[Asymptomatic course of rhabdomyoma of the heart].

The article describes a clinical case of cardiac rhabdomyoma first diagnosed in an 18-year-old girl. At the age of 12 months, the patient first developed generalized, prolonged convulsive seizure with the eyeballs rolling upward, tonic arm tension, and profuse salivation. From 1.5 to 2 years, according to her mother, the girl had frequent "freezing" with fixed stare. Anticonvulsant therapy was not administered. From the age of 2 years 8 months, the child began to experience episodes of drowsiness, lethargy, blurred speech, and repeated vomiting lasting up to 2 weeks. The patient was regularly treated at the neurological department. According to CT at the age of four, the patient showed characteristic alterations in the brain and was diagnosed with tuberous sclerosis, symptomatic generalized epilepsy, and psychoorganic syndrome. Only at the age of 18, cardiac ultrasound detected a 7x6 mm hyperechoic formation with endogenous growth buried in the myocardium of the left ventricular (LV) anterior-lateral wall and another one in the area of the LV lateral wall with endogenous growth of 2×4 mm. Magnetic resonance imaging (MRI) revealed multiple focal formations with clear, even contours in the area of the middle anterior septal segment (closely adjacent to papillary muscles) in the region of the apex, buried in the myocardium. The formation sizes were 9×7 mm, 8×13 mm, and 7.5×6 mm, respectively, and they moderately accumulated the contrast agent. Lesions with identical characteristics and a diameter up to 4.5 mm were visualized on the anterior wall in the region of the apex, in the depth of the myocardium. Due to the absence of arrhythmias and hemodynamic disorders, immunosuppressive therapy was not administered. Follow-up and dynamic MRI control of the heart were recommended. If signs of tumor growth are detected, consider immunosuppressive therapy with everolimus. The case is of interest for a long asymptomatic growth of rhabdomyoma. Generally, cardiac rhabdomyomas are diagnosed in the postnatal period and may be the earliest manifestation of tuberous sclerosis.

Results of Computed Tomographic Coronary Angiography in Comparison with the Table of Pretest Probability of Chronic Coronary Syndrome.

Aim        To compare results of computed tomography coronary angiography (CTCA) with a table of pretest probability of chronic coronary syndrome (CCS) taking into account the following key variants: abnormality, microvascular damage, nonobstructive or obstructive atherosclerotic damage.Material and methods        50 patients (39 men, 20 women) aged 30 to 67 years were evaluated with a computed tomography scanner PHILIPS Brilliance iCT SP 128. A high pretest probability of ischemic heart disease was found in 44 % of cases and medium in 40%.Results   According to CCS data, coronary artery (CA) pathology was not found in 28 % of patients. CA hypoplasia was observed in 4 % of patients. 22 % of patients had muscular bridges narrowing the CA lumen during systole by 40-50%. In 26 % of cases, CA had minimal and early stenoses. Moderate and pronounced stenoses were observed in 20% of cases. In one case, there was a total occlusion of the circumflex branch. Calcinates were found in 9.1 % of patients with muscular bridges, in 61.5 % of patients with minimal and early stenoses, and in 80% of patients with moderate and pronounced stenoses. In the group with "clean" CA and congenital defects, calcinates were absent. The mean value of pretest probability was the highest in the patient group with moderate and pronounced stenoses, 22.5±13.13. It was significantly higher than in the group with muscular bridges (р=0.045) and congenital pathology of CA (р=0.01). At the same time, this value did not significantly differ from the group with "clean" CA and the group with minimal and early stenoses. Based on the study results, 2 bypass surgeries and 5 CA stentings were performed.Conclusion            Thus, the table of pretest probability of ischemic heart disease does not provide a differential diagnosis and evaluation of the nature of CA damage as compared to results of CTCA.

[Double Blockade of Aldosterone Receptors as a Method of Elimination Negative Effects of Non-Steroidal Anti-Inflammatory Drugs in Chronic Heart Failure].

The article deals with the dynamics of echocardioscopy indices during 1.5 years in a patient who underwent an acute myocardial infarction (MI). Two months after the MI left ventricular (LV) end-diastolic size and LV volume were 61 mm and 190 ml, respectively; LV ejection fraction (EF) was 42%. At the background of maximal possible doses of ramipril, bisoprolol, and selective antagonist of aldosterone receptors eplerenone, and after revascularization, within eight months LV end-diastolic size decreased down to 57 mm, LV volume - to 158 ml, and LVEF increased up to 51%. There was no change of potassium and creatinine blood serum levels. The situation changed dramatically after addition to ongoing therapy because of exacerbation of chronic osteochondrosis of ketoprofen 100, meloxicam 15 and tolperisone (Mydocalm) 450 mg/day. The patient noted an increase in dyspnea during walking, a decrease in exercise tolerance. LVEF fell to 36%, LV size increased up to values registered in 2 months after MI. There were no signs of overt fluid retention (no gain of weight, lower limbs edema, lung congestion on X-ray, hepatomegaly at ultrasound examination). In 4 months after addition to therapy of a loop diuretic torasemide (5 mg) the cardio-hemodynamic parameters almost returned to values prior to administration of anti-inflammatory drugs. CONCLUSION: Loop diuretic (such as torasemide) can be recommended for elimination of negative consequences of the use of nonsteroidal anti-inflammatory drugs in patients with chronic heart failure.

