Background: Atrial septal defect (ASD) repair surgery is the most common open heart surgery. In last5 years, a total of 729 patients underwent in open heart surgery, whereas 561 patients (76.95%) hadcongenital heart disease (CHD), its 284 patients (50.6%) had ASD.Objective: To describe approach of cardiopulmonary bypass (CPB) in surgery of common ASD.Methods: We analyzed condition and process of CPB in ASD repair surgery (Department ofCardiovascular Surgery, Shastin Central Hospital of Mongolia) in 118 patients who had undergonegenetic testing in Research Center of Leipzig and Halle, Germany and Mongolian Academy of MedicalSciences. This has been found to be adequate for the routine open heart case, flow rates of 2.6-3.5 l/m2/min. The perfusionist should record the flow rate, arterial blood pressure, gas flow rate, temperature andtime regularly every 5, 10, 20, 30 minutes during bypass or when one of these parameters in changed.The beginning of bypass an activated clothing time (ACT) may be performed at the pump side to determineanticoagulation status. With clotting times below 300 sec additional heparin should be administrateddepending on the stage of the operative procedure.Results: The process of extracorporeal circulation of ASD repair surgery was observed in 118 patientswho underwent in genetic testing. There were 32.2% (38) males and 67.8% (80) females. Mean agewere 22.3±12.9 and mean body weight were 70kg. O2 consumption was 240 ml/min and CO2 productionwas 196 ml/min. In the beginning of surgery mean blood pressure were 92±5 mmHg and 58 mmHg afterthe dissection of major vessels. It is associated with a decrease of venous return to heart and cardiacoutput. After 30 minutes of CPB, blood pressure was 63 mmHg. During CPB, metabolic acidosis isalways a result of inadequate perfusion. Although the acid-base status may be immediately correctedby the administration of bicarbonate the abnormal process leading to the metabolic acidosis is notcorrected until perfusion becomes adequate. The best corrective measure is therefore to take whateversteps necessary in order to increase perfusion.Conclusion:1. Perfusion measurement of the chosen cases was measured in the level of international expertise.2. Hemodynamic aberrations were observed in the beginning of CPB, which demonstrates arequirement for increasing the pump flow rate of the machine (2.6-3.5 l/m2/min).3. Due to the fact that ASD repair surgery lasts for short period, CPB can be done in 320C of bodytemperature. Hence there is no need of hemoconcentration.

Introduction: Studies demonstrated that the apolipoprotein B/apolipoprotein A-I (Apo B/apo A-I) ratio predicts cardiovascular risk better than any of the cholesterol indexes. Apo B and Apo A-1 are assumed to be superiormarkers for lipoprotein abnormalities [1,2]. The concentrations of Apo B and Apo A-1 are associated with cardiovascular disease more strongly than the corresponding lipoprotein cholesterol fractions, the discriminant value of these apoproteins in absolute terms appears to be less important than of their ratio (the Apo B/Apo A-1 ratio) [3, 5-7]. The Apo B/Apo A-1 ratio reflects the balance of atherogenic and antiatherogenic lipoproteins in plasma [4]. Multiple clinical and epidemiological studies have confirmed that the Apo B/Apo A-1 ratio is a superior marker for cardiovascular disease compared with lipids and lipoproteins or their ratios [8, 9]. Goal: We determined the variation limits of the Apo B/Apo A-1 ratio in healthy participants with normolipidemia and the relationship of this ratio with other lipid parameters. Material and Methods: A total of 146 normolipidemic healthy participants aged 25–60 years were included in the study. Anthropometric measurements (height and weight) and other personal information were obtained during the clinical examination and the interview. Participants were included in the study using the following criteria:
1. body mass index < 30 kg/m2;

2. TC < 5.2mmol/L;
3. triglycerides (TG) ≤1.7 mmol/L;
4. HDL-C ≥1.03 mmol/L ( woman), ≥ 1.29 mmol/L (male) .
The plasma levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), apo A-I, Apo B and Apo B/Apo A-1 were determined after a 12 h fasting period. The non-HDL-C was calculated as the difference between the TC and HDL-C. Most research data emphasized that the values for the Apo B/Apo A-1 ratio that define a high cardiovascular risk were proposed to be 0.9 for men and 0.8 for women. Statistical Analysis. The statistical analysis was performed using SPSS 21.0 (USA). Differences between the groups were analyzed using the Mann-Whitney test and the chi-squared test. Correlations between the indices were assessed using the Spearman’s rank correlation. A value of < 0.05 was accepted as statistically significant. Results: The relationship of ratio of apolipoprotein (Apo) B/Apo A-1 with other indicators of lipid metabolism in healthy people with normal lipidemia was analyzed. The Apo B/Apo A-1 ratio in the studied normolipidemic subjects was 0.69 ± 0.17. The percentage of subjects with the Apo B/Apo A-1 ratio exceeding 0.9 (the accepted risk value of cardiovascular disease) was 36.3 %.The subjects with Apo B/Apo A-1>0.9 were characterized by higher HDL-C levels and atherogenic Aпo B, Apo B/Apo A-1 but lower values Apo A-1. Conclusion The subjects with normolipidemia the unfavorable Apo B/Apo A-I ratio> 0.9 had more atherogenic lipid profile.

