Abstract:

Introduction: half-year data on results of using new domestic NanoMed devices for closing atrial septal defects (ASD) were obtained. The occluder is a nitinol self-expanding and self-centering double disc device with a polyester membrane.

Aim: was to evaluate the safety and efficacy of a new domestic occluder for closing of atrial septal defect in a small group of patients over a 6-month follow-up period.

Material and methods: four pediatric patients underwent closure of atrial septal defects with domestic NanoMed occluders. Clinical examination and transthoracic echocardiography were performed at 24 hours, 1, 3, and 6 months. Endpoints included technical success of intervention, efficacy and safety of the procedure at follow-up instrumentation and physical examination.

Results: the average age of patients was 5,2 years (range 4 to 7 years). Mean ASD diameters and device waist sizes were 11,9 ± 1,2 mm and 13,7 ± 1,2 mm and 13,7 ± 1,2 mm, respectively. Technical and procedural success achieved in 100% of cases. During the six-month follow-up, no adverse events and residual flows were identified.

Conclusion: initial half-year data on the absence of adverse events and residual flows indicate the safety and effectiveness of the use of NanoMed occluders.

References

1.     Stout K, Daniels C, Aboulhosn J, et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019; 73(12): 1494-1563.

https://doi.org/10.1016/j.jacc.2018.08.1028

2.     Pettersen MD, Du W, Skeens ME, Humes RA. Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study. Journal of the American Society of Echocardiography. 2008; 21(8): 922-934.

https://doi.org/10.1016/j.echo.2008.02.006

3.     Gillespie MJ, Javois AJ, Moore P, et al. Use of the GORE CARDIOFORM septal occluder for percutaneous closure of secundum atrial septal defects: results of the multicenter U.S. IDE trial. Catheterization and Cardiovascular Interventions. 2020; 95(7): 1296-1304.

https://doi.org/10.1002/ccd.28814

4.     Sharifi M, Burks J. Efficacy of clopidogrel in the treatment of post-ASD closure migraines. Catheter Cardiovasc Interv. 2004; 63: 255.

https://doi.org/10.1002/ccd.20144

Abstract:

Currently, endovascular correction has become the method of choice in most cases of secondary atrial septal defects.

The obvious superiority lies in low trauma, a decrease in the incidence of early complications, atrial flutter and fibrillation, systemic thromboembolism, ischemic stroke, and all-cause mortality.

We present the initial experience of using new occluders for ASD closure.

References

1.     Warnes CA, Williams RG, Bashore TM, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American heart association task force on practice guidelines (Writing committee to develop guidelines on the management of adults with congenital heart disease). Developed in collaboration with the American society of echocardiography, heart rhythm society, international society for adult congenital heart disease, society for cardiovascular angiography and interventions, and society of thoracic surgeons. J Am Coll Cardiol. 2008; 52: 143-263.

2.     King TD, Thompson SL, Steiner C, et al. Secundum atrial septal defect. Nonoperative closure during cardiac catheterization. JAMA. 1976; 235: 2506-2509.

3.     Alexi-Meskishvili VV, Konstantinov IE. Surgery for atrial septal defect: from the first experiments to clinical practice. Ann Thorac Surg. 2003; 76: 322-327.

4.     Nassif М, Abdelghani М, Bouma J, et al. Historical developments of atrial septal defect closure devices: what we learn from the past. Expert Review of Medical Devices. 2016; 13(6).

5.     Регистрационное удостоверение на медицинское изделие от 30 марта 2020 года № РЗН 2020/9850: «Окклюдер кардиологический «NanoMed» по НАЕФ.942511.015 ТУ.

Registration certificate for medical device, March 30, 2020 No. RZN 2020/9850: «NanoMed cardiological occluder» ac. to NAEF.942511.015 [In Russ].

6.     Базылев В.В., Шматков М.Г., Пьянзин А.И., Морозов З.А. «Отдаленные результаты применения отечественных коронарных стентов с биоинертным углеродным покрытием «Наномед». Журнал Диагностическая и интервенционная радиология. 2020; 14(1); 47-54.

Bazylev VV, Shmatkov MG, Pianzin AI, Morozov ZA. Long-term results of using domestic coronary stents with bioinert carbon coating, «Nanomed». Journal Diagnostic & interventional radiology. 2020; 14(1); 47-54 [In Russ].

https://doi.org/10.25512/DIR.2020.14.1.05

7.     Базылев В.В., Шматков М.Г., Морозов З.А. «Сравнительные результаты использования коронарных стентов с лекарственным покрытием «НаноМед» и Orsiro. Журнал Диагностическая и интервенционная радиология. 2019; 13(4); 21-26.

