The aim — to compare clinical, electrocardiographic characteristics, myocardial structure and function in patients with non-valvular atrial flutter (AFL) with and without restoration and maintenance of sinus rhythm during short-term hospital follow-up.
Materials and methods. The one-center study included 105 patients with documented persistent AFL, among them 73 (69.5 %) men and 32 (30.5 %) women, median age — 66 (quartiles 56 — 73) years. All patients were retrospectively divided into two groups depending on restoration and maintenance of the sinus rhythm (SR) during short-term follow-up. The first group (n = 70) included patients with restored and maintained SR, second group (n = 35) — patients without SR restoration or with conversion to atrial fibrillation. Demographic parameters, risk factors, concomitant diseases, ECG data, laboratory tests, echocardiography, drug therapy were compared in two groups.
Results and discussion. There were no significant differences between two groups regarding age, gender and prevalence of concomitant diseases. Patients with restored SR had higher left ventricular ejection fraction compared to patients whose rhythm was restored (49 (40 — 58) % vs 40 (30 — 49) %, р = 0.001). The episode duration of AFL was significantly shorter in groups with and without SR restoration (10 (1 — 96) vs 48 (10 — 240) weeks, p = 0.048). Heart rate and frequency of the atrial wave were larger in the SR restored group (respectively, 136 (107 — 150) vs 115 (84 — 136) per minute, p = 0.001 and 300 (272 — 300) against 272 (250 — 300) per minute, p = 0.041). Warfarin use was less frequent in patients with recovered SR (19 (27.1 %) vs 21 (60.0 %), p = 0.001).
Conclusions. The restoration and maintenance of sinus rhythm in patients with persistent AFL were associated with shorter duration of arrhythmia, higher frequency of its first episode, less severe manifestations of heart failure and left ventricular dysfunction, as well as less frequent features of atypical AFL by ECG characteristics.

Keywords: atrial flutter, cardioversion, efficiency.

List of references:  
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11.    Da Costa A, Thévenin J, Roche F et al. Loire-Ardèche-Drôm Isère-Puy-de-Dôme Trial of Atrial Flutter Investigators. Results from the Loire-Ardèche-Drôme-Isère-Puy-de-Dôme (LADIP) trial on atrial flutter, a multicentric prospective randomized study comparing amiodarone and radiofrequency ablation after the first episode of symptomatic atrial flutter. Circulation. 2006;114:1676-1681.
12.    De Loma-Osorio F, Diaz-Infante E, Gallego M. Spanish Catheter Ablation Registry. 12th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2012). Rev Esp Cardiol (Engl Ed). 2013;66:983-992.
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17.    Lee K, Yang Y, Scheinman M. Atrial flutter: A review of its history, mechanisms, clinical features, and current therapy. Current Problems in Cardiology. 2005;30:121-167.
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The aim — to investigate the factors influencing the nature of the course and long-term prognosis of patients with atherosclerosis of the peripheral arteries of the lower extremities (APALE).
Materials and methods. 100 people with APALE were surveyed, average age 60.7 ± 5.8 years. Patients underwent a transthoracic echo-cardiographic examination, doppler-ultrasound examination of arteries of the lower extremities and carotid arteries, Holter monitoring of the electrocardiogram, DNA determination by the polymerase chain reaction. The average age of onset APALE demonstration is 53.76 ± 0.67 years. Blood hypertension was observed in 55 (55 %), obesity — 42 (42 %), type 2 diabetes mellitus — 28 (28 %), tobacco smoking — 54 (54 %), hereditary tainted for early development of cardiovascular diseases — 60 (60 %), hyperlipidemia before the prescription of lipid-lowering therapy was registered in 73 (73 %) patients, acute cerebral circulation disturbances in anamnesis presented in 13 (13 %), ischemic heart disease was diagnosed in 37 (37 %). The observation period lasted 29 months.
Results and discussion. Patients were divided into 2 groups depending on the presence of end points: 1st group (average age 55.81 ± 5.86 years) — 16 patients with cardiovascular events 1 (1 %) cardiovascular death, 2 (2 %) — myocardial infarction (MI), 7 (7 %) — unstable angina, 6 (6 %) — acute cerebral circulation disturbances, 1 (1 %) — myocardial revascularization. The 2nd group (average age 61.68 ± 8.35 years) — 84 patients without end points. Patients of the Ist group were younger (p = 0.009), had an early APALE manifestation (p = 0.004), more severe ischemic affect of the arteries of the lower extremities (p = 0.0005) and involvement of three vascular pools (p = 0.000001), more often Ischemic heart disease (IHD) (p = 0.00001) was manifested, atherosclerotic vascular disease (p = 0.000001) and data about the past of acute cerebral circulation disturbances (p = 0.049). In group I, carriers of C allele (p = 0.001) and SS genotype (p = 0.02) prevailed according to genetic analysis of the gene of the eNOs promoter gene C(–786)T polymorphism. According to the regression data, a connection between the development of adverse cardiovascular events in patients with APALE with the presence of MI (p = 0.005) in anamnesis, atherosclerotic affect of arteria carotis (p = 0.0000001) and feedback with the age of the examined patients (p = 0.001).
Conclusions. An unfavorable prognosis in the examined patients with APALE is related to the aggressiveness of the atherosclerotic process: an early manifestation of the disease (p = 0.004), more significant ischemic affect of the arteries of the lower extremities (p = 0.0005), involvement of three vascular pools (p = 0.000001); the presence of coronary artery disease (p = 0.00001) with MI (p = 0.003) and reduction in GFR (≤ 60 ml/min/1.73 m2) (p = 0.03), C allele (p = 0.001) and CC genotype (p = 0.02) of the C(–786)T polymorphism of the eNOs promoter gene. In the long-term observation of patients with APALE, according to regression analysis, a direct connection was established between the occurrence of adverse cardiovascular events with the presence of atherosclerotic affect of arteria carotis (p = 0.0000001), having in the anamnesis MI (p = 0.005) and feedback with middle age of patients (p = 0.001).