Introduction: Cardiovascular Disease (CVD) is a major cause of morbidity and a leading contributor to mortality in both developed and developing countries. With rapid socioeconomic development, CVD has reached epidemic proportions in developing countries in recent decades. Dyslipidemia, elevated level of plasma cholesterol, together with arterial hipertension, is the main modifiable risk factor atherosclerosis and cardiovascular diseases (CVD) development. Surveys to monitor and measure dyslipidemia burden in a Mongolian population has not been conducted in recent years and the available data on the prevalence, types, and associated factors of dyslipidemia in the general population is relatively insufficient and outdated. Monitoring of lipid profile at populational level is an important instrument of prevention medicine, applied for CVD populational risk assessment. Goal: Evaluate comparisons of adult blood lipid levels in age, gender and location. Material and Methods: In this study, 500 people aged 25-65 were classified into age groups (47.1% for males and 52.9% for females). Blood plasma in total cholesterol (TC), triglyceride (TG), high density (HDL-C) and low density (LDL-C) lipoprotein-cholesterol, apolipoprotein - ApoA1, Apo B and ratio of ApoB / ApoA1 were estimated. Statistical analysis was performed using SPSS 22.0 Results: Mean age of the participants was 48.8±14.2 years old. Mean values for male TC-4.85±0.92 mmol/l, TG-1.58±1.19 mmol/l, LDL-C-3.24±0.98 mmol/l, HLD-C-1.62±0.21, for women- 4.47±0.96 mmol/l, 1.22±0.47 mmol/l, 2.95±1.01 mmol/l, 1.77±0.23 mmol/l respectively. The mean blood TC,TG levels tended to increase with age group in male compared to women. The prevalence of an increased blood LDL-C levels or risks for an increased blood LDL-C was statistically significantly high in male. Conclusion The prevalence of lipid was shown as high, that demands respective prevention and management.

Article deals with age-related hypogonadism in men as an interdisciplinary problem. Current definition, prevalence, analyzes the relationship between age and the incidents of hypogonadism were shown. The detailed overview of clinical studies, meta analysis of causal link of androgen deficiency and erectile dysfunction, ischemic heart disease, arterial hypertension, dyslipidemia, and diabetes mellitus was presented. To date was found the relationship between metabolic syndrome and androgen deficiency. Low level of testosterone is closely connected with low libido as well as insulin resistance, abdominal obesity, dyslipidemia. Insulin resistance and hyperinsulinemia are noticed in patients with hypogonadism in comparison with obese and normal-weight patients. Therefore, metabolic risk factors are the connecting link of cardiovascular diseases and androgen deficiency. Meta-analysis of clinical trials of the effects of testosterone replacement therapy and safety of long term use was presented in the article. The article discusses the importance of a unified approach to the diagnosis and treatment of androgen-deficient conditions and cardiovascular disease.

Introduction: Coronary atherosclerosis is the leading cause of morbidity and mortality in the world. Hypogonadism is not considered a traditional risk factor for coronary artery disease (CAD). Higher CVD mortality may be partially attributed to behavioral and physical characteristics of males, including increased smoking, drinking, endocrine and metabolic factor like fat distribution, and low male engagement in preventive care. In the last decades, many studies have suggested that low testosterone levels are associated with increased prevalence of risk factors for CVD, including dyslipidemia and diabetes. For the reason, this research focused on identifying any association between testosterone deficiency and risk factors of coronary heart disease. Goal: This study aimed to identify any association between testosterone deficiency and risk factors of coronary heart disease in Mongolian men. Material and methods: In this case control study, we determined plasma total testosterone, total cholesterol, triglyceride, high density lipoprotein-cholesterol, apolipoprotein – ApoA1, Apo B and glucose in 287 subjects, among them 125 patients with ACS and 162 healthy subjects. Statistical analysis was performed using SPSS 22.0 of IBM. Results: Mean age of the participants was 55.19±6.99 years old. It was found that, mean plasma TT levels in patients with ACS (4.17 ng/ml) was significantly lower than in the healthy subjects (4.70 ng/ml). There was a negative association between plasma TT level and glucose level (r=-0.185; p=0.002) and ApoB/ApoA1 (r=-0.132, p=0.026). Conclusion The results in the present study suggest that low plasma TT level may be a risk factor for CHD in men, which may relate to the influence of plasma lipoprotein and glucose metabolism by endogenous testosterone.

