Objective: study was analysis of long-term results of medical and surgical treatment of patients with severe chronic heart failure (CHF).

Materials and methods. We studied 90 patients with CHF III–IV functional class (FC) of NYHA, treated in A.N. Bakulev Scientific Center for Cardiovascular Surgery in 2007. All patients were divided into 3 groups: 30 patients who underwent conventional medical therapy (MT); 30 patients who underwent cardiac resynchronization therapy (CRT); 30 patients extremely severe category, which was performed orthotopic heart transplantation. Patients were followed up for 5 years to assess long-term results of treatment of CHF.

Results. In patients with severe CHF, CRT (with respect to MT) significantly reduces the 5-year risk of total mortality, death from progressive heart failure, rehospitalization for heart failure, cardiac arrhythmias, need for heart transplantation, as well as helping to reduce FC of CHF, and an increase in ejection fraction the left ventricle.

Conclusion. Surgical treatment of patients with severe CHF demonstrated a significant advantage over conventional MT in terms of improving the 5-year forecast.

Aim of the study – reveal clinical efficacy of naftidrofuryl in the aspect of correcting structural and functional changes of microcirculation (MC) in relation to the influence of the endothelial dysfunction (ED) parameters in comorbid patients suffered stroke event.

Materials and methods. The study included 95 patients suffered ischemic type of stroke in the carotid bassin. An average age of patients was 69.0 ± 5.3 years, stroke duration was 73.5 ± 8.4 days. Patients were randomized in 2 groups by using blind method of envelopes. The mentioned groups matched on the main clinical and demographic characteristics. Patients from the 1st group (primary group, n = 47) were treated with naftidrofuryl (Duzofarm) at the daily dose of 300 mg, 2 patients (comparison group, n = 48) received basic therapy only. 50 people without an acute cerebrovascular accident in history were allocated as a control group (group 3). The following blood biochemical parameters were assessed: glucose, creatinine, total cholesterol, high density lipoprotein; triglycerides; markers of endothelial dysfunction: von Willebrand factor (VWF), tissue plasminogen activator inhibitor-1 (PAI 1), antithrombin III (AT III) and plasminogen. MC was studied by the method of laser doppler flowmetry. The duration of the observation period was 6 months, and 4 visits were performed during this period.

Results. Initial task of group formation within the study protocol has been solved by us in a full range. Patients from Group 1 that received naftidrofuryl noted statistically significant differences after 3 and 6 months of follow-up observation. These differences reflected improvement in perfusion index, coefficient of variation, as well as endothelial, neurogenic and myogenic regulation of microvasculature, increase in perfusion oxygen saturation index in the microcirculation. We have found that an index of relative perfusion oxygen saturation in microvascular blood (Sm) being the main indicator that reflects oxygen saturation of microcirculation has significantly correlated with ejection fraction, PAI1, AT III, and plasminogen levels in group 1 patients in 3 and 6 months. We have also found significant correlation with ED when comparing parameters that express endothelial, neurogenic and myogenic regulation of microvessels. These data clearly demonstrated an association between improving of MC parameters and ED parameters in Group 1 patients.

Conclusion. Possibility of correction of MC alterations leading to the worsening of ischemia and ED progression is one of the most promising directions in the treatment of stroke patients. Aim of the drug therapy is to prevent ED progression, reduced vascular tone and restore an adequate level of tissue hemoperfusion.

To date, cardiovascular diseases occupy the first place in the structure of total morbidity and mortality in many countries. In 2013 in the Russian Federation from cardiovascular disease died 1 million 799 thousand people, from the bottom 529.8 thousand from coronary heart disease, the primary role belongs to myocardial infarction and its complications. Currently, the "gold standard" for the diagnosis of coronary heart disease, including myocardial infarction, remains coronary angiography; the main objectives of coronary angiography are to assess the features of the coronary anatomy, determination of the possibility of endovascular treatment of myocardial infarction and revascularization by stent implantation. Despite the constant improvement of technology and the progress made in relation to pharmacological support, percutaneous coronary intervention (PCI) is an invasive manipulation, which is associated with a certain risk. Diagnostic criteria for myocardial infarction 4a type include increasing the level of troponin above 5 rules of 99th the upper threshold reference values within 48 hours after the PCI procedure, in patients with normal troponin increased (≤ 99th the upper threshold reference values), or a level of troponin 20 % or more in patients with initial high level troponin combined with evidence of prolonged myocardial ischemia. Stent when performing percutaneous coronary interventions, accompanied by the activation of thrombogenic reactions, can lead to thrombosis and development 4b type. To the diagnostic signs of the myocardial infarction 4b type are the stent thrombosis, angiographic proven and/or at autopsy, in combination with increased troponin level at least one greater than the 99th the upper threshold reference values. Stent when performing PCI, accompanied by the activation of thrombogenic reactions, can lead to thrombosis and development myocardial infarction 4b type. The diagnostic signs myocardial infarction 4b type are the stent thrombosis, angiographic proven and/or at autopsy, in combination with increased troponin level at least one greater than the 99th the upper threshold reference values. You should consider the fact that the setting of drug-eluting stents increases the period of their endothelization after implantation, which in turn increases the likelihood of late thrombosis and is an indication for long-term dual antiplatelet therapy. The article describes the varieties of myocardial infarction associated with PCI, an algorithm for the diagnosis and management of patients in accordance with current clinical recommendations.