Bazylev VV, Shmatkov MG, Morozov ZA. Comparison of results of the use of coronary stents with drug eluting, «Nanomed» and Orsiro. Journal Diagnostic & interventional radiology. 2019; 13(4); 21-26 [In Russ].

https://doi.org/10.25512/DIR.2019.13.4.02

8.     Majunke N, Sievert H. ASD/PFO devices: what is in the pipeline? J Interv Cardiol. 2007; 20: 517-523.

9.     Aytemir K, Oto A, Ozkutlu S, et al. Early-midterm follow-up results of percutaneous closure of the interatrial septal defects with occlutech figulla devices: a single center experience. J Interv Cardiol. 2012; 25: 375-381.

10.   Haas NA, Happel CM, Soetemann DB, et al. Optimal septum alignment of the Figulla(R) Flex occluder to the atrial septum in patients with secundum atrial septal defects. EuroIntervention. 2016: 11(10):1153-60.

https://doi.org/10.4244/EIJY14M12_09

11.   Roymanee S, Promphan W, Tonklang N, et al. Comparison of the Occlutech (R) Figulla (R) septal occluder and Amplatzer (R) septal occluder for atrial septal defect device closure. Pediatr Cardiol. 2015; 36: 935-941.

12.   Sharifi M, Burks J. Efficacy of clopidogrel in the treatment of post-ASD closure migraines. Catheter Cardiovasc Interv. 2004; 63: 255.

Abstract:

Background: atrial septal defect (ASD) is characterized by a progressive increase in pulmonary vascular resistance and, accordingly, pressure in small circulation circle. It is noteworthy that these hemodynamic changes go in parallel with morphofunctional changes in small vessels of pulmonary artery system. At the same time, changes in hemodynamics of small circulatory circulation after endovascular closure in this category of patients and reversibility of pulmonary hypertension are not fully studied.

Aim: was to assess clinical course, indicators of cardiac chamber geometry and hemodynamics of small circulation circle after transcatheter closure of secondary ASD in adult patients with moderate and significant pulmonary hypertension in immediate and long-term periods.

Material and methods: from 2009 to 2020, 103 patients (mean age 48,3 ± 15,3 years) with secondary ASD underwent endovascular transcatheter closure of the defect. 60 (58,3%) patients had pulmonary hypertension. Depending on systolic pulmonary arterial pressure (SPAP), patients were divided into 3 groups: the first group consisted of 41 (68,3%) patients with mild PH (from 40 to 49 mm Hg); the second group included 10 (16,6%) patients with moderate PH (50 to 59 Hg); and the third group consisted of 9 (15%) patients with high SPAP (? 60 mm Hg). Average pulmonary artery systolic pressure in groups was: 43,6 ± 2,9 mm Hg; 52,1 ± 2,5 mm Hg; 64,4 ± 5,2 mm Hg, respectively. Average sizes of ASD (according to Pre-TEE data) were 18,7 + 6,1 mm; 22,1 ± 7,5 mm and 21,3 ± 5,3 mm, respectively. In all cases, echocardiographic signs of the right heart volume overload were detected. Follow-up was performed on an outpatient basis with an assessment of the clinical status and TTE in the long-term period.

Results: technical success of endovascular defect closure was 100%. Average size of the occluder was 26,3 + 6,96 (from 12 to 40) mm. Immediately after implantation of device, complete closure of ASD was observed in 55 (91,7%) cases. Residual flow (<3 mm) was observed in 5 cases (2 cases in the first group, 1 case in second group, and 2 cases in third group, (p >0,05)). In the vast majority of cases - 54 (90%) hospital period proceeded smoothly. All patients were examined in the long-term period (on average 12,5 + 6,5 months). The survival rate in groups was 100%. In the long- term follow-up remodeling of the right heart was observed in all patients. In the first group the size of RA decreased from 6,0 ± 0,5 cm to 3,3 ± 0,4 cm, RV size decreased from 4,7 ± 0,5 to 3,1 ± 0,4 cm; in the second group RA from 5,7 ± 0,7 cm to 3,8 ± 0,5 cm, RV - from 4,7 ± 0,9 to 3,8 ± 0,6 cm; in the third group RA - from 5,5 ± 0,6 cm and 4,2 ± 0,5 cm, the size of RV decreased from 4,5 ± 0,6 4,0 ± 0,5 cm, respectively. In all patients, significant decrease in SPAP was observed, in some cases up to normalization. In the first group, SPAP decreased from 43,7 ± 2,9 to 32,1 ± 2,6 mmHg, in the second group - from 52,1 ± 2,5 to 34,3 ± 2,6 mmHg; in the third group - from 64,4 ± 5,2 to 50,3 ± 4,8 mmHg. The most expressed decrease of pressure occurred in the second group of patients. At the same time, in the third group, dynamics of pressure reduction was significantly less expressed in comparison with the other two groups. At the same time in two patients of third group high PH remained in the long-term period, despite the successful closure of the defect.