[The oxidative modifications of lipoproteins in male youths with primary mitral valve prolapse].

The sampling of 137 male youths with primary mitral valve prolapse underwent the analysis of content of lipoproteins, malonic dialdehyde and modified lipoproteins depending on conditions of adaptive reserves of organism. The decrease of adaptive reserves of organism documented by higher content of oxidized lipoproteins up to 2.84 times (p < 0.05) and malonic dialdehyde up to 1.85 times as compared with control group (p < 0.05). The reliable difference between lipidogram data in patients with high and lower adaptive reserves was not established.

Clinical and diagnostic significance of measurement of blood activity of endopeptidases and their inhibitors in youths with mitral valve prolapse.

Activity of leukocytic elastase in young male patients with mitral valve prolapse and high (group 1) and low (group 2) adaptive capacities was increased by 57.08 and 79.14%, respectively, compared to the control (p<0.05). The leukocytic elastase/α1-proteinase inhibitor ratio in groups 1 and 2 surpassed the control value by 55.6% and by 2.16 times, respectively (p<0.05), this parameter can serve as a biochemical marker of adaptive capacity.

[Kallikrein-kinin system parameters as markers of various adaptive capacities of the body in young male patients with mitral valve prolapse].

The activity of kinin system parameters was studied in 137 young male patients with mitral valve prolapse (MVP) in relation to the body's adaptive capacities. As compared with the controls, the patients with high (Group 1) and low (Group 2) adaptive capacities showed 57.08 and 79.14% increases in leukocyte elastase activity, respectively (p < 0.05). In Groups 1 and 2, the leukocyte elastase/alpha1-proteinase inhibitor ratio was 55.6% and by 2.16-fold higher, respectively, than in the controls (p < 0.05). Thus, the high the leukocyte elastase/alpha1-proteinase inhibitor ratio may serve as a biochemical marker of diminished adaptive capacities in young male patients with mitral valve prolapse and indicate a poor prognosis associated with degradation of a diversity of functionally significant proteins.

[The use of Magne B6 in order to increase compensatory-adaptive possibilities in youths with primary mitral valve prolapse].

The aim of the study--to estimate the effect of therapy with Magne 6 on the indices of cardiac hemodynamics, tolerance to physical load, activity of antioxidant protection enzymes and grade of hypoxia in youths with 1 grade mitral valve prolapse (MVP) without regurgitation. In 73 cases with impaired compensatory adaptive possibilities the extent of main syndromes of autonomic dystonia and state of cardiac hemodynamic indices were evaluated. The activity of catalase (C), glutathione reductase (GR), superoxide dismutase (SOD), lactate (L) and pyruvate (P) level were detected in red blood cells, the coefficient lactate/pyruvate (L/P) was been calculated according to the standard method. In the study the high-grade of autonomic dystonia (36.6 +/- 2.1 scores) was been revealed. The number of scores in the control group is 10.8 +/- 1.8. There was found the confident increase of stroke by 37.18%, cardiac output by 24%, stroke index--by 38.45% and cardiac index--by 43.06% in comparison with healthy persons (a < 0.05). The time of cycle ergometer load was significantly lower than in reference group 20.22% (a < 0.05). The red blood cells levels of PVK and L were correspondingly 95.4% and 51.4% higher than in control (p < 0.05). The L/P ratio was 22.5% in excess of the value in reference group (p < 0.05). C activity was 4.59 times less, SOD and GR activity were correspondingly 6.23 and 1.85 times (p < 0.05) as mush, than in healthy persons. Associated with Magne 6 therapy for a month the improvement in indices of cardiac hemodynamics, rising of tolerance to physical load, the fall in GR activity and decrease of hypoxia were been noted. Magne 6 may be used for magnifying of compensatory--adaptive possibilities in youths with 6 MVP.

Imbalance in the antioxidant defense system as a possible cause of decreased compensatory and adaptive reserves in youths with mitral valve prolapse.

An imbalance in the first line of the antioxidant defence and hyperactivity of the glutathione-dependent system were revealed in 137 youths with mitral valve prolapse. Increased activities of superoxide dismutase and glutathione reductase (by 6 and 1.82-2.10 times, respectively) can serve as an additional diagnostic criterion of decreased compensatory reserves in patients with mitral valve prolapse.