Surgical treatment of pseudoaneurysm of the free left ventricle wall: a clinical caseO. Kiziukevich, S. Spiridonov, A. Zhyhalkovich, D. Isachkin
Today diseases of the cardiovascular system are the leading cause of death in many countries. The key role in this pathology is played by ischemic heart disease. An extreme manifestation of ischemic heart disease – myocardial infarction is one of the main causes of complications and mortality in patients with ischemic heart disease. One of the most formidable complications of acute myocardial infarction is heart rupture, which most often leads to death, more than 60% of cases occurring in the prehospital stage. Many studies of similar groups of patients show a wide spread in assessing the incidence and mortality of this pathology. The development of myocardial ruptures has two frequency peaks: the first day and 5–7 days from the onset of AMI. The most common case is acute rupture of the free wall of the left ventricle with extensive hemorrhage in the pericardium leading to a fulminant death. The development of a pseudoaneurysm of the left ventricle is a very rare outcome of the myocardial rupture.
Some aspects of clinical and laboratory parameters in newborns from mothers with coronavirus infection SARS-CoV-2 (COVID-19), infected at different times of perinatal periodI. Loginova, A. Ustinovich, E. Alferovich, I. Payuk, V. Shnitko
The problem of coronavirus infection has been the world’s concern since 2019. At the same time, the issues of infection of newborn children remain unclear, the issue of vertical transmission of the virus from mother to child is being discussed. The aim of our study was to study the features of the period of postnatal adaptation of newborns born to mothers with coronavirus infection SARS-CoV-2 (COVID-19), taking into account the time of infection occurrence. We analyzed the features of the neonatal course in children from the mothers with confirmed Covid-19 infection (PCR RNA of SARS-Cov 2) revealed in the mothers either during pregnancy or in the postpartum period. When examining children, we used clinical, laboratory, and biochemical research methods. It was found that children whose mothers contracted coronavirus infection COVID-19 immediately before childbirth had an aggravated course of the neonatal period compared with children from mothers who had recovered in the middle of pregnancy, and the manifestations of infection and post-hypoxic syndrome were more pronounced in the former. Laboratory investigations proved that newborns from the mothers who fell ill shortly before childbirth had acute viral inflammation.
Tetralogy of Fallot – «Old» congenital heart defect in the xxi century – unresolved questions of stage-by-stage surgical correctionP.F. Charnahlaz
Despite the fact that the defect has been known for a long time and methods of surgical correction have been developed that allow achieving excellent immediate and long-term results, the tactical issues of stage-by-stage correction of the defect in situations where primary radical correction is impossible due to such reasons as a severe initial condition, low weight of the patient, underdevelopment of the branches of the pulmonary artery (PA) have not yet been fully resolved. In addition to classical Blalock-Taussig intersystem anastomoses, such endovascular techniques of maintaining pulmonary blood flow as stenting of the right ventricular outflow tract (RVOT) and stenting of the patent ductus arteriosus (PDA) are being introduced into clinical practice. These techniques, with all the advantages of minimally invasive technologies in certain clinical and anatomical situations, are not inferior, and in most cases surpass classical surgical techniques.
Independent predictors and prognosis of long-term myocardial infarction in patients with unstable angina after coronary artery stentingMiadzvedzeva Alena, Gelis Ludmila, Polonetsky Oleg, Russkikh Iryna
Objective. to develop independent predictors for predicting long-term myocardial infarction (MI) in patients (pts) with unstable angina (UA) after coronary artery stenting (PCI) based on the results of a seven-year follow-up. Materials and Methods. The study involved 165 pts with UA and coronary artery stenting (PCI). PCI was performed in 3.2±1.6 days after admission to the in-patient department. Drug-coated stents (Xience V and Biomatrix) were used, the average number of stents was 2.1±0.8 per person, the average length of the stented area was 43.12±25.6 mm, and the average diameter of the implanted stents was 3.12±0.5 mm. All patients were assessed for troponin I, myeloperoxidase, and C-reactive protein levels; coagulation hemostasis was assessed; and a thrombin generation test was performed. The aggregatogram was performed on the analyzer Multiplate (ASPI-test, ADP-test). The patients underwent echocardiography, coronary angiography. Double antithrombotic therapy with clopidogrel 75 mg and acetylsalicylic acid 75 mg was prescribed for 12 months. The follow-up period was 7.0±1.6 years.
