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Biomedical subjects

L A Bokeriia

Publications and source records attributed to L A Bokeriia.

At least 19 recordsLinked to original sources
PubMed2006

[Immediate and remote results of stenting of left coronary artery trunk in patients with ischemic heart disease].

The aim of this investigation was assessment of efficacy of stenting in patients with ischemic heart disease with lesions of left coronary artery (LCA) trunk. In the A.N. Bakulev Scientific Center of Cardiovascular Surgery between June 1997 and March 2005 stenting of LCA trunk was carried out in 50 patients (33 with stable effort angina and 17 with acute coronary syndrome). Immediate success rate was 100% in patients with stable angina. In a group of patients with acute coronary syndrome angiographic success rate was 100%. Total lethality in this group was (3 cases) 17.7%. In remote period (6 to 60 months) 33 of 39 patients were examined and recurrence of angina was noted in 7 of them (21.1%). Control angiography was carried out in 16 patients and restenosis of LCA was revealed in 18.75% of cases. The authors believe that stenting of LCA trunk is an effective and safe method of treatment of patients with stable angina and sufficiently safe method in patients with acute coronary syndrome. Roentgenoendovascular treatment may serve as an alternative to aortocoronary bypass surgery especially in isolated lesions of LCA trunk. Application of stents with drug coating allows to cardinally improve long term results of stenting.

Acute Disease↗
PubMed2006

[Implanted cardioverters-defibrillators in the treatment of arrhythmias and prevention of sudden death].

AIM: To present 15-year experience in use of implantable cardioverters-defibrillators (ICD) in patients with life threatening arrhythmias and a high risk of sudden cardiac death (SCD). MATERIAL AND METHODS: A total of 151 patients (116 males and 35 females aged 12-75 years) with life threatening arrhythmias and ICD were studied. RESULTS: There were neither complications nor lethality. Electrocardiotherapy was performed in 89 (58.9%) patients 4.5 +/- 9.4 months, on the average, after ICD implantation. Attacks of ventricular tachycardia (VT) were arrested by antitachycardia stimulation (974 episodes, 37.5 +/- 92.5 per patient, on the average). Effective cardioversion in VT was observed in 63 (41.7%) cases. Episodes of rapid ventricular tachycardia and ventricular fibrillation were stopped by defibrillation shocks in 28 (18.5%) patients. Additional surgical interventions were made in 3 patients because of electrodes dislocation, in 1--because of electrode brakage and in 1--suppuration of the bed. Fifteen patients (9%) died during follow-up because of cardiac failure (n = 13), cancer (n = 1), unknown cause (n = 1). CONCLUSION: Clinical application of ICD is not only treatment of arrhythmia and prevention of SCD but it is also a method of diagnosis, collection and accumulation of information about the disease course.

Adolescent↗
PubMed2005

[Short- and long-term effects of internal carotid arteries stenting in high-risk patients].

The efficacy of endovascular treatment of internal carotid arteries (ICA) stenosis (20 patients) has been compared to that of conventional carotid endarterectomy (25 control cases). ICA stenting was performed in case of stenosis, narrowing arteries to > or = 60% in "symptomatic" patients and to > or = 80% in "asymptomatic" ones. Angiographic indices revealed favorable outcome after stenting in 100%. Mean extent of residual stenosis was 8.3 +/- 0.8%. Significant complications (stroke/fatal outcome) after 22 procedures developed in 3 (13.6%) cases. Mortality was estimated as 4.5%. Taking stroke and fatal cases into account, the interventions were successful in 86.4% cases. The duration of follow-up study was from 1 to 48 months, with 1 case resulting in death and 2--in development of acute disturbance of cerebral blood circulation of contralateral ICA. Short- and long-term results of the intervention did not significantly differ between the study and control groups thus indicating ICA stenting as an alternative to carotid endarterectomy procedure.

Age Factors↗
PubMed2005

[Cryopreserved allo-grafts in aortic valve surgery].

Bakulev Scientific Center for Cardiovascular Surgery resumed research into cryopreservation and creation of valve bank in 1990. This technology allowed preparation of valve allo-grafts with preserved cell reproductive capacity for clinical use. A new technology, allowing reduction of calcinosis in the graft's aortic wall, was developed and experimentally tested in 2003. 61 aortic valve replacements with cryopreserved allo-grafts were performed between 1992 and 2003. The three techniques of implantation included: subcoronary (38), intraaortic cylinder (8) and "free-standing root" (15). 44 patients developed active infective or prosthetic endocarditis. Hospital mortality rate was 11.5%, 12-year survival rate--90%. Dysfunctions and reoperations were significantly rarer in cases of inclusion cylinder and free standing root. The authors conclude that cryopreserved allo-grafts allow good quality of life without use of anticoagulants and low rate of reinfection. The use of subcoronary technique for implantation must be limited and method of choice should be free-standing root, especially in cases of destructive infective or prosthetic endocarditis. Cellular engineering probably will elongate the stability of long-term results.

