Abstract: In interventional radiology department of clinical hospital № 27 (Moscow) since 2002 till 2009 TIPS was performed in 62 patients for hepatic cirrhosis with portal hypertension. One of the patients underwent orthotopic liver transplantation in Germany.
Material and methods. Mean age in the group was 5f ,6 y. o., 17 women, 45 men. Three types of stents were used: matrix stents, self-expanding and stent-grapfts. Patients were divided in 2 groups. In Group 1 (17 pts) we performed TIPS with stent-grafts (Gore Viatorr TIPS Endoprosthesis); in Group 2 (47 pts) bare metal stents were used (matrix stents Perico, Genesis, JoMed and self-expanding stents Za-stent, Zilver, Wallstent, sinus-SuperFlex Visual-Stent, SMART-control).
Results. During 18 months follow-up there were no thrombosis, significant stenosis in patients of Group 1, and primary patency rate was 100%. In Group 2 primary and secondary patency rates were 69,3% and 85,6% correspondingly. Freedom from recurr ent esophageal varices hemorrhage was 82,8% in Group 1 and 69,3% in Group 2, ascitis and hydrothorax regression - 93,9% and 80,0%, absence of hepatic cerebropathy progression - 93,9% and 80,0%, overall survival - 87,8% и 76,0% correspondingly.
Conclusions. Therefore use of stent-graft in TIPS procedure improve patency of intrahepatic shunt (p < 0,01), significantly reduce risk of recurrent variceal hemorrhage (0,1 < p < 0,5), and reduce volume of ascitis (0,1 < p < 0,5). It worth saying that cerebropathy progression was caused by non-compliance to diet, and was corrected with medicamental treatment. In long-term follow-up stent graft «Viatorr» deployment improves survival of patients (0,1 < p < 0,5). Introduction of stent-grafts marked a new stage of TIPS pro cedure improvement.
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 1. Jain S, Dalvi B. Atrial septal defect with pulmonary hypertension: when/how can we consider closure? J Thorac Dis. 2018; 10(24): 2890-2898. 2. Fraisse, et al. Atrial Septal Defect Closure: Indications and Contra-Indications. J Thorac Dis. 2018; 10(24): 2874-2881. 3. Akagi T. Current concept of transcatheter closure of atrial septal defect in adults. J Cardiol. 2015; 65(1): 17-25. 4. Kefer J. Percutaneous Transcatheter Closure of Interatrial Septal Defect in Adults: Procedural Outcome and Long-Term Results. Catheter Cardiovasc Interv. 2012; 79(2): 322-30. 5. Gruner C, Akkaya E, Kretschmar O, et al. Pharmacologic preconditioning therapy prior to atrial septal defect closure in patients at high risk for acute pulmonary edema. J Interv Cardiol. 2012; 25: 505-12. 6. Abaci A, Unlu S, Alsancak Y, et al. Short- and long-term complications of device closure of atrial septal defect and patent foramen ovale: metaanalysis of 28,142 patients from 203 studies. Catheter Cardiovasc Interv. 2013; 82(7): 1123-1138. 7. Humenberger M, Rosenhek R, Gabriel H, et al. Benefit of atrial septal defect closure in adults: impact of age. Eur Heart J. 2011; 32: 553-560. 8. Ioseliani DG, Kovalchuk IA, Rafaeli TR, et al. Simultaneous Percutaneous Coronary Intervention and Endovascular Closure of Atrial Septal Defect in Adults. Kardiologia. 2019; 59(2): 56-60 [In Russ]. 9. Correction to: 2018 AHA/ACC Guideline for the Management of Adults with Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019; 139(14): 833-834. 10. Gali? N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016; 37(1): 67-119. 11. Haas NA, Soetemann DB, Ates I, et al. Closure of secundum atrial septal defects by using the occlutech occluder devices in more than 1300 patients: the IRFACODE project: a retrospective case series. Catheter Cardiovasc Interv. 2016; 88: 71-81. 12. Nakahawa K, Akagi T, Taniguchi M, et al. Transcatheter closure of atrial septal defect in a geriatric population. Catheter Cardiovasc Interv. 2012. 13. Marwick TH, Gillebert TC, Aurigemma G, et al. Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). J Am Soc Echocardiogr. 2015; 28(7): 727-754. 14. Galderisi M, Cosyns B, Edvardsen T, et al. Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2017; 18(12): 1301-1310. 15. Bossone E, D'Andrea A, D'Alto M, et al. Echocardiography in pulmonary arterial hypertension: from diagnosis to prognosis. J Am Soc Echocardiogr. 2013; 26(1): 1-14. 16. Miranda WR, Hagler DJ, Reeder GS, et al. Temporary balloon occlusion of atrial septal defects in suspected or documented left ventricular diastolic dysfunction: Hemodynamic and clinical findings. Catheter Cardiovasc Interv. 2019; 93(6): 1069-1075. 17. Shin C, Kim J, Kim J-Y, et al. Determinants of serial left ventricular diastolic functional change after device closure of atrial septal defect. JACC. 2020; 75(11). 18. Martin-Garcia AC, Dimopoulos K, Boutsikou M, et al. Tricuspid regurgitation severity after atrial septal defect closure or pulmonic valve replacement. Heart. 2020; 106(6): 455-461. 19. Zwijnenburg RD, Baggen VJM, Witsenburg M, et al. Risk Factors for Pulmonary Hypertension in Adults After Atrial Septal Defect Closure. Am J Cardiol. 2019; 123(8): 1336-1342.
