Васильева Е.Ю., Калинская А.И.
Particularities of hemostasis changes in COVID-19 patients/
Vasilieva E.Yu., Kalinskaya A.I.
Новая коронавирусная инфекция характеризуется чрезвычайно разнообразным спектром клинических проявлений, наиболее заметную роль среди которых играют тромботические осложнения. Вирус SARS-CoV-2 способен приводить к активации системы гемостаза на различных уровнях, начиная от повреждения легочной ткани с активацией плазменного гемостаза, локального повреждения эндотелия и активации тромбоцитов в процессе болезни. Рутинное использование антикоагулянтной терапии представляется оправданным у пациентов, госпитализированных с новой коронавирусной инфекцией.
COVID-19 infection is characterized by different clinical presentations. The thrombotic complications play the leading role in COVID-19 infection. SARS-CoV-2 virus can activate hemostasis at different levels: pulmonary tissue damage with subsequent plasma coagulation activation; local endothelial dysfunction and platelet activation during the course of the disease. Routine use of the anticoagulation treatment seems reasonable in hospitalized patients with COVID-19.
Бусленко Н.С., Глянцев С.П.
The cardiology service origin and development in A.N. Bakoulev Center for Cardiovascular Surgery (to the 65th anniversary of the foundation). Part 1. Сardiological service: beginning, first employees. Diagnostics and treatment of patients with mulformations of the heart
Buslenko N.S., Glyantsev S.P.
Cardiological service at A.N. Bakoulev National Medical Research Center for Cardiovascular Surgery began with the opening of the therapeutic (cardiology) department and electrocardiography (ECG) room in 1956. In 1959 the ECG room was reorganized into an ECG laboratory, and then into a functional diagnostics laboratory (headed by Professor G.G. Gelstein). The cardiology department was successively headed by professors N.A. Shalkov, A.M. Damir and V.Kh. Nezlin. From 1962 to 1994 the department was headed by professor L.M. Fitileva, whose doctoral dissertation was devoted to clinical phonocardiography. Under her leadership, department employees and applicants from various regions of Russia and the republics of the USSR developed topical issues of diagnostics, pre-, intra- and postoperative examination of patients with heart diseases, their preparation for operations and treatment in the postoperative period. In part 1 of this article, 19 scientific works are considered, carried out by doctors of cardiology department from 1961 to 1978. The research works were dedicated to diagnosis and treatment of patients with congenital and acquired heart diseases. The contribution of the authors to cardiology and cardiac surgery development in the USSR is demonstrated.
Голухова Е.З., Рыбка М.М., Ключников И.В., Мамалыга М.Л., Сливнева И.В., Желихажева М.В., Рамненок Т.В.
Options for the course of COVID-19
Golukhova E.Z., Rybka M.M., Klyuchnikov I.V., Mamalyga M.L., Slivneva I.V., Zhelihazheva M.V., Ramnenok T.V.
Материал и методы. В исследование вошли 108 первых последовательных пациентов с COVID-19, поступивших в специализированный стационар, организованный на базе НМИЦССХ им. А.Н. Бакулева. В данное исследование включены только выписанные пациенты. Средний возраст больных 57,4 ± 2,3 года, 54,6% женщин, степень поражения легких 36,2 ± 2,3%. Всем больным были определены С-реактивный белок (CРБ) и D-димер.
Результаты. На основании полученных при поступлении биохимических данных пациенты были разделены на 4 группы: 1-я группа – повышен СРБ, D-димер в норме (n = 22), 2-я группа – СРБ в норме, повышен D-димер (n = 8), 3-я группа – повышены уровни СРБ и D-димера (n = 71), 4-я группа – СРБ и D-димер в норме (n = 7). По компьютерно-томографическим признакам тяжести поражения легочной паренхимы все 4 группы не различались. Уровень лактатдегидрогеназы (ЛДГ) был достоверно выше у пациентов 3-й группы (334,2 ± 20,6 Ед/л) по сравнению с ЛДГ в 1, 2 и 4-й группах (соответственно 264,2 ± 21,5, 231 ± 14,2, 206,3 ± 32,2 Ед/л, р < 0,01), что свидетельствует о более тяжелом повреждении легочной паренхимы. В 1-й и 3-й группах уровень лимфоцитов был ниже, чем во 2-й и 4-й. По уровню D-димера 3-я и 2-я группы не различались (1537,4 ± 126,7 и 1682,5 ± 394,2 соответственно, р > 0,05), но его уровень был достоверно выше в 3-й группе по сравнению с 1-й и 4-й (359 ± 32,9 и 309,3 ± 50,8, р < 0,01). За время госпитализации основные характеристики каждого варианта течения сохраняются. Длительность нахождения в стационаре между группами не различалась. Назначение кортикостероидов зависело от уровня СРБ. Выводы. Можно выделить 4 варианта течения COVID-19: воспалительный (1-я группа), гиперкоагуляционный (2-я группа), воспалительно-коагуляционный (3-я группа) и ареактивный (4-я группа). Наиболее распространенным вариантом течения COVID-19 является воспалительно-коагуляционный, который проявляется у 65% пациентов и характеризуется выраженными лабораторными отклонениями от нормы.