Keywords: peripheral artery disease, ischemic heart disease, polymorphism of endothelial NO-synthase gene, cardiovascular events.

List of references:  
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8.    Hur D, Kizilgul M, Aung W et al. Frequency of coronary artery disease in patients undergoing peripheral artery disease surgery. Am J Cardio. 2012;110:736-740.
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11.    Nigam PK. Calculated low density lipoprotein-cholesterol: Friedewald’s formula versus other modified formulas. International journal of life science and medical research. 2014;4, Iss. 2:25-23.
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The aim  —  carry out a comparative analysis of the central aortic pressure, pulse wave parameters, and levels of parathyroid hormone and 25 (OH) vit D in elderly female patients with uncomplicated essential hypertension and in healthy female of the control group.
Materials and methods. The study included 28 women mean age of 69.2 ± 0.9 years with postmenopausal duration 17.4 ± 1.1 years with essential hypertension II stage 2 degrees and 25 practically healthy women mean age of 65.6 ± 1.6 years, BMI 27.7 ± 0.8 kg/m2, the duration of the postmenopausal period is 15.0 ± 1.6 years. All patients underwent general clinical and laboratory examination, daily monitoring of blood pressure (BP) and echocardiography. Parameters of central hemodynamics and arterial stiffness were measured using SphygmoCor device (AtCor Medical, Australia). All patients were tested for the level of 25(OH) vit D, ionized calcium, blood phosphorus, parathyroid hormone (PTH), creatinine clearance.
Results and discussion. Patients with hypertension and control groups were matched with age, BMI, brachial indexes and central blood pressure (as at that study stage we achieved target blood pressure against the background of hypotensive therapy). Analyzing parameters of the pulse wave, we detected a significant increase in the augmentation index, including normalized for heart rate of 75 beats per min and augmentation pressure (AP) in the main group on (46 %, 35 %, 29.8 %, p < 0.001, p < 0.001, p < 0.001 respectively) compared with the control. Amplification pressure (PPampl.) in the main group was significantly lower (16.4 %, p < 0.001). Pulse wave velocity through the muscular type arteries (PWVrad.) and the arteries of the elastic type (PVW fem.) in the study group were higher (40 %, 17.7 %, p < 0.001, p < 0.01). The average level of 25(OH)D in patients in the main group is lower compared to the control group (23.1 ± 1.29 and 29.13 ± 1.5 ng/ml, p < 0.01). The deficiency of 25(OH)D among the patients in the main group was detected in 12 patients (42.9 %), insufficiency — 10 (35.7  %), normal level — 6 (21.4 %), compared with patients in the control group: deficiency 25(OH)D — 4 (12  %), level insufficiency — 3 (16 %). In 14 (50 % %) of the examined patients of the main group with a deficiency of 25(OH)D the secondary hyperparathyroidism was diagnosed. There was a positive correlation between the level of 25(ОH)D, parathyroid hormone (PTH) and PWV fem. and brachial pulse AP (bPAP). There were negative statistically significant correlations between PWV fem and a level of 25(OH)D (r = –0.39, p < 0.05) and an indicator of vitamin D level with PTH (r = –0.53, p < 0.01). There were positive correlation links between PWV fem. with bSAP (r = 0.69), bPAP (r = 0.58), cSAP (r = 0.68), cDAP (r = 0.39), cPAP (r = 0.46).
Conclusions. Elderly female patients with controlled uncomplicated hypertension, compared with healthy women, demonstrated the increase in arterial rigidity rates according to the pulse wave which is associated with secondary hyperparathyroidism against the backdrop of vitamin D insufficiency. The correlation between level 25(OH)D and carotid-femoral pulse rate may indicate the importance of vitamin D deficiency in the pathogenesis of arterial stiffness, which is probably mediated by increased calcification of intima and/or media, and determine the need for selection of combined therapy to correct the revealed violations.

