Abstract:

Introduction: improving the technique of radiofrequency denervation of renal arteries seems to be extremely important for optimizing the effectiveness of lowering blood pressure in patients with resistant arterial hypertension. Our study presents an assessment of the comparison of long-term results of renal artery denervation (RAD) using various techniques and instruments.

Aim: was to compare the use of various techniques for renal artery denervation and to evaluate longterm results in patients with resistant arterial hypertension using various radio frequency catheters.

Materials and methods: in a prospective study, three groups of patients (n = 58) aged 18-85 years with resistant systolic-diastolic arterial hypertension of 1-2 stages were studied: patients underwent denervation of renal arteries by various methods, against background of standardized antihypertensive therapy. In group I (n = 21), denervation was performed only in the proximal segment of the renal artery (before the first bifurcation). In group II (n = 19), ablation was performed both in proximal segment and in branches of the second and third order, as well as in the accessory renal arteries with a diameter of more than 3 mm. The third control group included 18 patients who received only standardized drug antihypertensive therapy.

Results: technical success of the operation was achieved in 100% of cases. According to the 24-hours ambulatory blood pressure monitoring (ABPM) data, the decrease in blood pressure (BP) in group I by the second year of observation was 6,7 mm Hg, p <0,05 for systolic BP (SBP) and ? 2,7 mm Hg, p> 0,05 for diastolic BP (DBP). In the second group, a greater decrease in mean SBP and DBP was recorded: ? 9,2 mm Hg, p <0,05 and ? 4,3 mm Hg, p <0,05, respectively. In the control group of drug treatment, the weakest antihypertensive effect of treatment was revealed. The average indicators of SBP and DBP decreased by - 4,9/1,9 mm Hg, p> 0,05.

Conclusion: results of the use of prolonged radiofrequency denervation of the main, segmental and accessory renal arteries with a large number of ablation points demonstrate a similar safety and greater efficacy in treatment of patients with resistant arterial hypertension, in comparison with denervation of only main trunk of renal artery.

References 

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https://doi.org/10.1093/eurheartj/eht295

4.     Fengler K, Ewen S, Hцllriegel R, et al. Blood Pressure Response to Main Renal Artery and Combined Main Renal Artery Plus Branch Renal Denervation in Patients with Resistant Hypertension. J Am Heart Assoc. 2017; 6(8): 006196.

https://doi.org/10.1161/JAHA.117.006196

5.     Reshetnik A, Gohlisch C, Scheurig-M?nkler C, et al. Predictors for success in renal denervation-a single centre retrospective analysis. Sci Rep. 2018; 8(1): 15505.

https://doi.org/10.1038/s41598-018-33783-3

6.     Wang A. 2019 Consensus Statement of the Taiwan Hypertension Society and the Taiwan Society of Cardiology on Renal Denervation for the Management of Arterial Hypertension. Acta Cardiologica Sinica. 2019; 35(3): 199-230.

https://doi.org/10.6515/ACS.201905_35(3).20190415A

7.     Steigerwald K, Titova A, Malle C, et al. Morphological assessment of renal arteries after radiofrequency catheter-based sympathetic denervation in a porcine model J Hypertens. 2012; 30(11).

https://doi.org/10.1097/HJH.0b013e32835821e5

8.     Пекарский С.Е., Баев А.Е., Фальковская А.Ю. и др. Анатомически оптимизированная дистальная ренальная денервация — стойкий гипотензивный эффект в течение 3 лет после вмешательства. Патология кровообращения и кардиохирургия. 2020; 24(3S): 98-107.

Pekarskij SE, Baev AE, Fal'kovskaya AYU, et al. Anatomically optimized distal renal denervation – permanent hypotensive effect for 3 years after intervention. Patologiya krovoobrashcheniya i kardiohirurgiya, 2020; 24(3S): 98-107 [In Russ].

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9.     Mahfoud F, Tunev S, Ewen S,et al. Impact of Lesion Placement on Efficacy and Safety of Catheter-Based Radiofrequency Renal Denervation. Journal of the American College of Cardiology. 2015; 66: 1766-1775.

