МРТ СЕРДЦА С КОНТРАСТИРОВАНИЕМ: АЛЬТЕРНАТИВНЫЙ ИЛИ НЕОБХОДИМЫЙ ДИАГНОСТИЧЕСКИЙ МОДУЛЬ В КАРДИОЛОГИЧЕСКОЙ И КАРДИОХИРУРГИЧЕСКОЙ ПРАКТИКЕ

The review discussed the need for the introduction of contrast agents during cardiac MRI in patients with cardiovascular diseases. Global studies highlighted the ability of gadolinium enhancement (LGE) technique provide detailed in vivo tissue characterisation to help identification cardiac lesions of different etiology. In agreement with the medical literature and own experience and data, the authors offer arguments in favor of mandatory inclusion of MRI with contrast enhancement in the standard diagnostic algorithm in patients with suspected cardiovascular disease of various origins.В статье обсуждается необходимость введения контрастного препарата при проведении МРТ сердца у пациентов c сердечно-сосудистыми заболеваниями. Данные мировых исследований подчеркивают способность МРТ с контрастным усилением в естественных условиях предоставить подробную информацию о поражении миокарда разной этиологии. На основе литературных и собственных данных авторами выдвинуты аргументы в пользу обязательного включения МРТ с контрастным усилением в стандартный диагностический алгоритм обследования пациентов с подозрением на сердечно-сосудистую патологию различного генеза.

СЕРДЕЧНАЯ РЕСИНХРОНИЗИРУЮЩАЯ ТЕРАПИЯ. ФОРМИРОВАНИЕ ПОКАЗАНИЙ И СОВРЕМЕННЫЕ ПОДХОДЫ К ПОВЫШЕНИЮ ЭФФЕКТИВНОСТИ МЕТОДА

The article provides new insights to cardiac resynchronization therapy (CRT), a method of treating chronic heart failure with cardiac biventricular pacing. The article covers the history of its development starting with the first attempts to eliminate heart dyssynchrony up to the present advances. Over the last decades, CRT has significantly improved, including both implantable devices and electrodes, and current CRT guidelines and indications. The article discusses serial changes in indications and selection criteria for patients based on the results of the recent clinical trials assessing its effectiveness. Evidence-based knowledge is presented for the CRT application in the routine clinical practice. Novel approaches and technologies aimed at improving the effectiveness of CRT are presented.Статья посвящена сердечной ресинхронизирующей терапии (СРТ) – методу лечения хронической сердечной недостаточности посредством бивентрикулярной кардиостимуляции. В статье рассматривается история развития метода от первых попыток устранения диссинхронии сердца до настоящего времени. За последние 20 лет метод претерпел существенное изменение как в плане технического совершенствования имплантируемых устройств и электродов, так и в плане формирования современных показаний к его применению. В статье изучается динамика изменений показаний и критериев отбора пациентов на основе результатов клинических исследований по изучению эффективности метода. Приводятся современные показания для применения СРТ и существующая доказательная база, лежащая в их основе. Описываются современные подходы и технологии, направленные на повышение эффективности метода СРТ

