Address to the readers
Russ J Cardiol 2014, 5 (109): 5
CLINICAL MEDICINE NEWS
Clinical medicine updates: a review of international news
Russ J Cardiol 2014, 5 (109): 6
MYOCARDITISES, VALVULAR AND NONCORONAROGENIC DISEASES
THE BLOOD FLOWS IN THE LEFT VENTRICLE AS PREDICTORS FOR MYOCARDIAL DYSFUNCTION IN DILATED CARDIOMYOPATHY
Sandrikov V. A.1, Kulagina T. Yu.1, Krylov A. S.2, Yatchenko A. M.2
Aim. To evaluate the treatment results and to estimate the early predictors for myocardial dysfunction in patients with DCMP.
Material and methods. Totally 69 patients with DCMP (median age 42±14) were investigated before and after operation. Patients were divided into 3 groups: 1st — 69 patients before surgical treatment; 2nd — 41 patients those who were examined in 9–12 months after operation; 3rd — patients being monitored for more than 24 months after operation. The control consisted of 110 volunteers with the menian age 37±8 y. o. To all patients the echocardiography was applied using expert class Vivid E9 (GE, USA) machine with multifrequency sensor 3,5–5,0 MHz. To visualize flows in the left ventricle the flow velocity was registered in the areas of fiber ring, middle and apical areas.
Results. With the LV function disturbing in DCMP patients the rise of pre- and postload causes significant changes in myocardial functioning. The direction of blood flow in the LV significantly changes with hypertrophy of myocardium and papillary muscles, valve dysfunction and other disorders. We had concluded that in DCMP, at the same time with high EDV and ESV there is incessance of blood flow which determines heart work by continuous blood motion, elasticity of magistral vessels and myocardium contraction. By echocardiography and computed tomography it was found that heart rotation is in order from the right to the left segments of basal area and then to descending and ascending segments of the heart apex.
Conclusion. The velocity of myocardial shifts, of blood flows in the LV make possible to evaluate heart functioning in patients with heart failure and to estimate the effectiveness of surgical treatment in closer and further postoperational periods. Basing on the measurements of blood flows in heart chambers and on estimation of intraventricular pressure gradients (from the apex to basement) it is possible to analyse the functioning and the performance of valves in patients with DCMP. The appearance in LV of additional turbulent flows, the decrease of flow velocity during the cardiac contraction cycle in one or another part are responsible for the failure and can be regarded as early predictors of myocardial dysfunction.
Russ J Cardiol 2014, 5 (109): 7–12
Key words: echocardiography, flows in the left ventricle.
1FSBI Petrovsky Russian Scientific Centre for Surgery, Moscow; 2Lomonosov Moscow State University, Moscow, Russia.
CONTEMPORARY MASKS OF THE MYOCARDITIS (FROM CLINICAL SIGNS TO DIAGNOSIS)
Blagova O. V., Nedostup A. V.
Contemporary myocarditis classifications are usually made up by morphological criteria due to a critical role of biopsy in its diagnostic. However in general medical practice this method is quite rare, though in the real practice internists and cardiologists meet this disease more and more ofted, including its non-classical forms. Clear connection of cardial symptomathic with an infection is the most specific sign of myocarditis, though its absence does not rule out the diagnosis. Using biopsy and complex algorhythm of diagnostics developed on the basis of biopsy we have usually seen these types: 1. Latent (without decompensation and general inflammatory changes) myocarditis in patients with so-called idiopathic rhythm and conduction disorders including atrial fibrillation; 2. Various clinical course and immunity-involvement types in patients with the dilated cardiomyopathy; 3. Paraneoplastic myocarditis; 4. Myocarditis with infarction-like manifesting (as acute and benevolent in its course and prognosis, as chronic with the outcome into severe heart failure), microvascular angina, and combination of myocarditis with coronary atherosclerosis and real MI; 5. Myocarditis it patients with different genetic cardiomyopathies (including arrhythmogenic right ventricle dysplasia and noncompact myocardium); 6. Myocarditis as the sign of latent autoimmunity disorders. The complete list and analysis of clinical situations is provided, in those it is obligatory to confirm or rule out a myocarditis. The guidelines for differential diagnosis are given with the discussion of various pathogenetic mechanisms clarification of which makes possible a basis therapy.