Conclusion: results show that in case of left-right shunt in the absence of hypoxemia, transcatheter closure of ASD in adult patients with moderate and significant pulmonary hypertension is a pathophysiologically and clinically justified, is a highly effective treatment method that allows achieving significant improvement of both clinical manifestations and intracardiac and systemic hemodynamics. In patients with a significant degree of pulmonary hypertension and a high probability of the latter, the following tactical approaches may be considered:

1. primary closure of defect with further drug therapy;

2. primary drug therapy aimed on regulating of the anatomic-functional state of the arterial bed of the small circulation and hence reducing pulmonary vascular resistance followed by endovascular ASD-closure;

3. closure of the defect with a fenestrated occluder (in case of a negative test for temporary balloon occlusion), followed by drug therapy. This assumption can be considered in future research.

References

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2.     Fraisse, et al. Atrial Septal Defect Closure: Indications and Contra-Indications. J Thorac Dis. 2018; 10(24): 2874-2881.

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Abstract:

Introduction: pulmonary arterial hypertension (PAH) is a pathophysiological syndrome that can occur in a variety of clinical conditions. Percutaneous balloon dilatation and stent implantation are methods for creating or expanding atrial communication in a variety of conditions to improve cardiac output. It should be kept in mind that creation of an inadequate size of the shunt leads to an excess of right-left shunt, worsening of pulmonary blood flow, severe hypoxemia, and acute left ventricular failure. Possibility of a calculated determination of required size of shunt in the interatrial septum will increase the effectiveness and safety of atrioseptostomy, which is especially important in this severe category of patients.

Aim: to substantiate a method of determining of optimal diameter of the atrial communication during atrioseptostomy in patients with PAH for increase of exercise tolerance, prevention of syncope and reducing the risk of sudden death.

Materials and methods: the choice of the diameter of the interatrial communication during atrioseptostomy operation in patients with PAH is as follows: before the operation, patient undergoes an invasive measurement of pressure in right and left atrium and determination of stroke volume of left ventricle. Then calculation the diameter of the interatrial communication according to the formula is performed. We performed calculation according to presented formula in 4 patients with PAH. In 2 patients, a fenestrated occluder was implanted, in 1 patient atrial septum stenting was performed, and 1 patient underwent open atrioseptostomy.

Results: in all patients after atrioseptostomy, an improvement in quality of life was observed: decreased dyspnea, increased exercise tolerance, decreased edema of lower limbs, and the absence of syncopal conditions. Thus, after the operation, there was a positive dynamics in clinical status of patients, indicators of test with a six-minute walk, as well as changes in echocardiographic indicators: a decrease in the size of the right ventricle and square area of right atrium, an increase in the end-diastolic size of the left ventricle, which indicates an improvement in function of both ventricles.

Conclusion: a mathematical model based on principles of intracardiac hemodynamics, demonstrates the importance of choosing of size of foramen to create a certain Qp/Qs. Size of foramen, depending on the pressure in atrium, in conditions of high pulmonary hypertension has a small range of values (from 6 to 8 mm). Therefore, the use of the 7 mm size, previously obtained empirically by other authors, is physically justified. Our first experience testifies to applicability of the developed model, but due to the small number of observations associated with the rarity of the pathology, it requires further research.