Objective – review current data on the use of beta-blockers (BB) in chronic heart failure (CHF).

Materials and methods. This article discusses beneficial effects of BB administration in CHF patients. It has been demonstrated that decrease in heart rate underlies clinical efficacy of BB therapy in patients with chronic heart failure. We reviewed the question of the necessity to achieve target doses of BB in the treatment of CHF patients. It has been shown that administration of BB in patients with chronic heart failure and reduced left ventricular ejection fraction increase pumping function of heart, and thus reduce the number of hospitalizations for decompensated heart failure, reducing the risk of total and sudden mortality. We demonstrated substantial advantages of β1-selective BB over nonselective ones with respect to their impact on hemodynamics, metabolic processes, rheological parameters of blood and bronchi. We also considered therapeutic tactics in case of BB administration in CHF patients.

Results. Based on the data of the current studies we proved high efficiency and safety of β1-selective BBs in CHF patients.

Conclusion. Correct choice of BB in patients with CHF and decrease in heart rate during the treatment can significantly increase an effectiveness of the treatment.

Objective: to identify the possible factors of thrombogenic risk and ways of its prevention in patients with von Willebrand disease.

Case description. Patient X., 42 years old, who suffers from von Willebrand disease type 3 with 5-years of age. Asked on reception to the traumatologist in the polyclinic of the Regional Hospital with pain in the left hip joint. Recommended planned operative treatment in the Altai Regional Clinical Hospital. Preoperative preparation included the infusion of concentrate of von Willebrand factor and coagulation factor VIII. Operation – cement total arthroplasty of the left hip joint. In the postoperative period analgesic treatment, elastic compression of the lower extremities, iron supplements, also conducted infusion of concentrate of von Willebrand factor and coagulation factor VIII for 20 days and thromboprophylactic with dabigatran. On the 3rd day after the operation the patient revealed deep vein thrombosis of the femoral segment (floating clot).

Results. The patient was operated for emergency indications in the Department of endovascular surgery – installation of venous cava filter “Volan”. Dabigatran is cancelled, appointed clexane for 3 months. In our clinical example the patient lacked risk factors of pulmonary embolism as obesity, age, smoking, prolonged immobilization, estrogen therapy. Overdose of factor VIII were not observed – the level of factor did not exceed 135 % on transfusions. At the same time, the patient was found polymorphisms in the genes ITGA2, FGB, MTHFR, MTR – heterozygote, MTRR – mutant homozygote, which may indicate the genetic factors of thrombogenic risk. Also a significant risk factor was massive surgical intervention (total hip replacement). Despite preventive measures (elastic compression, thromboprophylactic dabigatran, early activation) we cannot to avoid thrombotic complications.

Conclusion. This article presents a case demonstrating a thrombotic complication in patients with von Willebrand disease type 3 in the postoperative period of total hip arthroplasty. It is shown that despite preventive measures, she developed a very rare von Willebrand disease the phenomenon of deep vein thrombosis, bleeding was not observed. Pulmonary embolism was avoided by the installation of cava filter.

Aim of the study – draw attention to the differential diagnosis of systemic lupus erythematosus (SLE) and infective endocarditis.