Background: Lower extremity arterial diseases are chronic stenosis of the artery and occlusive arterial diseases, which are commonly caused by atherosclerosis. Prevalence of lower extremity arterial diseases has positive proportional relationship with age of the patients. Furthermore, prevalence of lower extremity arterial disease is 16% among the males over the age of 60, whereas prevalence among same aged woman is 13%. Among the age group of 38 to 59 age, 60 to 69 age and 70-82 age group, prevalence of lower extremity arterial disease was 5.6%, 15.9%, and 33.8%, respectively. Goal: Identifying lower extremity arterial occlusive disease and chronic stenosis of arteries by CTA-TASC classification of aorta-iliac and femoral popliteal lesions. Obiective:
1. To identify age and sex of the patients with lower extremity arterial occlusive disease and chronic stenosis of arteries.
2. To identify lower extremity arterial occlusive disease and chronic stenosis of arteries by CTA-TASC classification of aorta-iliac and femoral popliteal lesions. Material and methods: Study sample consisted of 237 patients, who were diagnosed with lower extremity arterial occlusive disease and chronic stenosis of arteries from 2019 to 2020 at reference centre on Diagnostic Imaging na after R.Purev State Laureate, People’s physician and Honorary professor of the State Third Central Hospital. Computed angiogram images of lower extremity arteries were examined. Contrast agent “Ultravist” was pumped by automatic syringe. Lower extremity arterial occlusive disease and chronic stenosis of arteries are categorized by CTA-TASC classification of аorta-iliac and femoral popliteal lesions. The youngest participant was 20 years old and the oldest participant was 76 years old. Common statistical measurements such as means and standard errors were calculated. Probability of results were checked using Student’s test. Results: We have found following results: 185(78.1%±3.0) cases out of 237 diagnosed patients with lower extremity arterial occlusive disease and chronic stenosis of arteries are males and 52(21.9%±3.0) cases are female. Distribution of lower extremity arterial occlusive disease and chronic stenosis of arteries by the age group of patients are: up to 20 years of age is 3 (1.3%±0.7), 21 to 40 years of age is 14(5.9%±1.5), 41 to 60 years of age is 86(36.3%±3.1) and over the age of 61 is 134(56.5%±3.2). It is statistically highly significant that experiencing lower extremity arterial occlusive disease and chronic stenosis of arteries among the age group of over 61(P<0.001).
The result of lower extremity arterial occlusive disease and chronic stenosis of arteries by the CTA-TASC classification of aorta-iliac and femoral popliteal lesions are: CTA-TASS аorta-iliac lesions A-16(6.8%±1.8), B-8(3.4%±1.2), C-12(5.1%±1.4), D-41(17.3%±2.5), CTA-TASS femoral popliteal A-41(17.29%±2.5), B-53(22.36%±3.6), C-47(19.83%±2.6), D-96(40.5%±3.2), respectively. Conclusions
1. Lower extremity arterial occlusive disease and chronic stenosis of arteries occurs 46.5% over the age of 60 and 78.1% of the patients are males.
2. Following two categories have identified more than the rest, 17.3% CTA-TASC classification of аorta-iliac lesions, type D and 23.3% CTA-TASC classification of femoral popliteal lesions, type D.

Background: The American Heart Association estimates that more than 1 million people die each year from acute coronary heart disease and half a million from acute coronary syndrome, and that $ 115 billion a year is spent on diagnosing and treating coronary heart disease [Word Health Organization, 2013]. Goal: In this study we aimed to using coronary computed tomography angiography (CCTA) to diagnose unstable plaques in coronary artery disease. Material and methods: From 2018 to 2021, we performed a coronary computed tomography angiography (CCTA) scan with a Philips Ingenuity 64-slice computed tomography (64 MD-CT) device and examined 47 patients diagnosed with unstable coronary artery disease at the Reference centre on Diagnostic Imaging named after R.Purev State Laureate, People’s physician and Honorary professor of the State Third Central Hospital.
Common statistical measurements such as means and standard errors were calculated. Probability of results were checked using Student’s test. Result: In studying signs of coronary computed tomography angiography (CCTA) to diagnose unstable plaques in coronary artery disease that coronary artery diameters more widening to compared healthy artery 16(34.0%±6.9), low density sites clarify in plaque (lower than +30HU)- 14(29.8%±6.7), small calcification detect in plaque 36 (74.5%±6.4), ring liked additional density (lower than +130 HU) sees in edge of plaque (Halo sign)-9(19.2%±5.8), plaque edge roughness, erosion liked changes- 18 (38.3%±7.1), rupture of intima (dissection)- 8(17.0%±5.5). Conclusion We detect that computed tomography angiography (CCTA)’s specific signs of unstable plaque of coronary artery disease are coronary artery diameters widening, low density sites clarify in plaque (lower than +30HU), small calcification detect in plaque, ring liked additional density (lower than +130 HU) sees in edge of plaque (Halo sign), plaque edge roughness, erosion liked changes and rupture of intima.