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Abstract:

The aim of the study was to assess the powers of complex ultrasonography in different stages of endovascular closure of atrial septal defects (ASD). 31 patients 13-56 years old (mean age 23,65 ±5,2 years) with septal defects were included into the study. Ultrasound (US) monitoring performed during the procedure of endovascular closure, and as a follow-up. There were prevalence (35,4%) of the patients with central ASD with rims of 5 mm and more. Abcence of anterio-superior or aortic rim, or its deficiency, noted in 19,2% of cases. Patent foramen ovale (PFO) registered in 25,81% of patients. Incidence of multiple ASDs and ASD in aneurysm occurred to be similar and was as high as 9,67%. In 2 cases of multiple ASDs, and 2 cases of PFO, transseptal puncture was used as an approach to left atrium, for the reason of complex anatomy of the septum. After the closure, transthoracic US showed reliable decrease of the right atrium, right ventricle, and pulmonary artery (PA) size. The majority of patients (64%) showed normalization of PA pressure and left ventricle enlargement in a week after the procedure. Two-dimensional echocardiography (EchoCG) with color Doppler mapping (CDM) is the key method for ASD imaging and assessing its suitability for endovascular closure. Transesophageal EchoCG can help in verification of the ASD anatomy and refinement of the ASD rims. Ultrasound guidance during the procedure of endovascular closure allows optimal positioning of the device, immediate assessment of the homodynamic effects, and timely diagnosis of complications.

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Abstract:

The purpose of the study is to evaluate the immediate and long-term effectiveness of percutaneous transluminal angioplasty (PTA) in patients with diabetes mellitus (DM) and critical lower limbs ischemia (CLLI).

Since November 2004 till February 2008 42 PTA were performed in 40 patients with CLLI; 28 (70%) of them had ischemic ulceration, in 6 patients (15%) there were foot gangrene, and 6 patients suffered of ischemic rest pain. 30 patients (75%) had the insulin-dependent DM, 8 patients (20%) took antihyperglycemic drugs, 2 (5%) kept to antihyperglycemic diet. There were the following comorbidities: CAD - 30 patients (75%); arterial hypertension - 31 (77,5%); cerebrovascular insufficiency - 15 (37,5%); chronic renal failure - 8 (20%), and 3 patients (7,5%) were on chronic hemodialisis.

One patient (1,4%) had iliac localization of the lesion, 38 (51,4%) - femoropopliteal disease, and there were infrapopliteal lesions in 35 (47,3%) patients. There were prevalence of TASC type C and type D lesions (89,2%), and 81,5% of all infrapopliteal lesions were occlusions. Subintimal tracking was used in 31,5% of lesions. Stenting performed in 2 cases. Angiography success rate was 92,7% - 37 patients. Clinical improvement registered in 36 (90%) patients. 12-month follow-up showed absence of critical ischemia in 72,8% of cases. 

Reference

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5.     Blair J.M., Gewertz B.L., Moosa H., Lu C.T.,Zarins C.K. Percutaneous transluminal angioplasty versus surgery for limb-threateningischemia.J. Vasc. Surg. 1989; 9 (5): 698-703.

6.     Treiman G.S., Treiman R.L., Ichikawa L., Van Allan R. Should percutaneous transluminal angioplasty be recommended for treatment of infrageniculate popliteal artery or tibioperoneal trunk stenosis?J. Vasc. Surg. 1995; 22 (4): 457-463, 464-465.

7.     Parsons R.E., Suggs W.D., Lee J.J., Sanchez L.A., Lyon R.T., Veith F.J. Percutaneous transluminal angioplasty for the treatment of limbthreatening ischemia: do the results justify anattempt before bypass grafting? / Vase. Surg. 1998; 28 (6): 1066-1071.

8.     Molloy K.J., Nasim A., London N.J., Naylor A.R., Bell PR., Fishwick G., Bolia A., Thornpson M.M. Percutaneous transluminal angioplasty in the treatment of critical limb ischemia.J. Endovasc. Ther. 2003; 10 (2): 298-303.

9.     Nasr M.K., McCarthy R.J., Hardman J., Chalmers A., Horrocks M. The increasing role ofpercutaneous transluminal angioplasty in theprimary management of critical limb ischaemia. Eur. J. Vasc. Endovasc. Surg. 2002; 23 (5):398-403.

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11.   Faglia E., DallaP.L., Clerici G., ClerissiJ., Gra ziani L., Fusaro M., Gabrielli L., Losa S., Stella A., Gargiulo M., Mantero M., Caminiti M., Ninkovic S., Curci V., Morabito A. Peripheral angioplasty as the first-choice revascularization procedure in diabetic patients with critical limb ischemia: prospective study of 993 consecutive patients hospitalized and followed between 1999 and 2003. Eur. J. Vasc. Endovasc. Surg. 2005; 29 (6): 620-627.

