Results of surgical treatment of postinfarction left ventricular aneurysm complicated with ventricular tachycardia with use of 3D-navigation system CARTO™

The aim of the research was to study localization of wandering focus and effectiveness of extensive endocardectomy at left ventricular reconstruction in patients with ischemic heart disease (IHD) with postinfarction left ventricular aneurysm (LVA) in combination with ventricular tachycardia (VT). Examined patients besides diagnostic routines had intracardiac electrophysiological examination (EPE) with use of 3D-navigation system CARTOTX (Biosense Webster). During EPE abnormal zones of delayed navigating and zones of double potential with main localization in the area of cacuminal and middle septate segments were found. All patients were divided into two groups: patients of the first group had aortocoronary bypass (ACB) in combination with left ventricular reconstruction completed with extended resection of endocardium with pinch of all cacuminal and middle septate segments; 2 patients of the second group had isolated ACB, 2 patients had ACB with mitral annuloplasty with rim and de Vega plasty of tricuspid valve, 1 patient had percutaneous transluminal coronary angioplasty, 10 patients hadACB in combination with LVA plasty without extended endocardium resection. As the result of the treatment in the first group there were no VT episodes after resection of aneurysm with extended endocardium resection; 33 % of patients in the second group had implantable cardioverter defibrillator, 7 % of the patients had radio frequency ablation of VT nidus, 7 % of the patients had anti-arrhythmic therapy. Taking into consideration that main localization of ectopic nidus in patients with IHD with postinfarction LVA and VT is in the area of cacuminal and middle septate segments, left ventricular reconstruction in these patients needs to be conducted with extended resection of endocardium of these segments

Interleukins 4 and 6 as factors of modulation of subpopulation composition of blood monocytes in patients with ischemic cardiomyopathy

Aim. To evaluate the ratio of the fractions of classical, intermediate, non-classical and transitional monocytes in correlation with the concentration of interleukins 4 and 6 in the blood of patients with ischemic cardiomyopathy. Methods. 18 patients with ischemic cardiomyopathy (17 men and 1 woman) aged 47-66 years with circulatory insufficiency of functional class II-III according to the classification of heart failure of the New York Heart Association, were examined. The control group included 14 healthy donors matched by gender and age to patients with ischemic cardiomyopathy without any diseases of cardiovascular system and other systems in an exacerbation stage. In blood of the patients with ischemic cardiomyopathy, the relative content of classical (CD14++CD16-), intermediate (CD14++CD16+), non-classical (CD14+CD16+) and transitional (CD14+CD16-) monocytes was assessed by flow cytometry and the concentration of interleukins 4 and 6 by enzyme-linked immunosorbent assay (ELISA). Results. It was shown that the number of non-classical monocytes in the blood of patients with ischemic cardiomyopathy was 2 times lower than normal (5.05 % [4.08; 6.58] and 10.07 % [9.34; 13.84], respectively, p < 0.01), as well as the concentration of interleukin-4 (0.02 pg/ml [0; 0.04] and 0.15 pg/ml [0.05; 0.65], respectively, p < 0.05). The number of classical monocytes in the blood of patients had a tendency to decrease, and the proportion of intermediate monocytes and the concentration of interleukin-6, on the contrary, were slightly higher than in healthy individuals, and were interdependent (r = 0.61; p < 0.05). The relative content of transitional monocytes in the blood was comparable with that of healthy donors. Conclusions. The subpopulation composition of blood monocytes in patients with ischemic cardiomyopathy is characterized by a deficiency of the fraction of non-classical monocytes with protective properties against endothelium, and interleukin-4 in the blood with a certain increase in the content of interleukin-6 and the number of intermediate cells with ability to cooperate with T-lymphocytes, which predisposes to diffuse atheromatosis of small coronary arteries and diffuse hypoxic myocardial damage in ischemic cardiomyopathy

Cytokines and HIF-1α as dysregulation factors of migration and differentiation of monocyte progenitor cells of endotheliocytes in the pathogenesis of ischemic cardiomyopathy

