Saratov JOURNAL of Medical and Scientific Research

cardiac surgery

Atrial fibrillation and obstructive sleep apnea syndrome

Year: 2016, volume 12 Issue: №2 Pages: 157-161
Heading: cardiac surgery Article type: Review
Authors: Cherkasova S.A.
Organization: Saratov State Medical University
Summary:

The literature review on the connection between atrial fibrillation and obstructive sleep apnea syndrome has been made. The etiology of sleep apnea, the mechanism of night breath pauses and possible consequences of this disorder have been described. The statistical data related to the frequency of atrial fibrillation among sleep apnea patients were presented in this article. The evidence regarding possible mechanisms of pathogenetic relation between atrial fibrillation onset and sleep breathing disorders was described. Nowadays it is assumed that night desaturations, the increase of sympathetic tonus, obesity, cardiac pathology, the increase of general inflammatory markers connected with sleep breathing disorders are the factors which contribute to the arrhythmia in patients with apnea. In the review the modern data concerning influence of apnea on the course of atrial fibrillation and recurrence of the arrhythmia relapse after cardioversion have been presented. The positive impact of sleep apnea treatment on the progress of atrial fibrillation was noted as well. The literature analysis has shown that pathogenetic mechanisms characterizing the connection between atrial fibrillation and sleep apnea have not been completely defined. The amount of published studies relating to the influence of apnea on the progress and long-term results of atrial fibrillation treatment is insufficient. There are not enough data about the frequency of different forms of atrial fibrillation in patients with apnea. There are other issues which require further investigations.

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Comparison of clinical results of pharmaceutical and surgical therapy in patients with severe chronic heart failure

Year: 2016, volume 12 Issue: №2 Pages: 145-156
Heading: cardiac surgery Article type: Review
Authors: Kotsoeva О.Т.
Organization: North-Caucasian Multidisciplinary Medical Center
Summary:

The aim of the presented paper is a meta-analysis of clinical studies on the comparative effectiveness of pharmaceutical therapy and surgical treatment such as cardiac resynchronization therapy (CRT), cardiac resynchronization therapy with cardioversion-defibrillation (CRT-D), circulatory support system and heart transplantation in patients with severe chronic heart failure (CHF). Material and Methods. Results of 41 clinical studies (29799 patients with severe CHF) were included in a meta-analysis. Data search was conducted in the following databases: Medline, Medscape, Pubmed, and websites dedicated to clinical research (National Institutes of Health, Clinical Center, ClinicalStudyResults.org, ClinicalTrials.gov). Results. As compared with pharmaceutical therapy, surgical treatment of severe CHF is better to reduce fatal risk, incidence of decompensation of CHF, frequency of cardiac arrhythmias, the need to perform or re-perform heart transplantation. It is also shown that CRT better reduced the mortality from progression of heart failure than heart transplantation. Both pharmaceutical therapy and surgical treatment improved functional class of CHF and quality of patients' life, but does not affect the left ventricular ejection fraction. Conclusion. It was found out that there was a number of significant advantages of surgical treatment of severe CHF, compared with pharmaceutical therapy. However, it is still a number of unresolved issues (particularly in relation to heart transplantation) on the effectiveness comparing pharmaceutical and surgical therapies of severe CHF

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Gender features of risk factors and clinical course of arterial hypertension

Year: 2015, volume 11 Issue: №4 Pages: 542-547
Heading: cardiac surgery Article type: Original article
Authors: Shkatova E.Yu., Bakshaev I.N., Korolkova G.S.
Organization: Igevsk State Medical Academy
Summary:

The aim of the article is to reveal the risk factors and features of the clinical course of hypertension in men and women. Material and Methods: A prospective study of 204 patients was carried out. The survey included a sociological survey, with the use of special socio-sanitary profiles, matters which concern lifestyle characteristics of respondents, hereditary risk factors, peculiarities of hypertension. Results: Men often have a hidden crisis-free for hypertension with a great number of complications; women have a longer duration of the disease, with a more severe clinical picture. Conclusion: The differences of social and health behavior with the existing risk factors and the clinical course of hypertension according to the gender of the patient have been revealed.

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Investigation of statistical characteristics of interaction between the low-frequency oscillations in heart rate variability and peripheral microcirculation in healthy subjects and myocardial infarction patients

Year: 2015, volume 11 Issue: №4 Pages: 537-542
Heading: cardiac surgery Article type: Original article
Authors: Shvartz V.A., Karavaev A.S., Borovkova E.l., Mironov S.A., Ponomarenko V.I., Prokhorov M.D., Butenko A.A., Gridnev V.I., Kiselev A.R.
Organization: Saratov state university, Saratov Institute of Cardiology, Russia, Saratov Branch of Institute of Radio Engineering and Electronics n.a. V.A. Kotelnikov, Bakulev Center of Cardiovascular Surgery
Summary:

