[Geometric and morphological features of the aortic root in norm and aortic regurgitation]. / Geometricheskie i morfologicheskie kharakteristiki kornia aorty v norme i pri nedostatochnosti aortal'nogo klapana.

AIM: To assess linear and geometric parameters of the aortic valve and to determine the changes which are associated with impaired leaflets coaptation and aortic root enlargement. MATERIAL AND METHODS: Surgical anatomy of the aortic root and its spatial relationships with surrounding heart structures were studied with plastination by using of combined silicon technologies. 123 specimens of the aortic root with preserved original geometry were created with silicone plastination technique and perfusion embalming. Analysis included 15 heart specimens with the signs of aortic root dilatation and 108 specimens without evidence of dilatation. Multiple logistic regression was used for statistical analysis. RESULTS: Anatomical and clinical analysis showed that deviation angle of the intercusp triangle is the factor contributing impaired aortic root geometry and aortic regurgitation (OR 1.3, 95% CI 1.114-1.350, p<0.0001). CONCLUSION: 1) Increased deviation angle of intercusp triangles is associated with impaired coaptation of aortic valve leaflets. 2) Restoration of intercusp triangle deviation angle within 1.7±1.2° degrees is geometrically necessary to achieve normal function of the aortic valve.

[Cardiac Resynchronization Therapy in the Treatment of Heart Failure in Children].

Cardiac resynchronizing therapy (CRT) is currently a leading approach to the treatment of heart failure in adults. However, data regarding application of CRT in children remain limited and indications for CRT are unclear. There is evidence that the best treatment outcomes result from the administration of CRT to the group of children whose heart failure is caused by dyssynchrony mediated by traditional stimulation of the right ventricle in patient with complete atrioventricular block. On the contrary, the presence of dilated cardiomyopathy and functional class III-IV heart failure are the predictors of ineffective CRT. Implantation of CRT devices in children has many peculiarities and challenges associated with anatomic and physiological characteristics of childhood age. Taking into consideration the expected length of treatment, one should admit that epicardial biventricular stimulation should be preferred. In the present paper the authors discuss pathophysiology of the electromechanical dyssynchrony, analyze their own experience with CRT, and suggest indications for this kind of treatment.

[Cardiac Resynchronization Therapy in the Treatment of Heart Failure in Children].

Cardiac resynchronizing therapy (CRT) is currently a leading approach to the treatment of heart failure in adults. However, data regarding application of CRT in children remain limited and indications for CRT are unclear. There is evidence that the best treatment outcomes result from the administration of CRT to the group of children whose heart failure is caused by dyssynchrony mediated by traditional stimulation of the right ventricle in patient with complete atrioventricular block. On the contrary, the presence of dilated cardiomyopathy and functional class III-IV heart failure are the predictors of ineffective CRT. Implantation of CRT devices in children has many peculiarities and challenges associated with anatomic and physiological characteristics of childhood age. Taking into consideration the expected length of treatment, one should admit that epicardial biventricular stimulation should be preferred. In the present paper the authors discuss pathophysiology of the electromechanical dyssynchrony, analyze their own experience with CRT, and suggest indications for this kind of treatment.

[Palivizumab: four seasons in Russia].

In 2010, the Russian Federation (RF) registered palivizumab--innovative drug, based on monoclonal antibodies for passive immunization of seasonal respiratory syncytial virus (RSV) infection in children of disease severe progress risk group, which include primarily premature infants, children with bronchopulmonary dysplasia and hemodynamically significant congenital heart disease. Currently, palivizumab is included in the list of recommended medicines and medical care standards of different countries, including Russia. In the review the results of Russian research on the progress of RSV infection, its epidemiology and immunization experience gained over the 2010-2014 period are summarized in relation to the foreign data. During the four epidemic seasons palivizumab immunization covered more than 3,200 children of severe RSV infection risk group with a progressive annual increase in the number of patients who received the drug. Geography of palivizumab immunization is also greatly expanded in our country during this time. If during the first two seasons measures of immunization were taken mainly in Moscow and St. Petersburg, at the present time, thirty one territorial entities of the Russian Federation have the experience in the drug application. Analysis of the results of RSV infection immunization (made in several regions) confirms the high clinical efficacy and palivizumab safety already demonstrated in international studies. In addition, the analysis presents the potential to improve the efficiency of the integrated RSV infection immunization programs, realizing in the establishment of high-risk child group register, adequate counseling for parents, as well as the development of the routing of patients and coordination of interaction between different health institutions during the immunization.

[Scintigaraphic assessment of viability of the ischemic myocardium while carrying out nitroglycerine-mediated and orthostatic tests].

The work deals with diagnostic possibilities of single photon emission computed tomography (SPECT) of the heart and ECG-synchronized planar scintigraphy (ECG-PS) with 99mTc-tetrophosmine used to determine viability of the ischaemic myocardium in patients presenting with postmyocardium infarction cardiosclerosis. A total of 20 patients diagnosed with Ischaemic heart disease (IHD), functional class III-IV angina of effort, postmyocardium infarction cardiosclerosis were examined. All the patients underwent SPECT of the heart with 99mTc-tetrophosmine, which was carried out at rest and on the background of sublingual administration of nitroglycerine, as well as planar ECG-synchronized scintigraphy of the myocardium according to the protocol: rest - nitroglycerine-mediated - orthostatic tests. Repeat examinations at rest were performed 4-6 weeks after the coronary artery bypass (CAB). The obtained findings showed that sensitivity of perfusion SPECT with 99mTc-tetrophosmine of the myocardium amounted to 85%, specificity to 76%, and diagnostic accuracy to 82%. Calculating the diagnostic parameters of perfusion while using ECG-PS with sublingual administration of nitroglycerine demonstrated that sensitivity of the method amounted to 71%, specificity to 91%, and diagnostic accuracy to 83%. Analyzing the orthostatic test yielded sensitivity equalling 72%, specificity - 84% and diagnostic accuracy - 81%. Sensitivity of assessing myocardial contractility by means of ECG-PS using nitroglycerine amounted to 83%, with specificity of 86% and diagnostic accuracy of 85%. At the same time, sensitivity of the orthostatic test amounted to 80%, specificity to 92%, and diagnostic accuracy to 88%. Hence, carrying out SPECT and ECG-synchronized planar scintigraphy of the heart with 99mTc-tetrophosmine on the background of sublingual administration of nitroglycerine and the orthostatic test makes it possible to simultaneously assess the reserve of myocardial contractility and perfusion, thus strongly suggesting a high informative value of the techniques involved in detecting myocardial viability in patients with postmyocardium infarction cardiosclerosis.