Comparative analysis of hemodynamic characteristics of the biological xenogenic pericardial prosthesis MEDINGE-BIO with “easy change” system and the xenogenic aortic prosthesis Hancock II after aortic valve replacement

Aim. To compare the outcomes of aortic valve replacement using the xenogenic aortic prosthesis Hancock II and the novel Russian xenogenic pericardial prosthesis MEDINGE-BIO.Material and methods. The study included patients operated on for aortic stenosis in the cardiac surgery department № 1 of the Cardiology Research Institute (Tomsk National Research Medical Center). All patients were divided into two groups. The first group included 54 patients with Hancock II prostheses, the second — 91 patients with MEDINGE-BIO prostheses. Hemodynamic characteristics of heart valves were assessed by echocardiography before surgery and before discharge (on average 10 days after surgery).Results. When comparing hemodynamic parameters before and after surgery, significant differences between the groups were not obtained. The average pressure gradient after surgery using Hancock II and MEDINGE-BIO prosthesis was 21,6±7,9 and 17,9±5,6 mm Hg, respectively (p=0,05).Conclusion. The comparative analysis showed that the novel biological prosthesis MEDINGE-BIO has comparable hemodynamic characteristics with the well-known aortic prosthesis Hancock II

Influence of implantation of a novel domestic prosthetic aortic valve on the functional class of heart failure one year after surgery

Aim. To assess the severity of heart failure (HF) 1 year after aortic valve replacement with a novel bioprosthetic valve with the “easy change” system.Material and methods. The study included 59 patients (24 men and 35 women) diagnosed with degenerative aortic valve disease without concomitant cardiac pathology. The mean age of the patients was 69,6±4,3 years. An assessment of NYHA HF class using six-minute walk test was carried out. The venous plasma level of N-terminal pro-brain natriuretric peptide (NT-proBNP) before and after surgery was also used to determine the severity of HF. In 31 patients (52,5%), NYHA class III HF was determined before surgery.Results. Comparative analysis of HF classes revealed a significant difference. Thus, after implantation of MedEng-BIO prosthetic aortic valve, the distance of the six-minute walk test increased by an average of 125 m (p=0,001). NT-proBNP level decreased from 162,2 pg/ml to 63,7 pg/ml (p=0,003).Conclusion. One-year follow-up of patients after implantation of a novel bioprosthetic aortic valve showed an objective decrease in the severity of HF according to six-minute walk test and NT-proBNP level in venous blood plasma

The Functional State of Intestinal Microcirculation in Diffuse Peritonitis

Objective: to evaluate the functional state of intestinal microcirculation in diffuse peritonitis caused by hollow organ perforation and to determine its possible relationship to skin microcirculation. Subjects and methods. Seventeen patients with diffuse peritonitis resulting from hollow organ perforation were examined. The patients’ mean age was 58.5±2.8 years; a control group consisted of 35 apparently healthy individuals. The functional state of the intestinal microcirculatory bed (the mid-transverse colon, the ileum at a distance of 60 cm from the ileocecal corner, the small bowel at a distance of 50 cm of the ligament of Treitz, and an area next hollow organ perforation) and skin was evaluated by laser Doppler flowmetry by means of a ЛАКК-02 laser capillary blood flow analyzer made in the Russian Federation (LAZMA Research-and-Production Association, Russian Federation). Results. Perforation of the affected intestinal portion became worse in patients with diffuse peritonitis. Blood flow stability was ensured by the higher effect of mainly active components of vascular tone regulation on the microvascular bed. Regulatory changes were equally pronounced at both the intraorgan and skin levels. Conclusion. The findings suggest that the patients with diffuse peritonitis have changes in microcirculatory regulation aimed at maintaining tissue perfusion. These changes are universal at both the intraorgan and skin levels. Key words: microcirculation, micro blood flow, intestine, peritonitis, tissue perfusion