Russ J Cardiol 2014, 5 (109): 13–22
Key words: myocarditis, idiopathic arrhythmias, dilated cardiomyopathy, infarctionlike type, microvascular angina, endomyocardial biopsy.
The Faculty Therapeutic Clinic n. a. Vinogradov of the Sechenov First MSMU, Moscow, Russia.
THE SIGNIFICANCE OF FUNCTIONAL AND ETHIOLOGICAL DIAGNOSTIC FOR TREATMENT STRATEGY DECISION IN PATIENTS WITH DILATED CARDIOMYOPATHY
Aim. To evaluate the role and importance of the functional and etiological diagnosis in determining the surgical treatment of patients with dilated cardiomyopathy (DCM).
Material and methods. We examined 156 patients (40 women and 116 men) with dilated cardiomyopathy (DCM) aged 18–75 (average age — 48.8+/- 11.4) for the period from 2008 to 2013. The history of the disease averaging 54.8 +/-5.7 months; 15 (10%) of patients were in functional class II, 49 (31%) — in class III, 92 (59%) — in class IV.
Results. The mean end-diastolic LV diameter was 7.45+/-1.2 cm, ejection fraction — 26.7+/- 2.1%. We performed blood PCR analysis in all the patients: Genome of herpes simplex virus type 1 was reported in 14 (9%), type 2 — in 7 (4%), type 6 — in 12 (8%) patients; of cytomegalovirus — in 20 (13%), of Epstein-Barr virus — in 24 (15%), of parvovirus B19 — in 29 (19%); we performed morphological study of the myocardium to detect cardiotropic viruses genome in 66 patients: genome of herpes simplex virus type 6 was found in 13 (23%), of cytomegalovirus — in 7 (12%), of Epstein-Barr virus — in 9 (15%), of parvovirus B19 — in 24 (42%). Depending on etiological factors, initial functional state of the patient as well as the severity of valvular regurgitation and the degree of interventricular dyssynchrony, 24 patients were implanted with cardioverter defibrillator (ICD) and 38 patients — with cardiac resynchronization therapy with cardioverter defibrillator function (CRT-D): in total, 62 patients with DCM; 24 patients underwent organ conserving reverse cardiac remodeling; orthotopic heart transplantation was performed in 13 patients; conservative treatment group consisted of 57 patients with DCM for whom surgical treatment was not recommended or impossible at the moment of the examination.
Conclusion. These data indicate that application of complex etiological and functional diagnostics allows us not only to make nosological diagnosis of patients with DCM but also to determine the type of treatment and prognosis.
Russ J Cardiol 2014, 5 (109): 23–28
Key words: dilated cardiomyopathy (DCM), heart failure, reverse remodeling of the heart, endomyocardial biopsy, cardioverter-defibrillator (ICD), resynchronization therapy (CRT-D).
FSBI Petrovsky Russian Scientific Centre for Surgery, Moscow.
DIFFERENTIAL DIAGNOSIS OF HYPERTROPHIC CARDIOMYOPATHY AND HYPERTENSIVE HEART DISEASE BY EXERCISE TESTING
Krylova N.S.1, Krylov A.L.2, Poteshkina N.G.1
Aim. Тo assess the effectiveness of a bicycle ergometer exercise test in differentiation of hypertrophic cardiomyopathy (HCM) and hypertensive heart disease (HHD).
Material and methods. 42 patients with HCM (mean age 49,8±15,3–28 male) and 25 patients with HHD (mean age 47,0±12,4–16 male) were studied. All patients underwent upright bicycle ergometer exercise test after withdrawal of drug therapy.