Adolescent↗
PubMed2005

[Spiral computed tomography in aortic aneurysm diagnostics].

10-year experience of use of spiral computed tomography (CT) with bolus intravascular contrasting allowed the authors to determine the advantages of this method in aortic aneurysm diagnostics and to show the importance of its application in dynamic monitoring. The article also covers drawbacks of the method, which are not so significant as the advantages, because the CT method answers practically all surgeon's questions, including the length, localization of aneurism, presence of congenital vascular anomalies, fistulas, hemorrhages or prosthesis infection in postoperative period. CT meets all the diagnostic requirements and bears minimal risk while quickly giving enough information about anomalies of bloodstream and surrounding tissues in a certain patient.

Aortic Aneurysm↗
PubMed2005

[Left ventricle dilatational lesion. Problems of nosology, diagnostics, and treatment].

The article deals with the problem concerning the use of the term "specific cardiomyopathy", adopted by WHO in 1995, in cases of advanced left ventricle lesion in patients with valvular heart defects. The group of patients with dilated left ventricle cavity, related to acquired heart diseases, is rather heterogeneous and large in number, and includes about 50% of the patients who underwent an operation. In the authors' opinion, it is reasonable to divide them into the following main subgroups: patients with quickly regressing symptomatic left ventricle dilatation, resulting from volume overload; patients with valvular cardiomyopathy (the terminal stage of heart defect); patients with left ventricle dilatational lesion, typical of the intermediate stage with characteristic pathological remodeling and the disturbance of its segmental contractility. The authors consider such a division to be useful for further study of patients with left ventricle dilatation due to valvular heart defects.

Cardiac Pacing, Artificial↗
PubMed2005

[A new view of anatomic substrate, electrophysiological mechanisms of atrial fibrillation, and results of interventional treatment].

Literature data on anatomic and electrophysiological properties of pulmonary veins (PVs) are very scarce. The study included an investigation of 20 human autopsy hearts with and without cardiovascular pathology. In addition, biopsy samples from the right superior PV were taken from 5 patients with atrial fibrillation (AF) for ultrastructural study. The investigation found myocardial sleeves (MS) in 86.3% of cases, an additional PV between right PVs--in 15%, a collector type of superior and inferior PV--in 25% of cases. MS were situated on the adventitial side of PVs; along the whole length of the PVs the MS myocyte fascicles ran in different directions. Local changes, such as productive myocarditis, fibrosis and fibro-lipomatosis, were observed in MS of PV of patients with AF. 106 patients (80 of whom were male; middle age 42.9 +/- 12.5 years) with symptomatic AF underwent clinical examination. Electrophysiological features of the PVs were evaluated in 30 patients. Effective and functional refractory periods of PVs were found to be shorter than those of the left atrium and non-arrhythmogenic PVs. Radiofrequency ablation (RA) with application of electrophysiological criteria proved to be effective in all patients with frequent ectopy from PVs. The use of electroanatomical mapping allowed successful RA in 82% of patients with persistent and chronic AF. The study demonstrates that the changes in MS of PV, discovered by means of light and electron microscopy, as well as their complex three-dimensional morphological structure may cause and maintain AF. Very distinct electrophysiological features, found in AF patients, probably play a major role in arrhythmogenicity.

Adolescent↗
PubMed2005

[Surgical treatment of pediatric hypertrophic obstructive cardiomyopathy using an original approach].

The authors offer an original technique of surgical correction of pediatric hypertrophic obstructive cardiomyopathy (HOCM), which allows excision of the hypertrophied area and elimination of the obstruction from the cone part of the right ventricle (RV) without penetrating into the LV cavity. 15 children aged 5 to 15 years have been operated on in Bakulev Scientific Center for Cardiovascular Surgery using this technique. 8 of the patients had simultaneous obstruction of the left and right ventricular outflow tract (LVOT and RVOT), 1 patient had RV obstruction. Medical therapy had failed in all cases. The follow-up period was 28 +/- 7 months. EchoCG examination, performed after the surgical treatment, found a decrease of the intraventricular gradient in LV from 72.9 +/- 8.9 to 12.7 +/- 5.5 mmHg; the mean gradient in RVOT also reduced from 43.6 +/- 5.7 to 4.3 +/- 2.7 mmHg. According to the EchoCG, septal thickness reduced from 31.5 +/- 6.5 to 16.5 +/- 4.1 mm. Sinus rhythm was noted in all the patients after the surgery and during the follow-up. The method proposed by the authors is preferable in surgical treatment of children with various forms of hypertrophic cardiomyopathy unresponsive to medical treatment and is a method of choice in a significant number of cases.

