Milner I. Clinical-pathogenetical significance of endothelium disfunction and its correction at chronic rheumatic heart desease

Object of study - patients with chronic rheumatic heart desease (CRHD) without infectious endocarditis (IE) and with secondary IE; purpose - establishment a pathogenetical significance of endothelium disfunction at CRHD not complicated and complicated by IE, rise a qality of diagnosis, treatment and prediction a feature of pathogenetical process in such patients; methods - clinical, electrophysiological, ultrasonic, biochemical, immunologic, bacteriological, immunoenzymatic, statistical; novelty - for the first time a pathogenetical significance of various links of endothelium disfunction (ID) at not complicated CRHD and complicated by IE was prooved, interrelations between particular rates of endothelium function (EF), character of valvular defects, stages of cardiac insufficiency, electrocardiographic and sonocardiographic parameters were established, factors, that determined an integral dynamics of significance of EF during a process of treatment such patients, were found out, an influance to a level of nitritemia (nitrogen oxide metabolites), endothelin - 1, citokins and jeikosanoids an angiotensin converting enzyme inhibitors, B-adrenolytic, diuretic and metabolic agents, calcium antagonists and cardial glicoside was elucidated; results - criterions of EF, that were permitted to predict a feature CRHD and efficiency of a further remedial measures, were found out, principles of rational medicine correction of endothelium disfunction were developed in such patients; it was applied in practice of Donetsk regional clinical territorial medical unification, terapeutic clinic of Donetsk medical university named by M. Gorkiy, terapeutic and cardiosurgical clinics of Institute of urgent restotating surgeon named by V.K. Gusak NHI of Ukraine, Lugansk regional clinical hospital and municipal clinical hospital №4 Poltava, and also in pedagogic process of Donetsk medical university named by M. Gorkiy; area of utilization - remedial and diagnostical process in reumatic, therapeutic, cardiological, cardiosurgical departments, educational process in therapeutic sub-faculties of medical higher institutions.