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13.   Rutherford R.B., Baker J.D., Ernst C., Johnston K.W., PorterJ.M., Ahn S.,Jones D.N. Recommended standards for reports dealing with lower extremity ischemia: revised version. [Erratum in: / Vase. Surg. 1997; 26 (3): 517-538.] J. Vasc. Surg. 2001; 33 (4): 805.

14.   Капутин М.Ю., Овчаренко Д.В., Сорока В.В. и др. Субинтимальная ангиопластика в лечении больных с критической ишемией нижних конечностей. Медицинский академический журнал. 2007; 6 (3): 103-108.

15.   Graziani L., Silvestro A., Bertone V., Manara E., Alicandri A., Parrinello G., Manganoni A. Percutaneous transluminal angioplasty is feasible and effective in patients on chronic dialysis with severe peripheral artery disease. Nephrol. Dial. Transplant. 2007; 22 (4): 1144-1149.

16.   Graziani L., Silvestro A., Bertone V., Manara E., Andreini R., Sigala A., Mingardi R., De Giglio R. Vascular involvement in diabetic subjects with ischemic foot ulcer: a new morphologic categorization of disease severity. Eur. J. Vasc. Endovasc. Surg. 2007; 33 (4): 453-460.

17.   Long-term mortality and its predictors in patients with critical leg ischaemia. The I.C.A.I. Group (Gruppo di Studio dell'Ischemia Cronica Critica degli Arti Inferiori). The Study Group of Criticial Chronic Ischemia of the Lower Exremities. Eur. J. Vasc. Endovasc. Surg. 1997; 14 (2): 91-95.

Abstract:

РТА and stenting of lower limb s arteries was performed in 28 diabetic patients with critical limb ischemia. Technical success rate of interventions was 96,3%. Clinical success rate after the procedure was 64,3%. Mean values of basal ТсРО2 on the foot after operation increased on 11 mm of mercury. At a favorable outcome of treatment ankle-brachial index values increased on 0,2-0,4. Ischemia recurrence rate was 25%. All recurrences of ischemia were observed in period of 3 to 9 months. Cumulative limb salvage rate in 6 months was 80 %, in 12 months - 75%.

In short period of observation PTA and stenting in diabetic patients is able to eliminate the necessity of amputation in majority of patients. Considering weight of the general condition of such patients, presence of accompanying diseases, risk of development of complications of surgical treatment, РТА can be considered as operation of the first choice. 

Reference

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2.     Шиповский В.Н. Баллонная ангиопластика в лечении хронической ишемии нижних конечностей.Дис. д-ра мед. наук. 2002; 16-17.

3.     Jeans W.D., Armstrong S. Fate of patients undergoing transluminal angioplasty for lower-limb ischemia. Radiology. 1990; 177: 559-564.

4.     Krepel V.M., van Andel G.J. et al. Percutaneous transluminal angioplasty of the femoropopliteal arteries: initial and long-term results. Radiology. 1985; 156:25-28.

5.     Харазов А Ф. Диагностика и результаты лечения пациентов с критической ишемией нижних конечностей при атеросклеротическом и диабетическом поражении артерий ниже паховой связки. Дис. канд.мед. наук. 2002; 12.

Abstract:

199 patients with ASD were included in the study. In 102 cases ASD was closed with Amplatzer system and in 97 cases cardiac surgery was performed. Analysis and comparison of ASD correction results (both short- and long-term) have been done, according to patient's age and type of ASD.

Reference 

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2.     Мутафьян О.А. Врожденные пороки сердца удетей. Санкт-Петербург: «Невский диалект». 2002; 331.

3.     Бокерия Л.А. Минимально инвазивная хирургия сердца: состояние проблемы и возможные перспективы. Мат. всероссийской конференции «Минимально инвазивная хирургия сердца и сосудов». 1997.

4.     Алекян Б.Г., Машура И., Пурсанов М.Г. и др. Первый в России опыт закрытия дефектов межпредсердной перегородки с использоанием «Amplatzer Septal Occluder». Мат. международного симпозиума. «Минимально инвазивная хирургия сердца и сосудов». 1998; 23.