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 1. Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 129: 49-73. https://doi.org/10.1161/01.cir.0000437741.48606.98 2. Group SR, Wright JT Jr, Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015; 373: 2103-2116. https://doi.org/10.1056/NEJMoa1511939 3. Chowdhury R, Khan H, Heydon E, et al. Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. Eur Heart J. 2013; 34: 2940-2948. 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]. http://dx.doi.org/10.21688/1681-3472-2020-3S-98-107 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. https://doi.org/10.1016/j.jacc.2015.08.018 10. Bertog S, Fischel T, Vega F, et al. Randomised, blinded and controlled comparative study of chemical and radiofrequency-based renal denervation in a porcine model. EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2017; 12: 1898-1906. https://doi.org/10.4244/EIJ-D-16-00206 11. Mahfoud F, Pipenhagen C, Moon L, et al. Comparison of branch and distally focused main renal artery denervation using two different radio-frequency systems in a porcine model. International journal of cardiology. 2017; 241: 373-378. https://doi.org/10.1016/j.ijcard.2017.04.057 12. Vink E, Goldschmeding R, Vink A, et al. Limited destruction of renal nerves after catheter-based renal denervation: results of a human case study. Nephrology, dialysis, transplantation - European Renal Association. 2014; 29: 1608-1610. https://doi.org/10.1093/ndt/gfu192 13. Агаева Р.А., Данилов Н.М., Щелкова Г.В. и др. Радиочастотная денервация почечных артерий моно-электродным и мультиэлектродным устройствами у пациентов с неконтролируемой артериальной гипертонией: результаты 6-месячного наблюдения. Системные гипертензии. 2020; 17(1): 46-50. Agaeva RA, Danilov NM, Shchcelkova GV, et al. Radiofrequency renal denervation with mono-electrode and multielectrode device for treatment in patient with uncontrolled hypertension: results of a 6-month follow-up. Sistemnye gipertenzii. 2020; 17(1): 46-50 [In Russ]. 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.
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. Referenses 1. Micheletti A, Hislop AA, Lammers A, et al. Role of atrial septostomy in the treatment of children with pulmonary arterial hypertension. Heart. 2006; 92: 969-72. http://doi.org/10.1136/hrt.2005.077669 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). http://doi.org/10.1016/j.carrev.2009.11.005 3. St?mper O, Gewillig M, Vettukattil J, et al. Modified technique of stent fenestration of the atrial septum. Heart. 2003; 89: 1227-30. http://doi.org/10.1136/heart.89.10.1227 4. Sivaprakasam M, Kiesewetter C, Veldtman GR, et al. New technique for fenestration of the interatrial septum. J Interv Cardiol. 2006; 19: 334-6. 5. Alekyan BG, Pursanov MG. Atrial septal stenting. Textbook of endovascular surgery for cardiovascular diseases. AN Bakulev National Medical Research Center of Cardiovascular Surgery. 2008; 2: 57-65 [In Russ]. 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(2): 11 [In Russ]. 7. Alekyan BG, Gorbachevskiy SV, Pursanov MG, et al. Atrial septal stenting with idiopathic pulmonary hypertension. AN Bakulev National Medical Research Center of Cardiovascular Surgery. Thoracic and Cardiovascular Surgery. 2016; 58(5): 258-314 [In Russ]. 8. Pardaev DB, Alekyan BG, Gorbachevskiy SV, et al. Atrioseptostomy with atrial septum stenting in patients with idiopathic pulmonary hypertension. AN Bakulev National Medical Research Center of Cardiovascular Surgery. 2017 [In Russ]. 9. Weimar T, Watanabe Y, Kazui T, et al. 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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. References 1. Gali? N, Rubin L. Pulmonary arterial hypertension. Epidemiology, pathobiology, assessment and therapy. Journal of the American College of Cardiology. 2004; 43:1–90. 2. Badesch DB, Abman SH, Simonneau G, et al. Medical therapy for pulmonary arterial hypertension: updated ACCP evidence-based clinical practice guidelines. Chest. 2007; 131:1918–28. http://doi.org/10.1378/chest.06-2674 3. Reichenberger F, Pepke-Zaba J, McNeil K, et al. Atrial seprostomy in the treatment of severe pulmonary arterial hypertension. Thorax. 2003; 58:797–800. http://doi.org/10.1136/thorax.58.9.797 4. Law M, Grifka RG, Mullins CE, et al. Atrial septostomy improves survival in select patients with pulmonary hypertension. Am Heart J. 2007; 153:779–84. http://doi.org/10.1016/j.ahj.2007.02.019 5. Kurzyna M, Dabrowski M, Bielecki D, et al. Atrial septostomy in treatment of end-stage right heart failure in patients with pulmonary hypertension. Chest. 2007; 131:977–83. 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. http://doi.org/10.1183/09031936.00072210 10. Chiu S, Zuckerman WA, Turner ME, et al. Balloon atrial septostomy in pulmonary arterial hypertension: Effect on survival and associated outcomes. J. Heart Transplant. 2015;34(3):376-80. http://doi.org/10.1016/j.healun.2015.01.004 11. Fraisse A, Chetaille P, Amin Z, et al. Use of Amplatzer fenestrated atrial septal defect device in a child with familial pulmonary hypertension. Pediatr. Cardiol. 2006; 27: 759–62. 12. O’loughlin AJ, Keogh A, Muller DW. Insertion of a fenestrated Amplatzer atrial septostomy device for severe pulmonary hypertension. Heart Lung Circ. 2006; 15: 275–7. http://doi.org/10.1016/j.hlc.2006.02.002 13. Prieto LR, Latson LA, Jennings C. Atrial septostomy using a butterfly stent in a patient with severe pulmonary arterial hypertension. Cathet. Cardiovasc. Interv. 