Background. Angiogenic endothelial dysfunction and progenitor endothelial cells (EPCs) in ischemic cardiomyopathy (ICMP) have not been studied enough.The aim. To establish the nature of changes in the cytokine profile and HIF-1α in blood and bone marrow associated with impaired differentiation of monocytic progenitor cells of endotheliocytes (CD14+VEGFR2+) in the bone marrow and their migration into the blood in patients with coronary heart disease (CHD), suffering and not suffering from ICMP.Materials and methods. A single-stage, single-centre, observational case-control study was conducted involving 74 patients with CHD, suffering and not suffering from ICMP (30 and 44 people, respectively), and 25 healthy donors. In patients with CHD, bone marrow was obtained during coronary bypass surgery, peripheral blood – before surgery. Healthy donors were taken peripheral blood. The number of CD14+VEGFR2+ in bone marrow and blood was determined by flow cytometry; the concentration of IL-6, TNF-α, M-CSF, GM-CSF, MCP-1 and HIF-1α – by the method of enzyme immunoassay.Results. A high content of CD14+VEGFR2+ cells in the blood of patients with CHD without cardiomyopathy was established relative to patients with ICMP against the background of a comparable number of these cells in myeloid tissue. Regardless of the presence of ICMP in the blood, patients with CHD showed an excess of TNF-α, a normal concentration of IL-6, GM-CSF, HIF-1α and a deficiency of M-CSF, and in the bone marrow supernatant, the concentration of IL-6 and TNF-α exceeded that in the blood plasma (the level of GM-CSF – only in patients without cardiomyopathy). With ICMP, the normal concentration of MCP-1 was determined in the blood plasma, and with CHD without cardiomyopathy, its elevated content was determined.Conclusion. The formation of ICMP is accompanied by insufficient activation of EPCs migration with the CD14+VEGFR2+ phenotype in blood without disruption of their differentiation in the bone marrow, which associated with the absence of an increase in the concentration of MCP-1 in blood plasma and not associated with the plasma content of M-CSF, GM-CSF, HIF-1α, IL-6 and TNF-α

Our experience of surgical treatment of aortic arch obstruction in children in the presence of antegrade selective cerebral perfusion

This work is about outcomes of surgical treatment aortic arch obstruction in children performed with the use of selective cerebral perfusion and moderate hypothermia. The study included 97 patients with aortic coarctation, recoarctation and hypoplastic aortic arch. The patients were divided into 3 groups. 75 patients with isolated coarctation and recoarctation or with concomitant atrial septal defects, patentforamen ovale and patent ductus arterious were assigned to the 1st group. The 2nd group included 13 patients with aortic arch obstruction and ventricular septal defects. The 3rd group consisted of 9 patients with coarctation, recoarctation and complex intracardiac anomalies. All patients underwent reconstruction of the aortic arch with selective cerebral perfusion and moderate hypothermia. Overall mortality rate was 4%. Postoperative complications took place in 7% of the cases: 1% - postoperative bleeding, 1% - paresis of the diaphragm, 2% - pneumothorax, 2% - chylothorax, and 1% of the cases - vocal cords paresis. Respiratory postoperative complications were registered in 5% of cases. In 6% of the cases patients had neurological postoperative complications. After the operation there was no gradientfound between the pressures on upper and lower extremities. We consider that antegrade selective cerebral perfusion and moderate hypothermia during aortic arch reconstruction are effective methods of brain and visceral organs protection

Improvement of Diagnostic System in a Real-Time RT-PCR “AmpliSens EBOV (ZAIRE)-FL” Format for Zaire ebolavirus RNA Detection