5.     Бураковский В.П., Бухарин В.А., Подзолков В.П. и др. Врожденные пороки сердца. В кн.: Сердечно сосудистая хирургия. Под ред. В.И. Бураковского, Л.А. Бокерия. М.: Медицина. 1996; 768.

6.     Усупбаева Д.А. и др. Ремоделирование сердца после транскатетерного закрытия вторичного межпредсердного дефекта системой Amplatzer. Терапевтический архив. 2006; 6.

7.     Усупбаева Д.А. и др. Двухмерная эхокардиоскопия в транскатетерном закрытии вторичного межпредсердного дефекта окклюдером Амплатца. Ультразвуковая и функциональная диагностика. 2005; 4: 74-81.

8.     Chan К.С, Godman MJ. Morphologic a variations of fossa ovalis atrial septal defects (secundum): feasibility for transcutaneous closure with the clamshell device. Br. Heart J. 1993; 69 (1): 52-55.

Abstract:

Background. Significant coronary artery disease (CAD), occurring in 7-10% of patients with obstructive hypertrophic cardiomyopathy (HCM), deteriorates the clinical course and survival rates. Until recently, such combination of abnormalities was an indication for coronary artery bypass graft (CABG) and septal myoseptecmy

Aim: was to investigate the efficacy, safety and technique of combined percutaneous intervention in patients with obstructive HCM and CAD. Materials and methods. We have performed 15 combined percutaneous interventions: alcohol septal ablation (ASA) and coronary revascularization. All patients had a marked asymmetric hypertrophy of LV with outflow tract obstruction at rest, as well as severe coronary lesions (75% - 95%). During the procedure, we performed consistently ASA of target zone in charge of obstruction and coronary stenting (10 stents in LAD, 8 stents in RCA, 4 stents in LCX).

Results. Among the effects of interventions were disappearance of angina pectoris and dyspnea, reduction of the pressure gradient in the LV outflow tract and a significant decrease in the thickness of septum. No serious complications (such as MI, complete av-block, ventricular tachiarrhythmias) occured

Conclusion. These results indicate efficacy and safety of ASA combined with coronary revascularization in patients with obstructive HCM who have concomitant CAD.

References

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2.    Romeo F., Pelliccia F., Cristofani R. et al. Hypertrophic cardiomyopathy: Is a left ventricular outflow tract gradient a major prognostic determinant? Eur. Heart J. 1990; 11: 233-240.

3.    Maron M.S., Olivotto I., Betocchi S. et al. Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy. N. Engl. J. Med. 2003;348: 295-303.

4.    Sigwart U. Non surgical myocardial reduction for hypertrophic obstructive cardiomyopathy. Lancet. 1995; 346: 211-214.

5.    Knight C., Kurbaan A., Seggewiss H. et al. Non surgical septal reduction for hypertrophic obstructive   cardiomyopathy. Circulation. 1997; 95: 2075 -2081.

6.    Burry Х., Sigwart U. Alcohol ablation of interventricular septum as a method of treatment of hypertrophic obstructive cardiomyopathy. International. Journal of Interventional Cardioangiology. 2004; 4: 11-17 [In Russ].

7.    Shloydo E.A., Sukhov V.K., Kochanov I.N. Transcatheter alcohol septal ablation for hypertrophic obstructive cardiomyopathy. Report to the XII All-Russian Congress of cardiovascular surgeons. The Bulletin of Bakoulev CCVS for Cardiovascular Surgery «Cardiovascular diseases». 2006; 7(5): 84 [In Russ].

8.    Sorajja P., Ommen S.R., Nishimura R.A. et al. Adverse Prognosis of Patients With Hypertrophic Cardiomyopathy Who Have Epicardial Coronary Artery Disease. Circulation. 2003; 108: 2342-2348.

9.    Cokkinos D.V., Krajcer Z., Leachman R.D. Hypertrophic Cardiomyopathy and Associated Coronary Artery Disease. Texas Heart Institute Journal. 1985; 2: 12.

10.  2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy. J. Am. Coll,. Cardiol. 2011; 58 (25): 212-260.

11.  2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. J. Am Coll. Cardiol. 2011; 58(24): 44-122.

12.  Honda T., Sakamoto T., Miyamoto S. et al. Successful Coronary Stenting of the Left Anterior Descending Artery at the Branching Site of the Targeted Septal Perforator Immediately after Percutaneous Transluminal Septal Myocardial Ablation in Hypertrophic Obstructive Cardiomyopathy. Internal. Medicine. 2005; 44: 722-726.