2006; 68: 642–7. http://doi.org/10.1002/ccd.20745 14. Althoff TF, Knebel F, Panda A, et al. Longterm follow-up of a fenestrated Amplatzer atrial septal occlude in pulmonary arterial hypertension. Chest. 2008; 133; 283–5. http://doi.org/10.1378/chest.07-1222 15. Troost E, Delcroix M, Gewillig M, et al. A modified technique of stent fenestration of the interatrial septum improves patients with pulmonary hypertension. Cathet. Cardiovasc. Interv. 2008; 73: 173–9. https://doi.org/10.1002/ccd.21760 16. Roy AK, Gaine SP, Walsh KP. Percutaneous atrial septostomy with modified butterfly stent and intracardiac echocardiographic guidance in a patient with syncope and refractory pulmonary arterial hypertension. Heart Lung Circ. 2013; 22(8):668–71. https://doi.org/10.1016/j.hlc.2013.01.005 17. Alekyan BG, Pursanov MG. Atrial septal stenting. Guide to endovascular surgery of the heart and blood vessels. 2008; 2:57–65 [In Russ]. 18. Sager JS, Ahya VN. Surgical therapies for pulmonary arterial hypertension. Clin. Chest Med. 2007; 28: 187–202. https://doi.org/10.1016/j.ccm.2006.11.003 19. Unger P, Stoupel E, Vachiery JL, et al. Atrial septostomy under transesophageal guidance in a patient with primary pulmonary hypertension and absent right superior vena cava. Intensive Care Med. 1996; 22:1410–11. https://doi.org/10.1007/BF01709560 20. Bidoggia H, Maciel JP, Alvarez JA. Transseptal left heart catheterization: usefulness of the intracavitary electrocardiogram in the localization of the fossa ovalis. Cathet. Cardiovasc. Diagn. 1991; 24:221–5. https://doi.org/10.1002/ccd.1810240318 21. Moscucci M, Dairywala IT, Chetcuti S, et al. Balloon atrial septostomy in end-stage pulmonary hypertension guided by a novel intracardiac echocardiographic transducer. Cathet. Cardiovasc. Interv. 2001; 52:530–4. https://doi.org/10.1002/ccd.1116 22. Sorajja P, Cabalka AK, Hagler DJ, et al. Long-term follow-up of percutaneous repair of paravalvular prosthetic regurgitation. J Am Coll Cardiol. 2011; 58:2218–2224. https://doi.org/10.1016/j.jacc.2011.07.041 23. Zorinas A, Janusauskas V, Davidavicius G, et al. Fusion of real-time 3D transesophageal echocardiography and cardiac fluoroscopy imaging in transapical catheter-based mitral paravalvular leak closure. Advances in Interventional Cardiology. 2017; 13(3):263-268. https://doi.org/10.5114/aic.2017.70200 24. Corti R, Biaggi P, Gaemperli O, et al. Integrated x-ray and echocardiography imaging for structural heart interventions. EuroIntervention. 2013; 9:863-869. https://doi.org/10.4244/EIJV9I7A140 25. S?ndermann SH, Biaggi P, Gr?nenfelder J, et al. Safety and feasibility of novel technology fusing echocardiography and fluoroscopy images during MitraClip interventions. EuroIntervention. 2014; 9:1210-1216.
Abstract: Background: pulmonary hypertension not only aggravates the course of myocardial infarction, but also significantly worsens the prognosis, increasing disability and mortality due to the steadily progressing course. The need to predict the development of pulmonary hypertension in patients with myocardial infarction is not in doubt, since a clear clinical picture manifests itself only in the late stages of the disease, when the effectiveness of the treatment reduces and its cost increases. Aim: was to define most significant factors, influencing the development of pulmonary hypertension in the subacute period of myocardial infarction to elaborate a model for predicting this pathological condition. Material and methods: study included 451 men aged 18-60 y.o. with a verified diagnosis of myocardial infarction. All patients underwent a standard diagnostic algorithm, including a comprehensive echocardiographic examination - in first 48 hours and at the end of the third week of the disease. The study group included 84 patients with pulmonary hypertension, which had occurred at the end of the third week of the disease at an initially normal level of mean pressure in the pulmonary artery. Control group consisted of 367 patients with a normal level of mean pulmonary artery pressure in both phases of the study or normalization of this indicator at the end of the subacute period of the disease. Using multivariate analysis of variance from the analytical base, we selected parameters associated with levels of mean pulmonary artery pressure, the proportion of patients with firsttime pulmonary hypertension at the end of the subacute Ml. Then, with step-by-step and binary logistic regressions, most sensitive of them were selected for the prognostic model. Results: study established a number of significant for the development of pulmonary hypertension in the subacute period of myocardial infarction clinical and anamnestic (heart rate, diastolic blood pressure, the presence of pulmonary edema and chronic lung diseases), laboratory (concentrations of the sodium, potassium, chloride; glucose, some parameters of lipid concentration in the blood plasma) and instrumental (the value of left atrium, end-diastolic size of the right ventricle, values of indices of end-systolic and end-diastolic left ventricular volumes, cardiac index, total pulmonary resistance, the presence of regurgitation at the aortic valve) parameters. Final prognostic model included mean pulmonary artery pressure, heart rate and the presence of aortic valve regurgitation of the second degree and higher in first 48 hours of myocardial infarction. Characteristics of the resulting model allow us to recommend it for practical use. Conclusions: using a combination of these predictors, as well as prognostic modeling, makes it possible to distinguish among men under 60 years, a high-risk group for the development of pulmonary hypertension in the subacute period of the disease in order to conduct timely additional diagnostic and therapeutic measures. References 1. Galie N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology and the European Respiratory Society: Endorsed by: Association for European Pediatric and Congenital Cardiology, International Society for Heart and Lung Transplantation. Eur Heart J. 2016;37(1): 67-119. PMID:26320113. https://doi.org/10.1093/eurhearti/ehv317 2. Haeck ML, Hoogslag GE, Boden H, et al. Prognostic Implications of Elevated Pulmonary Artery Pressure After ST-Segment Elevation Myocardial Infarction. Am J Cardiol. 