Combination therapy is a new standard for treatment of pulmonary arterial hypertension.

At present, compelling evidence has been obtained that combined therapy of pulmonary arterial hypertension (PAH) with specific drugs can significantly slow progression of PAH. Therefore, in current guidelines combination therapy is already considered as standard treatment for a significant proportion of patients with moderately severe and severe forms of PAH. However, the quality of life and long-term prognosis of patients receiving combination therapy, should be the object of further research. The future research is absolutely necessary to identify the most optimal strategy of treatment of patients with PAH, such as initial combination therapy or rapid sequential combination therapy, double or triple combinations as well as exploring new signaling pathways PAH, which can become targets for new specific drugs PAH.

Pregnancy in women with hypertrophic cardiomyopathy: data from the European Society of Cardiology initiated Registry of Pregnancy and Cardiac disease (ROPAC).

AIMS: We report the maternal and foetal outcomes at birth and after 6 months in a cohort of pregnant women with hypertrophic cardiomyopathy (HCM). Although most women with HCM tolerate pregnancy well, there is an increased risk of obstetric and cardiovascular complications. METHODS AND RESULTS: All pregnant women with HCM entered into the prospective worldwide Registry of Pregnancy and Cardiac disease (ROPAC) were included in this analysis. The primary endpoint was a major adverse cardiovascular event (MACE), which included death, heart failure (HF), thrombo-embolic event, and arrhythmia. Baseline and outcome data were analysed and compared for patients with MACE vs. without MACE and for patients with obstructive HCM vs. non-obstructive HCM. Sixty pregnant women (mean age 30.4 ± 6.0 years) with HCM (41.7% obstructive) were included. No maternal mortality occurred in this cohort. In 14 (23%) patients at least one MACE occurred: 9 (15.0%) HF and 7 (12%) an arrhythmia (6 ventricular and 1 atrial fibrillation). MACE occurred most commonly during the 3rd trimester and postpartum period. In total, 3 (5.0%) women experienced foetal loss. Women with MACE had a higher rate of emergency Caesarean delivery for cardiac reasons (21.4% vs. 0%, P = 0.01). No significant differences in pregnancy outcome were found between women with obstructive and non-obstructive HCM. NYHA functional class of ≥II and signs of HF before pregnancy, were associated with MACE. CONCLUSION: Although most women with HCM tolerated pregnancy well, cardiovascular complications were not uncommon and predicted by pre-pregnancy status facilitating pre-pregnancy counselling and targeted antenatal care.

[Efficacy of intravenous iloprost (Ilomedin®) in salvage of the only extremity in a patient with thrombangiitis obliterans].

Buerger s disease, or thromboangiitis obliterans, is a severe invalidating systemic vascular disease. The present article deals with a clinical case report concerning treatment of a patient suffering from thromboangiitis obliterans with three limbs amputated (on the background of therapy with alprostadil, Karavanov s mixture, rheopolyglukin, pentoxyphyllin). The course intravenous administration of the stable analogue of prostacyclin - iloprost (IlomedinR) made it possible to save the only extremity.

[Magnesium orotate in treatment of chronic hypertension in pregnant women].

We examined 150 pregnant women with essential hypertension (EHT), EHT and connective tissue dysplasia (CTD), and healthy. Presence of CTD aggravated clinical picture of EHT and was associated with pronounced cardialgic, neurological, asthenic, vertebrogenic, visceral, and other syndromes. The use of antihypertensive, metabolic (magnesium orotate) drugs, sedative and uroseptic phytotherapy, application of other nondrug measures in conditions of multidisciplinary dynamic support of the gestational period facilitated regress of clinical symptoms of EHT and EHT+CTD, favorable course of pregnancy and successful delivery.

[Structure of cardiovascular pathology in pregnant women and efficacy of regional specialized management].

From 2000 to 2011 in prospective and retrospective studies we investigated pregnancy outcomes in all 30417 women treated within framework of the multidisciplinary management system for pregnant patients with cardiovascular diseases (hypertension, structural heart disease, aortic pathology and inflammatory autoimmune rheumatic diseases) designed and conducted in the Udmurt Republic of Russian Federation in late 1980-th. The system comprises specialized outpatient and inpatient departments, sanatorium and a maternity hospital at the regional cardiological center and provides ambulatory and hospital management and rehabilitation. Perinatal mortality decreased 65.8% from 11.1% in 2000 to 3.8% in 2011. Within 20 years no mother died.

[Cardiac angiosarcoma in a pregnant women].