Функциональное состояние микроциркуляции кишечника при разлитом перитоните

Objective: to evaluate the functional state of intestinal microcirculation in diffuse peritonitis caused by hollow organ perforation and to determine its possible relationship to skin microcirculation. Subjects and methods. Seventeen patients with diffuse peritonitis resulting from hollow organ perforation were examined. The patients’ mean age was 58.5±2.8 years; a control group consisted of 35 apparently healthy individuals. The functional state of the intestinal microcirculatory bed (the mid-transverse colon, the ileum at a distance of 60 cm from the ileocecal corner, the small bowel at a distance of 50 cm of the ligament of Treitz, and an area next hollow organ perforation) and skin was evaluated by laser Doppler flowmetry by means of a ЛАКК-02 laser capillary blood flow analyzer made in the Russian Federation (LAZMA Research-and-Production Association, Russian Federation). Results. Perforation of the affected intestinal portion became worse in patients with diffuse peritonitis. Blood flow stability was ensured by the higher effect of mainly active components of vascular tone regulation on the microvascular bed. Regulatory changes were equally pronounced at both the intraorgan and skin levels. Conclusion. The findings suggest that the patients with diffuse peritonitis have changes in microcirculatory regulation aimed at maintaining tissue perfusion. These changes are universal at both the intraorgan and skin levels. Key words: microcirculation, micro blood flow, intestine, peritonitis, tissue perfusion.Цель исследования . Оценить функциональное состояние микроциркуляции кишечника при разлитом перитоните, вызванном перфорацией полого органа, и определить возможные взаимоотношения с микроциркуляцией кожи. Материал и методы. Обследовано 17 пациентов с разлитым перитонитом, развившимся вследствие перфорации полого органа. Средний возраст составил 58,5±2,8 лет, контрольную группу составили 35 практически здоровых человека. Интраоперационно проводили оценку функционального состояния микроциркуляторного русла кишечника (середина поперечно-ободочной кишки, подвздошная кишка на расстоянии 60 см от илеоцекального угла, тонкая кишка на расстоянии 50 см от связки Трейца и область рядом с перфорацией полого органа) и кожи методом лазерной доппле-ровской флоуметрии, которую осуществляли с помощью лазерного анализатора капиллярного кровотока (ЛАКК-02) отечественного производства (НПО «ЛАЗМА», РФ). Результаты. У пациентов с разлитым перитонитом происходило ухудшение перфузии пораженного участка кишки. Стабильность кровотока в интактных участках кишки обеспечивалась повышением влияния на микрососудистое русло преимущественно активных компонентов регуляции сосудистого тонуса. Изменения регуляции были одинаково выражены как на внутриорганном уровне, так и на коже. Заключение. Полученные в ходе исследования результаты свидетельствуют об изменении регуляции микрокровотока у пациентов с разлитым перитонитом, направленной на поддержание тканевой перфузии. Данные изменения носят всеобщий характер как на внутриорганном уровне, так и на коже. Ключевые слова: микроциркуляция, микрокровоток, кишечник, перитонит, перфузия тканей

Периферическая микроциркуляция и функции эндотелия при комах, обусловленных острым нарушением мозгового кровообращения

