Adaptational role of mitochondrial changes in congenital central core myopathy: new proofs

The objective of the investigation was to study the ultrastructural morphology of muscle tissue mitochondria versus other clinical and laboratory indicators in 21 patients with congenital central core myopathy. The findings demonstrate that the sizes of mitochondria are correlated with the levels of lactate and pyruvate; however, the magnitude and direction of this correlation differ in the subsarco-lemmal and intermyofibrillar mitochondrial fractions. It is concluded that the baseline level of lactic acid in the blood of the patients depends on the number of mitochondria whereas the maturity of organelles largely provides a tissue response to elevated lactic acid levels. Our data are evidence in favor of an assumption that rounded mitochondria are less mature and effective in performing then-main functions. The increase in the number of ellipsoidal organelles in the subsarcolemmal region of muscle fibers is ascertained to be an important compensatory mechanism in nonmitochondrial muscle diseases. Thus, the investigation has established the role of changes in the number and sizes of mitochondria in tissue adaptation to the conditions of functional insufficiency. The found

THE RESULTS OF SURGICAL TREATMENT OF TRICUSPID VALVE INFECTIVE ENDOCARDITIS USING VALVE REPAIR AND VALVE REPLACEMENT OPERATIONS

Aim. To evaluate in-hospital and long-term results of surgical treatment of patients with infective endocarditis of the tricuspid valve, to compare the effectiveness of valve repair and valve replacement techniques, and to identify risk factors of mortality and reoperations. Materials and methods. 31 surgical patients with tricuspid valve infective endocarditis were evaluated. Patients were divided into 2 groups. In Group 1 (n = 14) repairs of the tricuspid valve were performed, in Group 2 (n = 17) patients had undergone tricuspid valve replacements. Epidemiological, clinical, microbiological and echocardiographic data were studied. Methods of comparative analysis, the Kaplan–Meier method, and Cox risk models were applied. Results. The most common complication of in-hospital stay was atrioventricular block (17.7% of cases in Group 2). In Group 1, this type of complication was not found. Hospital mortality was 7.14% in Group 1, and 0% in Group 2. Long-term results have shown the significant reduction of heart failure in general cohort and in both groups. In Group 1 the severity of heart failure in the long term was less than in Group 2. No significant differences in the severity of tricuspid regurgitation were found between the groups. In 7-year follow up no cases of death were registered in Group 1. Cumulative survival rate in Group 2 within 60 months was 67.3 ± 16.2%. No reoperations were performed in patients from Group 1. In Group 2, the freedom from reoperation within 60 months was 70.9 ± 15.3%. Combined intervention was found as predictor of postoperative mortality. Prosthetic valve endocarditis was identified as risk factor for reoperation. Conclusion. Valve repair and valve replacement techniques of surgical treatment of tricuspid valve endocarditis can provide satisfactory hospital and long-term results. Tricuspid valve repair techniques allowed reducing the incidence of postoperative atrioventricular block. In the long-term, patients after tricuspid valve repair have shown less severity of heart failure as well as better rates of survival and freedom from reoperation. Combined intervention and prosthetic endocarditis were found to be main risk factors for adverse outcome