Results. It is well-known that abnormal blood pressure response (ABPR) and ST depression with angina during exercise are the criteria for the termination of test (RTT) and are the HCM attributes (after ruling out the coronary atherosclerosis by coronarography). With the use of nonparametric statistics we found significant difference between HCM and HHD in systolic blood pressure (SBP) at the end of the test (174,6±30,8 and 210,4±21,1 mmHg; p=0,000006), time recovery after test (TR) (10,0±4,0 and 7,1±1,6 min; p=0,007), breathlessness as a RTT (38,4% and 4%, p=0,022); extrasystole as a RTT (12,5% and 0%). With the use of logistic regression we found a dependency for differential diagnosis of HCM and HHD: Diagnosis = 0,41*SBPe–40,79–3,65*TR–13,34*BR-41,87*EXT–1000*OTH Where SBPe is SBP at the end of the test; TR equals 1 if breathlessness was the RTT and 0 otherwise; EXT equals 1 if extrasystole was the RTT and 0 otherwise; OTH equals 1 if ABPR, ST depression or stenocardia were the RTT and 0 otherwise. Diagnosis is greater than 0 for HHD and less than 0 for HCM patients. For all patients included in our study the dependency provides correct result.
Conclusion. The exercise testing gives useful information and can be applied for differential diagnosis of HCM and HDD.
Russ J Cardiol 2014, 5 (109): 29–34
Key words: hypertrophic cardiomyopathy, hypertensive heart disease, exercise test, differential diagnosis.
1Pirogov Russian National Research Medical University, Moscow, Russia; 2Institution for the Safe Nuclear Energy Development of RSA, Moscow, Russia.
HYPERTROPHIC CARDIOMYOPATHY: GENETIC ALTERATIONS, PATHOGENESIS AND PATHOPHYSIOLOGY
Vatutin N. T.1, Taradin G. G.1, Maron M. S.2
The review is dedicated to the description of genetic alterations, pathogenetic mechanisms and pathophysiology of hypertrophic cardiomyopathy, based on the analysis of current up to date information. A contemporary data is provided on the role a plenty discovered mutations of structural, contractile and regulatory sarcomere proteins in cardiomyopathy. The main hypotheses of pathogenetic processes are highlighted, especially the disordered calcium exchange. The importance of genetic testing of patients with hypertrophic cardiomyopathy and their relatives is underlined. The review concerns the basic pathophysiologic characteristics of the disease according to their diagnostic, clinical and prognostic value. Except the description of pathophysiologic properties, as a matter of fact, the obstruction of outflow in the left ventricle, diastolic dysfunction, myocardial ischemia and rhythm disorders, the connection of these conditions is underlined to clinical picture, and the role of contemporary instrumental diagnostic methods (positron-emission tomography, computed tomography) in early diagnostic and monitoring of the disease.
Russ J Cardiol 2014, 5 (109): 35–42
Key words: hypertrophic cardiomyopathy, genetic mutations, pathogenesis, pathophysiology
1Donetsk State Medical University n. a. M. Gorkiy, Donetsk, Ukraine; 2Tuft University School of Medicine, Hypertrophic Cardiomyopathy Center, Boston, Massachusetts, USA.
CONTEMPORARY METHODS FOR MYOCARDIAL FUNCTION EVALUATION IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY BEFORE AND AFTER SURGICAL TREATMENT
Van E. Yu., Kulagina T. Yu., Berezina E. V., Frolova Yu.V., Abugov S. A., Dzemeshkevitch S. L.
Aim. To invent and qualify a diagnostic algorhythm for systolic and diastolic myocardium function evaluation in the left ventricle in patients with hypertrophic cardiomyopathy before and after surgical treatment.
Material and methods. Totally 88 patients included, 54 with hypertrophic cardiomyopathy (27 male, 27 female) with median age 59±13 y. o. Obstructive type of HCMP was found in 41 pt. Transluminal ethanol-based septal ablation was done for 17 pts. Myoectomy/myotomy was done for 11 pts. The control consisted of 34 healthy volunteers with medial age 36,7±8,3 y. o.: 24 men (70%) and 10 women (30%). To everyone included the echocardiography was performed using the Vivid E9 machine (GE, USA) with multifrequent sensor 3,5–5,0 MHz. The data was then processed by computer-based Multivox program. The “flow-volume” loop of the single cardiac cycle was reconstructed using numeric data for everyone of patients; also the data on myocardium segment shift were used.