2016; 118(3): 326-31. PMID: 27265675. https://doi.orq/10.1016/i.amicard.2016.05.008 3. Thygesen K, Alpert JS, Jaffe AS, et al. Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol. 2018;72(18):2231-2264. PMID: 30153967. https://doi.org/10.1016/i.iacc.2O18.08.1038 4. Lang RM, Badano LP, Mor-AviV, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015; 16(3): 233-70. PMID: 25712077. https://doi.org/10.1093/ehici/iev014 5. Erlikh AD. Novel score for mortality risk prediction 6 months after acute coronary syndrome. Russian Journal of Cardiology. 2020;25(2):3416 [In Russ]. https://doi.org/10.15829/1560-4071 -2020-2-3416 6. Sotnikov AV, Epifanov SYu, Kudinova AN etal. Predictors of recurrent ischemic damages in men under 60 years of age with myocardial infarction. Science of the young (Eruditio Juvenium) 2019; 7(4): 565-574 [In Russ]. http://doi.org/10.23888/HMJ201974565-574 7. Panev Nl, FilimonovSN, Korotenko OYu et al. System for predicting the probability of developing respiratory failure in chronic mechanic bronchitis. Medicine in Kuzbass. 2017;16(3): 52-56 [In Russ]. 8. Bax JJ, Di Carli M, Narula J, Delgado V. Multimodality imaging in ischaemic heart failure. Lancet. 2019;393(10175):1056-1070. PMID: 30860031. https://doi.org/10.1016/S0140-6736(18)33207-0 9. Sheludko EG, Naumov DE, Prikhodko AG, Kolosov VP. Clinical and functional peculiarities of comorbid obstructive sleep apnea syndrome and asthma. Bulletin Physiology and Pathology o f Respiration. 2019; (71): 23-30 [In Russ]. http://doi.org/10.12737/article_5c88b5e86b9c18.75963991 10. Chistyakova MV, Govorin AV, Radaeva EV. Opportunities for prediction of pulmonary hypertension development in patients with viral liver cirrhosis. Russian Journal of Cardiology. 2017;(4):70-74 [In Russ]. https://doi.org/10.15829/1560-4071-2017-4-70-74 11. Agapitov LI. Diagnostics and treatment of childish pulmonary arterial hypertension. Diagnostics and treatment of childish pulmonary arterial hypertension. Lechaschi Vrach Journal. 2014; 4: 50 [In Russ]. 12. Laletin DA, Bautin AE, Rubinchik VE, Mikhailov AP. Right ventricle contractility during early postoperative period after coronary artery bypass grafting with cardiopulmonary bypass. Circulation Pathology and Cardiac Surgery. 2014; 18(3): 34-38 [In Russ]. 13. Kirillova W. Early ultrasound detection of venous congestion in pulmonary circulation in patients with chronic heart failure. Russian Heart Failure Journal. 2017; 18(3):208-212 [In Russ].
Abstract: 122 cases of gastroesophageal bleeding due to portal hypertension are analyzed in the article. It is shown that transcatheter interventions, as a part of the complex hemostasis strategy, can significantly improve the results. Keeping to algorithms and acting in accordance with protocols developed for any diagnostic procedure or intervention are declared to be crucial to success. The complex approach to profuse bleeding management, that included transcatheter procedures, decreased mortality rate from 72,2% to 22,1% and reduced rebleeding rate from 47,2% to 31,4%. Reference 1. Хрупкин В.И., Ханевич М.Д., Зубрицкий В.Ф., Теканадзе А.Н. Неотложная эндоваскулярная хирургия гастродуоденальных кровотечений. Петрозаводск, 2002; 90. 2. Бабенков Г.Д., Усов С.Н., Глазунов В.К. и др.Результаты лечения больных циррозом печени, осложненного кровотечением. Анналыхирургической гепатологии. 2000; 5 (2): 210-211. 3. Ерамишанцев А.К., Щерцингер А.Г., Китенко Е.А. и др. 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Abstract: Renal artery stenosis is a common condition that can cause renovascular hypertension or ischemic nephropathy. Endovascular treatment for atherosclerotic renal artery stenosis is performed frequently and its usage has rapidly increased during the last few years. However clinical benefit of renal artery stenting is questionable. Many researchers suppose that clinical outcomes after renal artery stenting may be improved. Several potential ways to this improvement is discussed: the evaluation of hemodinamical parameters of the stenosis, viability of the renal tissue, prophylactic of the atheroembolisation and restenosis. This article reviews the recent data concerning perspective trends in endovascular procedures on renal arteries that can improve long-term clinical outcomes after renal artery stenting. References 1. Wheatley K., Phil D., Ives N. Revascularization versus medical therapy for renal-artery stenosis. N. Engl. J. Med. 2009; 36: 1953 - 62. 2. Textor S. 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Phase analysys of renal blood flow in hypertensive patients
DOI: https://doi.org/10.25512/DIR.2012.06.2.04
For quoting:
Makarenko E.S. "Phase analysys of renal blood flow in hypertensive patients". Journal Diagnostic & interventional radiology. 2012; 6(2); 25-29.
