[Pulmonary Hypertension in Takayasu Arteritis].

Takayasu arteritis is well-known rare form of large vessel vasculitis. Pulmonary involvement is observed in 50% of cases. However, pulmonary hypertension is a rare complication of pulmonary artery stenosis. In this article we present a rare clinical case of Takayasus arteritis with typical stenosis of subclavian, carotid arteries, and involvement of pulmonary arteries with development of severe pulmonary hypertension. The article also contains discussion of current methods of diagnosis and treatment of pulmonary artery stenosis in Takayasus arteritis with special focus on effectiveness and complications of angioplasty and surgery.

[Surgical treatment of chronic thrombo-embolic pulmonary hypertension with floating thrombi in the right heart ventricle].

A 31 years old male patient was admitted to a resuscitation unit with severe dyspnea (MMRC 4 grade). The patient had the dyspnea for 3 months.The diagnosis of chronic thrombo-embolic pulmonary hypertension with floating thrombi in the right heart ventricle was established. On the sixth day of admission after IVC filter insertion, the patient underwent thromboectomy with pulmonary endarterectomy. For an access to segmentary pulmonary arteries during operation SVC and the aorta had been cross-clamped. The duration of deep hypothermic (20 degrees C) circulatory arrest was 54 minutes. The patient was discharged in satisfactory condition on the 17th day. At the check-up at 3 months the dyspnea was absent and heart hemodynamic parameters had been normalized.

[Peculiarities of interval QT changes and its prognostic role in patients with acute myocardial infarction].

Prognostic significance of duration and dispersion of interval QT as well as relationship of these parameters to other clinical and instrumental signs were studied in 220 survivors of acute myocardial infarction (MI). These patients were examined on days 10-14 of MI and then followed for 12-36 months. Values of corrected QT (QTc) increased with increase of degree of severity of heart failure and derangements of left ventricular function, intensity of ventricular disturbances of rhythm. QT dispersion depended on left ventricular contractile function and rose in anterior localization of MI and non-Q MI. Dependence was observed between QTc duration and mortality of patients after MI, both total and cardiovascular including sudden. At multifactorial analysis QTc>440 ms appeared to be independent predictor of risk of total and cardiac mortality in patients with anterior non-Q MI. QT dispersion did not possess sufficient informative power for prognostication of outcomes.

[Diagnostic value of ventricular late potentials, heart rate variability and QT dispersion in patients with acute myocardial infarction]. / Diagnosticheskoe znachenie pozdnikh potentsialov zheludochkov, variabel'nosti serdechnogo ritma i dispersii intervala Q-T u bol'nykh infarktom miokarda.

Late ventricular potentials (LVP), heart rate variability (HRV) and dispersion of QT interval (QTd) were studied in 91 patients with myocardial infarction with various ventricular arrhythmias. Patients with episodes of sustained ventricular tachycardia (group 4) had the following characteristics: prevalence of LVP 73.7%, QTd 82.5 ms, standard deviation of RR intervals (SD) 26.5 ms; spectral analysis of HRV revealed preponderance of sympathetic influences and lowered vagal activity. Frequency of LVP detection, QTd and SD in patients with ventricular extrasystoles (Lown classes 3-5) (group 3) were 33.3%, 72.8 ms, and 42.8 ms, respectively. Patients of group 3 also had augmented sympathetic and lowered parasympathetic influences. These data significantly differed from those obtained in patients with Lown class 1-2 ventricular extrasystoles (group 2) and patients without extrasystoles (group 1). Groups 3 and 4 had significantly different prevalences of LVP and values of some HRV parameters but similar QTd. There was close correlation between presence of severe ventricular arrhythmias and some parameters of HRV and signal averaged ECG. Stepwise regression analysis showed that the following group of parameters was related to the presence of malignant ventricular rhythm disturbances: heart rate, SD and total QRS duration (p<0.05). Thus patients with life threatening ventricular arrhythmias were characterized by the presence of LVP and changes of some parameters of HRV and QTd. Registration of these parameters can apparently be used for prediction of potentially fatal ventricular arrhythmias in patients with myocardial infarction.