Cardiac arrhythmias in adolescents with mitral valve prolapse and myxomatous degeneration of mitral valve leaflets.

INTRODUCTION: myxomatous degeneration (MD) of valve leaflets and other structures of the valve apparatus and the degree of its severity in particular is of great prognostic significance as this determines the risk of complications development as well as the prognosis. The aim of the paper was to assess heart rhythm and heart conduction disorders in adolescents with primary mitral valve prolapse (MVP) and myxomatous valve degeneration of various degrees. MATERIALS AND METHODS: complete physical examination of 145 adolescents aged 12-16 with MVP was carried out. Patients were divided into four groups according to the degree of myxomatous degeneration (MD): group 1 - 29 patients without MD; group 2 - 43 patients with MD and 3-4 mm leaflets thickness; group 3 - patients with MD and 5-6 mm leaflets thickness; group 4 - patients with MD and 7-8 mm leaflets thickness. Our own methods used to determine the degree of MD are presented in the paper. RESULTS: in general, significant increase in the total number of both ventricular and supraventricular arrhythmias was observed in all patients with myxomatous degeneration when compared with the group of patients with no MD. While in patients from group 2 the number of ventricular premature beats was 6.5 times higher than in group 1, it was 10 times higher in group 3 and 20 times higher in group 4. The same significant changes (p < 0.05) were seen in extrasystoles in Lown's grading (increase from grade I to grade IV), the episodes of ventricular tachycardia (VT) and their number, mean heart rate as well as maximal duration of ventricular tachycardia episodes. CONCLUSIONS: thus, the presence of MD of mitral valve leaflets in MVP and its degree of severity in particular, were found to be the major risk factor in arrhythmia development.

STRUCTURAL HEART ANOMALIES (REVIEW).

Structural heart anomalies (SHA) are congenital abnormalities of cardiovascular system, characterized by various anatomical departures of heart and great vessels from normal conditions. SHA are a part of connective tissue dysplasia syndrome (CTDS), one of the most common congenital autosomal-dominant diseases in people of young and middle age. The most common SHA are a mitral valve prolapse, abnormal chords of left ventricle and their combinations. The clinical significance of these anomalies depends on a degree of severity and impact on intracardial hemodynamics, as described in the article. The most prognostically dangerous are multiple abnormal chords of left ventricle, which can be a sign of serious hereditary disease - a left ventricular non-compaction.

[INSTRUMENTAL CRITERIA OF DIFFERENTIAL DIAGNOSIS OF THE ASCENDING AORTA ANEURISM IN PATIENTS OF DIFFERENT AGE].

Criteria of differential diagnosis for the aortal aneurysm etiological factor, especially in patients of a young age, are studied insufficiently. Peculiarities of cardio­vascular remodeling in patients of different age, in whom the ascending aorta aneurysm was diagnosed, were studied with the objective to search for criteria of differential diagnosis of the aneurysm etiological factor. Echocardiography constitute the main method of the ascending aorta aneurysm diagnosis. There was established, that changes in the cardio­vascular remodeling indices in patients are caused not by cardiac pathology only, but by their age as well. The aortal bulb dilation is frequently caused by dysplasia of connective tissue and dilation of the ascending aorta distal part ­ predominantly by atherosclerosis and arterial hypertension. Enhancement of the ascending aorta/aortal bulb coefficient (aortal bulb diameter/ascending aorta diameter) more, than 1.11 have had witnessed, as a rule, the connective tissue origin of the ascending aorta aneurysm; the coefficient lowering down from 0.88 ­ about atherosclerotic and/or hypertensive genesis of aneurysm

[THE CORRECTION WITH NOOPHEN OF AUTONOMIC DYSFUNCTION IN YOUNG MEN WITH HYPERTENSION].

The aim of this study was to investigate the influence of antihypertensive therapy with adding of gamma-amino-beta-phenylbutyric acid hydrochloride on the autonornic regulation of tcardiovascular system and the psychoemotional status in young men with hypertension. The study included 58 male with hypertension, aged 18-39 years (mean age 31.7 yearst 2.3 years), of them 28 patients (group I) administered beta-blocker and the other received a complex therapy which included beta-blocker and gamma-amino-beta-phenylbutyric acid hydrochiotide--Noofen ("OlainFarm", Latvia) 250 mg 3 times a day for 4 weeks. The control group consisted of 20 healthy indi&iduals aged 18-39 years (mean age 31.5 years +/- 2.5 years). The examination included of standard clinical; biochemical and instrumental investigatIons. We conducted a clinical measurement of blorid pressure, ambulatory blood pressure monitoring (ABPM), Doppler echocardiography, heart rate variability, autononlic symptoms questionnaire and Spielberger--Hanina Anxiety Scale. Analysis of circadian blbod pressure profile arid autonomic nervous system state in young men with hypertension, in spite of the short disenle history demonstratnl violations of the blood pressure circadian rhythm associated with the violation of the autonomic regulation of cardiovascular system as indreased sympathetic activity and decreased parasympathetic activity heart tate. In hypertensive patients with autonomic dysfunction we noted a reduction of level of mental health, which was reflected in an increase in'the number of people with high and moderate levels of reactive and personal anxiety It has been demonstratedthat the use of combination therapy with adding Noofen in young hypertensive men and autonomic dysfunction helped significantly improve the HRV parameters and restore autonomic balance on time parameters of heart rate variability reduced the level of reactive anxiety and imprdved the psychoemotional state.