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Issue. Articles

1(33) // 2011





Transkatheter patent ductus arteriosus closure

Yu.V. Panichkin, I.O. Ditkivsky, B.V. Cherpak, A.V. Klimenko, O.B. Ershova

The aim to prove efficacy and safety of the ductus arteriosus (PDA) endovascular treatment, to carry out comparative analysis of the modern equipment for transdermal removal of this defect.

Materials and methods. 106 endovascular PDA closures were carried out in the National Institute of the Cardio-vascular Surgery from 1983 until 2010. Gianturco coils were used in 44 patients, Nit-Occlud (PFM) in 53 patients, Amplatzer duct occluders in 9 patients.

Results and discussion. PDA closure was successful in all cases. Reshunts or other complications were not observed in any patient. Nit-Occlud system was recommended to be used for closure of the PDA with the diameter of 15 mm, Amplatzer occluders for the PDA with the diameter of 6 mm and more. Imitation of the PDA closure applying balloon is recommended for patients with severe pulmonary hypertension.

Conclusions. To date endovascular PDA closure is an effective and safe method of this defect removal in the majority of patients; this method should become the basic alternative for classic operations on heart.

Keywords: patent ductus arteriosus, endovascular closure, coil, occluder.



Anti-ischemic efficacy of ivabradine in combination with beta-blocker versus increase in dose of beta-blocker in patients with chronic coronary artery disease and moderate left ventricular systolic dysfunction

.. Amosova, E.V. Andreyev, I.P. Zaderey, Yu.V. Rudenko, I.Yu. Katsytadze

The aim – to compare anti-ischemic efficacy and hemodynamic support of physical activity produced by combination of ivabradine with bisoprolol or uptitration of bisoprolol in patients with chronic coronary artery disease (CAD), moderate chronic heart failure (HF) and left ventricular (LV) systolic dysfunction.

Materials and methods. This prospective study included 29 patients with sinus rhythm of heart rate (HR) > 60 bpm with chronic stable angina (I–II functional class), verified by documented myocardial infarction > 3 months and accompanying HF of no more than IIA stage with moderate LV systolic dysfunction, treated with bisoprolol 5 mg/day, ACE inhibitors, diuretics. Patients were randomized into 2 groups according to treatment received: patients of the main group (n = 17) in addition to bisoprolol (5 mg/day) received ivabradint (5mg bid uptitrated to 7.5 mg bid), in controls (n = 12) – bisoprolol was uptitrated to the total dose of 10 mg/day. The monitoring lasted for 2 months. All patients underwent clinical examination, ECHO with LV systolic function estimation, a 6-min walking test, treadmill exercise (Bruce protocol) at baseline and after a 2-month treatment.

Results and discussion. After 2 months, HR at rest was equally reduced in both groups: from (76.6 ± 4.6) to (59.3 ± 2.5) bpm. (p < 0.001) in the main group and from (75.9 ± 2.97) to (60.5 ± 2.3) bpm (p = 0.002) in the controls, but more patients in the main group moved to angina class I (82.4 % vs 53 % at baseline) than in controls (66.7 % vs. 58 %) (p = 0.037). EF increased by 9.2 % (p = 0.03) in the main group, which was not observed in the controls. In main group, 6 – min walking distance increased from (387.9 ± 76.3) to (445.6 ± 55.4) m (p < 0.001) and exercise tolerance – from (5.9 ± 1.63) to (7.0 ± 1.4) MET (p = 0.004), whereas in the control group these values did not change – (400 ± 84) m and (6.2 ± 1.4) MET vs. (386 ± 69) m and (5.7 ± 1.7) MET ( > 0.05). The elevation of exercise tolerance in group of ivabradine after treatment occurred in spite of a more pronounced absolute increase of HR at peak workload – (60.9 ± 21) vs (41.9 ± 10.5) bpm at baseline, p = 0.006) and higher double product at peak workload – (204 ± 36.6) vs (168 ± 20.5), p = 0.006), while in the control group these parameters did not change – (43.0 ± 11.8) vs (43.9 ± 10.6) bpm and (158 ± 28.2) vs (179 ± 46), p > 0.05).

Conclusions. In patients with coronary artery disease and moderate left ventricular systolic dysfunction, addition of ivabradine to beta-blockers, but not uptitration of beta-blocker improves exercise tolerance in spite of a more pronounced absolute increase in HR and double product at peak workload. Addition of ivabradine to beta-blockers to therapy of such patients is associated with a 9 % increase of EF in 2 months, which is not observed in case of uptitration of beta-blockers.