Introduction. Currently it is well-recognized that tissue markers allow to classify the process of different infectious diseases and help to identify patients’ to subclasses and endotypes for clarifying the prognosis and therapy effectiveness. Objective. To detect different COVID-19 course types according to pathophysiological mechanisms, and evaluate clinical, lab and instrumental features of each clinical course.
Material and methods. 108 first COVID-19 patients were admitted at special hospital based on Bakoulev National Medical Research Center for Cardiovascular Surgery. The average age of patients was 57.4 ± 2.3 years, 54.6% of women, the degree of lung damage was 36.2 ± 2.3%. All patients were identified with C-reactive protein (CRP) and D-dimer.
Results. The patients were divided in 4 groups depending on the degree of main pathophysiological process of system inflammatory response (SIR) and hypercoagulation: with inflammatory (1group) (n = 22), coagulation (2 group) (n = 8), inflammatory-coagulation (3 group) (n = 71) and affectless (4 group) (n = 7) types of disease progression. All the 4 groups of the discharged patients were equal in pulmonic parenchymatous tissue damage degree. The level of lactate dehydrogenase (LDH) was significantly higher in patients of group 3 (334.2 ± 20.6 U/L) compared with LDH in groups 1, 2 and 4 (respectively 264.2 ± 21.5, 231 ± 14.2, 206.3 ± 32.2 U/L, p < 0.01), which indicates more severe damage to the pulmonary parenchyma. In groups 1 and 3, the level of lymphocytes was lower than in groups 2 and 4. In terms of the D-dimer level, the 3rd and 2nd groups did not differ (1537.4 ± 126.7 and 1682.5 ± 394.2, respectively, p > 0.05), but its level was significantly higher in the 3rd group compared with the 1st and 4th (359 ± 32.9 and 309.3 ± 50.8, p < 0.01). Over the course of staying in hospital the features of each type of disease progression kept preserved. Conclusions. It is possible to accentuate 4 possible development scenario of the COVID-19: the inflammatory one (with SVR manifestation without hypercoagulation), the hypercoagulation one (without SVR activation), the inflammatory-coagulation (active SVR together with hypercoagulation) and affectless type (without SVR and hypercoagulation). The most prevalent type of COVID-19 disease progression is inflammatory-coagulation scenario which is manifested at 65% of patients.
Моллаева Д.Д., Машина Т.В., Мрикаев Д.В., Бердибеков Б.Ш., Филатов А.Г., Голухова Е.З.
Modern ultrasound techniques in the assessment of left atrium structural abnormalities in patients with atrial fibrillation
Mollaeva D.D., Mashina T.V. , Mrikaev D.V., Berdibekov B.Sh., Filatov A.G., Golukhova E.Z.
The incidence of atrial fibrillation (AF) and its recurrence after treatment increase every year. The evolution of diagnostic research methods, such as echocardiography and magnetic resonance tomography, provides an opportunity to evaluate the structures of the heart in detail and identify its significant changes, sometimes before the manifestation of the first symptoms. This review article is about structural and functional remodeling of left atrium in patients with various forms of atrial fibrillation based on the Speckle Tracking (STE) method. In particular the quantitative analysis of the parameters of left atrial longitudinal deformation (strain) and the deformation rate (strain rate) was distinguished. A detailed study of left atrial deformation can be a predictor of success after different variants of catheter AF surgery. Use of the new high-tech catheters can increase the success of the surgery for AF and reduce the AF recurrence.
