Relationship of Complications of the Postoperative Period with the Characteristics of Myocardial Morphology in Patients with Chronic Rheumatic Heart Disease
Introduction. The features of morphogenesis of carditis in persons with CRHD exposed to operations on heart valves are not sufficiently studied. The influence of operation on the activity of the process of exudation in myocardium in the early postoperative period in persons with repeated rheumatic fever and without it is unknown. The role of immune inflammation in the progress of heart failure is not sufficiently studied. There are no data on the interrelation of autoantibodies to the proteins of cardiomyocytes with the structural and functional indicators of cardiovascular system in patients after surgical correction of valvular heart diseases. Purpose. To reveal the connection of the clinical course of the postoperative period and its complications with the features of morphology of the myocardium in patients with chronic rheumatic heart disease (CRHD) after surgical correction of valvular defects.Materials and methods. There were examined 46 patients with CRHD, who underwent surgical correction of valvular heart diseases on the 7th - 14th day after the operation. The condition of the uniform elements in the whole blue blood is studied. Quantitative determination of biochemical indicators of inflammation - C-reactive protein, antistreptolizin-O, the components of the system of the complement of C3 and C4 - was carried out in blood serum. The level of presepsin was determined in blood plasma.The morphological research of the material received in surgeries on correction of valvular heart diseases macroscopically and in light microscopy was conducted. Histological conducting of material was carried out in the automatic mode. The antibodies to myocardial cells were determined in the serum of patients with the method of indirect immunofluorescence. The presence of antibodies to the tissue of heart was estimated on the existence of fibrillary, sarcolemmic, and diffusion cytoplasmic reactions. Instrumental examinations: echocardiography, daily monitoring of electrocardiogram. There was used the multiple-factor analysis with drawing up the tables of contingency and use of the exact test of Fischer and criterion of consent of Pearson.Results and discussion. There was revealed a significant relationship between the presence of myocardial hypertrophy of the left ventricle before the surgery and accumulation of fluid in the pericardial cavity and cavitas pleuralis in the early postoperative period; the presence of mitral valvestenosis before operation and emergence of new atrial fibrillation and paroxysmal supraventricular arrhythmias in the early postoperative period; the presence of histological signs of subacute rheumatic process and repeated development of rheumatic fever in the early postoperative period; the presence of histological signs of the mucoid swelling of heart valves and reduced left ventricular ejection fraction after the surgery; the presence of histological signs of the acute rheumatic process of the heart valves and increase of the level of presepsin with the persistence of repeated rheumatic fever in the early postoperative period.Conclusion. The revealed connection of the clinical course of the early postoperative period and its complications with the features of morphology of the myocardium promotes correct understanding of development of pathological reactions after the operation, adequate prevention and treatment of early complications in patients with chronic rheumatic heart disease after surgical correction of valvular heart diseases.