Keywords: heart failure, left ventricular systolic dysfunction, exercise tolerance, bisoprolol, ivabradin.



Choice of medical tactics in acute superficial thrombophlebitis

V.G. Mishalov, L.Yu. Markulan, S.V. Beychuk

The aim the improvement of the treatment effects in patients with acute superficial thrombophlebitis (ST), based on the definition of rational tactical approaches and surgical interventions for this disease.

Materials and methods. The study was performed on the basis of Oleksandrivska City Clinical Hospital in Kiev from 2001 to 2010. The study included 362 patients with ST: 224 (61.9 %) women and 138 (38.1 %) men aged 19 to 73 years, mean age (46.73 0.72) years. Duration of disease ranged from one to 29 days, on average (6.95 0.28) days. According to CEAP classification, C2 class of CVI was present at 193 (53.3 %) patients, C3 at 146 (40.3 %), C4 at 21 (5.8 %), C5 at 2 (0.6 %). The first type of ST was registered at 161 (44.5 %) patients, the second at 137 (37.8 %), the third at 46 (12.7 %), the fourth at 18 (5.0 %). The first group consisted of patients who were treated in compliance with the non-invasive therapeutic approach (163), the second with active surgical tactics (193). Palliative and radical operations were used in combination with the complex conservative therapy (venotonics Detralex, tight bandaging of the limbs, NSAIDs). Long-term results of treatment were followed for three years. Cumulative percentage of indicators was determined by means of Kaplan Meier method using the regression analysis of Cox and Log-Rank test to compare frequencies.

Results and discussion. Patients of the first group manifested the progression of thrombosis (6.7 %), with its transition to perforating veins (13.3 %), the emergence of thrombosis of deep veins (6.7 %) and pulmonary embolism (1.7 %). The average value of beddays in case of noninvasive therapeutic approach was 1.52 times higher compared with the rate in case of active tactics (p < 0.05). With conservative treatment, cumulative three-year ST recurrence rate was 14.6 % against 3.2 % in patients who underwent surgery (p = 0.001). In the case of radical treatment it was 1.9 %, palliative care 9.1 % (p = 0.009). Three-year rate of thrombosis of deep veins in the case of conservative treatment was 8.0 %, in the case of operational 0.7 %, p = 0.003 (in the case of radical surgery 0.0 %, palliative 3.5 %, p = 0.01). Within three years, the surgery on the veins of the lower extremities was performed in 30.5 % of patients who underwent conservative therapy for ST, and in 23.8 % of patients after palliative crossectomy.

Conclusions. In patients with ST, active surgical tactics with radical phlebectomy has advantages over non-invasive therapeutic approach and palliative operations.

Keywords: acute varicothrombophlebitis, treatment approaches, surgical treatment.



Results of long-term observation of patients with coronary heart disease after surgical intervention

V.I. Tseluyko, A.V. Rudenko, Ya.O. Peremot, L.M. Yakovleva, S.D. Peremot, K.Yu. Kinoshenko

The aim to conduct a comparative assessment of the effectiveness of a single drug therapy and its combination with a coronary artery bypass grafting (CABG) with regard to the impact on heart remodeling in patients with chronic coronary heart disease (CHD) in the course of long-term observation.

Materials and methods. During the period of (3.0 0.2) years, we examined 79 patients who underwent CABG (I group) and 48 patients who received only medical therapy (II group).

Results and discussion. According to the results of echocardiography, the positive dynamics of the size of the left atrium (LA) (p < 0.05) in both groups was observed. Whereas a decrease in end-diastolic dimension (EDD) of the left ventricle (LV) by 18 % (p < 0.05) and increased ejection fraction (EF) occurred in groups of patients who underwent surgery on the coronary arteries. This was accompanied by a decrease in myocardial mass of LV (LV MM) in patients of I group by 14 % (p < 0.05). The best recovery rates of myocardial contractility in the dynamics of the long-term observation occurred in patients with initially reduced EF (< 40 %). After three years of observation, as evidenced by echocardiography results, the effectiveness of surgical revascularization, in relation to systolic and diastolic functions restoration, is largely influenced by such factors as diabetes, obesity, myocardial infarction in anamnesis, low EF before revascularization, the presence of deletion of the ACE gene.