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Abstract: Aim. Was to investigate phase-parameters of renal arteries blood flow in hypertensive patients. Material and methods. We have examined 173 patients with arterial hypertension, aged 38-78 years, including associated ischemic heart disease or heart stroke in the past. Control group consisted of 27 almost healthy patients aged 39-76 yrs. Acceleration phase index AT/RR, systolic phase index ET/R-R, and flow propagation index RA/R-R (RA is the time from R wave of ECG to the beginning of the systolic flow in the main renal artery at the hilus of kidney) were derived from the Doppler ultrasound. Results and conclusions. Acceleration phase index in hypertensive patients was higher and systolic phase index was lower than in healthy subjects. Changing in the phase parameters of renal flow depends on associated clinical conditions. The most expressed changes occur in hypertensive patients with old myocardial infarction. Correlations between the phase parameters, the age and the serum lipids were analyzed. Age dependent normal values of the phase indices of renal flow were established. References 1. Mourad J.J., Girerd X., Boutouyrie P. et al. Opposite Effects of Remodeling and Hypertrophy on Arterial Compliance in Hypertension. Hypertension. 1998; 31: 529-533. 2. Подзолков В.И., Булатов В.А. Миокард. Нефрон. Взгляд через призму эволюции артериальной гипертензии. Русский медицинский журнал. 2008; 11: 1517-1523. 3. Riccabona M., Preidler K., Szolar D. et al. Evaluation of renal vascularization using amplitude-coded Doppler ultrasound. Ultraschall Med. 1997; 18(6): 244-248. 4. Щетинин В.В., Берестень Н.Ф. Кардиосовместимая допплерография. М.: Медицина. 2002; 240. 5. Макаренко Е.С. Анализ временных показателей кровотока в артериях каротидного бассейна у больных артериальной гипертензией. Вестник рентгенологии и радиологии. 2011;5:21-23. 6. Макаренко Е.С., Неласов Н.Ю., Поморцев А.В. и др. Возможности комплексной ультрасонографии в оценке структурнофункциональных изменений общих сонных артерий (ОСА) у больных артериальной гипертензией (АГ). Кубанский научный медицинский вестник. 2010; 6(120): 78-84. 7. Мельникова Л.В., Бартош Л.Ф. Ранние допплерографические признаки структурнофункциональных изменений почечных артерий у больных с эссенциальной гипертензией. Артериальная гипертензия. 2010; 16 (3): 282-285.
Abstract: During our research we have studied x-ray and morphology features of lungs sarcoidosis (LS), levelof fibrosis disorders and rate of pulmonary hypertention (PHT) as a way of calculation pulmonary-thoracical index (PTI) during chest multi-slice computed tomography (MSCT). We have examined 50 patients aged 30-75 with different forms of lungs sarcoidosis. As a result of clinical aboratory, x-ray and morphologicaldata comparison patients were divided into 3 groups.During data analysis we found out that PHT leads to inverse connection of PTIdecrease with increase of interstitial fibrosis (the most expressed changes were in group of patients with chronic recur disease current The analysis data allows to reveal early symptoms of PHT, that promotes well-timed tactics of treatment. References 1. Архипова Д.В., Попова Е.Н., Осипенко В.И. и др. Легочная гипертензия при интерстициальных болезнях легких. 12-й Национальный конгресс по болезням органов дыхания. Москва. 2002; 135-136. 2. Борисов С.Е. Дифференциальная диагностика саркоидоза. Вестник НИИ фтизиопульмонологии ММА им. И.М. Сеченова. 1999; 1: 34-39. 3. Bartz R.R., Stern E.J. Airways obstruction in patients with sarcoidosis. Expiratory CT scan findings. J. Thorac. Imag. 2000; 15 (4): 285-289. 4. Хоменко А.Г., Озерова Л.В., Романов В.В. и др. Саркоидоз. 25-летний опыт клинического наблюдения. Проблемы туберкулеза. 1996; 6: 64-68. 5. Tan R.T. еt al. Utility of CT scan evalution for predicting pulmonary hypertension in patients with parenchymal lung disease. Medical College of Winsconsin Lung Transplant Group. Chest. 1998; 113 (5):1250-1256. 6. Саницкая Л.Н., Зубков А.А., Адамович В.Н. Особенности клиники и течения саркоидоза 1-й стадии. В сб. Дифференциальная диагностика саркоидоза и туберкулеза легких. Под ред. В. Н. Адамовича. М. 1998; 52-58. 7. Соколина И.А., Дмитращенко А.А., Осипенко В.И., Шехтер А.И. Компьютер но-томографические признаки поражения плевры при саркоидозе. Международный союз по борьбе с туберкулезом и легочными заболеваниями (IUATLD). 3-й конгресс Европейского региона. Российское респираторное общество. 14-й Национальный конгресс. Сборник тезисов. Москва. 2004; 376-378. 8. Коган Е.А., Козловская Л.В., Корнев Б.М. и др. Интерстициальные болезни легких. Под ред. Н.А. Мухина. 2007; 120-144. 9. Hunninghake G.W. et al. Statement on sarcoidosis. Sarcoid. Vasc. Dif. L. Dis. 1999; 16 (2): 149-173. 10. Коган Е.А., Деньгин В.В., Жак Г., Корнев Б.М. Клинико-морфологические и молекулярно-биологические особенности идиопатического фиброзирующего альвеолита и саркоидоза легких. Архив патологии. 2000; 6: 32-37. 11. Шмелев Е.И. Дифференциальная диагностика интерстициальных болезней легких. Consil. medic. 2003; 5 (4): 176-181. 12. Wells A.U., Padley S.P. A CT sing of chronic pulmonary arterial hypertension the ratio of main pulmonary artery to aortic diameter. J. Thorax. Imag. 1999; 14 (4): 270-278. 13. Осипенко В.И., Попова Е.Н., Терновой С.К. и др. Способ компьютерной диагностики степени легочной гипертензии. Авт. св. № 2269931 РФ, 09.06.2004 г.