Objective: to study the state of systemic microcirculation and endothelial function in comas induced by acute cerebrovascular accident (ACA). Subjects and methods. The study was conducted within the first 7 days of ACA in 38 coma patients, who were divided into groups according to the etiology of stroke: Group 1 comprised 20 patients with hemorrhagic stroke; their mean age was 56.6±2.3 years; Group 2 consisted of 18 patients with ischemic stroke; their mean age was 58.5±2.2 years. A control group included 34 apparently healthy individuals; their mean age was 55.1±2.1 years. The microcirculatory bed was evaluated within 7 days, by applying cutaneous laser Doppler flowmetry using a LAKK-02 capillary blood flow laser analyzer made in Russia (LAZMA Research-and-Production Association, the Russian Federation). Coincidentally with recording of the microcirculatory blood flow, blood samples were collected to explore the serum concentrations of endothelin-1, stable nitric oxide metabolites, van Willebrand factor, and thrombomodulin. Results. Throughout the study, the patients with coma induced by ACA were found to have microcirculatory disorders consisting in higher microperfusion along with the markedly increased influence of active modulators of vascular tone, as well as endothelial functional structural changes. Conclusion. The data obtained in the study suggest that there were uniform changes in the state and regulation of systemic microcirculation in patients with ACA irrespective of the type of stroke (hemorrhagic or ischemic). Key words: stroke, microcirculation, microvascular bed, micro blood flow, tissue perfusion, endothelium.Цель исследования — изучить состояние общей микроциркуляции и функции эндотелия при комах, обусловленных острым нарушением мозгового кровообращения. Материал и методы. Исследование проведено в первые 7 суток острого периода ОНМК у 38 человек, находящихся в коме, которые были разделены на группы согласно этиологии инсульта: 20 больных геморрагическим инсультом составили I группу, средний возраст у них составил 56,6±2,3 лет, 18 человек с ишемическим инсультом — II группу, средний возраст — 58,5±2,2 лет. Контрольную группу составили 34 практически здоровых человека, средний возраст 55,1±2,1 лет. Состояние микроциркуляторного русла оценивалось на протяжении 7 суток методом накожной лазерной допплеровской флоуметрии, которую осуществляли с помощью лазерного анализатора капиллярного кровотока (ЛАКК-02) отечественного производства (НПО «ЛАЗМА», РФ). Одновременно с регистрацией состояния микроциркуляторного кровотока проводили забор образцов крови для исследования концентрации в сыворотке крови эндотелина 1, стабильных метаболитов оксида азота, фактора Виллебранда и тромбомодулина. Результаты. На протяжении всего периода исследования у пациентов, находящихся в коме, обусловленной острым нарушением мозгового кровообращения, регистрируются нарушения микроциркуляции, заключающиеся в увеличении микроперфузии на фоне выраженного повышения влияний активных модуляторов сосудистого тонуса и определяются функционально-структурные изменения эндотелия. Заключение. Полученные в ходе исследования данные свидетельствуют об однотипности изменений состояния и регуляции общего микрокровотока у больных острыми нарушениями мозгового кровообращения вне зависимости от типа инсульта (геморрагический или ишемический). Ключевые слова: инсульт, микроциркуляция, микрососудистое русло, микрокровоток, перфузия тканей, эндотелий

Central Hemodynamics and Microcirculation in Critical Conditions

Objective: to compare central hemodynamic and microcirculatory changes in critical conditions caused by different factors and to reveal their possible differences for a further differentiated approach to intensive therapy. Subjects and methods. The study covered 16 subjects with severe concomitant injury (mean age 41.96±2.83 years) and 19 patients with general purulent peritonitis (mean age 45.34±2.16 years). Their follow-up was 7 days. The central hemodynamics was estimated by transpulmonary thermodilution using a Pulsion PiCCO Plus system (Pulsion Medical Systems, Germany). The microcirculatory bed was evaluated by cutaneous laser Doppler flowmetry using a LAKK-02 capillary blood flow laser analyzer (LAZMA Research-and-Production Association, Russian Federation). Results. The pattern of central hemodynamic and microcirculatory disorders varies with the trigger that has led to a critical condition. Central hemodynamics should be stabilized to ensure the average level of tissue perfusion in victims with severe concomitant injury. In general purulent peritonitis, microcirculatory disorders may persist even if the macrohemodynamic parameters are normal. Conclusion. The macrohemodynamic and microcirculatory differences obtained during the study suggest that a complex of intensive therapy should be differentiated and, if the latter is used, it is necessary not only to be based on the central hemodynamics, but also to take into consideration functional changes in microcirculation. Key words: severe concomitant injury, general purulent peritonitis, micro-circulation, central hemodynamics, type of circulation