[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.