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 1. Russell I. A. et al. Congenital heart disease in the adult. А review with internet-accessible transesophageal echocardiographic images. Anesth Analg. 2006; 102: 694–723. 2. Brickner E.M., Hillis D.L., Lange R.A. Congenital heart disease in adults. First of two parts. NEJM. 2000; 32 (4): 256–263. 3. Rodstein M., Zeman F.D. Gerber I. Atrial septal defect in the aged. Circulation. 1961; 23: 665–674. 4. Сердечно-сосудистая хирургия. Под ред. В.К. Бураковского, Л.А. Бокерия. М.: Медицина. 1989. 5. Белоконь Н.А., Подзолков В. П. Врожденные пороки сердца. М.: Медицина, 1991. 6. Laks H. Plunkett M., Myers J. Adult сongenital heart disease. Cardiac surgery in the adult. Ed. dy cohn L. New York: McGraw-Hill. 2008; 431–1464. 7. Дземешкевич С. Л., Синицын В. Е., Королев С. В. и др. Септальные дефекты у взрослых: современная диагностика и лечебная тактика. Грудная и сердечно сосудистая хирургия. 2001; 2: 40–45. 8. Houston A. et al. Echocardiography in adult congenital heart disease. Heart. 1998;80: 12–26. 9. Currie P.J. et al. Continuous wave Doppler determination of right ventricular pressure. A simultaneous Doppler-catheterization study in 127 patients. J. Am. Coll. Cardiol. 1985;6: 750–756. 10. Шиллер Н., Осипов М.А. Клиническая эхо-кардиография. 2-е изд. М.: Практика. 2005. 11. Ruiz O. et al. Evaluation of congenital heart disease in adults. Rev. Esp. Cardiol. 2003; 56(6): 607–620. 12. Беленков Ю.Н., Терновой С.К., Синицын В.Е. Магнитно-резонансная томография сердца и сосудов. М.: Видар. 1997. 13. Wang Z.J. et al. Cardiovascular shunts: MR imaging evaluation. Radiographics. 2003;23: 181–194. 14. Коробкова И.З. Рентгенологические методы исследования сердечно-сосудистой системы. Функциональная диагностика сердечно-сосудистых заболеваний. Под ред. Ю.Н. Беленкова, С.К. Тернового. М.: ГЕОТАР-Медиа. 2007. 15. Blount S. G., Davides H., Swan H. Atrial septal defect – results of surgical correction in one hundred patients. JAMA. 1959; 169: 210. 16. Henry D.A., Jolles H., Berberich J.J. The post-cardiac surgery chest radiograph. А clinically integrated approach. J. Thorac. Imaging. 1989; 4 (3): 20–41. 17. Sanders C. et al. Atrial septal defect in older adults. Аtypical radiographic appearances. Radiology. 1988; 167: 123.
Abstract: Purpose. Was to investigate ability of videodensitometry for assessment the effect of renal artery stenosis on parenchymal perfusion. Materials and methods. Аngiographic data of 97 patients with and 55 patients without renal artery stenosis were analyzed by means of videodensitometry, using «Multivox» software. All patients underwent renal arteries duplex ultrasound and kidneys ultrasound examination. Levels of blood pressure and kidney function as a clinical signs of renovascular hypertension were assessed. Risk factors of kidney parenchymal injury such as diabetes mellitus, chronic kidney diseases were monitored. Results. Videodensitometric analysis allows to detect statistically significant differences in parenchymal perfusion between kidneys with and without renal artery stenosis. A grade of changes in parenchymal perfusion correlates with angiographicaly measured degree of renal artery stenosis and renal artery blood flow velocity. Conclusion. Videodensitometric perfusion parameters can be used to assess the effect of renal artery stenosis on parenchymal blood flow. Thus, videodensitometry extends diagnostic capability of angiographic study. References 1. Hansen K.J. et al. Prevalence of renovascular desease in eldery. А populaton based study. J. Vasc. Surg. 2002; 36: 443–451. 2. Safian R.D., Textor S.C. Renal artery stenosis. N. Engl. J. Med. 2001; 344: 431–442. 3. Rihal C.S. et al. Incedental renal artery stenosis among a prospective cohort of hypertensive patients undergoing coronary angiography. May. Clin. Proc. 2002; 77:309–316. 4. Olin J.W. et al. Prevalence of atherosclerotic RAS in patients with atherosclerosis else-where. Am. J. Med. 1990; 88: 46–51. 5. Galaria I.I. et al. Percutaneous and open renal revascularizations have equivalent long-term functional outcomes. Ann. Vasc. Surgery. 2005; 19 (2): 218–228.
6. Weibull H. et al. Percutaneous transluminal renal angioplasty versus surgical reconstruction of atherosclerotic renal artery stenosis. А prospective randomized study.J. Vasc. Surg. 1993; 18: 841–850. 7. Murphy T.P. et al. Increase of utilization of percutaneous renal artery interventions. Am.J. of Roentgenol. 2004; 183: 561–568. 8. Wheatley K. et al. Revascularization versus medical therapy for renal artery stenosis. N.Engl. J. Med. 2009; 361: 1953–1962. 9. Rocha-Singh K.J. et al. Atherosclerotic Peripheral Vascular Disease Symposium II: Intervention for Renal Artery Disease. Circulation. 2008; 118: 2873–2878. 10. Волынский Ю.Д., Кириллов М.Г., Шамалов Н.А. и др. Анализ экстра- и интракраниальной гемодинамики с помощью метода рентгеноденситометрии. Спец. выпуск «Инсульт». Ж. невр. и псих. им. С.С.Корсакова. 2007; 243. 11. Meier P., Zierler K.L. On the theory of the indicator-dilution method for measurement of blood flow and volume. J. Appl. Physiol. 1954; 12: 731–744.
