Modern advances in the medical and surgical treatment of coronary heart disease (CHD), unfortunately, will not solve the entire arsenal of problems, associated with impaired microcirculatory myocardial perfusion. The proposed methods of influence on microvascular dysfunction of the ischemic myocardium, including cell cardiomyoplasty and laser myocardial tunneling, include a relatively short-lasting positive effect. For a more successful application of these modern approaches, an increase in the compensatory-reparative capabilities in these patients plays a significant role. A positive result of treatment, in this case, can be achieved by applying pre- and postoperative immunocorrection, since all these processes are immuno-conditioned.

Myocardial hibernation is a persistent inhibition of contractility of the viable myocardium of the left ventricle, resulting from its hypoperfusion. The most important manifestation of hibernation is the preservation of the viability of the myocardial tissue. This phenomenon is based on three main mechanisms: 1) myocardial metabolic adaptation, manifested by enhanced glucose uptake; 2) activation of the cardiomyocyte death gene program; 3) programmed cell death, i. e. autophagy and apoptosis of cardiomyocytes. Methods for diagnosing viable myocardium include dobutamine stress echocardiography, single photon emission computed tomography of the myocardium, positron emission tomography, magnetic resonance imaging and electromechanical mapping. In the clinical aspect, the presence and volume of viable myocardium are taken into account when addressing the issue of revascularization in patients with one- and two-vessel coronary artery disease without involvement of the anterior descending artery, as well as in patients with a significant decrease in the global myocardial contractile function, when surgery can lead to an increase in the left ventricular ejection fraction.

Introduction. It seems relevant to study the ultrasound anatomy and physiology of the proximal valve segments of the superficial femoral vein (SFV) and the great saphenous vein (GSV) to develop effective reconstructive surgical interventions on venous valves in chronic vein diseases.

The aim of the survey was to study the ultrasound anatomy of the venous wall, the size and shape of the proximal SFV and GSV valves are normal at rest and during the functional test Valsalva.

Material and methods. Proximal valve SFV studies were performed in 144 lower limbs in 115 people (mean age 51.1 ± 14.4 years, 60 women and 55 men), proximal GSV valves studies - in 82 lower limbs in 67 persons (average age 45, 1 ± 13.3 years, 33 women, 34 men). A longitudinal and transverse ultrasound scanning of the femoral vein bifurcation and safenofemoral junction areas were performed, the structures of the proximal SFV and GSV valves were visualized, the valve shape was measured and the diameter of the veins was measured at the level valves at the base of the valves (inlet diameter), at the point of maximum ectasia (diameter of ectasia), at the upper border of the valve (diameter of the outlet), as well as measuring the length of the valve a (length to ectasia, the total length of the valve). The degree of ectasia over the valve was judged by calculating the relative venous diameter change (RVDC).

Results. the average diameter of the SFV at the level of the lower boundary of its first valve was 10.01 ± 1.44 mm. The average diameter of the SFV at the level of the maximum ectasia of its first valve was 13,1±2 mm. The average value of the index of RVDC for SFV was 31%±10,4%. An increase in the diameter of the vein in the zone of supravalvular ectasia up to 20% corresponded to the spindle-shaped valve, more than 20% - to the clavate form, which was noted in the majority of the examined. The change in the relative venous diameter of the SFV on the Valsalva test was 38,2%±12,4%. The average diameter of the GSV at the base of the first valves was 6,07±1,25 mm. The average diameter of the GSV at the level of the maximum ectasia of the osteal valve was 9,44±1,69 mm. The average RVDC for GSV was 58%±24%.

Conclusion. the natural form of proximal SFV and GSV valves is clavate with presence of the significant supravalvular ectasia, which was noted in the majority of the subjects alone and in all during the performance of the Valsalva functional test.

Introduction. Radionuclide imaging is included in diagnostic methods after PCI and CABG in patients with symptoms, but the recommendations caution against routine testing in all asymptomatic patients after revascularization. The paper shows the results of single-photon emission computed tomography after hybrid coronary myocardial revascularization; an analysis of the sensitivity and specificity of three methods of surgical myocardial revascularization was carried out in 12 months.

Aim of the study was to determine the sensitivity and specificity of SPECT in determining coronary artery stenosis ≥ 50 % after performing three methods of surgical myocardial revascularization: CABG, PCI, and hybrid myocardial revascularization in patients with coronary artery disease and multi-vascular coronary lesion.

Material and methods. A retrospective analysis of 82 patients with stable forms of coronary artery disease who underwent myocardial revascularization for the presence of the multivascular coronary lesion was carried out. The patients were divided into three groups: the first group consisted of 40 patients who underwent CABG, the second – 29 patients after PCI, and the third – 23 patients who underwent hybrid myocardial revascularization.

