The study included 238 cases of surgical treatment of patients with infectious endocarditis of left parts of heart. The operations of single or multivalve reconstruction or restoration in conditions of artificial circulation were made to these patients. The patients were divided into groups depending on the type of cardioplegic solution. The influence of methods of cold crystalloid (extracellu-lar and intracellular), and blood cardioplegia on clinical and laboratory indices, which characterize the severity of myocardial damage in intra - and postoperative periods, was studied. The obtained results showed that the use of all types of cardioplegic solutions allows to provide the myocardial protection during the operation and to decrease the risk of life-threatening complications in this category of patients. The increase in the level of laboratory parameters of myocardial damage was registered in the use of all types of cardioplegic solutions in patients with long anoxia. The lowest intensity of changes in the levels of blood lactate marked using a solution for cold crystalloid intracellular cardioplegia. The greatest changes of this indicator were identified in patients receiving blood potassium cardioplegia. The use of cardioplegic solution "Custodial" caused the greatest intensity of acidosis in the intra-operative period.
To determine the diagnostic validity of histological study and the feasibility of using this type of data for the correction of treatment tactics, the comparison of the data obtained on the basis of morphometric analysis of remote intracardiac structures in patients operated on for valve infective endocarditis of left parts of the heart, with the main clinical, microbiological and echocardiographic characteristics of the disease was performed in this research. Data were studied from 62 patients with left part of infective endocarditis in the period from 2010 to 2013. This study showed that the morphological and histological criteria allow more detail to describe the notion «active endocarditis» and to choose the most adequate treatment strategy. In the control group of patients the severity of morphological changes according to most of the criteria corresponds to the severity of clinical manifestations that determine the severity of the condition and the forecast in infective endocarditis. It is necessary to use a comprehensive approach, including histological and morphological criteria of infective endocarditis.
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