Keywords: arterial hypertension, osteoporosis, arterial stiffness, vitamin D.

The aim — to identify basic symptoms for the diagnosis of carotid body tumor.
Materials and methods. The analysis of the clinical symptoms of 56 patients who were hospitalized in the department of vascular surgery Lviv regional hospital for the period 1995 to 2016 in this group of patients in the 31 case diagnosed tumor of the carotid body (study group) and 25 cases of tumors of other oncogenesis in section of carotid arteries (control group).
Results and discussion. In the group of carotid body tumor (CBT) main symptom is the appearance of painless, round, tight elastic consistency, formation of the neck in the projection of the bifurcation of the common carotid artery, which slowly increased in size 25 (81 %) patients with CBT. The episodes of vertigo were in history of 9 (17 %) of clinical cases, headache — 7 (23 %), episodes of fainting — 5 (16 %), the appearance of a painful lesion on his neck — 6 (19 %), lymphadenopathy — 5 (16 %), amnesia — 2 (6 %), dysphagia — 2 (6 %), dysarthria — 2 (6 %), cough, ear disorder — 1 (3 %). 5 (16 %) patients with CBT from the study group we diagnosed the syndrome of carotid node. The basis for the diagnosis of this syndrome in patients was the presence of bradycardia and hypotension, which regressed after removal of CBT. Based on the comparative analysis between the frequency of symptoms in study groups by Fisher test we identified that in the study group a statistically significant lesion is the emergence of asymptomatic lesion in the neck in the projection of carotid arteries in 81 % of patients (p = 0.0021), dizziness in 29 % of patients (p = 0.0489) syndrome of carotid node in 16 % (p = 0.0445).
Conclusions. Analysis of the clinical picture in patients with carotid body tumor showed that this disease is marked by the appearance of painless, oval-shaped, tight elastic consistency lesion in the neck in the projection of the bifurcation of the common carotid artery, which is accompanied by vertigo syndrome and syndrome of carotid node.

Keywords: carotid body tumor, carotid artery, tumor.

List of references:  
1.    Shidlovs’kyy VO, Shidlovs’kyy OV. Shyyni parahanhliomy [Neck paraganglia]. Visnyk naukovykh doslidzhen. 2012;1:4-7. (In Ukr)
2.    Amato B, Bianco T, Compagna R et al. Surgical resection of carotid body paragangliomas: 10 years of experience. Am J Surg. 2014;207:293-298.
3.    Boscarino G, Parente E, Minelli F et al. An evaluation on management of carotid body tumour (CBT). A twelve years’ experience. G Chir. 2014;35:47-51.
4.    Beigi AA, Ashtari F, Salari M, Norouzi R. Convulsive syncope as presenting symptom of carotid body tumors: case series. J Res Med Sci. 2013;18(2):164-166.
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7.    Gwon JG, Kwon TW, Kim H, Cho YP. Risk factors for stroke during surgery for carotid body tumors. World J Surg. 2011;35:2154-2158.
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The aim — to analyse the dynamics of miocardium structural and functional parameters, to demonstrate the heart rate variability in patients with miocardial infarction with ST segment elevation depending on polymorphism А1166С of ATIIR1 gene.
Materials and methods. 87 patients with STEMI, 70 (80 %) male and 17 (20 %) female average age 58.94 ± 10.16 years were examined. Patients were hospitalized to SI «L. T. Mala National Therapy Institute of NAMS of Ukraine» during first three days after selective coronary angiography and infarct-related artery stenting were performed. After 6-month observation period 57 patients were examined. Allele polymorphism A1166C of ATIIR1 gene was determined by polymerase chain reaction in real time, heart rate variability (HRV) — Cholter 24-hour monitoring, morpho-functional data — ultrasound research.
Results and discussion. In patients with АС and СС-genotypes compared with АА on 1 — 3 day of STEMI higher level of LVEDD (p = 0.004), LVESD (p = 0.043), LVMM (p = 0.041), frequency of mitral regurgitation (p = 0.028), the tendency to higher LVEDV (p = 0.089) were revealed. These means unfavorable structure of early post infarction myocardial remodeling (RM). After 6 month patients with АС and СС-genotypes compared with АА demonstrated higher LVEDD (p = 0.083), left atrium (p = 0.091), LVMM (p = 0.081). When analysed echocardiographic data in acute period of STEMI and after 6-month observation, groups with АА and АС and СС-genotypes demonstrated significant increasing or growth tendency to higher level of LVEDV (p = 0.06, p = 0.034), LVEDD (p = 0.057, p = 0.01), LVEF (p = 0.037, p = 0.07) respectevly. In patients with AC and CC-genotypes compared with AA were lower level of SDNN (p = 0.049), HF (p = 0.053), higher level of LF (p = 0.069) and LF/HF-index (p = 0.046).
Conclusions. Polymorphic АС and СС-genotype cariers compared with АА-genotype of ATIIR1 gene demonstrated more relevant increase of left ventricular diameters and volume, left atrium and LV myocardial mass in acute period of STEMI. After 6-month period in both groups LV dilatation and LVEF were observed. These data refer to the similar with Frank — Starling law dynamic of compensation. Patients with АС and СС-genotypes compared with AА demonstrate unfavorable structure of LV CR which is associated with more expressed sympathic-vagous dysbalance.