ОТЕЧЕСТВЕННЫЕ ЭКСПЛАНТАТЫ «БАСЭКС» В РЕКОНСТРУКТИВНОЙ ХИРУРГИИ АОРТЫ И МАГИСТРАЛЬНЫХ АРТЕРИЙ

Purpose. The use of explants in cardiovascular surgery is often accompanied by infectious, thrombotic, hemorrhagic complications and the most severe complication of postoperative period represents the infection of the explants itself, which develops at a frequency of 1.5 to 6 % followed by a mortality rate of 75–100 %. Thrombosis of the explants after surgery occur with a frequency of 6 to 42 %. Materials and methods. From 1996 to 2015, explants of BASEKS were used in 3 600 patients. Implants of BASEKS were used in 75 patients with aortic valve malformation in combination with an aneurysm of the ascending aorta and prosthetic endocarditis and in 1 944 patients with reconstruction of the aorta and arteries.Results. Bacteriological studies have demonstrated a wide range of antimicrobial action of the modifying components covering the explant and patches. The most promising results were obtained for micro-organisms which most commonly caused infections of these explants. All the sample explants had antimicrobial property and the zone of lysis around these explants were maintained for a longer time (up to 30 days or more). The residual anti-microbial explants after surgery were studied in vitro in 5 patients who died from peritonitis, heart, lungs and kidney failure. Explants after sampling were placed on growth media seeded with clinical strains of microorganisms. Within 12–24 hours, zones (15–18 mm) that caused the delay of the growth of microorganisms were formed around the studied fragments, confirming the preservation of the residual antimicrobial activity of the explants after implantation. During the period of follow-up, in 1.9 % of the patients in immediate postoperative period and in 4.1 % of patients in later postoperative period occurred thrombosis of the explants. Surface festering of the postoperative wound was observed in 155 (4.3 %) patients, deep festering – in 51 (1.4 %), 98 (2.7 %) patients succumbed to postoperative complications.Conclusion. The explants and patches of BASEKS which is antimicrobial, thromb-resistant and impermeable, could be widely used in cardiovascular surgery.Применение эксплантатов в сердечно-сосудистой хирургии нередко сопровождается инфекционными, тромботическими, геморрагическими осложнениями, самым грозным из них является инфицирование протезов, развивающееся с частотой от 1,5 до 6 % и сопровождающееся летальностью от 75 до 100 %. Тромбозы эксплантатов в послеоперационном периоде встречаются с частотой от 6 до 42 %.Цель. Оценка эффективности и безопасности имплантации протезов «БАСЭКС» в сердечно-сосудистой хирургии.Материалы и методы. С 1996 по 2015 год эксплантаты и заплаты «БАСЭКС» были имплантированы у 3 600 больных: у 75 пациентов при пороке аортального клапана в сочетании с аневризмой восходящей аорты и протезном эндокардите, у 1944 – при реконструкции аорты и магистральных артерий.Результаты. Бактериологические исследования продемонстрировали широкий спектр действия антимикробных компонентов модифицирующего покрытия эксплантата и заплат. Все образцы эксплантата обладали антимикробными свойствами, что наблюдалось вплоть до 30 суток после имплантации. Остаточные антиинфекционные свойства эксплантатов после операции были изучены in vitro у 5 умерших пациентов от перитонита, сердечной, легочной и почечной недостаточности. Эксплантаты после забора были помещены на питательные среды, засеянные клиническими штаммами микроорганизмов. Через 12–24 ч зоны задержки роста микроорганизмов вокруг исследуемых фрагментов составляли 15–18 мм, подтверждая тем самым сохранение остаточной антимикробной активности эксплантатов после их имплантации. За период наблюдения у 1,9 % больных в ближайшем послеоперационном периоде и у 4,1 % пациентов в отдаленном периоде наступил тромбоз эксплантатов. Поверхностное нагноение послеоперационной раны отмечалось у 155 (4,3 %), глубокое нагноение – у 51 (1,4%) больных. Послеоперационная летальность составила 2,7%.Заключение. Эксплантаты «БАСЭКС» демонстрируют удовлетворительные антимикробные, тромборезистентные свойства и могут широко применяться в сердечно-сосудистой хирургии.

Reduced costs with bisoprolol treatment for heart failure - An economic analysis of the second Cardiac Insufficiency Bisoprolol Study (CIBIS-II)

Background Beta-blockers, used as an adjunctive to diuretics, digoxin and angiotensin converting enzyme inhibitors, improve survival in chronic heart failure. We report a prospectively planned economic analysis of the cost of adjunctive beta-blocker therapy in the second Cardiac Insufficiency BIsoprolol Study (CIBIS II). Methods Resource utilization data (drug therapy, number of hospital admissions, length of hospital stay, ward type) were collected prospectively in all patients in CIBIS . These data were used to determine the additional direct costs incurred, and savings made, with bisoprolol therapy. As well as the cost of the drug, additional costs related to bisoprolol therapy were added to cover the supervision of treatment initiation and titration (four outpatient clinic/office visits). Per them (hospital bed day) costings were carried out for France, Germany and the U.K. Diagnosis related group costings were performed for France and the U.K. Our analyses took the perspective of a third party payer in France and Germany and the National Health Service in the U.K. Results Overall, fewer patients were hospitalized in the bisoprolol group, there were fewer hospital admissions perpatient hospitalized, fewer hospital admissions overall, fewer days spent in hospital and fewer days spent in the most expensive type of ward. As a consequence the cost of care in the bisoprolol group was 5-10% less in all three countries, in the per them analysis, even taking into account the cost of bisoprolol and the extra initiation/up-titration visits. The cost per patient treated in the placebo and bisoprolol groups was FF35 009 vs FF31 762 in France, DM11 563 vs DM10 784 in Germany and pound 4987 vs pound 4722 in the U.K. The diagnosis related group analysis gave similar results. Interpretation Not only did bisoprolol increase survival and reduce hospital admissions in CIBIS II, it also cut the cost of care in so doing. This `win-win' situation of positive health benefits associated with cost savings is Favourable from the point of view of both the patient and health care systems. These findings add further support for the use of beta-blockers in chronic heart failure

IMPLANTABLE CARDIOVERTER DEFIBRILLATORS ARE THE MAIN MODE FOR SUDDEN CARDIAC DEATH PREVENTION

This review is devoted to a method of sudden cardiac death (SCD) prevention by means of the implanted cardioverter defibrillators (ICD). In our study we present definition, epidemiology, mechanism and the nosological reasons of SCD. Further is the historical review of defibrillation development, cardioversion, creation and improvement of the implanted antiarrhytmic devices. Thus we present the analysis of the main clinical trials on ICD efficiency studying in primary and secondary prevention of SCD. The main advantages of these devices in patients with high risk of SCD development are shown