Materials and methods. Patient A., 44 years old, was admitted to the cardiologic department of Ryazan Regional Clinical Cardiology Clinic diagnosed with probable infective subacute endocarditis, glomerulonephritis, with complaints of weakness, fatigue, increase in body temperature up to 37.7 °C preferably in the evening, dry cough, shortness of breath on mild exertion, swelling of legs and feet. In early October 2015, the patient's body temperature increased up to 37.8 °C, there was a dry cough. Patient was treated on an outpatient basis for acute respiratory viral infections with antibiotics, decreased body temperature. Acute deterioration of the condition was observed in mid-October: severe shortness of breath even on mild physical exertion, heart rate increased, as well as lower limb edema, blood pressure (BP) increased up to 240/140 mmHg. The patient was hospitalized in the therapeutic department. Against the background of the treatment (antibiotics, antihypertensive agents, diuretics, digoxin) patient’s condition was improved: shortness of breath decreased, as well as the heart rate, limb edema, blood pressure down to 180/110–190/120 mmHg. However, there was persistent proteinuria (0.33–1.65–3.3 g/L), low grade fever persisting in the evening. On admission to the cardiological department of Ryazan Regional Clinical Cardiology Clinic patient underwent the following survey: assessment of lab parameters in dynamics, electrocardiography, heart echocardiography, computed tomography (CT) of lungs.

Results. We revealed left ventricular hypertrophy on heart ultrasonography; an increase in the volume of left atrium, right ventricle, right atrium; mitral, aortic, tricuspid valve insufficiency (grade II regurgitation); pulmonary hypertension; on lung CT – the picture of hydrothorax on the right side, hydropericardium. General analysis of the urine revealed proteinuria equal to 3.3 g/L. These data, combined with the history of the disease (fever for several months) confirmed diagnosis of infective endocarditis, despite the absence of vegetations on heart valves. However, high degree of proteinuria required differential diagnosis with systemic connective tissue diseases, such as system lupus erythematosus. Additional examination revealed increased titers of antinuclear factor (1:5120) antibodies (AB) to the double-stranded deoxyribonucleic acid (DNA) (93 IU/mL). In this regard, and due to an increase in proteinuria up to 10 g/L we re-assessed diagnosis: systemic lupus erythematosus, acute course, grade III of activity with the affection of kidneys (lupus nephritis with nephrotic syndrome and impaired renal function, glomerular filtration rate equal to 35 mL/min), serous membranes (hydrothorax on the right side, hydropericardium), heart (moderate insufficiency of mitral, aortic, tricuspid valve (grade II regurgitation), respiratory system (grade I pulmonary hypertension), haematological disorders (anemia, thrombocytopenia), seropositive for antibodies to double-stranded DNA, anti-nuclear factor; secondary hypertension.

Conclusion. This case illustrates difficulties of differential diagnosis between system lupus erythematosus and infective endocarditis, especially in the early stages, when there are still no data of additional examinations.

The article presents a review of published data on the problem of osteoporosis in patients older than 75 years who have had fractures of the proximal femur. We used descriptive and analytical methods. Search publications have done in accessible to free search databases. Based on our analysis, it was found: the majority of researchers in Russia and abroad are united in the opinion that this issue requires a multidisciplinary approach; surgical treatment should be initiated as early as possible after the onset of fracture, before the complications from side of the internal organs; patients with fractures on the background of senile osteoporosis should receive drugs that affect to the quantitative and qualitative components of bone.

Cardiac surgery is the only radical method of treatment of valvular defects (congenital or acquired): valve preservation procedures or prosthetics operations. 250 000 – 280 000 valve prostheses are implanted every year worldwide, while the number of prosthetic valves operation increases by an average of 5–7 % per year (biological prostheses – 8–11 %, mechanical prostheses – 3–5 %). Selection of biological or mechanical types of prosthesis, its location, the presence of associated risk factors for embolic events, such as atrial fibrillation, previous embolism, left ventricular dysfunction, hypercoagulable states determine patient management tactics. Particularly high risk of prosthetic thrombosis and thromboembolic complications can be seen in case of mechanical prosthesis implantation. Numerous prospective and retrospective clinical studies have proven high effectiveness of anticoagulants for reduction the risk of cardioembolic complications. The degree of anticoagulation (optimal international normalized ratio (INR)) is determined by risk factors for prosthetic thrombosis and thromboembolic complications in a patient, as well as thrombogenicity of the prosthesis by itself; INR may range from 2.5 to 4.0. International recommendations take into account the presence/absence of additional risk factors for thromboembolism, and based on warfarin administration with the achievement of target INR values combined with low-dose aspirin. Administration of novel direct oral anticoagulation remedies in patients with prosthetic heart valves has not been studied sufficiently up to date and is contraindicated. Thus, warfarin currently is a drug of choice for the prevention of thromboembolic complications in patients with prosthetic heart valves.