Annotation. In the 20th century cardiovascular diseases (CVD) is remain a leading global public health problem. The aim of the study was to analyze the general trends and regional characteristics of mortality from CVD in Ukraine in 2010-2020. The dynamic analysis covered the period 2010-2020 and carried out using indicators of absolute growth and growth rate. Regional differentiation of mortality rates from CVD in Ukraine was assessed by the amplitude of a series of regional distribution of indicators, upper and lower quartiles, and the coefficient of regional variation. The stability of territorial characteristics of mortality from CVD was determined using the correlation coefficient (Pearson, r), calculated based on regional indicators in 2010 and 2020. Comparison of age-standardized mortality rates from CVD in Ukraine and countries of Europe and the European Union was carried out based on materials obtained from the statistical database of the international epidemiological study "Global Burden of Disease (GBD)", updated for 2019. It has been established that CVD cause 66.2% of all deaths and CVD are significant medical, social and economic problem for Ukraine. Every day more than 1000 people die from CVD, and 100 of them are of working age. In 2020 408,163 Ukrainians died from this cause, and during 2010-2020, Ukraine lost almost 4.6 million of its inhabitants due to this cause. Almost 70% of these losses are caused by coronary heart disease and 20% by cerebrovascular disease. Age-standardized mortality rates from CVD in Ukraine exceed similar indicators in European countries by 2.5 times, and in EU countries by 3.7 times, and from coronary artery disease – by 3.4 and 5.4 times, respectively. Ukraine lags far behind in terms of the rate of decline in standardized mortality rates from European countries. The regions of Ukraine are characterized by a significant regional variation and a stable territorial profile of mortality from CVD with the concentration of its maximum levels in the most demographically old regions in terms of age composition. The Ukrainian strategy for the prevention of mortality from CVD should be comprehensive, regionally differentiated, depending on the territorial characteristics of the morbidity and mortality from CVD, and combine population-based approach for controlling modified risk factors for CVD with modern methods of secondary and tertiary prevention of CVD, which proven to be effective in European countries with positive experience of prevention of premature death from CVD.
The gold standard treatment for end-stage heart and kidney failure is simultaneous heart and kidney transplantation. The global number of recipients on the waiting list and performed organ transplants increases annually. However, there is a lack of well-defined selection criteria for multi-organ transplants, leading to variations based on geographic region and local protocols. In this study, we present our initial experience with simultaneous heart and kidney transplantation in Patient P, a 51-year-old individual with severe calcification of the mitral valve and end-stage chronic kidney disease. Surgical correction was not possible, and thus the patient underwent orthotopic simultaneous heart and kidney transplantation. During the early postoperative period, the patient experienced acute renal failure in the transplanted kidney, which was managed through courses of hemodialysis. The findings of this clinical observation represent the first experience of multi-organ transplantation in Ukraine. Our clinical observation illustrates the successful feasibility of simultaneous orthotopic heart and kidney transplantation, showcasing promising immediate and medium-term follow-up results.
Р ецидивирующий полихондрит (РПХ) относят к числу редких, орфанных, патологий. Он характеризуется аутоиммунным генезом с периодическим возникновением поражения хрящей различной локализации, а также других органов и систем, что может приводить к развитию тяжелых осложнений [1, 10, 11, 14, 17]. По мнению некоторых авторов [10], данное заболевание относится к аутовоспалительным болезням, когда вследствие нарушения регуляции механизмов воспаления возникает клиническая симптоматика с периодическими приступами лихорадки, без выявления инфекционного фактора, иммунодефицита, высоких титров аутоиммунных антител. В мировой литературе описано около 800 случаев РПХ [1, 7, 17]. Ежегодно появляются сведения приблизительно о 30 случаях наблюдений за больными РПХ. По данным J. Clement из клиники Мейо [18], зарегистрировано 3,5 случая заболевания на 1 миллион чело-Бортняк Наталія Володимирівна, к. мед. н., лікар-ревматолог 02660, м. Київ, вул. Братиславська, 5а.