Conclusions. Administration of the standard drug therapy, aimed at improving the prognosis in CHD patients with hemodynamically significant coronary artery stenosis, provides a positive dynamics only in respect of LA dimension, which may indirectly indicate the improvement in diastolic function of the LV. Significant decrease in EDD, the increase in EF occur only in case of combination of drug therapy with surgical myocardial revascularization.

Keywords: coronary atherosclerosis, surgical revascularization, risk factors.



All-round examination of lower extremity collateral circulation

S.V. Snder

The aim the development of methodology for assessing the collateral circulation during ischemia of the lower extremities.

Materials and methods.We examined 297 persons aged 1882 years. Physical examination, oximetry, laser photopletismography (LFPG), ultrasound scanning, arteriography, the blockade of the femoral and sciatic nerves, forced (3 ml/s) introduction of 20 ml of infusate into the femoral artery with an estimation of the rate and prevalence of sensations were conducted.

Results and discussion. Subcompensative collateral circulation was diagnosed in 106 patients with II degree of ischema, primary decompensation in 23 patients. 24 patients with degree of ischemia had primary decompensative collateral circulation, 3 had a developed decompensation. 4 patients with ischemia of B degree had primary decompensative collateral circulation, 28 a developed decompensation, 2 an irreversible decompensation. 16 patients with ischemia of V degree had a developed decompensative collateral circulation, 53 an irreversible decompensation. In case of subcompensation and primary decompensation, preservation of the lower extremity was reached in 95.6 % of cases. Developed decompensation allowed to maintain the support function of the lower extremity in 68.3 % of patients. The best results (83.3 %) were provided by reconstructive surgery. In case of irreversible decompensation, the support function was preserved only in one third of cases. For patients with subcompensative collateral circulation we recommend conservative treatment, for patients with primary and developed decompensation reconstructive surgery (if the patient refuses or has no conditions for reconstruction indirect revascularisation). In case of their failure and irreversible decompensation, we recommend amputation at the level of the compensated collateral circulation.

Conclusions. Pains, hypoxic and necrotic changes, the test for reactive hyperemia, LFPG, trial block in the complex allow determining the stage of decompensation of collateral circulation. Tactics of treatment based on the results of these studies, gives 89 % positive results.

Keywords: occlusive diseases of lower extremities arteries, collateral circulation, examination.



Lipid-lowering and pleiotropic effects of simvastatin therapy in patients with systemic lupus erythematosus with hyperlipidemia

systemic lupus erythematosus, atherogenic dyslipoproteinemia, endothelium-dependent vasodilatation, atherosclerosis.

The aim to evaluate changes of lipid profile in patients with systemic lupus erythematosus (SLE) and to study hypolipidemic and pleiotropic effects after six-months treatment with simvastatin in patients with hyperlipidemia.

Materials and methods. 100 patients with SLE were examined (90 women and 10 men aged from 18 to 66; the disease duration (9.93 0.88 years) with I and II degree of activity of the disease and glucocorticoid therapy duration not less than 1 year. The patients with dyslipidemia were divided into 2 groups: I 27 patients who took simvastatin 40 mg/day, II 25 patients who did not take simvastatin. The control group consisted of 32 healthy volunteers.

Results and discussion. In total cohort of patients with SLE there were changes typical of atherogenic dyslipoproteinemia: increased low-density lipoprotein (LDL) cholesterol (C) level at 83 %, triglycerides (TG) level at 48 % and decreased high-density lipoprotein (HDL) cholesterol level at 49 % patients. Most often the boundaries of normal values exceeded LDL-C and TG: respectively 2.2 and 2.7 times more frequently than in the control group. After six-months treatment with simvastatin total cholesterol level significantly decreased by 28 %, TG by 36.1 %, LDL-C by 41.7 % and attained the target level of LDL-C at 48.1 % patients. After simvastatin therapy erythrocyte sedimentation rate (ESR) significantly reduced by 34.7 %, C-reactive protein (CRP) by 51.1 % and interleukin-6 (IL-6) level by 47.7 %; mean ranges of endothelium dependent vasodilatation (EDVD) increased by 26.0 % to the values that did not significantly differ from the healthy persons value. In the control group, none of the indicators changed significantly.

