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Eldyrev A.Y.,Nizhny Novgorod State Medical Academy | Medvedev A.P.,Nizhny Novgorod State Medical Academy | Bober V.M.,Specialized Cardiological Clinical Hospital | Bogush A.V.,Specialized Cardiological Clinical Hospital | And 3 more authors.
Sovremennye Tehnologii v Medicine | Year: 2012

The aim of the investigation is to give full estimation of organ protective effect of isoflurane anesthesia in cardiac surgeries with artificial circulation. Materials and Methods. There were analyzed the results of clinical, functional, biochemical and morphological examinations of 424 patients operated under the conditions of artificial circulation using two variants of anesthesia: 203 patients were given isoflurane (experimental group); 221 patients - propofol (control group). There were studied clinical progression of rehabilitation period, the change of myocardial contractile function indices, myocardial ultrastructure, and biochemical blood values after the operation. Conclusion. Isoflurane anesthesia provides an additional protective effect in cardiac surgeries with artificial circulation. This effect is proved by complex clinical studies regarding the heart, liver, and kidneys. Myocardial effect of additional protection is supported by clinical, functional, morphological, and biochemical criteria.


Ivanov L.N.,Nizhny Novgorod State Medical Academy | Petrenko V.G.,Specialized Cardiological Clinical Hospital | Katynov V.V.,Specialized Cardiological Clinical Hospital | Yurasova E.V.,Specialized Cardiological Clinical Hospital | And 4 more authors.
Sovremennye Tehnologii v Medicine | Year: 2013

The aim of the investigation was to develop a new technique to estimate myocardial and peripheral reserves; and on the basis of the obtained responsiveness indices of coronary and peripheral arteries - to improve the diagnostics and optimize the choice of surgical treatment modality of patients with multifocal atherosclerosis. Materials and Methods. 296 patients with concomitant lesions of coronary arteries and lower extremity vessels were examined. In 15 patients, according to the findings of synchronously performed stress-echocardiography and ultrasound Doppler of lower extremities, we compared the severity of coronary and peripheral syndromes using the developed technique of graphic representation of ejection fraction and ankle brachial index (initial, load-peak, recovery time 3 min, 6 min later) on phase plane. Results. The study of the distribution dynamics of the indices of ejection fraction and ankle brachial index - the basic indices of intracardiac regional circulatory dynamics - enabled to distinguish 4 zones: A1 zone - low coronary and satisfactory peripheral reserves, A{cyrillic}2 zone - low coronary and peripheral reserves, A3 zone - low peripheral and satisfactory coronary reserves, B zone - satisfactory coronary and peripheral reserves. A surgical approach will depend on the zone the indices of the measured parameters are referred to. Conclusion. The suggested technique for the assessment of functional coronary and peripheral reserves by means of graphic representation of the findings on phase plane enables to specify the indications to surgical management and prognosticate ischemic complications.


Petrova E.B.,Nizhny Novgorod State Medical Academy | Fedorova M.V.,Specialized Cardiological Clinical Hospital | Shakhov B.E.,Nizhny Novgorod State Medical Academy
Sovremennye Tehnologii v Medicine | Year: 2014

The aim of the investigation was to estimate the diagnostic capabilities of left ventricular (LV) functional indices in patients with coronary heart disease (CHD) using conventional imaging techniques (echoCG) and VVI technology.Materials and Methods: 52 patients with CHD were examined. By visual estimation (echoCG) of LV segmental contractility all patients were divided into two groups: without LV contractile dysfunction (n=26); with segmental contractile dysfunction (n=26).The investigation of LV function using VVI system included the study of longitudinal, radial and circular LV fibers, and the analysis of rotation indices.Results and Discussion: VVI system helped to reveal in all patients systolic dysfunction and abnormal strain rate of LV myocardium. Patients of both groups were found to have dysfunction of longitudinal and circular fibers of LV myocardium. Decreased indices of radial fiber function were recorded in a group of patients with segmental contractility dysfunction.Rotation function analysis was impossible in visual estimation. VVI application enabled to find disturbed rotation of basal and apical LV parts. So, the patients of both groups had decreased apical rotation indices, and 14 of them were recorded to have disturbed apical and basal rotational direction of LV.Conclusion: The use of VVI system enables to study in more detail the characteristics of LV function in CHD patients and reveal the alteration of those indices which are not found in visual control. The detection of disturbed strain and rotational properties of LV myocardium is the most urgent problem in patients with regular contractility that makes it possible to define well the management of such patients. © 2014, Nizhny Novgorod State Medical Academy. All rights reserved.