HIGH GRADE PULMONARY HYPERTENSION: OPPROTUNITIES OF ECHOCARDIOGRAPHY IN ASSESSING FAULTS IN CARDIAC FUNCTION AND PROGNOSIS OF THE CLINICAL COURSE

High grade pulmonary hypertension (HGPH) determines invalidization, low quality of life and causes fatal outcomes. Aim of the study: to use echocardiography to evaluate the morphological and functional condition of ventricular myocardium and criteria determining prognosis. Materials and methods: 40 patients with HGPH aged 3 to 56 underwent echocardiography for the period of 1999-2000 in the Center and were divided into the following groups: 1) patients with congenital heart disease and Eisenmenger complex (22); 2) patients with progressing pulmonary hypertension after a vicium cordis is corrected; 3) patients with primary pulmonary hypertension (PLH) (11). Echocardiography was used to evaluate: systolic function – ejection fraction for each ventricle, fractional change in right ventricle, cardiac index of the greater circle; diastolic function of the ventricles, LV excentricity index, reflecting septum geometry, the degree of RV hypertrophy, end diastolic square of the right ventricle, hemodynamics of the lesser circle. Results: in patients with progressing pulmonary hypertension after a vicium is corrected and in patients with pulmonary hypertension we have revealed RV dysfunction and decreased cardiac index of the greater circle which defines a severe clinical course of the disease. In a group with NYHA IV we observed a marked decrease in RV systolic function, impaired RV diastolic function in a restrictive way and decreased cardiac index of the greater circle. In patients with a septum defect and Eisenmenger complex RV diastolic function was not impaired in a restrictive way (end diastolic pressure in RA and RV not increased), despite significantly dilated right heart chambers, decreased RV systolic function and cardiac index of the greater circle. Therefore we draw a conclusion that a defect levels RV failure defining a favorable prognosis. Preserved ventricular systolic function, their hypertrophy and normal cardiac index of the greater circle is typical in most cases of septum defects, persisting ductus arteriosus and Eisenmenger complex. The severe clinical course is defined by a significant hypoxemia, playing an important role in the impairment of either ventricle

Comparative results of isolated profundoplasty and distal bypass surgery in patients with diabetes mellitus and trophic ulcers

Aim. To compare the results of lower limb revascularization in patients with diffuse lesions of lower limb arteries who underwent femoral-distal bypass surgery and isolated reconstruction of the deep femoral artery (DFA) in the immediate postoperative period.Materials and methods. The study included 86 patients with diffuse arterial lesions of lower extremities, 52 (60.4%) men and 34 (39.6%) women with the average age of 67.3 ± 16.8 years. All patients had diffuse lesions of the arteries below the Poupart’s ligament; the condition of the lower leg arteries was 5–8.5 points on the Rutherford scale. Trophic ulcers were present in all cases. Group 1 included 48 patients who underwent reconstruction of lower leg arteries. Group 2 included 38 patients whose surgical intervention was limited to endarterectomy from the common femoral and deep femoral arteries.Results. In the early postoperative period, 1 (2.1%) patient (from group 1) died from developed myocardial infarction. The patient underwent a femoral-popliteal-tibial bypass surgery with a composite Y-shaped graft. In group 2, no fatal complications were observed. After the operation, all patients demonstrated an increase in the linear blood flow velocity in the arteries of the foot and the transcutaneous oxygen tension (TOT). The TOT level 14 days after surgery comprised 44.1 mm Hg and 39.9 mm Hg (p> 0.05) in groups 1 and 2, respectively.Conclusions. In 86.8% of patients, isolated profundoplasty followed by vasotropic therapy allows the target values of TOT to be obtained, which is necessary for successful healing of lower limb trophic ulcers

МРТ СЕРДЦА С КОНТРАСТИРОВАНИЕМ: АЛЬТЕРНАТИВНЫЙ ИЛИ НЕОБХОДИМЫЙ ДИАГНОСТИЧЕСКИЙ МОДУЛЬ В КАРДИОЛОГИЧЕСКОЙ И КАРДИОХИРУРГИЧЕСКОЙ ПРАКТИКЕ

The review discussed the need for the introduction of contrast agents during cardiac MRI in patients with cardiovascular diseases. Global studies highlighted the ability of gadolinium enhancement (LGE) technique provide detailed in vivo tissue characterisation to help identification cardiac lesions of different etiology. In agreement with the medical literature and own experience and data, the authors offer arguments in favor of mandatory inclusion of MRI with contrast enhancement in the standard diagnostic algorithm in patients with suspected cardiovascular disease of various origins.В статье обсуждается необходимость введения контрастного препарата при проведении МРТ сердца у пациентов c сердечно-сосудистыми заболеваниями. Данные мировых исследований подчеркивают способность МРТ с контрастным усилением в естественных условиях предоставить подробную информацию о поражении миокарда разной этиологии. На основе литературных и собственных данных авторами выдвинуты аргументы в пользу обязательного включения МРТ с контрастным усилением в стандартный диагностический алгоритм обследования пациентов с подозрением на сердечно-сосудистую патологию различного генеза. </p