Conclusions. The development of pro-atherogenic changes in lipid profile by increasing the levels of LDL cholesterol (83 % of patients), TG (48 % of patients) and by decreasing HDL-C (49 % of patients) is characteristic of SLE patients of mean age (40.9 1.4) years with III degree of activity of process and chronic renal failure of no more than I degree. Compared with healthy people of comparable age and frequency of the main factors (except hypertension), cardiovascular risk, hyper (dis- lipi) demia occurs 2.5 times more often. Supplement of standard treatment for patients with SLE and hypercholesterolemia with simvastatin in the doze of 40 mg / day for 6 months can reduce LDL cholesterol levels by 42 %, total cholesterol by 28 %, TG by 36 % and reach the target level of LDL-C at 48.1 % of patients. It is associated with decreased levels of laboratory markers of inflammation activity of C-reactive protein by 2 times, ESR by 35 % and IL-6 by 48 % and is accompanied by improvement of EDVD by 26 % with its normalization.

Keywords: systemic lupus erythematosus, atherogenic dyslipoproteinemia, endothelium-dependent vasodilatation, atherosclerosis.



Phenomenology of the blood pressure salt reactivity: from pressure natriuresis to renal determinants

.. Bobryshev

Mechanisms of different salt-reactivity types of hypertension (H) have been analyzed in the review. Evidence of volume-dependent hypertensive sodium action has been considered. Essence of A. Guyton concept has been revealed, especially the dominant role of cardiac output («cardiocentric theory»), but not total peripheral resistance of vessels («vasocentric theory»), in the long-term blood pressure (BP) regulation and hypertension. In its turn, the increased cardiac output (volume overload) as the pathogenetic sign of hypertension is realized through fluid-renal mechanism function (i.e. pressure natriuresis). In accordance with experimental data, increased intra-arterial hydrostatic pressure is needed to excrete excessive sodium and fluid. If pressure natriuresis is normal, small (clinically insignificant) increase in BP is enough for adequate sodium excretion. In impaired pressure natriuresis, sodium excretion is possible due to significant BP increase. The «water tank» model, which was developed on the basis of pressure natriuresis curve, discloses renal determinants of different salt-reactivity types of hypertension. In particular, the cause of salt-resistant hypertension is the glomerular filtration restriction due to decrease in glomerular hydrostatic pressure, mainly at the background of increased afferent resistance and decreased renal blood flow. Salt-sensitive hypertension is a manifestation of tubulo-glomerular disbalance which develops because of insufficient sodium delivery to tubuli (e. g. hyponatraemia, decreased ultrafiltration coefficientand / or excessive reabsorption of cation in the kidneys. Conformity of the pathophysiology of experimental and clinical hypertensive models to the theoretically predictable role of renal determinants is examined.

Keywords: review, arterial hypertension, salt-reactivity of blood pressure, fluid-volume mechanism, pressure natriuresis, water tank model, installation point of barostat, tubulo-glomerular balance.



Potential of using of deproteinized hemoderivative of calf blood (Solcoseryl) in treatment of obliterative arterial diseases of lower extremities

V.G. Mishalov, I.I. Tesliuk, Y.S. Zavodovskyy, .V. Mishalov

The literature review is devoted to analyzing the potential of using deproteinized hemoderivative of calf blood (DHCB, Solcoseril by Legacy Pharmaceuticals Switzerland for Meda company) in treatment of obliterative diseases of lower extremities. The reactants of the drug activate transportation of oxygen and nutrients on cellular level, stimulate adenosine triphosphoric acid synthesis, enhance proliferation of reversibly damaged cells, accelerate the healing processes. DHCB promotes collagen synthesis and growth of fresh granulation tissue, accelerates wound reepithelialization. The drug has a membrane stabilizing and cytoprotective action. The content of serofendic acid and Selenium provides antioxidant effect. DHCB can be recommended for treatment of patients with obliterative arterial diseases of lower extremities.

Keywords: obliterative arterial diseases of lower extremities, treatment, deproteinized hemoderivative of calf blood.



Carotid endarterectomy, mitral and aortic valve replacement and coronary arteries bypass grafting within one operation: a case report

B.M. Todurov, M.D. Glagola, V.V. Studnikova, M.V. Lukasevych, V.B. Demyanchuk

Issues of surgical treatment of multifocal atherosclerosis have been of high priority. We present a case of successful carotid endarterectomy, mitral and aortic valve replacement and coronary arteries bypass grafting within one operation.

Keywords: atherosclerosis, carotid endarterectomy, coronary heart disease, heart valves replacement.

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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