[Experience of Endovascular Implantation of the WATCHMAN Device in Patients With Atrial Fibrillation].

Atrial fibrillation is one of most frequent heart rhythm disorders in clinical practice. In this article, we present data of review of relevant literature including consideration of prevention of thromboembolic complications. We also present our own experience of endovascular implantation of the WATCHMAN device in left atrial appendage of patients with atrial fibrillation.

[Myxoma of the cor triatriatum].

We present a rare case of myxoma in a patient with cor triatriatum. This pathology was symptomless and was revealed at transthoracic echocardiographic examination in a patient with ischemic heart disease. The patient was successfully subjected to surgery which consisted in removal of the tumor together with accessory membrane to which myxoma was attached and reconstruction of the atrial wall. In international medical literature we found no communication on the combination of myxoma with cor triatriatum.

[Multiple abscessing of valvular apparatus of the heart in a patient with secondary infectious endocarditis].

Progressive growth of infectious endocarditis morbidity has been noted in the world during recent 10 years. Among secondary forms of endocarditis rate of congenital heart defects is 21%. According to data of M.K. Rybakova (2007) the highest risk of development of infectious endocarditis (74%) is noted on bicuspid aortic valve. We present a clinical case of the patient C. with bicuspid aortic valve, secondary infectious endocarditis of aortic and mitral valves complicated with multiple abscessing of valvular apparatus of the heart. The following operation was carried out: mitral valve replacement with mechanical prosthesis ON-X 27 - 29 with preservation of subvalvular structures of posterior mitral valve leaflet, and replacement of aortic valve with mechanical prostheses ON-X-23. Despite development of severe complications in the patient C the outcome of disease was favorable. After course of rehabilitation the patient returned to work.

[Detection of left atrial auricular thrombus in patients with atrial fibrillation and risk factors of thromboembolic complications: the role of transesophageal echocardiography and multispiral computer tomography].

Transesophageal echocardiography (TEE) is routinely used for visualization of left auricular thrombi in patients with atrial fibrillation (AF). Multispiral computed tomography (MSCT) with the use of contrast preparations is a novel method of visualization of intracardiac structures. Forty three patients (27 men, 16 women aged 46-81 years) with duration of atrial fibrillation > 48 hours and scheduled for sinus rhythm restoration were included in this study. TEE and MSCT were carried out in all patients during first 3 days of hospitalization. If according to both methods there were no thrombi in the left auricle cardioversion was performed. If data of one of the methods were suspicious of left auricular thrombus cardioversion was not performed. In these patients both investigations were repeated after 8 weeks of therapy with warfarin. If initially detected mass decreased or disappeared at the background of indirect anticoagulants, it was considered to be a thrombus. In 1/3 of patients repeat examination allowed to reject initial diagnosis of left auricular thrombosis. Simultaneous application of TEE and MSCT detected more thrombi than the use of either of these methods. Rate of detection of thrombi in left atrial auricle with the use of both methods was 32%.

[Assessment of left ventricular global contractility by a shift of mitral fibrous ring using tissue trace mode].

AIM: To study a correlation between tissue trace shift (TTS) of mitral fibrous ring (MFR) in ventricular systole and left ventricular (LV) ejection fraction estimated by two-dimentional echocardiography (TDE). MATERIAL AND METHODS: A correlation between TTS of MFR and LV ejection fraction estimated by TDE was studied in 64 patients with LV systolic dysfunction of different severity. The shift was estimated with tissue trace which is a mode of tissue dopplerography. RESULTS: The test for TTS was made in all the patients. Patients with LV global systolic dysfunction had a significantly less TTS of MFR. The maximal diagnostic value was detected for the 8 mm shift. This value allowed detection of the LV global contractility loss under 40% with 91% sensitivity and 96% specificity. CONCLUSION: Tissue trace of MFR in ventricular systole not only reveals disorders in LV global contractility but also estimates the severity of these disorders.

[Safety of exercise and dobutamine stress echocardiography (results of 2383 tests)]. / Bezopasnost' stress-ékhokardiografii s dinamicheskoi nagruzkoi i dobutaminom (opyt 2383 issledovanii).

AIM: To elucidate complications and unfavorable side effects of diagnostic exercise and dobutamine stress echocardiography. MATERIAL: Results of exercise (n=1969) and dobutamine (n=414, 34% with the use of atropine) stress echocardiography conducted in 2 centers for diagnosis of coronary heart disease. Mean age of patients 54,4+/-9,4 years. RESULTS: There were no deaths or life threatening complications. Disturbances of cardiac rhythm and conduction (31% during exercise and 61% during dobutamine stress tests) were most frequent events. One of 13 exercise and of 5 dobutamine stress tests was stopped because of complications or side effects. Of 15 cases of ventricular tachycardia and 16 of hypotension (lowering of blood pressure by 20 mm Hg) 9 and 13, respectively, occurred during dobutamine tests. There were differences between centers in frequency of atropine use during dobutamine tests and therapy of stress induced chest pain. CONCLUSION: The data confirmed that both exercise and dobutamine/atropine stress echocardiography could be safely used in diagnosis of coronary heart disease.

[Prospects for surgical and combined methods for treating acute coronary syndrome]. / Vozhmosnosti khirurgicheskikh i kombinirovannykh metodov lecheniia ostrogo koronarnogo sindroma.

From 1997 to 2000 diagnostic coronaroangiography was performed in 334 patients with acute coronary syndrome (ACS) which is the group of diseases with common pathophysiological mechanism, namely coronary artery thrombosis. ACS needs revascularization of the affected artery as quickly as possible. 26.6% patients underwent balloon angioplasty (BAP). 14.9% patients underwent emergency and urgent coronary artery bypasses with cold and pharmacological cardioplegia. Minimally invasive coronary bypass (MICB) was used in 4.2% patients. Combined BAP + MICB were performed in 2.1% patients. Indications, terms, sequence and future of ACS surgical treatment are discussed.