Objective. This study compares the statistical characteristics of interaction between 0.1 Hz oscillations in heart rate variability (HRV) and photoplethysmogram (PPG) in healthy subjects and myocardial infarction (Ml) patients. Material and methods. We studied 23 healthy subjects (20 men and 3 women aged 26±3 years) and 23 patients (12 men and 11 women aged 52±4 years) at about one month after Ml. The 10-minute signals of simultaneously recorded cardioin-tervalogram (CIG) and PPG were studied. We calculated the total percentage of phase synchronization between the studied 0.1 Hz oscillations and estimated the distribution functions of duration of synchronous and non-synchronous epochs, the variability of basic frequency of oscillations, and variance of phase noises in 0.1 Hz oscillations in HRV and PPG. Results. The total percentage of phase synchronization between 0.1 Hz oscillations is significantly greater in healthy subjects than in Ml patients (47±3% and 26±4%, respectively). Significant difference between these two groups in the distribution of duration of synchronous and non-synchronous epochs was not revealed. The Ml patients had greater variance between the basic frequencies of 0.1 Hz oscillations in HRV and PPG than healthy subjects. This phenomenon correlates with the increased level of phase noises in the records of Ml patients. Conclusion. The quality of synchronization between 0.1 Hz oscillations in HRV and PPG is associated with the strength of influence of external factors (noises) and variability of the basic frequency of these oscillations.

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Arrhythmia after heart transplantation: causes and treatment

Year: 2015, volume 11 Issue: №4 Pages: 534-537
Heading: cardiac surgery Article type: Review
Authors: Kotsoeva О.Т.
Organization: North-Caucasian Multidisciplinary Medical Center
Summary:

This review covers various aspects of etiology, pathogenesis and modern methods of prevention and treatment of postoperative arrhythmias after heart transplantation.

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Hospital registry in special department for patients with acute cerebrovascular disease

Year: 2014, volume 10 Issue: №4 Pages: 819-823
Heading: cardiac surgery Article type: Original article
Authors: Maslyuk О.А., Smolentseva I.G., Amosova N.A., Krivonos O.V., Shevchenko N.S., Milagina V.S.
Organization: State Scientific Research Center n.a. A.I. Burnasyan — Federal Medical Biophysical Center of Federal Medical Biological Agency
Summary:

Aim: organization and follow-up of a registry of patients with cerebrovascular disease in in special department. Materials and methods. In the period from January 2011 to December 2013 all cases of cerebrovascular disease in the special department were recorded. Each patient had an electronic case book and thematic record, developed on the basis of the materials of the National Stoke Association of "Registry of stroke." Results. 418 cases of cerebral stroke were registered. Male to female ratio was 3.7: 1. Patients with initial diagnosed cerebral stroke were 78%, secondary 22%. The average age of patients was 63. The big number of strokes was observed in men aged 56-57 years; in women aged 75-77 years. TOAST criteria for subtypes of ischemic stroke were distributed to: atherothrombotic (29,3%), cardioembolic (29,1 %), 22,4% lacunar ischemic stroke due to other established reasons (8,8%), crptogenic (10,4%). Hemorrhagic stroke was observed in 16.8% of cases. Parenchymal hemorrhage was observed in 10.7% of cases, nontraumatic subarachnoid hemorrhage (4,5%). Among the risk factors in patients with ischemic stroke identified: arterial hypertension (88,9%), coronary heart disease (43%), heart rhythm disorders (28,4%), diabetes (18,6%). The proportion of endovascular interventions performed for 3 years was 31.2%. Mortality rate was 3.74% (10 people) in 2011; 4.65% (14 people) in 2012; 2.48% (7 people) in 2013. Conclusion. Follow up the hospital stroke registry allowed to estimate the structure andcourse of cerebral stroke, found the risk factors to identify the most important factors of death.

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Clinical and functional characteristics of athletes with mitral valve prolapse

Summary:

The purpose: to conduct a comprehensive assessment of clinical and functional characteristics of athletes with mitral valve prolapse (MVP). Material and Methods. 541 athletes were examined for the study, 132 athletes with MVP were in the main group, 132 athletes without MVP were in the comparison group. Functional, laboratory and diagnostic methods of examination in the framework of an in-depth medical examination were used in the study. Results. The examined athletes with mitral valve prolapse often have changes in the peripheral blood, immune and endocrine systems, macroelement composition, ECG, functional sample. Conclusion. Clinical and functional state of athletes with MVP is different from athletes without MVP, what requires an adequate assessment of MVP to improve the effectiveness of the training process with the possible use of medical and diagnostic and preventive measures.