Results. The parameters of volume change rapidity (dVol/dt (s, d)) and the parameters of systolic and diastolic summes of normal velocities (?V? (s, d)) serve as strict independent predictors of the impaired systolic and diastolic function of LV myocardium and also as early markers of LV disordered function recovery in HCMP after surgical treatment. The markers of long axis diastolic shift (dL/dt (d)) and diastolic volume changes (dVol/dt (d)) are the most accurate in prediction of left ventricle changes after surgical treatment in HCMP.
Conclusion. We have invented a novel and original approach to the evaluation of systolic and diastolic myocardial function in patients with obstructive type hypertrophic cardiomyopathy before and after surgical treatment using our own algorhythm based on echocardiographical measurements of myocardium shift rapidity.
Russ J Cardiol 2014, 5 (109): 43–48
Key words: echocardiography, hypertrophic cardiomyopathy, myocardium shift rapidity, myotomy, alcohol ablation.
FSBI Petrovsky Russian Scientific Centre for Surgery, Moscow, Russia.
BICUSPID AORTIC VALVE (A DEVELOPMENT OF INSIGHT INTO VALVULOPATHIES)
Dzemeshkevitch S. L., Ivanov V. A., Charchian E. R., Evseev E. P., Frolova Yu.V., Lugovoy A. N., Fedulova S. V., Khovrin V. V., Bukaeva A. A., Zaklyazminskaya E. V.
Aim. To study different ways of development and combinational abilities of pathological changes common for bicuspid aortic valvulopathy.
Material and methods. Totally 207 patients included, who had during previous 5 years been operated for progression of inherited aortic valve defect. The age varied from 17 to 75 years (median 49,6±0,9 y.), men to women — 3:1. Comorbidities included rheumatic fever in 33 (15,9%) patients and infectious endocarditis in the past in 45 (21,7%). In 111 (53,6%) patients aortic stenosis dominated and distension of ascending aorta — in 82 (39,6%) patients.
Results. For most of patients mechanical prostheses were used and only for 12 — biological; 13 patients underwent valvulopastic or no any operation. One third of patients (31,9%) required a prosthesis of ascending aorta. Combinations of additional procedures (as aortic valve plastic or prosthesis, tricuspid plastic, left atrium plastic, septal defects sewing, coronary bypass grafting) were not unusual — in 57. In-hospital mortality reached 2,9%.
Conclusion. Bicuspid aortic valve is a specific kind of valvulopathy, commonly combined with aortopathy. The development of this pathology is probably inherited. Clinical picture of the defect develops during time and its exacerbation might be accelerated by rheumathic fever and infectious endocarditis. Surgical treatment is effective.
Russ J Cardiol 2014, 5 (109): 49–54
Key words: bicuspid aortic valve, aortopathy, valve prosthesis, the genetics of connective tissue dysplasia.
FSBI Petrovsky Russian Scientific Centre for Surgery of the Academy of Medical Sciences, Moscow, Russia.
NEONATAL MARFAN SYNDROME: CLINICAL DESCRIPTION AND COMPLEX APPROACH TO DIAGNOSTICS AND TREATMENT
Rumyantseva V. A.1, Rogozhina Yu.A.1, Kotlukova N. P.2, Zaklyazminskaya E. V.1
Aim. Molecular-genetic tests for neonatal type of Mrfan syndrome make possible to clarify a dignosis in children with multiple phenotype anomalies and to choose correct treatment strategy.
Material and methods. Medical-genetic testing and instrumental diagnostics (echo, Doppler, ECG, chest X-rays) made possible to guess the diagnosis of neonatal Marfan syndrome (MS). Direct DNA-diagnostics of MS for these patients including direct Senger-sequencing of the coding plots and neighbouring introne areas of exones 24–32 gene FBN1 completely proved the diagnosis.
Results. First time in Russia in two non-relative families with newborns having multiple phenotype anomalies the diagnosis of MS was set at the first year of life and confirmed by molecular-genetic methods.