Results. All patients after myocardial revascularization, on average, after 21.8±8.6 months, were hospitalized, where singlephoton emission computed tomography of the myocardium with 99mTc-technetril (SPECT) and control coronarography/ shuntography were performed. The frequency of the presence of significant stenosis during coronary angiography with a perfusion defect of ≥5 % on SPECT during exercise was 50, 50 and 33 % in the CABG, PCI, and hybrid revascularization, respectively (p=0.894). The least sensitivity of SPECT was after hybrid myocardial revascularization (20 %), while in the CABG group, the sensitivity was 71.4 % (p = 0.190). The SPECT specificity indices were much higher: in the GABG, PCI, and hybrid revascularization groups, respectively, 75.8, 79 and 88.9 % (p=0.530).

Conclusion. There is no significant relationship between the size of the defect on SPECT and coronary angiography data, regardless of the type of surgical myocardial revascularization in patients after myocardial revascularization. Detection of a perfusion defect with a load of more than 10% in SPECT after surgical myocardial revascularization is the basis for coronary angiography in order to exclude stent restenosis or shunt dysfunction, as well as progression of coronary atherosclerosis.

Introduction. One of the most difficult and completely unsolved problems of modern interventional cardiology is bifurcation stenting of the coronary arteries. This problem requires a comprehensive study, including using the possibility of morphological analysis.

Material and methods. Stenting of the bifurcation lesions of the coronary arteries on 46 cadaveric hearts was performed using the bifurcation and conventional stents with subsequent plating and study of the preparations obtained.

Results. From the point of view of the safety of the lateral branch, T-stenting is optimal, especially when implanting a BIOSS stent. When using the Tryton stent with the culotte stenting technique, there was never a stenosis of the side branch, due to the stent in the lumen, but there was always an excessive metal saturation in the main branch before the bifurcation. When using conventional stent with a provisional T-stenting technique residual, stenosis of the mouth of the lateral branch was also observed. In addition, in all cases there was a deformation of the stent beams near the mouth of the lateral branch.

Conclusions. Morphological studies of stented coronary arteries on anatomical preparations of the heart, plastized with epoxy resin, make it possible to obtain new results that cannot be obtained with traditional morphological and clinical research methods (histological, corrosive, radiological, etc.).

Aim – determine a forms of metabolic acidosis (MetAc) after cardiac surgery with cardiopulmonary bypass (CPB). Estimate significance of MetAc in an early postoperative period.

Material and methods. We included the 129 adult cardiac surgery patients. We studied the indicators of acid-base blood status, markers of systemic inflammation, an oxygen delivery and consumption, the hemodynamic parameters, the clinical course of the postoperative period.

Results. The acid-base disorders were found in 73.6 % of cases. The metabolic acidosis was in 51.2 % of cases: the lactate acidosis was in 92.4 % and the hyperchloremic acidosis was in 7.6 %. The metabolic lactate acidosis was represented by two forms: 1. the acid-base disorders due to a low cardiac output syndrome with a decrease in oxygen delivery and contractility (14.7 %); 2. the lactate acidosis due to a systemic inflammatory response syndrome (49.2 % of cases). It is associated with a high delivery and a low oxygen extraction, increased cardiac output and a vasoplegia. Patients with these disorders had a higher level of leukocytosis after 24 hours of the end the operation, had a longer duration of respiratory support and a long ICU stay and hospital stay.

Conclusion. The lactate acidosis is represented by two forms: the lactate acidosis associated with the low cardiac output syndrome and lactate acidosis associated with the systemic inflammatory response. The lactate acidosis is a predictor of adverse outcome after cardiac surgery with CPB and associated with a postoperative complications and a mortality.

It is known that hemostatic, immune and autoimmune reactions can play a role in the development and progression of abdominal aortic aneurysms (AAA), including the activation of platelets and CEC However the role of those in pathogenesis of AAA remains unclear.

The aim of this study was to study the influence of EVAR on functional activity of platelets and number of circulating endothelial cells (CEC) in comparison with small abdominal aortic aneurysms – AAA (less than 5 cm)

Material and methods. Platelets activity has been analyzed due to the assessment of quantity of GP IIb/IIIa receptors and expression of P-selectin. CD14-FITC/CD16-PE/ HLADR-PC5/CD45-PC7 has been used to assess the monocytes activity CEC were counted by flow cytometry in blood samples of patients before EVAR, within 4 weeks and in 18 months after the operation in comparison with non-operated patients due to small diameter AAA. Markers (CD146 + CD45) were used to identify CEC.

Results. The amount of Р-selectin, СD62 in patients with small aneurysms (SAAA) in comparison of aneurysms more the 5 cm (BAAA). has been increased (р<0,05). There was the statistically significant difference in amount of GP IIb/IIIa in SAAA and BAAA(р=0,04). The number of monocytes were less in SAAA Positive correlation between CEC and monocytes and between the size of aneurysms in BAAA before the operation have been revealed. We found the positive correlation between CEC number and P-selectin (CD62), in patients at early postoperative period. The significant difference (р=0,02) (GP) IIb/IIIa receptors in patients before and at late postoperative period has been found ><0,05). There was the statistically significant difference in amount of GP IIb/IIIa in SAAA and BAAA(р=0,04). The number of monocytes were less in SAAA Positive correlation between CEC and monocytes and between the size of aneurysms in BAAA before the operation have been revealed. We found the positive correlation between CEC number and P-selectin (CD62), in patients at early postoperative period. The significant difference (р=0,02) (GP) IIb/IIIa receptors in patients before and at late postoperative period has been found.