Keywords: STEMI, single nuclear polymorphism А1166С of ATIIR1, cardiac remodeling.

List of references:  
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2.    Zhebel VM, Starzhynska OL, Hefter Yu.O. ta in. Genotype of angiotensin II type 1 receptor as a factor of influence on myocardials structure and function in patients with essential hypertension of different severity. Arterial’naya Hipertenziya [Hypertension]. 2009. № 1 (3). C.24-29. (Ukrainian).
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4.    Tseluyko VY, Yakovleva LM, Popova KI. Faktory, shcho vplyvayut’ na perebih infarktu miokarda u khvorykh na ishemichnu khvorobu sertsya [Factors that influence a myocardial infarction current in patients with ischemic heart disease]. Liky Ukrayiny [Medications of Ukraine]. 2013. № 3-4 (16-17). С.19-23. (Ukrainian).
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6.    ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33: 2569-2619. DOI:10.1093/eurheartj/ehs215
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10.    Martin MM, Buckenberger JA, Jiang J et al. The human angiotensin II type 1 receptor +1166 A/C polymorphism attenuates microrna-155 binding. J Biol Chem. 2007;282:24262-24269. DOI: 10.1074/jbc.M701050200.
11.    Martinez-Quintata E, Chirino R, Nieto-Lago V et al. Prognostic value of ACE I/D, AT1R A1166C, PAI-1 3G/5G and GPIIIa a1/a2 polymorphisms in myocardial infarction. Cardiol J. 2014;21, suppl. 3:229-237. doi: 10.5603/CJ.a2013.0107.
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13.    Nossent AY, Hansen JL, Doggen C et al. SNPs in microRNA binding sites in 3-UTRs of RAAS genes influence arterial blood pressure and risk of myocardial infarction. Am J Hypertens. 2011;24:999-1006. doi: 10.1038/ajh.2011.92.
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21.    Zhang K, Zhou B, Zhang L. Association study of angiotensin II type 1 receptor: A1166C (rs5186) polymorphism with coronary heart disease using systematic meta-analysis. J Renin-Angiotensin-Aldosterone Syst. 2013;14, suppl. 2:181-188. DOI: 10.1177/1470320312447652 jra.sagepub.com.

The aim —  to improve the results of treatment of deep vein tromobosis (DVT) in the system of vena cava inferior.
Materials and methods. 678 patients with DVT in the system of vena cava inferior were treated in the surgical clinic of the Regional Clinical Hospital A. Novak. Considering the method of treatment, the patients were divided into two groups. The first (main) group consisted of 443 (65.3 %) patients with deep vein thrombosis (DVT) in the system of the vena cava inferior (VCI), who underwent an open full or partial thrombectomy. The second (control) group included 235 (33.7 %) patients with DVT in the VCI system receiving only conservative treatment.
Results and discussion. Surgical treatment of deep vein thrombosis according to the cumulative analysis allowed to achieve a positive result of treatment in 89.5 % of patients, and with conservative treatment — only in 48.8 % of patients. At the end of 3 years of observation, the marked signs of chronic venous insufficiency in patients in the control group were observed in 51.6 % of patients, and in the main group — only in 13.1 %.
Conclusions. Surgical lumen restoration of deep veins in the system of the vena cava inferior allows to preserve vein valves, prevent postthrombophlebitic syndrome with following chronic venous insufficiency occurrence, to improve treatment results in patients with DVT.

Keywords: deep vein thrombosis, vena cava inferior, thrombectomy, conservative treatment.