Conclusion. The results of the study must be introduced into practice at specialized pediatric, cardiological and cardiosurgical centres and departments to estimate the risk of sudden death, choose treatment strategy, prescribe gene-specific therapy.
Russian Journal of Cardiology 2014, 5 (109): 55–60
Key words: Marfan syndrome, fibrilin, DNA-diagnostics, genetic consulting in cardiology.
1FSBI Petrovsky Russian Scientific Centre for Surgery, Moscow; 2Perinatal Cardiovascular Centre, Moscow, Russia.
ARRHYTHMOGENIC CARDIOMYOPATHY OF THE RIGHT VENTRICLE COMORBID WITH HEMODYNAMICALLY SIGNIFICANT SECONDARY INTERATRIAL SEPTAL DEFECT
Shapieva A. N., Zaklyazminskaya E. V., Frolova Yu.V., Nechaenko M. A., Shestak A. G., Dzemeshkevich S. L.
Congenital atrial septal defect (ASD) is a common heart defect. The subjects for differential diagnosis of atrial septal defect, also leading to morpho-functional disturbances in the right parts of the heart, must be either inherited or acquired diseases. One such disease is arrhythmogenic right ventricular cardiomyopathy (ARVC), which leads to higher risk of sudden cardiac death (SCD) in young people. In the article we present the case of the patient with congenital heart disease: atrial septal defect operated at the age of 19. Deterioration of the condition was interpreted as a consequence of atrial septal defect. During examination at Russian scientific centre of surgery named after B. V. Petrovsky an independent hereditary disease — ARVC was dignosed. The disease was confirmed by molecular-genetic testing methods. A novel mutation in the gene p.S194L DSG2 homozygous was identified. On the basis of ARVC diagnosed on the base of physical, instrumental and genetic testing, the decision was made to implant a dual-chamber frequency adaptive cardioverter-defibrillator (ICD) for the prevention of SCD risk. The further tactics of patient monitoring must include not only regular ECG, echocardiogram, ICD function testing, but also cascade screening mutations responsible for the development of the ARVC in family members.
Russ J Cardiol 2014, 5 (109): 61–65
Key words: ARVC, secondary ASD, ICD, genetic testing.
FSBI Petrovsky Russian Scientific Centre for Surgery, Moscow, Russia.
THE CLINICAL POLYMORPHISM AND TREATMENT STRATEGY IN A LARGE FAMILY WITH BRUGADA SYNDROME
Saber S.1, Fazelifar A. F.2, Haghjoo M.2, Emkanjoo Z.2, Alizadeh A.2, Shojaifard M.2, Dalili M.2, Houshmand M.3, Gavrilenko A. V.1,4, Zaklyazminskaya E. V.1,4
Brugada syndrome (BrS) is an inherited arrhythmia characterized by ST-segment elevation in V1-V2 leads followed by negative T-wave on standard ECG, and high risk of ventricular tachyarrhythmias and sudden cardiac death (SCD). A wide range of supraventricular arrhythmias and conduction disturbances was described for BrS. The disease was considered of the high frequency in Southeast Asia, but current estimation of BrS is at least 1:10 000 in all ethnic groups. At least 17 genes are known to be responsible for BrS. Approximately 15–30% of individuals with Brugada syndrome cases are affected by mutations in SCN5A gene. In this study we discuss the clinical polymorphism and surgical treatment in a large family with Brugada syndrome caused by p.A735V mutation in SCN5A gene.
Russ J Cardiol 2014, 5 (109): 66–71
Key words: Brugada syndrome, atrial fibrillation/flutter, sick sinus syndrome, SCN5A, implantable cardioverter-defibrillator (ICD).
1The Sechenov First State Medical University, Moscow, Russia; 2Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; 3Dept. of Medical Genetics, National Institute of Genetic Engineering and Biotechnology, Tehran, Iran; 4FSBI Petrovsky Russian Scientific Centre for Surgery, Moscow, Russia.