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https://doi.org/10.4244/EIJ-D-16-00206

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https://doi.org/10.26442/2075082X.2020.1.200077

14.   Mahfoud F, Tunev S, Ewen S, et al. Impact of lesion placement on efficacy and safety of catheter-based radiofrequency renal denervation. J Am Coll Cardiol. 2015; 66: 1766-1775.

https://doi.org/10.1016/j.jacc.2015.08.018

15.   Henegar JR, Zhang Y, Hata C, et al. Catheter-based radiofrequency renal denervation: location effects on renal norepinephrine. Am J Hypertens. 2015; 28: 909-914.

https://doi.org/10.1093/ajh/hpu258

16.   Konstantinos PT, Lida F, Kyriakos D. Safety and performance of diagnostic electrical mapping of renal nerves in hypertensive patients. EuroIntervention. 2018; 14: 1334-1342.

https://doi.org/10.4244/EIJ-D-18-00536

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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2.     Baglini R, Scardulla C., Reduction of a previous atrial septostomy in a patient with end-stage pulmonary hypertension by a manually fenestrated device. Cardiovasc Revasc Med. 2010; 11(4).

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Abstract:

Introduction: pulmonary arterial hypertension (PAH) is a disease characterized by a progressive increase in pulmonary vascular resistance that leads to the development of right ventricular heart failure and premature death of patients. Today, there are several ways to create an atrial communication: balloon dilatation, Park procedure, balloon knife atrial septostomy, atrial septum stenting and implantation of fenestrated occluder.

The main problem with positioning of the device is that the atrial septum is not visible on fluoroscopy, where the stent is visible throughout. And the stent is not visible throughout on echocardiography, where the septum is visible. Exactly for this operation, the combination of echo- and fluoroscopic image in real time is very useful in order to accurately place in the middle at the level of stent in the septum and to avoid its dislocation with embolization of right or left heart chambers, or vessels of pulmonary and systemic circuit.

Material and methods: we present a case report of atrial septostomy with stent implantation into the atrial septum using the EchoNavigator® hybrid imaging system in a patient with pulmonary arterial hypertension.Surgical intervention was performed on a patient with PAH: atrial septostomy with intubation anesthesia under the control of fluoroscopy and transesophageal echocardiography (TEE) using the EchoNavigator® system. The procedure was performed using a Palmaz stent, that was implanted without additional fixation.

Results: patient with pulmonary hypertension underwent an atrial septostomy using the EchoNavigator® hybrid imaging system, which was used for positioning and implantation of stent into the atrial septum as quickly and accurately as possible. This surgical intervention significantly improved patient's clinical condition, cardiac hemodynamics and, accordingly, increased the quality of life.

Conclusion: atrial septostomy is a surgical method for patients with severe pulmonary arterial hypertension. Carrying out this operation under the control of the EchoNavigator® system with the function of hybrid imaging in real time greatly facilitated the procedure for positioning and implanting of stent, facilitated the safe implementation.

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http://doi.org/10.1378/chest.06-1227

6.     Gorbachevsky SV, Belkina MV, Pursanov MG, et al. Atrial septostomy as a long bridge to lung transplantation in patients with idiopathic pulmonary arterial hypertension. J. Cardiovasc. Surg. 2012; 53:11.

7.     Alekyan BG, Gorbachevsky SV, Pursanov MG, et al. Atrial septal stenting in idiopathic pulmonary hypertension. Journal of thoracic and cardiovascular surgery. 2016; 58(5): 258-314 [In Russ].

8.     Schmaltz АА, Nishonov NА. Atrioseptostomy in patients with pulmonary hypertension. Journal of thoracic and cardiovascular surgery. 2015; 57(5): 18-25 [In Russ].

9.     Sandoval J, Gaspar J, Pena H, et al. Effect of atrial septostomy on the survival of patients with severe pulmonary arterial hypertension. Eur. Respir. J. 2011; 38: 1343–8.

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 Abstract:

Material and methods. Study population includes 47 women with arterial hypertension (AH) in the third term of pregnancy.

Results and сonclusion. High grade AG was shown to be associated with high resistive index and thus higher value of total peripheral vascular resistance (TPVR). Bisoprolol and Nifedipin GITS normalize blood pressure and alleviates endothelial dysfunction. Antihypertensive therapy tends to lower TPVR in fetal, placental and uterine circulation providing better flow. 

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Abstract:

Article describes the clinical case of a patient suffering from Takayasu's disease and stenotic lesion of the renal artery with early restenosis of renal artery after stenting, causes of mistakes in diagnosis and choice of treatment are also discussed.

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