Early and alternative markers of chronic heart failure in patients with diabetes mellitusV. Vasilkova, T. Mokhort, L. Korotaeva, Y. Yarets, I. Pchelin, V. Bayrasheva, O. Shestovets, Y. Borovets, E. Naumenko, N. Filiptsova
Aim: to assess the relationship of proinflammatory cytokines and chemokines with the levels of natriuretic peptides in patients with diabetes mellitus (DM). Materials and methods. A total of 155 patients (14 men and 61 women) with type 1 and type 2 diabetes, aged 34 to 84 years, were examined. All patients underwent standard clinical and laboratory examination, with an assessment of the levels of pro-inflammatory cytokines (interleukin 6 (IL-6), tumour necrosis factor alpha (TNF-alpha), chemokines (monokine induced by interferon-gamma (MIG), regulated upon activation, normal T cell expressed and presumably secreted (RANTES), growth factors (fibroblast growth factor-23 (FGF-23), vascular endothelial growth factor (VEGF-A), natriuretic peptides (B‐type natriuretic peptide (BNP), N‐terminal fragment of B‐type natriuretic peptide (proBNP). Renal function was assessed based on the levels of serum creatinine, glomerular filtration rate (GFR), which was calculated according to the CKD-EPI formula, and albuminuria, which was assessed as albumin/creatinine ratio (A/C). An echocardiographic examination was conducted according to the standard protocol with the calculation of dimensional, volume and speed characteristics. Statistical data analysis was performed using smSTATA 14.2 for Mac (2018).
Prognostic factors of Wolff-Parkinson-White syndrome in childrenE. Zasim, V. Strogiy
Objective: to determine the prognostic factors determining the severity of Wolff-Parkinson-White syndrome (WPW) in children. Methods: a retrospective analysis of the course of the disease was performed in 108 children with WPW syndrome aged 13.6 (12-16) years. Depending on the number of attacks of paroxysmal tachycardia (PT), all children were divided into 2 groups: group A consisted of 47 children (43.5%) with a history of no more than three attacks of PT and they were rare-group B included 61 children (56.5%) with frequent (more than once a month) attacks of PT, more than four in the history. We studied: the family history, the clinical picture of the disease, the nature of paroxysmal tachycardia, the effectiveness of treatment, and the results of instrumental studies. Using the method of mathematical modeling, the informative value of each feature was determined, and the diagnostic value was determined.
Application of photomodification of blood using low-intensity optical radiation in the combination treatment of patients with unstable anginaO. Laskina, G. Zalesskaya, N. Mitkovskaya
The in vivo effect of low-intensity optical radiation (LIOR) on the blood of patients with unstable angina (UA) was studied. The integration of LIOR in the combined therapy of patients with UA proved to result in positive changes in the oxygen uptake system. Changes in the absorption spectra of the patients’ blood samples, blood oxygenation characteristics, and the proportion of metabolic products were studied at all stages of light exposure. The absorption of LIOR by the blood was found to lead to its photomodifica tion, which was manifested in changes of the partial pressure of blood gases, the content of oxyhemoglobin and the degree of saturation of hemoglobin with oxygen. LIOR affects the oxygen exchange in the body of patients with UA, changes the delivery and consumption of oxygen by tissues, initiates positive changes in the balance between the production of reactive oxygen intermediates, acting as physiologically active compounds, and their inhibition by antioxidant systems.
Diagnostic signs of myocardial reperfusion injury after coronary artery bypass graftingShybekа Nаtallia, Gelis Lyudmila, Rusak Tatsiana
One of the main causes for operative mortality and perioperative complications after coronary artery bypass grafting is myocardial reper fusion injur y following the restoration of the coronar y circulation in the ischemic zone of the myocardium and characterized by myocardial, electrophysiological and vascular dysfunction. In order to identify the diagnostic signs of myocardial reperfusion injury after coronary artery bypass grafting, a prospective study was conducted, which included 89 patients with ischemic heart disease and forthcoming coronary artery bypass grafting either on-pump or off-pump. Postischemic myocardial dysfunction was assessed using transesophageal echocardiography, morphological and functional signs of myocardial reperfusion injury were detected using cardiac magnetic resonance imaging, moreover, the level of highly sensitive troponin, myoglobin, creatine phosphokinase-MB, metalloproteinase-2, and highly sensitive C-reactive protein was measured to assess the contribution of biomarkers to the development of reperfusion injuries. The obtained data allowed us to assess the morphological and functional characteristics of postischemic myocardial dysfunction and identify diagnostic signs of irreversible reperfusion injuries.