LIFE-THREATENING MANIFEST OF LONG-QT-SYNDROME
Polyak M. E.1, Podolyak D. G.1, Glazova O. V.1, Artyukhina E. A.2, Nechaenko M. A.1, Zaklyazminskaya E. V.1
Aim. To complete DNA-diagnostics for the patients with syncopes and not showing clinically significant rhythm disorders, but with family anamnesis of sudden death.
Material and methods. Clinical case. The patient 22 y. o. consulted at RSCS n. a.Petrovsky with the primary diagnosis of “inherited epilepsy” and complaints on presyncopes and dizziness. During examination there was no data found to prove the inherited epilepsy and clinically significant rhythm disorders. Taking into account the family anamnesis of sudden death a dignosis of “idiopathic ventricular tachycardia” was suggested and the patient underwent two-chamber rate-adaptive cardioverter-defibrillator Maximo II DR D284DRG implantation. DNA-testing revealed a mutation of p.R583H in the gene KCNQ1, that had been previously described as probable to cause type 1 long-QT-syndrome. During the next 12 month after implantation there were 2 proven strobes recorded. The patient was consulted by cardiologist to prescribe beta-blocker therapy.
Results. Although there were no clinically significant heart rhythm disorders found, the patient with suspected family type of idiopathic ventricular tachicardia underwent cardioverter-defibrillator setting up procedure. Molecular-genetic methods helped to prove the diagnosis of “long-QT-syndrome type 1” and the cascade family screening was started to choose a treatment strategy for asymptopathic mutation bearers.
Conclusion. By the example of the clinical case described we showed a significance of DNA-diagnostics in the diagnosis clarification, treatment strategy choice and sufficient medical-genetic consulting for the disease mentioned.
Russ J Cardiol 2014, 5 (109): 72–74
Key words: LQTS, KCNQ1, sudden cardiac death, idiopathic ventricular tachycardia.
1FSBI Petrovsky Russian Scientific Centre for Surgery, Moscow; 2The Scientific Centre for Cardiovascular Surgery n. a. Bakulev, Moscow, Russia.
CARDIO-ONCOLOGY IN TREATMENT AND REHABILITATION PROGRAMS OF ONCOLOGICAL PATIENTS
Balluzek M. F., Ionova A. K.
While studying the nearest and distant consequences of chemo- and radiation therapy, systemic effects of cancer on human, frequent comorbidity, a control of the state of cardiovascular system in all of the stages of medical cancer treatment become necessary. A classification of cardiological and cardiotoxic events, which are common in treatment of cancer, is provided. The need of development of the new interdisciplinary direction — cardio-oncology — in algorithm of treatment and rehabilitation process is revealed.
Russ J Cardiol 2014, 5 (109): 75–80
Key words: cardioncology, cardiotoxicity, cancer disease, cardiological rehabilitation of cancer patients.
FSBH Saint-Petersburg city clinical hospital of Russian Scientific Academy, Saint-Petersburg, Russia.
DIAGNOSTIC AND SURGICAL TACTICS IN PSEUDOTUMOROUS VOLUMINOUS HEART FORMATIONS
Nechaenko M. A., Kuznetsova L. M., Podolyak D. G., Kiprensky A. Yu.
Aim. To study clinical and diagnostic, surgical and morphological properties of pseudotumorous heart formations, possibilities for early diagnostics and to invent optimal treatment strategy.
Material and methods. Petrovsky Centre for Surgery has the heart tumours treatment experience of 326 patients during the time from December 1962 till December 2010. Morphologically confirmed were tumours of 259 (79,4%) patients. At the current moment the study includes 67 patients with pseudotumorous formations of the heart, continuously supervised at the Centre from February 1960 till December 2010. Of those 36 were males and 31 females at the age of 2,2–74 (median 34,1±2,1),
Results. Total survival not including in-hospital mortality, evaluated by Kaplan-Meier method, gained 100% and 94,3% at the 1st and 24th year of observation, respectively. Analysis of the “life quality” of these patients at the remote periods after operation shows its significant improvement. Treatment results claimed as “good” were set for 62,8%; “satisfactory” for 31,4% and “nonsatisfactory” for 5,8% of cases. Treatment strategy for the patients with morphologically not confirmed voluminous formations (29,9%) was predestinated by smaller sizes (4–10 mm diameter), nonmobility that could be regarded as the risk for embolism, smooth echogenity with sharp border, absence of hemodynamical malfunction and clinical signs.