List of references:  
1.    Gudz IM. Diagnostyka ta likuvannja gostrogo trombozu glybokyh ven nyzhnih kincivok i tazu. Rekomendacii’ Tovarystva sudynnyh hirurgiv Nimechchyny (Ukrainian). Serce i sudyny [Heart and vessels] (Ukrainian). 2006;2 (14):34-36.
2.    Kobza II, Gavryliv BM, Orel Ju.G., R.A. Zhuk, M.G. Orel, A.T. Kihtjak, S.A. Lebedjeva, V.D. Luzhans’kyj Likuvannja flebotromboziv systemy nyzhn’oi’ porozhnystoi’ veny, uskladnenyh flotacijeju verhivky trombu (Ukrainian). Nauk. visnyk Uzhgorods’kogo universytetu, serija «Medycyna» [Scientific Bulletin of Uzhgorod University Medical Series] (Ukrainian). 2012;2 (44):52-53.
3.    Pokrovskyj AV. Sostojanye sosudystoj hyrurgyy v Rossyy v 2007 godu (Russian). Moskva, 2008:46.
4.    Sergejev OO, Kutovyj OB, Ljul’ko I.V., Habarlak ІV, Єvsjukov SV. , Sokolov ЄA,  El’hash O. V. Hirurgichne likuvannja gostryh venoznyh klubovo-stegnovyh tromboziv (Ukrainian). Shpytal’na hirurgija [Hospital Surgery] (Ukrainian). 2009;4:27-29.
5.    Comerota AJ. Treatment of acute iliofemoral deep venous thrombosis: a strategy of thrombus removal. Eur J Vasc Endovasc Surg. 2007;33(3):351-360.
6.    Bergan John J. The vein book: monograph. London-Oxford: Elsevier Academic Press, 2007:617.
7.    Ekloef B. Aggressive treatment of proximal deep venous thrombosis: 6th North Sea Meeting on Venous Diseases. Antwerpen, 2007:15-17.
8.    Geier B, Asciutto G, Strohmann B et al. Long-term results after transfemoral venous thrombectomy for iliofemoral deep venous thrombosis. Abstracts XXIII Annual Meeting European Society for Vascular Surgery (3-6 September 2009, Oslo, Norway):148.
9.    Pillny M, Sandmann W. Deep venous thrombosis: surgical options. Minimally invasive venous surgery. Turin: Edizioni Minevra Medica S.p.A., 2008:93-98.
10.    Rosales A, Sanbæk G, Jørgensen JJ. Stenting for chronic postthrombotic cava and iliofemoral occlusions. clinical outcome and midterm patency. Abstracts XXIII Annual Meeting European Society for Vascular Surgery (3-6 September 2009, Oslo, Norway):59.

The aim — to establish features of the proteolytic system by the example of neutrophil elastase in patients with trophic ulcers of arterial and venous genesis.
Materials and methods. We examined and treated 38 patients with vascular disease of arterial and venous nature. The patients were divided into 2 groups. The first group consisted of 20 patients with trophic ulcers against the background of postthrombophlebitic syndrome and venous varices. In the second group, there were patients with trophic ulcers (n = 18) with diabetic angiopathy and obliterating atherosclerosis of the arteries of the lower extremities. The control group comprised 20 practically healthy individuals. The activity of neutrophil elastases was measured in nmol/min/ml.
Results and discussion. In the study of the proteolytic system by the example of neutrophil elastase in  patients with trophic ulcers of arterial genesis, it was shown that the average level of the enzyme was 286.17 ± 2.00 nmol/min/ml, which was  71.10 ± 0.52 nmol/min/ml in the control group. That was 4 times more. In patients with trophic ulcers of the venous genesis the average level of this indicator was 229.55 ± 0.55 nmol/min/ml. Compared with the control group), it was 3.2 times more. Comparing the results obtained in patients of both groups, we noted that the level of neutrophil elastases was significantly higher (1.2 times) in patients with trophic ulcers of the arterial genesis than the venous genesis. The difference between these groups was 56.62 nmol/min/ml.
Conclusions. The level of neutrophil elastase in patients with trophic ulcers of the lower extremities of the arterial and venous genesis is higher in comparison with the control group. After a more detailed study of the level of neutrophilic elastases, this data may be included in the standard laboratory test in the future.

Keywords: trophic ulcers, elastase, atherosclerosis, venous varice.