SARS CO-V-2 coronaviral infection in pregnant women (clinical data USE “6 City Clinical Hospital”)L. Vasilyeva, E. Nikitina, S. Tsarova, L. Gulyaeva, V. Werbitzky
Аbstract: The article analyzes the features of the course of pregnancy in 110 women hospitalized in the Healthcare Institution “6th City Clinical Hospital” of Minsk for SARS CoV-2 coronavirus infection in April-October 2020. The authors studied the anamnestic data of pregnant women, analyzed the clinical data and the data from the instrumental and laboratory examinations of pregnant women with SARS CoV-2 coronavirus infection in the Republic of Belarus. A comparative analysis was carried out dealing with the treatment of pregnant women for coronavirus infection with SARS CoV-2 in a hospital setting.
Pancreatogenic morphostructural changes in the heart, lungs and other target organs in destructive pancreatitisP. Koshevsky, S. Alekseyev, O. Popkov, V. Ginyuk, N. Bovtiuk
Introduction. Pathomorphological changes in destructive pancreatitis develop both in the pancreas and in various organs and tissues, it determining the clinical course and outcome of the disease. Most often in destructive pancreatitis, the cardiopulmonary system is affected, as well as the liver, kidneys, and brain. Damage to these target organs is one of the main elements of pathogenesis and thanatogenesis in destructive pancreatitis and is of interest not only for surgeons, but also for other clinical specialists, including cardiologists. Aim. To conduct a retrospective analysis of the most common morphostructural changes in the cardiopulmonary system and other target organs based on the results of autopsy reports of the deceased from destructive forms of acute and chronic pancreatitis and to identify the most characteristic morphostructural changes in the target organs.
Coronavirus infection (SARS-CoV-2): focus on COVID-19 associated coagulopathyA.A. Pleshko, E.B. Petrova, S.V. Gunich, S.V. Rakovich, E.A. Grigorenko, N.P. Mitkovskaya
Officially announced by the World Health Organization (WHO) in March 2020, the coronavirus disease 2019 (COVID-19) pandemic is terrifying with the unimaginable rate of spreading and the large number of deaths. Morethan 171 million COVID-19 cases including more than 3,6 million deaths have been confirmed worldwide since the start of the pandemic. The high incidence of venous thromboembolic events and non-ARDS (acute respiratory distress syndrome) associated death of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, despite prophylactic antithrombotic therapy, may indicate the need for a more intensified personalized regime of preventive measures.
Justification of technologies for organizing medical care for patients with high cardiovascular risk on the example of the Brest region (Part 1)N. Pabivantsava
In order to substantiate organizational measures for early detection and tertiary prevention of cardiovascular diseases, the causal relationships of high morbidity, disability, and mortality due to cardiovascular diseases, coronary heart disease and its complications were studied in the population of the Brest region in the period from 2006 to 2010. Measures to improve the organization of preventive medical examination of patients from cardiovascular risk groups with prognostically unfavorable outcomes were suggested. Through the implementation of an organizational experiment in 2012–2017, it was possible to achieve a positive medical and social effect, expressed in increasing the availability of multi-level and hightech care to patients in need, as well as in improving the medical and demographic indicators of the Brest region in general and in the diseases of the circulatory system in particular, which formed the basis of the second part of this article.
Implementation and evaluation of the effect of technologies for organizing medical care for patients with high cardiovascular risk on the example of the Brest region (part 2)N.F. Pabivantsava, M.Yu. Surmach
The article shows how organizational measures were implemented to improve the organization of medical examinations of patients from cardiovascular risk groups with prognostically unfavorable outcomes on the example of the Brest region. By studying the health indicators of the region’s population before and after implementation, the paper analyzes the effectiveness of new organizational technologies. It is established that due to the adopted preventive measures at each territorial site and monitoring the patient’s route through databases from the district to the regional level of care, there is a decrease in the cardiovascular primary incidence, including coronary heart disease, with a significant decrease in the rate of acute conditions (acute coronary syndrome). The increase in prevalence indicates increased monitoring of all patients with circulatory diseases and coronary heart disease who were invited for conducting dynamic follow-up (dispensarization) in order to stratify the risks of their complications.
Exercise tolerance tests in the diagnosis of coronary heart disease, testing of patients with myocardial infarction and revascularizationL. Ushakova, E. Vertinsky, M. Shtonda, I. Semenenkov
Exercise tolerance test is one of the most commonly used non-invasive cardiac tests used to diagnose coronary heart disease, determine prognosis, and evaluate treatment. Treadmill test or bicycle ergometry allows determining how much more expensive and complex follow-up examination is necessary for the patient: myocardial perfusion scintigraphy with stress, stress echocardiography, multispiral computed tomography, as well as defining more clearly the indications for coronary angiography. The article presents modern ideas about a differentiated approach to performing exercise tolerance tests in patients with coronary heart disease, myocardial infarction, and revascularization.