Conclusion. The change in the quantitative characteristics of CEC, platelets and monocytes during the growth of AAA confirms the idea about the activation of innate immunity as an important pathogenetic link in the development of this disease, closely associated with the destruction of the vascular wall and, in particular, of its endothelial lining. The obtained data partly explain the unsatisfactory long-term results of the EVAR and provide an opportunity for developing new approaches for prevention of postoperative complications and the treatment of AAA.

Introduction. It was previously unknown that the form of erythrocytes depends on their interaction with oxygen. The form of red blood cells is reversible and changes both after passing through the lungs (oxygenator), and after gas exchanges in the tissues.

Purpose of the study. In order to study the effect of cardiopulmonary bypass (CPB) on the erythrocyte morphology, the intensity of gas exchanges in the body tissues of the patient was determined using morphometric analysis of the form of erythrocytes.

Material and methods. To achieve this goal, we developed a method for the morphometric analysis of erythrocytes «in vitro». Blood test was performed before surgery, on the 10th and every 30^th minute of CPB, 12 hours after surgery.

Results. Using this fact, we studied tissue respiration intensity. We found that normal arterial blood contains 85 % [80–95 %] red blood cells covered with small «villi» (0.3–0.4 μm), whereas venous blood consists mostly of «large-villous» erythrocytes (length of the «villi» 0.4–1.0 μm, 70 % [6–80 %]). During pairwise comparison we found the significant difference in the proportion of «large-villous» red blood cells in arterial blood before (15 % [5–20 %]) and after (35 % [20–50 %]) CPB. Partial pressure of oxygen and carbon dioxide changes throughout CPB and it shows changes in oxygen carrying capacity of blood. Decrease in the oxygen capacity of the blood reflects the intensity of tissue respiration on the one hand, and the degree of mechanical damage to red blood cells on the other.

Conclusion. Heart surgery in infrared conditions lead to pronounced shifts in the ratio of discocytes and pathological forms of red blood cells in the blood. Inhibition of the red blood oxygen consumption during CPB indicates changes in the metabolic reactions, erythrocytes morphology and functionality. These data give us more complete understanding of the pathophysiological changes throughout CPB. The proposed method of erythrocytes morphometric analysis can be used as an express blood test in heart surgery with CPB, enabling better understanding of red blood state.

This article describes in detail the modified method of heterotopic heart transplantation in rats. The methods of animal anesthesia, surgical features of the removal of a donor heart and its implantation to a recipient rat are described in detail. The advantages and disadvantages of donor heart preservation methods are described, as well as methods for evaluating a donor heart preparation, the quality of preservation and the effectiveness of cardioprotection. Experimental approaches to the study of the effectiveness of cardioplegic and preservative solutions using this technique are proposed. The data of our own pilot study on a comparative analysis of the effectiveness of cardioprotection using preservative solutions using this experimental model are presented.

Introduction. Rosacea is a chronic inflammatory dermatosis characterized by the presence of pathogenesis of inflammation and vascular changes caused by exposure to antimicrobial peptides (LL-37) and toll-like receptors (TLR2). It has been established that the pathogenetic link is a target for a new therapy of rosacea.

Objective – to evaluate the potential combined effect of local Ivermectin 1 % cream and a pulsed dye laser (PDL) with a wavelength of 595 nm on a model of rosacea-like inflammation on mice after 4-fold introduction of recombinant antimicrobial peptide LL-37.

Material and methods. Adult female BALB/c white mice weighing 23.5±0.66 g were used, divided into 4 groups: control; group 2 (biodistillate water was introduced in a volume of 40 μl, within 48 hours); group 3 (without treatment, intracutaneously injected paravertebrally into the lumbar region 40 μl of peptide LL-37 (320 μM), 4 times every 12 hours); group 4 (with treatment, 1 % Ivermectin cream was applied after each peptide injection, 60 hours after the first injection, the PDL device with a wavelength of 595 nm was treated, the area irradiated with a surface of 50 mm2).

Results. The result indicates that the local injection of LL-37 into the skin of mice caused a dramatic expansion and fullness of the vessels of both the arterial and venous link. The integrity of the walls of the blood vessels of the microcirculatory bed in the dermis and the hypodermis has broken, resulting in multiple small hemorrhages in the tissues. In the remaining vessels, the endothelium was swollen, the adventitia was infiltrated with leukocytes. The number of mast cells increased significantly, but only some of them degranulated.

Conlusions. As a result of the combined local anti-inflammatory and laser effects, leukocyte infiltration of the dermis and hypodermis decreased, in the dermis a part of the vessels was desolate, the endothelium in them was swollen. Enlarged full blood vessels remained in the hypodermis, the endothelium was absent in them, insignificant adventitia infiltration remained. The proposed combination of effects, taking into account the morphological picture, is promising and requires additional study in patients with rosacea without the use of invasive research methods.