Successful surgical treatment of massive thrombosis of right parts of the heart in a woman-patient with oncological anamnesis
Background. Extracorporeal membrane oxygenation has become an effective method in the treatment of adults and children with severe cardiac and pulmonary dysfunction resistant to conventional therapy. The aim of this article was to summarize an experience of extracorporeal membrane oxygenation usage for cardiac dysfunction, which develops in patients with coronary heart disease du-ring percutaneous transluminal coronary angioplasty. Materials and methods. The study comprised a retrospective, single-center analysis of 23 patients with coronary heart disease (19 men and 4 women, average age — 65.7 ± 12.3 years), who undertook the extracorporeal membrane oxygenation technique during percutaneous transluminal coronary angioplasty. Results. Thirteen (56.52 %) patients died directly in the hospital, or 30 days after a discharge. Independent predictors of fatal outcomes were: diabetes mellitus (OR = 17.58; 95% CI = 6.47–47.48; p = 0.00125), chronic renal failure (OR = 20.81; 95% CI = 5.95–72.21; p = 0.00014), damage to the right coronary artery (OR = 25.51; 95% CI = 8.27–79.12; p = 0.00013). For deceased patients, the “no-reflow” phenomenon was indicated in a larger portion of cases (23.1 % in the group of deceased versus 10 % in the group of survivors). A routine connection to extracorporeal membrane oxygenation before the occurrence of cardiac events was significantly more often used in the group of survived patients (90 % of cases) compared with the deceased (p = 0.0000001). Conclusions. Diabetes mellitus, chronic renal failure, and damage to the right co-ronary artery were independent predictors of mortality during percutaneous transluminal coronary angioplasty in patients with coronary heart disease. The routine use of extracorporeal membrane oxyge-nation in high-risk patients with percutaneous transluminal coronary angioplasty was a positive prognostic factor of patient survival.
Today, heart transplantation is a gold standard treatment of the terminal chronic heart failure. Despite the constant improvement of the technique of this operation and the emergence of new protocols of immunosuppressive therapy, one of the main problems in the development of heart transplantation in Ukraine is a limited donor pool. The article presents a clinical case of successful orthotopic heart transplantation, followed by mitral valve repair in the early postoperative period. Our experience shows that mitral valve repair after orthotopic heart transplantation provides good results in the medium term, and this type of intervention can potentially expand the donor pool, thus increasing the number of heart transplants. Key words: chronic heart failure, heart transplantation, mitral valve repair.
Background. Currently, about 40 million people in the world suffer from heart failure (HF). The development of severe HF is most often caused by dilated cardiomyopathy (DCM) that is a frequent indication for heart transplantation worldwide. Despite significant advances in the medical treatment of this pathology, the morbidity, hospitalization rates, and mortality are constantly increasing. This study aimed to evaluate the effectiveness of hemosorption in patients with severe HF on the background of DCM compared to surgical left ventricular remodeling. Materials and methods. The study is based on the results of a retrospective study that included 80 patients with severe HF on the background of DCM (NYHA III–IV). In group 1 (59 patients; left ventricular ejection fraction (LVEF) 21.10 ± 4.66 %), conservative medical therapy was supplemented with a course of 3 hemosorption procedures using granular deligandizing hemosorbent. In group 2 (21 patients; LVEF 22.40 ± 2.27 %), patients underwent surgical interventions in the form of LV remodeling. Results. There was a significant improvement in the clinical state and LV contractility in both groups. In group 1, LVEF increased by 12.90 ± 2.06 % (p < 0.01), in group 2 — by 13.25 ± 2.98 % (p < 0.05). However, more complications, longer hospital stay, and higher mortality were associated with LV remodeling. Conclusions. The use of extracorporeal hemocorrection methods in the comprehensive treatment of patients with DCM can improve the clinical state of patients, treatment outcomes and avoid the risks associated with surgical interventions.
Hypertrophic obstructive cardiomyopathy іs a relatively common condition and one of the most common causes of sudden cardiac death in young age. One of the options for the surgical treatment of this pathology is septal myoectomy, which has been the gold standard for decades. However, despite this, surgical treatment is intended for young patients with a low risk of postoperative complications, while patients with concomitant diseases and a higher surgical risk require alternative treatment. Today, alcohol septal ablation is considered an effective, minimally invasive method for treating hypertrophic obstructive cardiomyopathy in patients with a left ventricular outflow tract gradient ≥ 50 mm Hg. The article presents the experience of using alcohol septal ablation in 57 patients with obstruction of the left ventricular outflow tract. Key words: alcoholic septal ablation, hypertrophic cardiomyopathy, left ventricular outflow tract obstruction.
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