Taking into consideration experience in utilization of “AmpliSens EBOV (ZAIRE)-FL” in the setting of SAET mobile laboratory complex, carried out has been the improvement of the panel with a view to elapsed time reduction and analytical sensitivity enhancement. It provides for the analytical sensitivity increase up to 200 copies per ml, which is 10 times higher than the previous measurement, that accounted for 2·103 copies per ml. The timing of the assay has been reduced up to 1 h 25 min, which is 25 % less than the time needed for the standard study. Modification of “AmpliSens EBOV (ZAIRE)-FL” panel benefits to the enhancement of epidemiological surveillance activities intended to stop the spread of Zaire ebolavirus in West Africa and prevent its importation into the Russian Federation

ХИРУРГИЧЕСКАЯ КОРРЕКЦИЯ МЕТАСТАТИЧЕСКОГО ПОРАЖЕНИЯ СЕРДЦА ПРИ РАКЕ ШЕЙКИ МАТКИ

Metastases to the heart are extremely rare, and the reported incidence of cardiac metastasis at autopsy ranges from 1.5 to 21.8  %. In cancer patients, cardiac metastases are usually difficult to  diagnose unless the patients do not complain of any related  symptoms. Common tumors with cardiac metastasis potential are  usually carcinomas of the lung, breast, and malignant lymphoma.  The prognosis of a metastatic heart tumor is unfavorable. The  average life expectancy for patients with this diagnosis is less than  six months. In addition, surgical treatment of primary cardiac tumors or metastatic cardiac tumors is associated with high risk of  perioperative lethality. Case report. We present a rare case of  cervical cancer metastasis to the heart in a 33-year-old woman.  Cytological examination revealed no evidence of disease recurrence  14 months after the completion of external beam radiotherapy.  Echocardiography showed a mass in the outflow tract of the right ventricle and findings of severe pulmonary hypertension.  omputed tomography and magnetic resonance imaging revealed a  large right ventricular thrombus. The patient underwent surgery with  artificial circulation. Pathohistological and immunohistochemical studies revealed metastasis of squamous cell carcinoma. The control  echocardiography showed decrease in pulmonary hypertension. No  evidence of right ventricular mass was detected. Conclusion. Cardiac metastasis should be included in the differential diagnosis in patients with complaints of dyspnea and chest pain, especially in cases with history of cancer. Surgical treatment of cardiac metastasis  contributes to the prevention of cardiopulmonary complications and  improvement of survival rates in this group of patients.Актуальность. Метастатическое поражение сердца – крайне редкая патология, частота которой по данным аутопсии онкологических больных составляет 1,5–21,8 %. Клинический  диагноз метастазов в сердце затруднен и не всегда устанавливается прижизненно.  Источником метастазов в сердце, как правило, являются злокачественные опухоли легких,  рак молочной железы, лимфомы. Прогноз неблагоприятен, средняя продолжительность  жизни таких пациентов, по данным различных авторов, составляет менее 6 мес.  Оперативное вмешательство по поводу первичных или метастатических опухолей сердца  сопровождается высокой периоперационной летальностью и требует взвешенного решения.  Представлено редкое клиническое наблюдение метастатического поражения правых камер сердца с последующей хирургической коррекцией.Описание клинического случая. Метастатическое поражение сердца у больной 33 лет,  страдающей раком шейки матки. Через 14 мес после завершения курса дистанционной  лучевой терапии по данным цитологии с рубца влагалища не было выявлено признаков  рецидива. При эхографическом исследовании обнаружено объемное образование правого желудочка с обструкцией выводного отдела, признаки выраженной легочной  гипертензии. По данным КТ и МРТ выявлен массивный тромбоз правого желудочка (ПЖ). По  жизненным показаниям было выполнено оперативное вмешательство в объеме удаления  новообразования правого желудочка в условиях искусственного кровообращения. При  гистологическом и иммуногистохимическом исследованиях операционного материала  выявлен метастаз плоскоклеточного рака. При контрольном эхокардиографическом  исследовании определялось снижение степени легочной гипертензии, признаков  новообразований полости ПЖ не выявлено.Заключение. Представленное клиническое наблюдение показывает, что метастатическое  поражение сердца необходимо включать в дифференциальный ряд у пациентов с жалобами  на одышку и боли в грудной клетке, особенно при наличии онкологического анамнеза.  Хирургическая коррекция метастатического поражения сердца способствует профилактике возможных сердечно-легочных осложнений, а также является вариантом  улучшения продолжительности жизни у данной группы пациентов

