EH with AO (4 %), 5 group – EH, AO, dislipidemia (29.6 %), 6 group – EH, AO, dislipidemia, HI (33.6 %). Basal insulin level was directly proportional to the body mass index (r = 0.56, p < 0.05), waist circumference (r = 0.45, p < 0.05 for man and r = 0.48, p < 0.05 for women), blood TG level (r = 0.54, p < 0.05) and inversely proportional to HDLC level (r = –0.38, p < 0.05). There was no relation between the insulin level and blood pressure, TC, LDLC and blood glucose level on an empty stomach.

Conclusions. Patients with essential arterial hypertension without diabetes mellitus had high frequency of metabolic disorders: dislipidemia – 88.8 %, AO – 67.2 %, HI – 44.8 %. Combinations of EH, AO, dislipidemia, HI (33.6 %) and EH, AO, dislipidemia (29.6 %) were observed more frequently. There was direct correlation between basal insulin and triglycerides, body mass index, waist circumference and inverse correlation – with HDLC. Prescription of nonmedical correction (low-calorie diet and great physical exercise) is necessary in addition to standard complex therapy of EH patients with dislipidemia and AO without type diabetes mellitus.

Keywords: essential hypertension, metabolic disorders, dislipidemia, abdominal obesity, basal hyperinsulinemia



Structural changes of cardiomyocytes and heart connective tissue and microvessels during experimental hypothyroidism

N.A. Kolesova, A.N. Grabovoy, V.I. Litvinenko, O.A. Masitska, N.N. Sukhareva

The aim of the work was to study and compare the dynamics of the structural changes of cardiomyocytes, microvessels and intermuscular connective tissue in the heart during experimental hypothyroidism.

Materials and methods. The morphological study of the changes of cardiomyocytes, microvessels and interstitial tissue of the myocardium of the right atrium and the left ventricle was conducted in an experiment on white rats (n = 110) in 14, 35, 50, 100, and 150 days after the removal of the thyroid gland with the use of standard pathomorphological and histochemical methods (metachromasia reaction, PAS-reaction with adequate controls).

Results and discussion. The established phased metabolism and structure changes of cardiomyocytes, microvessels and intramuscular connective tissue are connected when the changes of particularized structures of the heart are in close connection with the status of the connective tissue. As a result they cause the development of deep pathological heart changes which can lead to heart insufficiency development. On the assumption of sudden reduction of blood thyroid hormones level, structure changes and increasing microvessels permeability which correlate with cardiomyocytes dystrophic changes were established. During the postoperative period, the recurrence of changes in content, distribution and chemism of glycosaminoglycans and also in quantity and functional activity of tissue basophiles were established in intramuscular connective tissue and microvessels walls. Connection between heart structure changes and tissue and circulatory hypoxia was proved.

Conclusions. Heart pathology development during the postoperative period is cyclic: from day 14 to day 50, the predominant processes are edema of cardiomyocytes, microvessels and intramuscular connective tissue; in 100 – 150 days the edema decreases but dystrophic changes of cardiomyocytes to the extent of necrobiosis and necrosis increase. The following factors are important for the development of pathological changes of the heart interstitial tissue typical of hypothyroidism: 1) the accumulation in the interstitial tissue of substances of protein and polysaccharide nature from the bloodstream and those which result from changing polysaccharide complex of the basic substance, particularly in the period from 14 to 50 days; 2) the increase of the functional activity of the tissue basophils, particularly in the period from 100 to 150 days; 3) the manifestation of tissue and circulatory hypoxia.

Keywords: heart, hypothyroidism, metabolism and structure of connective tissue and cardiomyocytes



Heart rate variability and its relation to the structural and functional condition of the right ventricle at patients with primary right ventricular heart failure resulting from idiopathic and chronic post-thromboembolic pulmonary hypertension

.. Gonza

The aim – to estimate the parameters of heart rate variability (HRV) and their relation to the indexes of the systole function of right ventricle (RV) of heart at patients with primary right ventricular heart failure (PRVHF) resulting from idiopathic (IPH) and chronic post-thromboembolic pulmonary hypertension (CPTPH) depending on the degree of violation of the functional state of the cardiovascular system.