13.  Nambi V., Buergler J.M., LakkisN.M. et al. Effectiveness of Percutaneous Intervention for Patients With Obstructive Hypertrophic Cardiomyopathy and Coronary Artery Disease. Am J. Cardiol. 2005; 96: 580-581.

Abstract:

Palliative surgery plays a major role as a stage of congenitalheart disease treatment.Palliative endovascular interventions are safe n neonates. Such treatment can stabilize patients and adequately prepare them for radical operation and in some cases it is an alternative to classic bypass methodic.

References

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10.  Bisoi A.K. et al. Primary arterial switch operation in children presenting late with d-transposition of great arteriaes and intact ventricular septum. When is it too late for a primary arterial switch operation? Eur. J. Cardiothorac. Surg. 2010; 38: 707-713.

Abstract:

Purpose. Was to investigate the radiodiagnostic features of ASD in different age groups and to evaluate the role of chest X-rays in diagnostics of this disease.

Materials and methods. 48 patients with ASD were studied (aged 15–71 yaers, mean 47,2 ± 15), including 16 men and 32 women. We have diagnosed ostium primum defect (3 pts), ostium secundum defect (42 pts), sinus venosus defect, combined with PAPVD (3 pts). All of them underwent chest x-rays, echocardiography and cardiac MRI (with phase-contrast sequences). Patients were divided into two groups: 1st group – older than 40 years (30 pts) and 2nd group – less than 40 years (18 pts).

Results. In the 1st group, heart failure, valve regurgitations and atypical radiographic findings were more common than in the 2nd group. The size of both atria, pulmonary arteries' diameter and systolic PAP levels were also greater in patients older than 40 yaers. Groups did not differ by the volume of intracardiac shunt and the size of the defect. 6 pts with small defects had no radiographical signs of CHD. 11 patients from the 1st group had signs of hypervolemic CHD, but significant heart chambers’ enlargement impeded more accurate diagnostics. Patients with marked pulmonary arterial hypertension differed significantly from patients with lower PAP levels by radiographical signs.

Conclusions. Specificity of chest x-rays in diagnostics of ASD is lower in patients of 2nd group. Chest x-rays is an effective screening method to reveal abnormalities of pulmonary circulation, such as pulmonary venous hypertension and pulmonary plethora.

References

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Abstract:

Aim: was to estimate possibilities of two-dimensional and three-dimensional transesophageal echocardiography (TEE) in the diagnosis of atrial septal defects (ASD).

Material and methods: 52 patients with atrial septal defect underwent TEE. In 32 cases - 3D TEE, 20-2D TEE. 44 patients further underwent endovascular closure of ASD, 8 underwent cardiac surgical correction of ASD with extracorporeal circulation.

Results: 3D TEE allows to make more accurately and correctly measure of ASD, to determine its location, shape, and number of defects and to quantify all edges, including top, and to measure the length of the partition in three standard areas and additional-caval from lower to upper edge.

Conclusions: 3D TEE gives the most correct estimation of localization, shape and size of the defect, as well as contributes the proper determination of the optimal tactics of surgical correction of the defect.

References

1.    Tkachev I.V., Kondrabulatova S.S., Tarasov D.S. Rol' trehmernoj jehokardiografii v predoperacionnoj ocenke defektov mezhpredserdnoj peregorodki[The role of 3D echocardiography in preoperative estimation of atrial septal defects] Patologija krovoobrashhenija i kardiohirurgija. 2014; 1:58-61 [In Russ].

2.     Klinicheskaja kardiologija: diagnostika i lechenie v treh tomah [Clinical cardiology: diagnostics and treatment in 3 volumes. Under edition of L.A. Bokeria, E.Z.Golukhov]. T 1. ( pod redakciej L.A. Bokerija., E.Z. Goluhova) M.: NCSSH im. A.N. Bakuleva RAMN. 2011; 518-52[ In Russ].