Pichugin V.V.,Nizhny Novgorod State Medical Academy | Melnikov N.Y.,Specialized Cardiological Clinical Hospital | Bober V.M.,Specialized Cardiological Clinical Hospital | Bodashkov M.V.,Specialized Cardiological Clinical Hospital | And 4 more authors.
Sovremennye Tehnologii v Medicine | Year: 2013

The aim of the investigation was clinical assessment of sugammadex (Bridan) use efficiency for early activization of patients after openheart operations with cardiopulmonary bypass. Materials and Methods. We analyzed the results of sugammadex (Bridan) treatment of 30 patients after open-heart operations under cardiopulmonary bypass. Among them there were 17 male and 13 female aged from 25 to 62 years (mean age 49.4±5.3 years). Cardiopulmonary bypass time was from 50 to 129 min (mean time 78.9±10.4 min), aortic compression time, from 38 to 111 min (mean time 62.1±8.2 min). We studied clinical progression of postperfusion period, acid-base composition and blood gases, the change of central hemodynamics indices and TOF index (neuromuscular conduction index). Total dose of the administered drug was 4.3-6.9 mg/kg. Results. The recovery of a good muscle tone and autonomous breathing was observed immediately after the drug injection in 29 patients (96.7%). TOF index (neuromuscular conduction index) increased from 0.23±0.03 to 0.92±0.01 (p≤0.05) within 3-5 min after the drug administration. The drug had no effect on the changes of central hemodynamics indices, contributed to rapid and full recovery of muscle tone and autonomous breathing in patients. Extubation was performed in operating room, and activization time was 30-120 min (on average 47.0±10.4 min). 27 patients (90.0%) stayed in the intensive care unit (ICU) for 18 h on average, three patients stayed in ICU for 2 days due to the continuous cardiac pacing. The complication resulted from sugammadex usage was delayed vomiting (40-50 min after the drug administration) in 3 patients. Conclusion. The use of sugammadex (Bridan) for fast track extubation protocol of patients after cardiosurgical interventions with cardiopulmonary bypass is feasible and very efficient.


Orlov V.E.,Specialized Cardiological Clinical Hospital | Belousov Y.V.,Nizhny Novgorod State Medical Academy
Sovremennye Tehnologii v Medicine | Year: 2013

The aim of the investigation was to analyze the features of surgical interventions, correction technique, immediate and long-term results of the treatment of a rare morphological type of subaortal stenosis - dome-shaped membrane taking into consideration differential diagnosis with other congenital anomalies causing left ventricular outflow obstruction. Materials and Methods. Two medical cases were under study: a 20-year-old male patient and a 4-year-old girl operated in Nizhny Novgorod Specialized Cardiological Clinical Hospital. The operations were performed according to standard practice using transsternal median approach. Both patients underwent normothermic perfusion with aortic occlusion under pharmaco-hypothermic cardioplegia. Results. Echocardiography was found to be the most informative diagnostic technique of any anatomical variant of subaortal stenosis, since it enables to make a diagnosis and determine a morphological obstruction type on the way "left ventricle-ascending aorta". When determining the indications for a surgical correction of the studied anomaly, one should carry out a differential diagnosis of a dome-shaped morphological type of subaortal membrane with characteristic deformity of the anterior mitral leaflet as one of the causes of subaortal obstruction. The surgery technique for a dome-shaped membrane consists in circular resection of fibrous mass obstructing the left ventricular outflow.


Katynov V.V.,Specialized Cardiological Clinical Hospital | Loginov O.E.,Nizhny Novgorod State Medical Academy | Kordatov P.N.,Nizhny Novgorod State Medical Academy | Maksimov A.L.,Specialized Cardiological Clinical Hospital | And 3 more authors.
Sovremennye Tehnologii v Medicine | Year: 2013

The aim of the investigation was to develop an optimal approach enabling to improve the results of surgical management of abdominal aortic aneurysms combined with coronary heart disease. Materials and Methods. We analyzed prospectively and retrospectively the results of surgical management of 203 patients operated for abdominal aortic aneurysm, including 173 male and 30 female patients. Mean age was 65.20±9.26 years. 133 patients (65.7%) were found to have coronary heart disease (CHD). Noncomplicated aneurysms were revealed in 121 patients (59.6%), among them 71 (58.7%) had CHD, 82 (40.4%) patients had complicated aneurysms including 62 (75.6%) with CHD. The surgical treatment modality was determined due to clinical progression of the disease and diagnostic findings. We used a single-stage coronary and abdominal aortic pathology correction, and two-stage correction with primary coronary correction and isolated correction of abdominal aortic pathology. Results. 30 of 203 patients had lethal outcomes, among them there were 24 cases with complicated aneurysm, 6 - with noncomplicated aneurysm. In 24 cases (77.4%) the death was caused by acute cardiovascular insufficiency due to massive blood loss in 15 (48.4%) patients and myocardfial infarction - in 9 (29%). In 4 patients the death was caused by acute renal failure, in one - gastrointestinal bleeding, and in one - multi-organ failure. Among dead patients there were 28 (90.3%) with CHD, all of them having complicated aneurysms. Conclusion. The leading cause of fatal cases in operations for abdominal aortic aneurysms is acute cardiovascular insufficiency due to major bleeding, as well as fatal coronary event. The use of a staged surgical approach enables to improve the results of surgical management of patients with abdominal aortic aneurysm combined with CHD.