We present a case of cardiac angiosarcoma in a pregnant women. Clinical manifestations of angiosarcoma were unspecific and progressed rapidly as hemopericardium, cardiac tamponade, heart failure, fever, chest pain. Pregnancy was interrupted at 22-nd week. The patient died in 6 months after appearance of first symptoms.

[Hypertension in pregnant women--a novel cardiorenal continuum].

AIM: To investigate cardiorenal correlations in pregnant patients with arterial hypertension. MATERIAL AND METHODS: Risk factors (RF), initial stages, progression, and final stage of both cardiovascular disease (CVD) and chronic kidney disease (CKD) were analysed in a cohort of 159 pregnant women with hypertensive disorders versus a cohort of 32 healthy pregnant controls. Cardiorenal continuum factors were investigated in patients with different ways of gestational hypertension (HT) diagnosis: 13 with isolated clinic HT (ICHT), 11--isolated ambulatory HT (IAHT), and 18--HT found by all three blood pressure (BP) measurement modalities (clinic, ambulatory, and home BP). RESULTS: A novel cardiorenal continuum exists in pregnant women with HT where chronic HT (essential HT) on the one hand and pre-eclampsia on the other hand may lead through the common RF and initial stages (subclinical organ damage) to the stage of progression (CVD, CKD) and to the final stage (cardiovascular events and renal failure). The number of RF signs of subclinical organ damage, and total cardiovascular risk progressively increase from the condition of being normotensive on clinic, home, and 24-hour definitions to the condition of being found hypertensive by one, two and all three BP measurement methods, forming the continuum "healthy pregnant women--ICHT--IAHT--gestational HT" in which each item is almost the same as the ones next to it but the last is very different from the first. CONCLUSION: Assessment of the cardiorenal state in all pregnant women allows to compose the cline "healthy pregnants--gestational HT--stage I essential HT--stage II essential HT--pre-eclampsia--essential HT with superimposed pre-eclampsia" with growing risk of CVD and CKD and a potential danger of cardiovascular events (complications) and chronic renal failure.

[Basic and metabolic therapy of hypertensive disease in pregnant women].

This open non-randomized study had the objective to analyse the course of pregnancy and labor as well as their outcomes in 62 women with hypertensive disease (essential hypertention). The patients were allocated to two groups, one (group 1) comprising 32 the other (group 2, control) 30 women. All patients in group 1 underwent pregravid preparation and remained under observation throughout the pregnancy period in specialized cardiological departments. They were given treatment that included intake of antihypertensive drugs (methyldopa, long-acting nifedipin, metoprolol), desaggregant (dipyridamole, pentoxifllin), and metabolically active agent (vitamin E, folic acid, magnesium orotate, actovegin, cocarboxylase, and inosin). Gestosis developed in 25% of the patients in group 1 within 37 weeks and in 56.7% of the women (p < 0.05) in group 2 within 23-37 weeks of pregnancy. Circulatory disturbances in the mother-placenta-fetus system were recorded in 25% and 50% of the women in groups 1 and 2 respectively (p < 0.05), intrauterine fetal hypoxia in 18.8 and 50% (p < 0.05), chronic fetoplacental insufficiency in and fetal growth retardation syndrome in 12.5 and 40% (p < 0.05). In group 2, the perinatal mortality rate was 66.7% and perinatal losses amounted to 100.0% compared with their absence in group 1 (p < 0.05). Premature delivery occurred in 30% of the women in group 2 and was absent in group 1 (p < 0.05). In group 1, 9.4 of the newborn infants had low birth weight compared with 33.3% of the live full-term infants in group 2 (p < 0.05). Conjugated jaundice prevailed among the diseases affecting newborns in group 1 whereas intrauterine infections and posthypoxic encephalopathies were most common in group 2 It is concluded than combined therapy of hypertensive disease in women delayed the development of gestosis and made it possible to maintain pregnancy till normal outcome for both the mother and the child.

[Use of antioxidants and trimetazidine in preparation of patients with ischemic heart disease for coronary angiography]. / Ispol'zovanie antioksidantov i trimetazidina pri podgotovke bol'nykh ishemicheskoi bolezn'iu serdtsa k koronaroangiografii.

Lipid peroxidation, cell stability, lipid spectrum, conjunctival microcirculation, levels of ceruloplasmin and myoglobin were studied in 107 males with ischemic heart disease before and after coronaroangiography by M. Judkins (CAG). It was found that CAG provokes oxidative stress, promotes membranodestructive processes, dyslipidemia and circulation disorders in the bulbar conjunctive. Preventive (3 days before CAG) administration of alpha-tocopherol or emoxipin proved cardioprotective. The highest cytoprotective effect was produced by trimetasidine given 10 days before the procedure.