List of references:  
1.    Arefeva M. Osobennosti konservativnoy terapii troficheskih yazv smeshanoy etiologii. Praktichna angIologIya. (Russian). 2015;2 (69):33-38.
2.    Golubnichiy SO, Golubnicha VM, PIddubna GP, Gupalo MV. OsoblivostI spontannogo pnevmotoraksu tuberkuloznogo ta nespetsifIchnogo Genezu. Tuberkuloz v suchasnomu svItI – chastota, simptomi , lIkuvannya: stattI. LyublIn. (Ukrainian), 2013:129-140.
3.    Kudyikin MN. Kompleksnoe lechenie troficheskih yazv. Flebologiya. (Russian). 2008;3:16-20.
4.    Schupakova AN, Okulich VK, Belyaeva LE, Prudnikova AR.. Proteoliticheskaya aktivnost neytrofilnoy elastazyi kak prognosticheskiy faktor razvitiya zabolevaniy serdechno-sosudistoy sistemyi. Vesnik VGMU. (Russian). 2016;2:17-26.
5.    El-Eshmawy M.M, El-Adawy EH, Mousa AA et al. Elevated serum neutrophil elastase is related to prehypertension and airflow limitation in obese women. BMC Womens Health. 2011;N 11:1.
6.    Khokha R, Murthy A, Weiss A. Metalloproteinases and their natural inhibitors ininflammation and immunity. Nat Rev Immunol. 2011;13(9):649-665.
7.    Liu Z, Shapiro S. A critical role for neutrophil elastase in experimental bullous pemphigoid. J Clin Invest. 2000;105(1):113-123.
8.    Rahman GA, Adigun IA, Fadeyi A. Epidemiology, etiology, and treatment of chronic leg ulcer: experience with sixty patients. Ann Afr Med. 2010;9(1):1-4.

The aim — to evaluate the carotid-femoral pulse wave velocity (cfPWV) and the intima media thickness of the common carotid artery (TIM CCA) in patients with coronary artery disease (CAD), depending on the presence of type 2 diabetes mellitus (T2DM), lesions of the coronary arteries (CA) prior to therapy and in the process of standard and combined therapy with the addition of alpha-lipoic acid (ALA).
Materials and methods. 131 patients with CAD (89 men, 42 women), mean age of 59.6 ± 9.11 years were examined. Depending on the presence of T2DM patients with CAD were divided into 2 groups: 1st group (n = 70) — patients with concomitant T2DM, 2nd group (n = 61) — patients with CAD and without T2DM. All patients were performed coronary angiography to verify the diagnosis of CAD. All  patients depending on the nature of the therapy were divided into 2 subgroups — subgroup IA (standard therapy) and the subgroup IB (combined therapy). Also cfPWV and TIM CCA were assessed before treatment and after 3 month of treatment.
Results and discussion. The study demonstrated that in patients with CAD, the values of cfPWV were significantly increased in comparison with the control group (p < 0.05). In the 1st group patients, in comparison with the 2nd group, the values of cfPWV (12.29 ± 2.10 m/s vs 11.02 ± 2.15 m/s, p = 0.0009) were significantly increased. In the 1st group of patients TIM CCA was significantly higher in comparison with the control (1.22 ± 0.10 mm vs 0.89 ± 0.06 mm, p = 0.00001), in the 2nd group patients also TIM CCA was significantly higher in comparison with the control group (1.11 ± 0.15 mm vs 0.89 ± 0.06 mm, p = 0.00001). In addition, in the 1st group patients TIM CCA was significantly higher in comparison with patients of the 2nd group (1.22 ± 0.10 mm vs 1.11 ± 0.15 mm, p = 0.00001). In the 1st group patients of standard therapy, after 3 months of treatment, an unreliable decrease cfPWV (10.60 ± 2.26 m/s vs 10.23 ± 2.16 m/s, p > 0.05) and TIM CCA (1.11 ± 0.07 mm vs 1.07 ± 0.07 mm, p > 0.05). In the 2nd group patients of standard therapy, after 3 months of treatment, there was a slight decrease cfPWV (9.85 ± 2.10 m/s 9.49 ± 2.10 m/s), TIM CCA (1.07 ± 0.10 mm vs 1.05 ± 0.10 mm, p > 0.05), but there was no significant difference (p > 0.05). In the 1st group patients of combined therapy, after 3 months of treatment, an unreliable decrease in the value of cfPWV was noted (12.64 ± 1.87 m/s vs 12.12 ± 1.88 m/s, p > 0.05), a significant decrease TIM CCA (1.24 ± 0.08 mm vs 1.21 ± 0.09 mm, p = 0.0302). In the 2nd group patients of combined therapy, after 3 months of treatment, an unreliable decrease cfPWV was noted (11.37 ± 2.10 m/s vs 10.83 ± 2.07 m/s, p > 0.05), and TIM CCA (1.11 ± 0.14 mm vs 1.08 ± 0.14 mm, p > 0.05).
Conclusions. For patients with CAD accompanied with T2DM, opposite to patients without T2DM, the addition of ALA to recommended therapy during 3 months was associated with decrease of TIM CCA. Addition of ALA to therapy for patients with CAD during 3 months was associated with decrease of TIM CCA as well as cfPWV.

Keywords: carotid-femoral pulse wave velocity, arterial stiffness, intima media thickness of the common carotid artery, atherosclerosis, coronary heart disease, type 2 diabetes mellitus, a marker of endothelial dysfunction, alpha-lipoic acid.