Adolescent↗
PubMed2005

[Transmyocardial laser revascularization of the myocardium].

The paper presents the results of a 5-year follow-up after coronary artery bypass grafting (CABG) combined with transmyocardial laser revascularization (TMLR). The study revealed high efficiency and safety of the combined surgery in patients with coronary heart disease (CHD) associated with diffuse lesions of coronary arteries. The procedure improved the myocardial perfusion and contractile function, thus significantly increasing the patients' life quality. Combined CABG + TMLR noticeably improved stenocardia functional class, increased physical exercise tolerance and led to a significant reduction in nitrate agent consumption in patients with CHD.

Angioplasty, Balloon, Coronary↗
PubMed2005

[Acute coronary syndrome and cell technologies].

The authors researched into the possibility of autologous bone marrow stem cell (MSC) application in patients with acute myocardial infarction (AMI). 10 patients with AMI received cell therapy after giving an informed consent. ECG and EchoCG revealed myocardial infarction (MI) in the basin of the anterior interventricular branch (AIB) of the left coronary artery (LCA) in 4 patients, in the basin of the circumflex branch (CB) of the LCA--in 3 patients, and in the basin of the right coronary artery (RCA)--in 3 patients. Patients older than 70, patients with acute heart failure and those who developed AMI more than 48 hours ago, were excluded from the study. All the patients were male, aged 56.3 +/- 5.2 years, mean time from pain onset to the performance of myocardial revascularization was 11.4 +/- 7.2 hours. Marrow mononuclear fraction was introduced into the infarction-related artery on the 5th-7th day after primary angioplasty and stenting. Marrow sampling and cell material introduction did not cause any complications. All the patients were re-studied 1 month after the MSC transplantation. All the patients' condition improved; no complications or side effects of the interventions were observed. Left ventricle ejection fraction increased from 42.9% to 51.4%; the average number of asynergic segments was 5.3 +/- 0.7 before the intervention and decreased to 2.6 +/- 0.7 (p < 0.01) afterwards. Systolic velocity before the intervention was 2.5 cm/sec, and after the procedure it increased to 4.6 cm/sec in the segments submitted to isolated revascularization and to 6.1 cm/sec--in segments where the intervention was accompanied by the introduction of MSC (p < 0.01). Contrast EchoCG demonstrated an increase of myocardial perfusion in the area of cell therapy. The chief results of the study are as follows: 1) autologous MSC transplantation in patients with acute coronary syndrome is a safe and well-tolerated procedure; 2) myocardial revascularization in combination with MSC introduction in AMI area improves total and local contractile myocardial function and normalizes diastolic filling process in the LV; 3) cell therapy improves the myocardial perfusion.

Animals↗
PubMed2005

[ECG-gated single-photon emission computed tomography with 99mTC-tetraphosmin in diagnostics of short-term myocardium stunning under the condition of stress-induced ischemia in CHD patients with multivascular lesions of coronary vessels].

The authors analyzed the efficiency of ECG-gated single-photon emission computed tomography (SPECT) with 99mTc-tetraphosmin in diagnostics of short-term myocardium stunning in CAD patients with transient ischemia. The technique was applied to 16 CAD patients. Combined evaluation of perfusion was based on the analysis of radiotracer uptake level in left ventricle (LV) myocardium. In order to evaluate myocardium function the authors measured LV systolic thickening index, using 20-segment pattern. 8 out of 16 patients (50%) displayed the phenomenon of stress-induced stunning. The volume of stunned myocardium in individual patients was 2 to 7 LV segments. In general, up to 37% (29/78) of reversible perfusion defects are subjected to short-term stunning under the condition of transient ischemia. After surgical treatment, 84% of segments with signs of stunning normalized their functioning both under stress and at rest.

Coronary Disease↗
PubMed2005

[Smooth muscle cell apoptosis in aneurysmal aortic lesion in the light of surgical treatment results].

Aortic aneurysm is a polyethiologic disease associated with high disability and perioperative mortality rate. The evolution of ethiopathogenesis of aortic aneurysm development is considered in the article. The findings of recent worldwide studies on immune status impact on the disease progress and the postoperative period are presented. All studies showed that 25% of patients had immune status disturbances accompanied by changes in the hemostasis system and high apoptosis index in blood serum and aneurysm tissue. Variants of clinical course of different aortic aneurysm forms and perioperative managements of patients aimed at prevention of possible complications are highlighted.

Animals↗
PubMed2004

[Effect of aortic clamping on hemodynamics at reconstruction of the thoracoabdominal aorta].