Chebotar E.V.,Specialized Cardiological Clinical Hospital | Britvina O.V.,Nizhny Novgorod State Medical Academy | Shakhov B.E.,Nizhny Novgorod State Medical Academy
Sovremennye Tehnologii v Medicine | Year: 2012

The aim of the investigation is to study the results of endovascular treatment of patients with coronary bifurcation disorders performed under the control of selective coronography and intravascular manometry, and to assess on the basis of their analysis the manometric findings of blood flow in bifurcation branches when choosing endovascular correction management. Materials and methods. The analysis of peculiarities and the results of endovascular correction of coronary bifurcations was performed in 67 patients with test T-stenting. The bifurcation state of the 1st group patients (n=32) was assessed by contrast angiography and the measurement of fractional flow reserve, the patients of the 2nd group (n=35) - by angiography findings only. Long-term results (follow-up period is 12 months) were studied in 30 patients (93.8%) of the 1st group, and in 33 patients (94.3%) of the 2nd group. Results. In 11 of 32 cases angiographic assessment of stenosis in the lateral branch mouth was different from that of manometric one. There was determined an average degree of correlation (R=0.46; r{cyrillic}=0.008). In Y-type bifurcation there was no correlation between the assessments of hemodynamic significance of stenosis in the lateral branch (R=0.21; r{cyrillic}=0.464). In a follow-up period, angina recurrence or the increase of its degree was revealed in 3 patients (10.0%) of the 1st group, and in 11 patients (33.3%) of the 2nd one (r{cyrillic}=0.035). Restenoses in lateral branches were found in 2 patients (6.7%) of the group under study and in 10 patients (30.3%) in the control group (r{cyrillic}=0.024). Conclusion. The use of complex approach to the assessment of the results of coronary bifurcation correction improves the results of surgeries due to the decrease of restenoses rate and the necessity of re-revascularization in the follow-up. The advantage of the approach is more accurate assessment of hemodynamic changes in bifurcation branches and, therefore, the possibility to choose an optimal technique of endovascular correction.


Shakhova E.B.,Nizhny Novgorod State Medical Academy | Budkina M.L.,Nizhny Novgorod State Medical Academy | Fedorova M.V.,Specialized Cardiological Clinical Hospital | Shakhov B.E.,Nizhny Novgorod State Medical Academy
Sovremennye Tehnologii v Medicine | Year: 2012

The aim of the investigation is to estimate the feasibility of Velocity Vector Imaging (VVI) program in studying left ventricular systolic function in patients with dilated cardiomyopathy and healthy volunteers. Materials and methods. The study included 3 patients with dilated cardiomyopathy and 4 patients without cardiovascular pathology. Left ventricle was analyzed using VVI program, from apical four-chamber position and from parasternal position along short axis at the level of papillary muscles. There were analyzed the indices of myocardial motion speed, strain, left ventricular ejection fraction and volume. Results. The indices of left ventricular systolic function in standard echocardiography (using Simpson method) and using VVI program were equal in both groups. Axial and radial velocity of left ventricular endocardium were higher in healthy volunteers (p<0.05). The group of volunteers had the tendency for speed reduction from left ventricular base to apex, while in the group of patients with dilated cardiomyopathy the tendency was less expressed. In patients with dilated cardiomyopathy there was relatively uniform decrease of axial and radial velocities in the studied segments. Compared to healthy volunteers, the patients with dilated cardiomyopathy had lower indices of axial strain (p<0.05). Conclusion. VVI program in estimating left ventricular systolic function enables to assess accurately and objectively the degree of contractility defect.


The aim of the investigation is to study the influence of echocardiological parameters of the left ventricle (LV) on lethality and reversion of LV remodelation in the long-term period after aortic valve replacement for aortic valve failure. Materials and methods. 154 patients were included into the study: 86 patients with aortic stenosis (56%), 68 - with aortic insufficiency (44%). Echocardiogram consisted of the following measurements: end-diastolic LV dimension, the thickness of posterior wall and interventricular septum. There were determined end-diastolic and end-systolic volumes and ejection fraction, myocardium mass, LV wall relative thickness index. Results. Four LV structural and geometrical types (SGT) were distinguished. The best results of LV hypertrophy regression were observed in SGT-II group (aortic stenosis with moderate hypertrophy). In hospital period the patients with SGT-III (aortic stenosis with LV marked hypertrophy) and those with SGT-IV (aortic stenosis with LV dilatation) had the same lethality risk. In a long-term period high lethality was revealed in the patients with SGT-IV. Conclusion. The use of LV structural and geometrical types enables to make prognoses about the risk and the results of aortic valve failure correction.

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