Materials and methods. We surveyed 30 patients with PRVHF resulting from IPH (17 patients) and CPTPH (13 patients) aged (31.6 ± 2.7) years who were treated at the Cardiological Department of the Central City Clinical Hospital. The patients were divided into two groups: with II heart failure functional grade (FG) by NYHA (12 patients) and with III-IV heart failure functional grade by NYHA (18 patients). The tolerance of the patients to physical loading on the distance of 6-minute walking test was measured for the estimation of the functional condition of the cardiovascular systems. For the estimation of the RV systolic function and its remodeling, the standard parameters of Doppler-EchoCG were used. Basal time (RRNN, SDNN, PNN50) and frequency (LF, HF, LF/HF) parameters of HRV at rest were determined. The reliability of the differences of the parameters in the groups was estimated with the help of Kolmogorov-Smirnov criterion; the correlation analysis was carried out with the help of Pirson linear factor of correlation.

Results and discussion. The systole function of RV at rest in patients with PRVHF was characterized by the increase of its diameter (from parasternal position – by 37.1 %, (p < 0.001), from the apex – by 38.8 %, (p < 0.001) and the thicknesses of the free wall (by 49.0 %, p < 0.001); however, there was no reliable decrease of the fraction of shortening of the RV. The distance of the 6-minute walking test was (437.3 ± 20.6) m and it was diminished as compared to the healthy persons (560.2 ± 43.5 m, < 0.05). The basal time parameters of the HRV, which represent the general level of the vegetative support of the cardiovascular system, were lowered (SDNN – by 1.5 times and PNN50 by 1.5 times, all p < 0.05). The decline of the power of the low-frequency fluctuation was observed (LF – by 1.94 times p < 0.001) with no reliable changes of the power of the high-frequency (HF) waves. We revealed some reliable correlation between SDNN on the one hand, and the transversal size of the RV (r = –0.48, p < 0.001), the thickness of the free wall of the RV (r = –0.71, p < 0.001), the systole pressure in the pulmonary artery (r = –0.46, p < 0.05), the distance of the 6-minute walking test (r = 0.55, p < 0.05) and NYHA FG (r = –0.40, p < 0.05) – on the other.

Conclusions. According to the data of the analysis of the HRV basal time parameters at patients with PRVHF of II-IV NYHA FG resulting from IPH and CPTPH, we observed the increase of the activity of the sympathetic department of the vegetative nervous system and the decrease of the activity of the parasympathetic region, which is associated with the diminishing of the LF as a sign of the increase of the parasympathetic activity. The activation of the sympathetic vegetative system, according to the analysis of the basal time parameters of HRV, at these patients is in close interrelation with the expressed systolic dysfunction of the RV, the increase of the level of the systolic pressure in the pulmonary artery, the decrease of the distance of the 6-minute walking test and the worsening of NYHA FG.

Keywords: primary right ventricular heart failure, systolic dysfunction of the right ventricle, functional condition of the cardio-vascular system, heart rate variability



The use of the rush-stenting technique during multiple and multivessel stenting of diffuse coronary artery lesions

L.S. Tkachuk, D.V. Demidyuk, Khorram Sohrab Mohammed Ali

Until recently the treatment of patients with ischemic heart disease (IHD) and diffuse atherosclerotic lesions of coronary arteries (CA) used to be performed only with the help of coronary artery bypass graft (CABG) operation. With the introduction of drug eluting stents it became possible to treat such patients with multiple endovascular stenting.

The aim – To present a clinical case of the treatment of a patient with diffuse atherosclerotic lesions of coronary arteries by multiple implantations of drug eluting stents using the «crush stenting technique».

rials and methods. The patient I, 56 years old, was admitted to the clinic within 40 days after an infero-lateral Q-myocardial infarction on the background of type II diabetes mellitus and after the recurrence of angina pectoris. During coronaroventriculography (CVG), multiple lesions of 3 coronary arteries were found: stenosis of the right coronary artery (RCA) at the level of the second segment (70 %), occlusion of the RCA at the level of the distal segment (100 %), stenosis of the middle and distal segments of the left anterior descending (LAD) branch of LCA (90 % each), stenosis of the 1st diagonal branch (DB) of LAD (70 %) and stenosis of the proximal segment of circumflex (CLX) artery (70 %). On the patient’s request, revascularization was performed by elective coronary stenting with the implantation of 10 drug eluting stents coated with paclitaxel and by using the «crush stenting technique». The follow-up period was 6 months. Exercise test and echocardiography were performed before and 6 months after the intervention in order to evaluate the exercise tolerance and the ejection fraction of the left ventricle.