Production of angiogenesis mediators and the structure of the vascular wall in the heart in ischemic cardiomyopathy

Background. In the pathogenesis of ischemic cardiomyopathy (ICMP), angiopoiesis remains unexplored.The aim. To describe the vasculature of the heart and the imbalance of angiogenesis mediators in the coronary circulation in association with the number of endothelial progenitor cells (EPC) and desquamated endothelial cells (DEC) in the blood of patients with coronary heart disease (CHD), suffering and not suffering from ICMP.Methods. Fifty-two patients with CHD (30  patients with ICMP, 22  patients without  ICMP), 15  healthy donors were examined. The content of EPC (CD14+CD34+VEGFR2+) in the blood from the cubital vein and DEC (CD45–CD146+) in the blood from the coronary sinus and the cubital vein was determined by flow cytometry. The concentrations of VEGF-A (vascular endothelial growth factor A), PDGF (platelet-derived growth factor), and SDF-1 (stromal cell-derived factor 1) in blood plasma were recorded using immunofluorescence assay; the angiopoietin-2, MMP-9 (matrix metallopeptidase 9) were recorded using enzyme immunoassay. In myocardial biopsies the specific area of vessels and the expression of αSMA (smooth muscle alpha-actin) were determined by morphometric and immunohistochemical methods.Results. In the peripheral blood of patients with CHD, regardless of the presence of ICMP, the DEC content exceeded the physiological level, and the VEGF-A, PDGF, angiopoietin-2, and MMP-9 corresponded to the norm. In CHD patients without cardiomyopathy, there was an excess of SDF-1 and EPC in the blood from the cubital vein, and in ICMP, their physiological significance was noted. In the coronary blood flow in patients with CHD without cardiomyopathy, an increase in the concentration of PDGF was found, which was not determined in patients with ICMP, who had an increased content of DEC, angiopoietin-2 and MMP-9. The specific area of the vessels in the patients of the two groups was comparable; the expression of αSMA in ICMP was 6.2 times lower than in patients with CHD without cardiomyopathy.Conclusion. The development of ICMP is accompanied by impaired maturation of vessels in the myocardium, associated with the absence of a compensatory reaction of activation of cellular and humoral factors of angiogenesis

Дифференциация и субпопуляционный состав VEGFR2+ моноцитов крови и костного мозга при ишемической кардиомиопатии

