[Echocardiography and magnetic resonance tomography of the heart in diagnosis of noncompaction of left ventricular myocardium].

Left ventricular (LV) noncompaction (NC) is a rare form of cardiomyopathy which initially was diagnosed by transthoracic echocardiography (EchoCG). This paper presents description of 15 patients with diagnosis of LVNC. Aim of the study was to compare results of EchoCG with data of magnetic resonance tomography (MRT) of the heart in diagnosis of LVNC. We used the following EchoCG criteria of LVNC: (1) two layer structure of thickened LV wall with ratio of noncompacted to compacted layers more or equal 2, (2) numerous, excessively prominent trabeculations with deep intertrabecular recesses, (3) intertrabecular discontinuity on color doppler flow imaging. It was established that in assessment of ratio of noncompacted and compacted layers both methods were informative and can replace or supplement each other in diagnosis of LVNC.

[Diagnosis of malignant pericardial mesothelioma].

Continuing growth of rate of detection of primary tumors of the heart has been noted recently. Prevalence of cardiac tumors in European population according to data of different authors varies from 25 to 5500 cases per 1 million of autopsies. Malignant mesothelioma belongs to most rarely met tumors. In most cases pericardial malignant mesothelioma possesses high secretory capacity what allows to suspect tumorous process in hemorrhagic pericarditis with recurrences after repetitive punctures. The paper contains description of a patient with malignant pericardial mesothelioma. Special feature of this case has been atypical clinical course of the disease complicated by development of acute myocardial infarction of posterior left ventricular wall.

[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.

[Noninvasive methods of investigation of mammary coronary grafts and coronary vascular bed in remote period after coronary artery bypass grafting].

Aim of the present study was to investigate diagnostic value of treadmill test, stress echocardiography during exercise on treadmill as well as color duplex scanning in assessment of the state of mammary coronary grafts and coronary vascular bed in remote period after coronary artery bypass grafting. Parameters of 73 patients (70 men and 3 women) were analyzed on the average after 4.9 +/- 1.8 years after aortocoronary-mammary coronary grafting surgery. Results of examination of patients in remote terms after operations of aortocoronary-mammary coronary grafting evidence for high sensitivity and low specificity of treadmill test for lesions of mammary coronary grafts and coronary arteries. We revealed high sensitivity and specificity of stress echocardiography in diagnosis of grafts lesions including those in patients with postinfarction cardiosclerosis of anterior localization. High informativity of the method of color duplex scanning of mammary coronary grafts at rest and at the background of stress test with high dose dipyridamole in detection of grafts stenoses and occlusions was also demonstrated.

[Peculiarities of atherosclerotic damage of brachiocephalic arteries in patients with type 2 diabetes mellitus].

The state of vascular bed of brachiocephalic arteries was studied by the method of color duplex scanning in 250 patients (116 men and 134 women) with atherosclerosis of various vascular basins which in 62 of them took place at the background of type 2 diabetes mellitus (DM). Two hundred five patients had atherosclerosis of brachiocephalic arteries, 45 patients without atherosclerotic plaques in carotid arteries comprised control group. Mean age of patients was 65.3 +/- 7.6 years. A correlation was revealed between parameters of carotid artery stenosis and age of patients, level of arterial pressure, blood plasma concentration of total cholesterol. Degree of interrelation of these parameters was closer in patients with type 2 DM. Among patients with IHD with class I-III effort angina severity of carotid artery stenoses increased with elevation of functional class of angina. This dependence was most pronounced in patients with type 2 DM. Unstable and calcinated plaques were significantly more frequent in patients with type 2 DM than in patients without DM.

[Non-compact left ventricular myocardium: current state of the problem].

Non-compaction of the left ventricle or spongy myocardium is a rare congenital cardiomyopathy which is characterized by impaired endomyocardial morphogenesis, hypertrophy of left ventricular myocardium with prominent trabeculation, and deep inter-trabecular recesses. According to WHO classification (1995) this disease belongs to unclassified cardiomyopathies. Main clinical signs of ventricular non-compaction are heart failure, ventricular arrhythmias, systemic and pulmonary embolism. Echocardiography which is a basic method of diagnosis can reveal double layer structure of thickened left ventricular wall and multiple prominent trabeculation with wide inter-trabecular spaces. Predominant localizations of pathological process are region of cardiac apex, inferior and lateral left ventricular walls. Treatment of patients with ventricular non-compaction concentrates on elimination of its main clinical symptoms.