3.    Narcyssova G.P., Malahova O.Ju., Osiev A.G. Ul'trazvukovye kriterii otbora pacientov s defektom mezhpredserdnoj peregorodki na jendovaskuljarnuju korrekciju sistemoj AMPLATZER i ocenku rezul'tatov - medicinskaja tehnologija. [Ultrasound criteria for selection of patients with atrial septal defect for endovascular correction with AMPLATZER system and the evaluation of results.] Novosibirsk. 2012; 10-11 [In Russ]

4.    Prakticheskaja jehokardiografija[Practical echocardiography (under edition Frank A. Flaksamph, translation from germany - V.A. Sandrikova] (pod red. Franka A. Flaksampfa perevod s nem. pod obshhej red. V.A. Sandrikova) M.MED-press-inform. 2013; 224-234 [In Russ].

5.    Tkacheva A.V. Diagnostika i jendovaskuljarnoe zakrytie vtorichnogo defekta mezhpredserdnoj peregorodki ustrojstvom «AMPLATZER» [Diagnosis and endovascular closure of secondary atrial septal defect with «AMPLATZER» device] Avtoreferat. Diss. kand. med. nauk. M. 2008; 24 [In Russ]. 

Abstract:

Endovascular correction of atrial septal defect (ASD) has become the «gold standard» of treatment, both in children and adults. In case of complicated anatomy of the defect (multiple defects, its large size, lack of edges, aneurysm of atrial septum), experts often chose surgical correction of such pathology Accumulated experience of interventional cardiology and appearance of specialized tools allow to perform a successful intervention in a non-standart situation.

Article describes cases of a successful endovascular correction of ASD in a two year child and adult patient with complicated anatomy factors. In both cases, during echocardiography, we diagnosed multiple ASD with aneurysm of atrial septum, accompanied by clinical symptoms. During multidisciplinary discussions, we identified indication for endovascular correction of the defect.

We performed successfull correction of ASD with occluder for closure of patent foramen ovale, and complete termination of left-to-right shunt on the operating table.

References

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2.     Medvedeva S.V. Metodicheskie rekomendacii. Dispansernoe nabljudenie detej s vrozhdennymi porokami serdca i sosudov [Guidelines. Clinical observation of children with congenital heart disease and blood vessels]. 2005; 5-20 [In Russ].

3.    Burakovskij V.I., Buharin V.A., Podzolkov V.I. i dr. Serdechno-sosudistaja hirurgija. Vrozhdennye poroki serdca [Cardiovascular surgery. Congenital heart diseases]. M. Medicina. 1989; 45-382 [In Russ].

4.    Dergachev A.V., Trojan V.V., Adzeriho I.Je., Kozlov O.A., Sprindzhuk M.V. Vrozhdennye poroki serdca s obednennym legochnym krovotokom. Uchebno-metodicheskoe posobie. Chast' 1 [Congenital heart diseases with depleted pulmonary circulation. Guidelines. Part 1.]. Mn.: BelMAPO. 2007; 29 il. 27 [In Russ].

5.    Amikulov B.D. Vrozhdennye poroki serdca blednogo tipa u vzroslyh [«Pale» congenital heart diseases in adults.]. Serdechno-sosudistaja hirurgija . 2004; 2: 3-9 [In Russ].

6.     Bokerija L.A., Gorbachevskij S.V. i dr. Nedostatochnost’ trikuspidal'nogo klapana i ee vlijanie na rezul'taty hirurgicheskogo lechenija defekta mezhpredserdnoj peregorodki u bol'nyh starshe 40 let. Serdechno-sosudistye zabolevanija [Tricuspid failure and its influence on results of surgical treatment of atrial septal defect in patients elder than 40]. 2009; 10 (2): 5-10 [In Russ].

7.     Nechkina I.V., Sokolov A.A. Kovalev I. A., Varvarenko V. I., Krivoshhekov E. V. Remodelirovanie serdca u detej posle jendovaskuljarnoj i hirurgicheskoj korrekcii defekta mezhpredserdnoj peregorodki [Cardiac remodeling in children after endovascular and surgical correction of atrial septal defect]. Sibirskij medicinskij zhurnal. 2012; 27(3): 77-81 [In Russ].

8.     Kurek V.V., Kulagin A.E. Anesteziologija i intensivnaja terapija detskogo vozrasta. Prakticheskoe rukovodstvo [Anesthesiology and intensive care of children]. M.: Medicinskoe informacionnoe agentstvo. 2011; S 992 [In Russ].

9.     Fredriksen P.M., Chen A., Veldtman G., Hechter S., Therrien J., Webb G. Exercise capacity in adult patients with congenitally corrected transposition of the great arteries. Heart. 85 (2). 191-195.

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