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. References 1. Генералов СИ. Прогнозирование, диагностика и лечение нарушений в системе мать - плацента - плод при заболеваниях сердечно-сосудистой системы. Автореф. дис. д-ра мед. наук. Киев. 1990; 54 с. 2. Милованов А.И. Патология системы мать - плацента - плод. М.: Медицина. 1999; 446 с. 3. Демченко Е. Ю. Течение и исход беременности, состояние центральной и маточно-плодово-плацентарной гемодинамики при неосложненном течении беременности и осложнении ее ОПГ-гестозом. Дис. д-ра мед. наук. М. 1996; 477 с. 4. Hefler L.A. et al. Endothelial-derived nitric oxide and angiotensinogen. Вlood pressure and metabolism during mouse pregnancy. Am.J. Physiol. Regul. Integr. Comp. Physiol. 2001; 280 (10): 174-182. 5. Шехтман М.М. Руководство по экстрагенитальной патологии у беременных. М.: Триада. 2003; 816 с. 6. Николаева Е.И., Тахиян А.А. Оценка современных перинатальных технологий у беременных и рожениц высокого риска. Вестник Рос. ассоц. акушеров-гинекологов. 2003;1: 26-28. 7. Радзинский В.Е. Фармакотерапия плацентарной недостаточности. Клинич. фармакол. и терап. 1998; 7 (3): 91-96. 8. Елисеев О.М., Шехтман М.М. Беременность: дагностика и лечение болезней сердца, сосудов и почек. Ростов-на-Дону: Феникс. 1997; 640 с. 9. Киншт Д.Н. Гёстоз как системная воспалительная реакция. Автореф. дис. канд. мед. наук. Новосибирск. 2000; 24 с. 10. Blatla N. et al. Cardiac disease in pregnancy. Int.J. Gynecol. Obstet. 2003; 82 (10): 153. 11. Стрижаков А.Н., Бунин А. Т., Медведев M.B., Григорян Г.А. Значение допплерометрии маточно-плацентарного и плодово-плацентарного кровотока в выборе рациональной тактики ведения беременной и метода родоразрешения. Акушерство и гинекология. 1991; 3: 23-25. 12. Bracero L.A. et al. Comparison of umbilical doppler velocimetry, nonstress testing, and biophysical profile in pregnancies complicated by diabetes. J. Ultrasound. Med. 1996; 15:301-308. 13. Агеева М.И. Допплерометрическое исследование в акушерской практике. М.: Медицина. 2000; 111. 14. Стрижакова М.А. Клинико-морфологическое обоснование допплерометрического исследования кровотока в маточных артериях при физиологическом и осложненном течении беременности. Автореф. дис.канд. мед. наук. М. 1992; 24 с. 15. Blackburn S. Maternal, fetal and neonatal physiology. А Clinical perspective. St. Louis: Saunders. 2003; 360 с. 16. Elkayam U. Pregnancy and cardiovascular disease. Ed. E. Braunwald. Heart disease: a textbook of cardiovascular medicine. 6-th ed. Philadelphia. 2001; 2181. 17. Abalos E. et al. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy (Cochrane Review). Coch. Datab. Syst. Rev. 2007; 1: 53-61. 18. Perloff J.K. Pregnancy in women with congenital heart disease. Specific lesions. Режим доступа: http://www. uptodate. com. 19. Макацария А.Д., Султанова И.О., Смирнова Л.М. Дифференциальная диагностика и принципы профилактики тромбоэмболических осложнений у беременных с искусственными клапанами сердца. Акуш. и гин. 1991; 11: 28-33. 20. Свечников П.Д. Маркеры повреждения эндотелия при беременности, осложненной гестозом. Автореф. дис. канд. мед.наук. С.-Пб. 2000; 50 с. 21. Радзинский В.Е., Смалько П.Я. Биохимия плацентарной недостаточности. М.: Медицина. 2001; 180 с. 22. Alexander B. T. et al. Differential expression of renal nitric oxide synthase isoforms during pregnancy in rats. Hypertension. 1999; 33 (4): 435-439. 23. Brooks V.L. et al. Does nitric oxide contribute to the basal vasodilation of pregnancy in conscious rabbits? Am. J. Physiol. Regul. Integr. Comp. Physiol. 2001; 281 (12): 1624-1632. 24. Мартынов А.И., Аветяк Н.Г., Акатова Е.В. и др. Эндотелиальная дисфункция и методы ее определения. Рос. кардиол. ж.2005; 4: 94-98.