[Noninvasive diagnosis of the state of lower extremities arterial vascular bed in patients with diabetes of type 2].

Complex noninvasive investigation of arterial vascular bed and microcirculation of lower extremities was carried out in 87 patients with diabetes and 47 patients with atherosclerosis obliterans of lower extremities without diabetes. Color duplex scanning allowed to detect occlusive-stenotic and nonocclusive changes of arterial vascular bed in patients with type 2 diabetes. Calcinated atherosclerotic plaques in patients with type 2 diabetes more often localize in superficial femoral, popliteal arteries and arteries of the calf. Such plaques are twice as frequent among patients with atherosclerosis obliterans with diabetes compared with those without diabetes. Laser Doppler flowmetry with test of reactive postocclusion hyperemia and positional test in patients with atherosclerosis obliterans and type 2 diabetes allows to reveal more pronounced disturbances of microcirculation compared with patients without diabetes. In patients with type 2 diabetes with hemodynamically insignificant stenoses of arteries of lower extremities laser doppler flowmetry and transcutaneous measurement of oxygen tension in skin of a foot reveal disturbances of microcirculation.

[Clinical value of the use of magnesium orotate in adolescents with syndrome of cardiac connective tissue dysplasia].

According to results of clinical and instrumental investigation magnesium orotate (50 mg/day during first week and 25 mg/day thereafter) was found to be effective therapy of children with syndrome of cardiac connective tissue dysplasia (mainly with mitral valve prolapse and anomalous chordae tendineae).

[Studies on the function of external respiration in adults and children with anomalous position of the heart chordae]. / Dannye issledovaniia funktsii vneshnego dykhaniia u vzroslykh i detei s anomal'no raspolozhennymi khordami serdtsa.

AIM: To compare respiratory function in adults and children whose heart chordae were in anomalous position (AC) with reference to severity of heart connective tissue dysplasia syndrome. MATERIALS AND METHODS: The study included ninety one 6-14-year-olds and 125 adults with AC. The patients were divided into groups by the degree of atrioventricular valvular prolapse (AVVP). External respiration function was examined, and the loop flow-volume was registered by the pulmonological computer system. Inhalation bronchospasmolytic test with berotec was performed. RESULTS: Tracheobronchial dyskinesia related in degree to AVVP severity was found in 76 and 35% of the adults and children with AC and AVVP, respectively. The berotec test allowed more precise evaluation of tracheobronchial dyskinesia. CONCLUSION: Functional insufficiency of the connective tissue in patients with cardiac connective tissue dysplasia syndrome progresses with age.

[The role of abnormally located chordae in the origin of accidental heart murmurs in children]. / Znachenie anomai'no raspolozhennykh khord v proiskhozhdenii aktsidental'nykh shumov serdtsa u detei.

A study of 55 children with accidental systolic and diastolic heart murmurs demonstrated that abnormal chorda position (ACP), detected at echocardiography in various heart cavities, was the principal contributing factor. The relationship between the intensity and other parameters of systolic murmurs and abnormal chorda topography is discussed. Abnormal position of the chordae was not associated with any deviations from basic morphometric characteristics of the heart and should therefore be regarded as a normal variant.

[Anomalously located chordae in the left ventricular cavity in the complex manifestations of minor connective tissue anomalies]. / Anomal'no raspolozhennye khordy v polosti levogo zheludochka v komplekse proiavlenii malykh anomalii soedinitel'noi tkani.

A study of 37 children and 32 adults with abnormally located chords in the left ventricular cavity detected by ultrasonic investigation of the heart, revealed a number of minor developmental defects of connective tissue which served as the basis for establishing diagnosis of connective tissue systemic involvement (probably, congenital).