Aim. To identify disturbances of differentiation and subpopulation composition of VEGFR2+ cells in the blood and bone marrow associated with the features of the cytokine profile in the blood and bone marrow in patients with coronary artery disease (CAD) with and without ischemic cardiomyopathy (ICM).Materials and methods. The study included 74 patients with СAD with and without ICM (30 and 44 people, respectively) and 18 healthy donors. In all patients with СAD, peripheral blood sampling was performed immediately before coronary artery bypass grafting, and bone marrow samples were taken during the surgery via a sternal incision. In the healthy donors, only peripheral blood sampling was performed. In the bone marrow and blood samples, the number of VEGFR2+ cells (CD14+VEGFR2+ cells) and their immunophenotypes CD14++CD16-VEGFR2+, CD14++CD16+VEGFR2+, CD14+CD16++VEGFR2+, and CD14+CD16-VEGFR2+ was determined by flow cytometry. Using enzyme-linked immunosorbent assay, the levels of VЕGF-А, TNFα, M-CSF, and IL-13, as well as the content of MCP-1 (only in the blood) and the M-CSF / IL-13 ratio (only in the bone marrow) were determined.Results. The content of CD14+VEGFR2+ cells in the blood of CAD patients with and without ICM was higher than normal values due to the greater number of CD14++CD16-VEGFR2+, CD14++CD16+VEGFR2+, and CD14+CD16++VEGFR2+. In the bone marrow of the patients with ICM, the content of CD14++CD16-VEGFR2+, CD14+CD16++VEGFR2+, and CD14+CD16-VEGFR2+ was lower than in patients with CAD without ICM, and the number of CD14++CD16+VEGFR2+ cells corresponded to that in the controls. Regardless of the presence of ICM in CAD, a high concentration of TNFα and normal levels of VEGF-A and IL-13 were observed in the blood. In CAD without ICM, an excess of MCP-1 and deficiency of M-CSF were revealed in the blood. In the bone marrow, the levels of VEGF-A, TNFα, M-CSF, and IL-13 were comparable between the groups of patients against the background of a decrease in the M-CSF / IL-13 ratio in the patients with ICM.Conclusion. Unlike CAD without cardiomyopathy, in ICM, no excess of VEGFR2+ cells and MCP-1 in the blood is observed, which hinders active migration of CD14+CD16++VEGFR2+ cells from the myeloid tissue, and a decrease in the M-CSF / IL-13 ratio in the bone marrow disrupts differentiation of other forms of VEGFR2+ cells, preventing vascular repair.Цель: установить нарушения дифференцировки и субпопуляционного состава VEGFR2+ моноцитов в крови и костном мозге во взаимосвязи с особенностями цитокинового профиля крови и костного мозга у больных ишемической болезнью сердца (ИБС), страдающих и не страдающих ишемической кардиомиопатией (ИКМП).Материалы и методы. В исследование вошли 74 больных ИБС, страдающих и не страдающих ИКМП (30 и 44 человека соответственно), и 18 здоровых доноров. У всех больных ИБС забор периферической крови производился непосредственно перед операцией коронарного шунтирования, а костного мозга – из разреза грудины во время операции. У здоровых доноров забирали только периферическую кровь.  В костном мозге и крови методом проточной цитофлуориметрии определяли численность VEGFR2+ моноцитов (CD14+VЕGFR2+ клеток) и их иммунофенотипов CD14++CD16-VEGFR2+, CD14++CD16+VEGFR2+, CD14+CD16++VEGFR2+, CD14+CD16-VEGFR2+, методом иммуноферментного анализа регистрировали концентрацию VЕGF-А, TNFα, M-CSF, IL-13, а также содержание MCP-1 (только в крови) и соотношение M-CSF/IL-13 (только в костном мозге).Результаты. Содержание CD14+VEGFR2+ клеток в крови у больных ИБС без кардиомиопатии и с ИКМП было выше нормы из-за большей численности CD14++CD16-VEGFR2+, CD14++CD16+VEGFR2+ и CD14+CD16++VEGFR2+ форм. В костном мозге у больных ИКМП содержание CD14++CD16-VEGFR2+, CD14+CD16++VEGFR2+ и CD14+CD16-VEGFR2+ форм было ниже, чем у больных ИБС без кардиомиопатии, а количество CD14++CD16+VEGFR2+ клеток соответствовало их числу в группе сравнения. Вне зависимости от наличия ИКМП при ИБС в крови отмечалась высокая концентрация TNFα, нормальный уровень VEGF-А и IL-13; при ИБС без кардиомиопатии – избыток МСР-1 и дефицит M-CSF в крови. В костном мозге концентрация VЕGF-А, TNFα, M-CSF, IL-13 была сопоставимой между группами больных на фоне снижения M-CSF/IL-13 у пациентов с ИКМП.Заключение. В отличие от ИБС без кардиомиопатии при ИКМП не формируется избыток VEGFR2+ моноцитов и МСР-1 в крови, что затрудняет активную миграцию CD14+CD16++VEGFR2+ клеток из миелоидной ткани, а снижение M-CSF/IL-13 в костном мозге нарушает дифференцировку остальных форм VEGFR2+ моноцитов, препятствуя репарации сосудов