Conclusion. The analysis has shown that on-time diagnostics of voluminous formations of the heart with pseudotumorous and morphologically non-recognizable properties is very complicated. Clinical awareness while interpreting the short clinical anamnesis and specificities of clinical picture made it possible to realise the individualized choice for the algorhythm of further diagnostics taking into account an oncological determinancy. The success of the operations was predicted by the conditions of normo- or hypotermic perfusion and cold-pharmacological cardioplegy, ensuring optimal exposition and adequate protection for the myocardium, following the rules for prophylaxy of “tumours” fragmentation and embolism, and correction of comorbid valve pathology, inherited valve defects and ischemic heart disease.
Russ J Cardiol 2014, 5 (109): 81–87
Key words: pseudotumorous heart formations, echocardiography, surgical tactics.
FSBI Petrovsky Russian Scientific Centre for Surgery, Moscow, Russia.
A CLINICAL CASE: A GIANT MYXOMA OF THE LEFT ATRIUM
Shilenko A. N., Bachinskaya I. N., Mataev V. S ., Urvantseva I. A.
Russ J Cardiol 2014, 5 (109): 88–89
Key words: myxoma, left atrium.
The District Cardiological Dispensary, The Centre for Diagnostics and Cardiovascular Surgery, Surgut, Russia.
A LEFT ATRIAL GIGANTIC MIXOMA ON BACKGROUND OF MITRAL VALVE DYSPLASIA
Dzemeshkevitch S. L., Frolova Yu.V., Rizun L. I., Dzemeshkevitch A. S ., Raskin V. V., Fedulova S . V., Dzeranova A. N., Mironovich S. A.
Aim. To demonstrate a clinical case of mixoma with mitral regurgitation
Material and methods. The operation performed: excision of voluminous formation of the left atrium, mitral valve plastic with supporting ring Edwards Lifescience 32, interatrial septum plastic with the VASCUTEC patch under conditions of artificial circulation and pharmacy-cold cardioplegy.
Results. Complete myxoma excision, absence of mitral regurgitation after operation.
Conclusion. Complete myxoma excision and mitral regurgitation correction lead to a good clinical result.
Russ J Cardiol 2014, 5 (109): 90–92
Key words: cardiac myxoma, left atrium, mitral regurgitation, dysplasia.
FSBI Petrovsky Russian Scientific Centre for Surgery of the Academy of Medical Sciences, Moscow, Russia.
A 24-YEAR LASTING MONITORING OF THE FEMALE PATIENT AFTER ORTHOTOPIC HEART TRANSPLANTATION
Frolova Yu.V.1, Voronina T. S.1, Tsyplenkova V. G.2
Russ J Cardiol 2014, 5 (109): 93–96
Key words: heart transplantation, immunosuppression.
1FSBI Petrovsky Russian Scientific Centre for Surgery of the Academy of Medical Sciences, Moscow; 2Medicine-Biology Department of FSBI PHE Pirogov Russian National Research Medical University; Laboratory for Electron Microscopy at Russian Cardiological Scientific-Practical Complex of the Ministry of Health, Moscow, Russia.
EVALUATION OF PREGNANCY ASSOCIATED HYPERTENSIVE STATES
Shakhbasova N. A.
Aim. The main aim of current study was to investigate the significance and prevalence of the different risk factors for hypertension, caused by pregnancy.
Material and methods. We evaluated different risk factors in 120 pregnant women with hypertensive states (main group) and in 50 healthy pregnant women at the same gestation period (control group). In pregnant women we evaluated the absence either presence of of pre-eclampsy risk factors: age, parity, hypertensive disorders during previous pregnancies, time gone since previous pregnancy, obesity, hypertension family anamnesis, inferlility, multiple precnancy, extragenital diseases. To calculate the relations between different qualitative signs the Pirson χ2 used.