This paper describes an experience with monitoring and computerized follow up of the hemodynamic status in 60 patients at and right after reconstruction of the thoracoabdominal aorta. In addition to the routine control, measurements were made of the pressure in the large vessels and cavities of the heart, duration of each heart contraction and CI. The following parameters were computed automatically: the status of the ventricles for each heart contraction, resistance of the greater end pulmonary circulation, elasticity of the arterial, venous, pulmonary arterial and pulmonary venous reservoirs, also for each cardiac cycle. At the generally accepted monitoring the hemodynamic responses to the surgeon's manipulations on the aorta appear smoothed or are not visualized at all. The control of each heart contraction reveals the responses to application of the clamp and its removal from the aorta, with their hemodynamic significance being not questionable. Aortic clamping and clamp removal from the aorta are associated with the generalized response of the regulatory systems of the body. The slow and thoroughly controlled aortic clamping and graded, controlled blood flow restoration due to clamp removal as well as the use of sodium nitroprusside (trimetafan or isofluran are preferable) allow to avoid an abrupt stroke load of the left ventricle of the heart and, respectively, the generalized response of the regulatory systems of the body.

Aortic Aneurysm, Abdominal↗
PubMed2004

[New approaches to the treatment of ischemic heart disease: therapeutic angiogenesis in combination with surgical revascularization of the myocardium].

AIM: To evaluate the results of surgical treatment of patients with ischemic heart disease in combination with intraoperative intramyocardial introduction of the human gene VEGF165 (angiostimulin). MATERIAL AND METHODS: Twenty four patients enrolled in the study were examined using 12-lead ECG, echocardiography, treadmill exercise test, single-photon emission computed tomography of the myocardium with Tc-99m-tetrophosmine, fluorodesoxyglucose (FDG) positron-emission tomography of the myocardium, selective coronarography. Out of 24 patients, 10 patients have been reexamined so far. The effect of the treatment was assessed by the data obtained at the treadmill test, transthoracic echocardiography, myocardial scintigraphy and FDG. RESULTS: All the patients demonstrated a clinical response. The class of effort angina improved, the dose of the prescribed nitric drugs was decreased, exercise tolerance and total stress time rose, quality of life improved. Myocardial scintigraphy registered reduction of the total area and better accumulation of the radiopharmaceutical under load and at rest 3 and 6 months after the operation including myocardial areas which had not been revacularised at coronary artery bypass grafting but had been treated with the preparation of the human gene VEGF165. CONCLUSION: The results of the study suggest that therapeutic angiogenesis may be an alternative impact on those myocardial areas which are supplied by the affected but ineligible for bypass grafting coronary arteries.

Collateral Circulation↗
PubMed2004

[First experience with the use of bone marrow stem cells for regeneration therapy of ischemic heart disease.].

AIM: To elucidate feasibility of the use of autologous bone marrow stem cells in candidates to myocardial revascularization- patients with ischemic heart disease and cardiosclerosis after myocardial infarction. METHODS: Between January 2003 and January 2004 25 men aged 56.3+/-5.4 years with ischemic heart disease were subjected to cell therapy including 4 patients with heart failure and 5 - with acute coronary syndrome. Subgroup of patients with postinfarction cardiosclerosis consisted of 16 men satisfying the following criteria: (1) history of myocardial infarction with scar formation; (2) class III-IV angina; (3) presence of indications for endovascular or surgical intervention on coronary arteries. Study protocol included clinical examination, coronary angiography; dobutamine stress-, contrast- and tissue echocardiography with assessment of segmental myocardial perfusion, systolic and diastolic left ventricular function. RESULTS: There were no complications during bone marrow sampling and administration of cells. All patients were restudied 1 month after transplantation. Improvement of clinical state without complications and adverse effects of the procedure noted in all patients was associated with lowering of mean angina class (from 3.4 to 1.4, p<0.05); decrease of NYHA heart failure class (from 3.1 to 1.5); rise of left ventricular ejection fraction (from 42.9 to 56.3%); decrease of average number of asynergic segments (from 5.3+/-0.7 to 2.1+/-0.3, p<0.01). Systolic velocity before intervention was 2.3 cm/s, after procedure in segments subjected to isolated revascularization it increased up to 4.8 cm/s, while in those subjected to revascularization combined with administration of stem cells - up to 6.2 cm/s. Contrast echocardiography in 9 patients demonstrated augmented myocardial perfusion in regions exposed to cell therapy. CONCLUSION: Transplantation of autologous bone marrow stem cells to ischemic heart disease patients - candidates for myocardial reperfusion - turned out to be safe and well tolerated procedure. Combination of myocardial revascularization with administration of stem cells into regions of postinfarction scars was associated with improvement of total and local myocardial contractility and normalization of left ventricular diastolic filling. Cell therapy facilitated augmentation of myocardial perfusion.

Bone Marrow Cells↗