Кудряшова Е.Н., Бердибеков Б.Ш., Булаева Н.И. Голухова Е.З.
The choice of revascularization method in patients with stable coronary artery disease and diabetes mellitus.
Kudryashova E.N., Berdibekov B.Sh., Bulaeva N.I., Golukhova E.Z.
Atherosclerotic cardiovascular disease remains the major cause of death and disability, especially among patients with type 2 diabetes mellitus. Patients with T2DM have an earlier manifestation of coronary artery disease, worse prognosis and excess risks of death from any cause and of ASCVD mortality. This is due to the diffuse multivessel disease, with distal lesions as well as the most frequent injury of the left main coronary artery. The choice of optimal revascularization strategy is very important for the improving clinical results and long-term outcomes in this group of patients. According to the latest results of randomized clinical trials, coronary artery bypass grafting is more preferable for patients with T2DM in most clinical situations. The exception is 1-, 2-vessel disease without proximal left anterior descending disease when suggest benefits from percutaneous coronary intervention. Meanwhile, a risk-adjusted comparison of revascularization strategies, including 1-, 2-vessel disease with involvement of the proximal LAD, as well as left main lesion with low SYNTAX Score 22, did not find any significant differences between both methods.
Степанова Н.М., Сергуладзе С.Ю.
Natural pathophysiological processes of heart aging as a factor in the development of cardiovascular diseases.
Stepanova N.M., Serguladze S.Yu.
An increase in the incidence of cardiovascular diseases (CVD) is directly associated with a patient’s age. CVD occur as a result of various modifiable (lifestyle) and non-modifiable (age and heredity) risk factors. An increase in the life expectancy as well as in the percentage of the elderly population in the developed countries has attract-ed the attention of researchers to the role of unmodifiable risk factors in the development of CVD. During the process of aging, changes affect micro- and macroscopic levels of the cardiovascular system, calcium homeostasis, regulation of the adrenergic and the renin-angiotensin-aldosterone systems, and normal functioning of intracellular structures. They lead to the age-related myocardial remodeling, disruption of the cardiac conduction system, and changes in the systolic and diastolic functions of the heart. Structural and functional alterations of vessels accumulate throughout life, culminating in increased risk of developing CVD. The average age of the world’s population is increasing at an unprecedented rate and this increase is changing the world. This “silver tsunami” emphasizes the need to provide advanced training in epidemiology and increase the cadre of experts in the study of aging. This review analyses studies performed to investigate the mechanisms of the pathophysiological processes of natural heart aging and their role in the development of CVD.
Богачевская С.А., Кузнецов А.Н., Богачевский А.Н.
Modern ultrasound technologies and their application in surgical treatment of patients with cardial diseases and increased surgical risk. Part 1. Open cardiac surgery
Bogachevskaya S.A., Kuznetsov A.N., Bogachevskiy A.N.
The increased surgical risk of standard cardiac surgery in patients with complicated cardiovascular diseases and comorbid conditions forces us to fined safer ways to correct the pathology of the heart and vessels. The article shows various methods of open and mini-invasive heart surgery among patients with increased surgical risk and need in echocardiographic support. An appearance of new methods of surgical correction, as well as new devices for minimally invasive and endovascular interventions, need in the control of increasingly accurate and spatial ultrasound imaging, such as transesophageal echocardiography, three-dimensional echocardiography, threedimensional transesophageal echocardiography, modes of rapid and accurate image post-processing. Types of surgery performed in the Khabarovsk Federal Center of cardiovascular surgery, and presented in this review. These types supplemented by clinical examples with illustrations of echocardiographic images and the results of surgery. A significant reduction in the time of forming a three-dimensional echocardiographic image and obtaining postprocessing results will allow the surgeon to receive high-quality information about the heart structures quickly. Such approach will become a guarantee of understanding between the diagnostician and the surgeon in a specialized surgical hospital.
Филатов А.Г., Самсонов В.Б., Шалов Р.З., Ковалев Д.В., Зеленикин М.М., Данилов Т.Ю., Подзолков В.П., Аванесян Г.А.
Hybrid approach to the elimination of atrioventricular nodal tachycardia by radiofrequency ablation in a patient after Fontan operation in the modification of extracardial conduit
Filatov A.G., Samsonov V.B., Shalov R.Z., Kovalev D.V., Zelenikin M.M., Danilov T.Yu., Podzolkov V.P., Avanesyan G.A.