List of references:  
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4.    Zhuravleva LV, Lopina NA, Kuznetsov IV  Comparative evaluation of pulse wave velocity measurement with the use of reography and Doppler ultrasound (Russian). Serce i sudyny [Heart and vessels] (Ukrainian). 2016;4:72-79.
5.    Moskalenko VF, Hulchii OP, Holubchykov MV, Liedoshchuk BO, Liekhan VM, Ohniev VA, Lytvynova LO, Maksymenko OP, Tonkovyd OB, authors; Moskalenko VF, editor. Biostatystyka. [Biostatistics]. К.: Knyha plius (Ukrainian), 2009:184.
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15.    Holme I, Faergeman O, Fayyad R et al. Prognostic model of residual risk for major cardiovascular events in statin-treated coronary patients: a combined analysis of the IDEAL and TNT trials. J Am Coll Cardiol. 2012;59, suppl. 13:E1495–E1495.
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18.    Liao YF, Feng Y, Chen LL et al. Coronary heart disease risk equivalence in diabetes and arterial diseases characterized by endothelial function and endothelial progenitor cell. J Diabetes Complications. 2014;28, suppl. 2:214-218.
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The aim —  to evaluate features and results of surgery for patients with primary mitral regurgitation by using the method of mitral plasty compared with mitral prosthesis method.
Materials and methods. We have analyzed results of treatment of 72 patients with primary MR (PMR) who were subjected to MVR or MVRe performed in the Department of cardiac surgery affiliated with Lviv regional clinical hospital (Ukraine) since October, 2013 till February, 2016.
Results and discussion. Males prevailed in the MVRe group — 12 persons (66.67 %), female prevailed in the MVR group — 29 persons (53.7 %). Before surgery in the group with MVRe and MVR all patients had moderate MR. After performed MVRe 16 patients (88.89 %) did not demonstrated MR and light MR was revealed in2 patients (11.11 %). In the group with performed MVR 100 % patients had no MR after surgery. The predominant correction method of MR was MVR — 54 patients (75 %). The most often etiological factor of MR were MV degenerative changes — 41 patient (56.9 %). The most often direct cause of MR was chordal rupture — 43 cases (59.7 %). In the MVRe group predominantly posterior cusp was involved — 11 patients (61.1 %), in the MVR group two cusps were affected — 20 patients (37.04 %). During MVRe, additional to valvuloplasty ring, more often wedge-shaped resection was used in 7 patients. Amount of early postsurgical complications was significantly higher in MVR group — 5 patients, compared to MVRe — 1 patient. The mortality was higher in MVR group — 3 patinets, compared to MVRe — none.
Conclusions. Key direct cause of MR is the chordal rupture of MV cusps (59.7 %), etiological factor in the majority of advanced countries is degenerative changes (56.9 %). Principal method of MR surgical correction in out center is MVR (54 patients, 75 %), though the preferable global trend is MVRe. Complications and lethality percentages in our study were higher among the patients from MVR group. This corresponds to results of other studies and guidelines that recommend MVRe as optional method for MR correction.

Keywords: primary mitral regurgitation, mitral valve replacement, mitral valve repair.

List of references:  
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The aim — to study OPG as indicator in complex treatment of patients with diabetic foot syndrome (DFS).
Materials and methods. Under our observation there were 118 patients with diabetic foot syndrome (F. W. Wagner IIІ—ІV stage), 59.4 ± 8.3 years old. 86 % of patients had purulent-necrotic process of IIІ—IV stages according to F. W. Wagner. Two patients groups were compared, the groups were age, gender and diabetes duration (from 5 till 15 years) matched. In 74 % of them the level of HbA1c was 7.9 ± 1.39 % (7.5—8.0). Patients with purulent-necrotic process of IIІ—IV stages according to F. W. Wagner (86 patients) were divided into two groups. First experimental group was formed with 49 patients who were operated on purulent-necrotic form of DFS. Comparing group contained 37 patients whom, additionally osteoperforation of tibia, at the side of damaged foot was performed. Control group was formed with 32 patients who had diabetes mellitus II with peripheral form of atherosclerosis without purulent-necrotic complications. We observed the dynamics of OPG level in blood by means of immune enzyme analysis. Severity of ischemic lesion of an extremity was evaluated by determination of transcutaneous oxygen pressure measurements (TcPO2) with TCM4 device.
Results and discussion. Levels of OPG in a control group was 8.2 pmol/L, at TcPO2 27.4 ± 5.2 mmHg. On 10th day after operation we saw the positive dynamic of TcPO2 accretion up to 40 — 50 %. At the moment, levels of OPG was 7.54 pmol/L. Patients with F. W. Wagner IIІ—ІV stage (86 patients), at the moment of hospitalization, OPG blood serum level was 17.5 pmol/L (p Kruskal — Wallis — 0.012). The elevation of TcPO2 up to 30 % was observed in the first group on the 10th day after an operation and weakly positive dynamic of pathological process. OPG level in this case was 16.1 pmol/L (p Kruskal — Wallis  — 0.006). In group ІІ, elevation of TcPO2 on 10th day was 43 %. OPG levels was 20.7 pmol/L (p Kruskal — Wallis 0.006). The support function of foot was saved in 88.3 % of patients.
Conclusions. OPG serum concentration increases at patients with DFS (F. W. Wagner IIІ—ІV stage) by 113 % comparing with patients with DFS without destructive processes. Increasing of OPG levels up to 18.1 %, comparing with hospitalization (p < 0.01), in patients who had osteoperforation in addition to small amputation because of DFS (W. Wagner IIІ—ІV stage), in case of positive progress of pathological  process, it can be a marker of neoangiogenesis.