Results. During the study it was revealed that in hypertension disorders the women had one risk factor in 30 (35,5%), two risk factors in 29 (34,1%), three and more risk factors in 26 (30,6%). It was found that in 30% of pregnants with pre-eclampsy and gestational hypertension there are no any risk factors. Most significant risk factors were first pregnancy and extragenital pathology. Combination of three and more risk factors is an anamnestic marker for higher risk of severe pre-eclampsy.
Conclusion. The analysis of hypertension risk factors in pregnant women makes evidence-based the recognition of the high-risk group for pre-eclampsy. Further detailed diagnostic investigation of these women provides the opportunity to start a prophylaxy of hypertension disorders in pregnancy and to monitor the condition of clotting system, fetus condition and to improve the outcomes of a pregnancy. Absence of the risk factors does not decline a possibility of pre-eclampsy and requires the search for additional markers that would be early and pathogenetically proven signs.
Russ J Cardiol 2014, 5 (109): 97–100
Key words: pregnancy, gestational hypertension, pre-eclampsy, risk factors.
SII for Ginaecology and Obstetrics, Baky, Azerbaijan.
CLINIC AND PHARMACOTHERAPY
AN ADAPTOGEN USAGE IN OUTPATIENT PRACTICE TO IMPROVE CARDIOVASCULAR ADAPTATION TO ABNORMAL CLIMATIC CONDITIONS (THE HEAT)
Smirnova M. D., Svirida O. N., Ageev F. T., Fofanova T. V., Vitsenya M. V., Mikhailov G. V., Konovalova G. G., Tikhaze A. K., Lankin V. Z.
Aim. To evaluate the drug implied to improve the metabolic resistance to stress (adaptogen), QudesanR, on its influence on cardiovascular system, psychological status and life quality of patients with average to high cardiovascular risk in the extreme climatic conditions (the summer heat).
Material and methods. We included 60 patients; for 30 of those the QudesanR 40 gtts. qd was added to standard drug therapy; other 30 patients were controls. We measured office BP, potassium and sodium concentrations; malonic dialdehyde (MDA), superoxidedysmutase (SOD) in erythrocytes. Then the relation of MDA/SOD was calculate. Patients also completed the questionnaire made up for this study.
Results. In the QudesanR group during the heat period we found lowering of SBP (Δ -13,8 mmHg, p=0,02), DBP (Δ -4,5 mmHg, p=0,05) and PWV (Δ -0,8 m/s, p=0,05) absent in the control. Also in QudesanR group the concentration of sodium starts to increase during the heat period (Δ +1,0 mM/l, p=0,008). This increase becomes significant by september (Δ +1,7 mM/l, p=0,008) and is probably adaptive. The level of MDA (p<0,05) and MDA/SOD relation, the signs of “antioxydant potential”, in blood were increasing significantly during the summer heat only in control group. The complaints on heart rhythm disorders (p=0,04) and on CHF worsening (p=0,09) after the end of heat period were more common in control group. That is the QudesanR shows adaptogenic effect and can be used to improve adaptability during the heat period and its switching to cloder time in patients with compensated CVD.
Russ J Cardiol 2014, 5 (109): 101–108
Key words: the heat wave, QudesanR, heat adaptation, cardiovascular risk.
Scientific and Dispensary Department of SII for Cardiology n. a.Myasnikov of FSBI RCSPC MH RF Moscow, Russia.
THE RELEVANCE OF THROMBOLYTIC THERAPY IN ST ELEVATION MYOCARDIAL INFARCTION
Teplova N. V., Taratukhin E. O.
The article is about contemporary views on thrombolytic drugs usage. Although there is a great improvement in endovascular treatments, systemic thrombolysis is still one of the most important approaches to MI with ST elevation. The data of a few studies of thrombolytics with percutaneous intervention is provided, as with it or instead of it. Also the importance of thrombolytic drug pharmacokynetic profile is underlined.
Russ J Cardiol 2014, 5 (109): 109–112
Key words: myocardial infarction, ST segment elevation, thrombolysis, percutaneous intervention, tenecteplase.
The Department for Hospital Therapy №1 of Pirogov Russian National Research Medical University, Moscow, Russia.