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The study of the prognostic value scales of assessing the risk of adverse coronary events in patients with acute coronary syndrome without ST-segment elevation in combination with comorbid conditions

Year: 2014, volume 10 Issue: №4 Pages: 809-814
Heading: cardiac surgery Article type: Original article
Authors: Dorokhova O.V., Firsakova V.Yu., Andreev D.A., Maslennikova O.M.
Organization: State Scientific Research Center n.a. A.I. Burnasyan — Federal Medical Biophysical Center of Federal Medical Biological Agency
Summary:

Objective: to identify the most prognostically significant scale risk assessment of patients with acute coronary syndrome without ST-segment elevation in combination with diabetes mellitus type 2, chronic renal failure, multifo-cal coronarocardiosclerosis, dyscirculatory encephalopathy. Material and methods. 260 patients with acute coronary syndrome without ST-segment elevation were divided into 4 groups according to the presence of severe concomitant diseases: patients with diabetes mellitus type 2 (71 people), chronic renal failure (49), multifocal lesions of the coronary arteries (76) and patients with dyscirculatory encephalopathy of grade 2-3, including ischemic stroke (64). All patients were stratified by major scales risk: TIMI, GRACE, PURSUIT. The development of negative coronary events was assessed in hospital and during the year after discharge. On the basis of the results, all scales were studied using the criterion of Mann-Whitney and identified the most predictably significant groups of patients with specific comorbid conditions. Results. It is revealed that the significance of the scales TIMI and GRACE in the study of distant forecast (up to 6 months) is the most reliable with acute coronary syndrome without ST-segment elevation in combination with diabetes mellitus type 2. For the patients with combination with chronic renal insufficiency the best prognostic significance was obtained by the GRACE scale in the study of hospital risk and forecast up to 6 months. TIMI and GRACE scales in the study of hospital risk and forecast up to 6 months had the greatest prognostic significance for the patients with acute coronary syndrome without ST-segment elevation on the background of multifocal lesions of the coronary arteries. For the patients with dyscirculatory encephalopathy of the 2nd and 3rd grades, the greatest prognostic significance was obtained by stratification of risk on PURSUIT and GRACE scales in the study of hospital risk and forecast up to 6 months. Conclusion. The results demonstrate the necessity of a differentiated approach to the risk stratification of patients with acute coronary syndrome without ST-segment elevation depending on the grade of a severe comorbid disease.

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Features of medical examination of suitability of employees for working at nuclear power plant after myocardial infarction

Year: 2014, volume 10 Issue: №4 Pages: 805-809
Heading: cardiac surgery Article type: Original article
Authors: Bushmanov A.Yu., Krasnyuk V.I., Korenkov V.V., Metlyaeva N.A., Afonin S.A., Ustyugova A.A.
Organization: State Scientific Research Center n.a. A.I. Burnasyan — Federal Medical Biophysical Center of Federal Medical Biological Agency, Public Limited Company "Concern "Rosenergoatom"
Summary:

Aim: examination of professional qualification of NPP personnel suffering from post-infarction cardiosclerosis, to work with sources of ionizing radiation with the formation of proposals of amendments to the order of the health Ministry from 12.04.2011 No. 302-N. Material and Methods. Medical database by making indicators with individual registration forms made from 269 persons with postinfarction cardiosclerosis staff of main and auxiliary production of Russian NPPs (272 men and 7 women), average age of the examined patients was 56.2 ± 7.0 years; the total number the analyzed characteristics, reflected in the generated database was 49 lines. Results. The results of the risk stratification of sudden cardiac death with the formation of risk groups and proposed draft amendments to the Order of the health Ministry of the Russian Federation of 12 April 2011 No. 302-n order differential approach to the assessment of competency in hazardous conditions patients with postinfarction cardiosclerosis. Conclusion. On the basis of clinical examination and assessment of risk for sudden cardiac death, it is necessary to make changes in the List of medical contraindications for admission to works in accordance with section 4 of Annex No. 3 to the Order of Ministry of health, April 12, 2011 No. 302 n in terms of access to work with ionizing radiation to persons suffering from post-infarction cardiosclerosis; to identify among patients postpartum cardiosclerosis persons not fit to continue the work in contact with sources of ionizing radiation, it is necessary referral to additional examination in occupational disease Centers in accordance with the Order of Ministry of health, April 12, 2011 No. 302 N.

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Case of successful prosthetics of aortic arch in a patient with congenital deformation of aortic arch in severe hypothermia and circulatory arrest

Year: 2014, volume 10 Issue: №3 Pages: 414-418
Heading: cardiac surgery Article type: Case report
Authors: Bokeria L.A., Bokeria O.L., Arakelyan V.S., Koasary A.K.
Organization: Bakulev Center of Cardiovascular Surgery
Summary:

Atresia of the aortic arch is a rare congenital disease, often accompanied by congenital heart defects. Isolated atresia of the aorta is rare and usually has a complex deformation with multiple aneurysms, bending of the aorta and its branches. This anatomy complicates the exposure and makes surgery technically complicated with conventional approaches. The aim of the work is the presentation of a case of successful prosthetics of aortic arch and a 5-year observation of a patient with congenital deformation of the aortic arch in severe hypothermia and circulatory arrest. The article presents the variant of surgical tactics in treatment of patients with this form of atresia of aortic arch.

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