Keywords: diabetic foot syndrome, osteoperforation, osteoprotegerine.

List of references:  
1.    Augoulea А, Vrachnis N, Lambrinoudaki І et al. Osteoprotegerin as a marker of atherosclerosis in diabetic patients. Int  J Endocrinol. 2013;N 10:1155-1161.
2.    Cassiano F,  Weege R, Barroso R, Luiz M. Immunohistochemical analysis of bone resorption regulators (RANKL and OPG), angiogenic index, and myofibroblasts in syndrome and non-syndrome odontogenic keratocysts. Arch Oral Biol.  2012.  Vol. 57, iss. 3:230-237.
3.    Esteghamati А, Aflatoonian М, Rad М et al. Association of osteoprotegerin with peripheral artery disease in patients with type 2 diabetes. Arch Cardiovasc Dis. 2015;N 108:412-419.
4.    Grigoropoulou P, Eleftheriadou I, Zoupas C, Tentolouris N. The role of the osteoprotegerin/RANKL/RANK system in diabetic vascular disease. Curr Med Chem. 2011;18(31):4813-4819.
5.    Huang K, Ma Y, Wang J et al. The correlation between transcutaneous oxygen tension and microvascular complications in type 2 diabetic patients. J Diabetes Complications. 2017;N 5:886-890.
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Amyloidosis with the synthesis of light chains of amyloid is a rare and fatal disease for which there are no approved methods of treatment. In patients with amyloidosis, amyloid light chains accumulate in the organs, leading to organ failure, which is especially predictive of seriousness when the heart is involved in the process. The diagnosis of the disease is complex and largely depends on the doctors’ knowledge of this pathology. It includes visualization methods: CT and MRI with contrast, surrogate markers of damage (NT-proBNP) and biopsy with immunohistochemical examination. There are no successful methods of treatment at the moment. However, frequently used treatment options, such as high-dose chemotherapy in combination with autologous stem cell transplantation, a combination of alkylating agents and steroids, proteasome inhibitors and/or immunomodulatory medications, can reduce the production of amyloid precursor protein by plasma cells.

Keywords: cardiomyopathy, restrictive cardiomyopathy, systemic amyloidosis, cardiac amyloidosis, magnetic resonance imaging.

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This article provides the literature review which includes an analysis of assessing the severity and functional status of adult patients with congenital heart disease (CHD). Different approaches to assessment the complexity of CHD are outlined. Disease severity index, Index ability to lead a normal life, Congenital heart disease functional index are described, the assessment of heart failure functional class by NYHA and left ventricular contractility (ejection fraction of left ventricle) is presented. Considerable attention is paid to applying the standard questionnaires to determine the Health-related quality of life. The subjective assessment of the health status in CHD should be supported by the analysis of symptoms, the ability to work physically, mood state and also by an objective assessment of satisfaction with environment, social relationships, and the ability to act in accordance with their religious and personal convictions. The complexity of CHD systematization, the problem of an adequate assessment of the severity of CHD cause necessity for studying the effect of this pathology on the quality and life expectancy of such patients with the aim of optimizing the system for providing them with cardiac treatment.

Keywords: congenital heart defects, adults, functional status, quality of life.

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The high frequency of different arterial pools aneurysms in abdominal aorta aneurysm became known as aneurysmal disease and allows to recommend the patients to be observed for aneurysmal process in all main arteries. The everyday use of mentioned predictors in clinical practice will improve the diagnostic results and surgical treatment of aneurysmal disease. When identifying the different arterial poolls aneurysms, the active surgical treatment is recommended. The choice of treatment strategy depends on the severity of the disease, clinical manifestations, aneurysm localization and its morphology, but always a preference is given to endovascular methods.

Keywords: aneurysmal disease, aorta, arterial pools, main arteries, matrix metalloproteinases.

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