One of the long-term complications after Fontan operation is cardiac arrhythmias. Nodal atrioventricular tachycardia is extremely rare. In the absence of the effect of drug therapy, patients are shown intracardiac intervention in order to eliminate the source of arrhythmia. Radiofrequency ablation of an arrhythmogenic focus is considered the least traumatic and effective. At the same time, after Fontan operation, especially after modification with the use of an extracardiac conduit and the absence of fenestration, certain difficulties arise when choosing access to the intracardiac structures. An alternative can be a hybrid approach with the provision of intracardiac access to the conduction system for ablation using sterno- or thoracotomy in a cardiac surgery operating room. The presented message describes a hybrid approach to the elimination of arrhythmias.
Скопин И.И., Кахкцян П.В., Латышев М.С., Копылова Н.С., Хугаев Г.А., Сокольская Н.О.
Reconstruction of atrioventricular valves in patients with antiphospholipid syndrome
Skopin I.I., Kakhktsyan P.V., Latyshev M.S., Kopylova N.S., Khugaev G.A., Sokol’skaya N.O.
In the mid-1980s, rheumatologist G.R. Hughes described an autoimmune state of hypercoagulation as a result of hyperproduction of antiphospholipid antibodies, which later became known as antiphospholipid syndrome or Hughes syndrome. The earliest clinical manifestation of Hughes syndrome is damage to the valvular complex of the heart, the frequency of which ranges from 33 to 76%. In most cases, mitral valve damage occurs, the severity of which varies from minimal changes (slight regurgitation or thickening of the valve cusps) to severe (hemodynamically significant stenosis and/or valve insufficiency). In the literature there is an extremely small number of publications devoted to the results of surgical treatment of patients with valve damage in the antiphospholipid syndrome. The article presents a case of successful mitral valve reconstruction in a patient with Libman–Sacks endocarditis caused by secondary antiphospholipid syndrome against systemic lupus erythematosus.
Алехин М.Н., Гогин Г.Е., Крючкова О.В., Молочков А.В.
Capabilities of three-dimensional image rendering technology TrueView for transesophageal echocardiography of aortic aneurysm dissection
Alekhin M.N., Gogin G.E., Kryuchkova O.V., Molochkov A.V.
The article presents a clinical case of a patient with an aortic aneurysm dissection who successfully used TrueVue technology during intraoperative transesophageal monitoring during aortic prosthetic surgery. The imaging capabilities of three-dimensional transesophageal echocardiography can be significantly expanded using the recently proposed new photorealistic technology TrueVue. This technology is designed to improve the visualization of anatomical structures in the pink-red range of illumination due to a virtual light source with its arbitrary location inside the heart and with the possibility of changing the intensity of illumination. Using a virtual light source and simulating the illumination of the surrounding heart structures creates a more realistic perception of the depth of the image of the heart structures based on the differences between the highlighted structures and those in shadow. Currently, the possibilities of using TrueVue technology are shown for the diagnosis of valvular pathology, blood clots of the left auricle, limited ruptures of the intima of the ascending aorta, as well as when using various intracardiac devices. We used the TrueVue technology to clarify the state of detached intima in the root, ascending and descending parts of the aorta.
Саломов М.А., Жалилов А.К., Рузина Е.В., Бокерия Л.А.
Successful surgical treatment of a giant left ventricular aneurysm
Salomov M.A., Zhalilov A.K., Ruzina E.V., Bockeria L.A.
Myocardial ischemia leads to the loss of a part of the viable myocardium and causes complex of morphological and functional disorders of the heart. Myocardial scar formation leads to disproportional stretching and thinning of its walls, dilatation and reshaping of its cavity. This in turn is a cause of intra-ventricular microscopic and electrophysiological changes, which define the concept of ischemic remodeling. The formation of left ventricular aneurysm often occurs with acute occlusion of the left anterior descending artery and leads to significant loss of pump function and clinic of heart failure. Reconstruction of left ventricular aneurysm and myocardial revascularization leads to a significant improvement in pumping function and a decrease of heart failure symptoms. But the problem of low cardiac output syndrome early after surgery make to carry out thorough instrumental investigation for right decision. A case of complex diagnostic and successful surgical treatment of a giant left ventricular aneurysm is presented.