Results and discussion. 5 stents were implanted in the RCA, of which 2 stents were implanted in the bifurcation lesion at the site of posterior descending artery (PDA) and posterior lateral artery (PLA) using the «crush stenting technique», 3 stents were implanted in the middle proximal and ostial parts of the RCA. 5 stents were also implanted in the LCA, of which 2 stents were implanted using the «crush stenting technique» in the proximal part of the LAD at the site of bifurcation with 1st DB; 1 stent was implanted in the distal and another – in the middle part of LAD. 1 stent was also implanted in the proximal segment of CLX artery. The coronary blood flow in the basins of the RCA and LCA were restored completely. Adequate antiagregant therapy included aspirin, clopidogrel and eptifibatid. There were no complications during stenting. Immediately after the operation, the symptoms of angina pectoris disappeared and did not recur during the follow-up period period. According to the exercise test (treadmill exercise test) protocols, the exercise tolerance before and 6 months after the stenting increased from 50 to 125 watts. There was also an increase in the ejection fraction of the left ventricle for the same period of time from 46 % to 58 %.

Conclusions. In some patients with diffuse atherosclerotic coronary artery lesions, multiple and multivessel coronary stenting using drug eluting stents with the «crush stenting technique» and supported by active antiagregant therapy can be considered a relatively effective and safe method for the reperfusion of myocardium.

Keywords: coronary arteries, ischaemic heart disease, drug eluting stents, multiple coronary stenting, crush-stenting technique



Exercise treadmill tests

O.J. Zharinov, M.S. Sorokivsky, V.O. Kuts, Yu.A. Ivaniv

Exercise treadmill test is a physiological, widely available and highly informative method of non-invasive diagnosis of ischemic heart disease (IHD). Treadmill test is of great significance for determining the functional status of patients with previously diagnosed IHD, choice of drug therapy, assessment of revascularisation procedures effectiveness, and it also allows distinguishing the group of patients with a high risk of coronary events. Standard protocols, methods of conducting, approaches to treadmill test results interpretation, examples of summaries and practical recommendations for the equipment of the laboratory are provided in this lecture. Treadmill test introduction substantially increases the quality of investigation and makes it possible to choose more appropriate treatment for patient with IHD.

Keywords: xercise test, treadmill



Tetralogy of Fallot. Part III

V.B. Demyanchuk

Some modern concepts as for complex congenital heart disease – tetralogy of Fallot – are described in the article. The signs and symptoms of tetralogy are presented. Modern diagnostic tools which permit making an accurate prognosis of the operative treatment are demonstrated in the manuscript.

Keywords: tetralogy of Fallot, symptoms, diagnosis



ChurgStrauss syndrome: etiology and immunopathogenesis

Kh.O. Lishchuk-Yakymovych

Churg–Strauss syndrome (CSS) is an eosinophilic granulomatous inflammation of the respiratory tract with the formation of necrotizing vasculitis of small and medium size vessels occurring in patients with asthma and eosinophilia. CSS constitutes 20 % of vasculites which are included into the group of periarteritis nodosa. According to the epidemiological research, the number of women patients is three times as big as the number of men patients. The onset of the disease occurs at the age of 35–45. It is established that the main trigger factors of the pathological process are genetic predisposition to the development of systemic autoimmune diseases, infections, medications. Many different immune mechanisms take part in CSS development: disbalance between Th1- and Th2- helpers, which influences the change of the cytokine profile, increased production of ANCA autoantibodies, increased synthesis of IL-5, eosinophilia, increased cells apoptosis.

Keywords: systemic vasculites, ChurgStrauss syndrome, epidemiology, etiology, immunopathogenesis

Current Issue Highlights

4(60) // 2017

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K. M. Amosova 1, I. I. Gorda 1, A. B. Bezrodnyi 1, G. V. Mostbauer 1, Yu. V. Rudenko 1, A. V. Sablin 2, N. V. Melnychenko 2, Yu. O. Sychenko 1, I. V. Prudkiy 1&a

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