Abstract: Purpose: to prove the safety and efficiency of minimally invasive endovascular and puncture techniques in management of splen diseases in children. Aims: to develop standard procedures and justify the necessity of splenic artery embolization (SAE) in hemangiomas, extrahepatic portal hypertension, and idiopathic thrombocytopenic purpura (ITP). Develop standard procedures for splenic cysts treatment in pediatric practice. Materials and methods: there were 129 children aged 3-16 years treated in Endovascular Surgery Department of Russian State Pediatric Hospital (Moscow) with the following diagnoses: hemangiomas (4 patients), hereditary hemolytic globular-cell anemia - HHGCA (41 cases), extrahepatic portal hypertension - EHPG (25 cases), ITP (24 cases), and nonparasitic cysts (35 patients). Results: SAE is shown to be effective in treatment the diseases where splenic hyperfunctioning is seen. In HHGCA and ITP no hemolytic crises were seen, and there was no need of substitution therapy after performing the SAE procedure. In cases of EHPG splenic artery embolization is proved to reduce the esophageal varices and decrease hypersplenia symptoms. Among the advantages of endovascular approach can be named minimal operation trauma and splenic tissue preservation. The authors present an algorithm for splenic cysts treatment in pediatric practice. It was shown that laparoscopy is effective in big (over 70-80 mm) subcapsular cysts, whereas intraparenchymatous cysts fewer than 70 mm in diameter are more suitable for puncture techniques. Conclusions: the minimally invasive techniques are shown to be safe and effective in management of splen diseases in pediatric practice. It was shown that their effectiveness is comparable to the conventional methods, meanwhile they cause much less operation trauma, reduce the hospital stay and terms of rehabilitation. References 1. LokichJ., Cosstello P. Splenic embolization to prevent dose limitation of cancer chemotherapy. Am.J. Roentgenol. 1983; 140: 159-161. 2. Spigos D.G., Jonasson O. Partial splenic embolisation in the treatment of hypersplenism. Am.J. Roentgenol. 1979; 132: 777-782. 3. Styrt B. Infection associated with asplenia: risk, echanism and prevention. Am. J. Med.1990; 88: 5-33. 4. Никаноров А.Ю. Рентгеноэндоваскулярная окклюзия в подавлении патологической функции селезенки у детей. Дис. канд.мед. наук. М. 1990. 13. 5. Григорьева Е.Г., Апарицина К.А. Органосохраняющая хирургия селезенки. Новосибирск. 2001; 23-78. 6. Дергачев А.И. Абдоминальная эхография. М. 2002; 15-25. 7. Журило И.П., Литовка В.П., Кононученко В.П., Москаленко В.З. Непаразитарные кисты селезенки у детей. Хирургия. 1993; 8:59-61 8. Куликов Л.К., Филиппов А.Г. Хирургическая тактика при непаразитарных кистах селезенки. Хирургия. 1995; 2: 62-63. 9. Fowler R.H. Nonparasitic bening cystic tumors of the spleen. Int. Abstr. Surg. 1953; 96: 209-227. 10. Martel M., Cheuk W. Angiomatoid Nodular Transformation (SANT). Report of 25 Cases of Distinctive Begin Splenic Lesion. J. Surg. Pathol. 2004; 28 (10): 1268-1279. 11. Кургузов О.П., Кузнецов Н.А., Артюхина Е.Г. Непаразитарные кисты селезенки. Хирургия. 1990; 6: 130-133. 12. Папаскуа И.З. Возможности чрескожных пункционно-дренирующих вмешательств с ультразвуковым контролем в лечении кист печени, почек и селезенки. Дис. канд. мед. наук. С-Пб. 2003. 13. Ратнер Г.Р. Непаразитарные кисты селезенки. Вестник хирургии.1997; 5: 104-105. 14. Шишкин К.В. Хирургическое лечение непаразитарных кист печени и селезенки. Хирургия (журнал имени Н.И. Пирогова). 2006; 10: 62-66. 15. Маннанов А.Г. Эндоскопическая хирургия непаразитарных кист селезенки у детей. Дис. канд. мед. наук. М. 2004. 16. Филижанко В.Н., Шеменева Е.Г., Фомин А.М. и др. Лапароскопические вмешательства при кистах печени и селезенки. Эндоскопическая хирургия. 1998; 1: 56. 17. Bove T., Delvaux G., Van Eijkelenburg P., De Backer A., Willems G. Laparoscopic-assisted surgery of the spleen: clinical experience in expanding indications. J. Laparoendosc. Surg. 1996; 6 (4): 213-217. 18. Bean WJ., Rodan B.A. Hepatic cysts: Treatment with alcohol. AJR. 1985; 237-241. 19. Gresik M.V. Pathology of the spleen. New-York. 1989; 37. 20. Velkova K., Nedeva A. Our experience in the diagnostiks of liver and spleen hemangiomas. Plovdiv. Folia. Med. 1997; 39 (1): 85-91. 21. Levy A.D., Abbot R.M., Abbondanso S.L. Littoral cell angioma of the splen: CT features with clinicopatologic comparison. Radiology. 2004; 230 (2): 485-490. 22. Yano H., Imasato M., Monde T. et al. Hand-assisted laparoscopic splenectomy for splenic vascular tumors: report of two cases. Surg.Laparosc. Percutan. Tech. 2003; 13 (4): 286-289. 23. Coon W.W. Splenectomy in the threatment of hemolitic anemia. Arch. Surg. 1985; 120: 625-628.
Abstract: Purpose: on the basis of long-term results of renal angioplasty and stenting, the authors define the indications for endovascular interventions in patients with renovascular hypertension (RVH). Materials and methods: since 1992-2008 in Tashkent Medical Academy Vascular Surgery Center were performed 131 endovascular interventions in 119 patients for renal arteries (RA) stenoses of various origins. 97 patients underwent balloon angioplasty (BA) of renal arteries (105 interventions), and stenting was performed in 22 cases (26 stenting procedures). Systolic blood pressure varied from 170 to 300 mm Hg (219,4±23,1 mmHg), with diastolic blood pressure from 170 to 300 mm Hg (118,1±8,9 mm Hg). Average arterial hypertension history was 5,2±3,7 years (6 months - 16 years). Results: technical success rate was 85,6% for balloon angioplasty, and 100 % for stenting procedures. Immediate hypotensive effect was good to satisfactory. Complication rate was 2,5% (3 patients). Long-term results were assessed in 76 cases of balloon angioplasty (78,4%), and in all patients with renal arteries stenting. The average follow-up was 72±32,5 months (6-144 months) for balloon angioplasty, and 6-24 months for stenting group. In the angioplasty group long-term hypotensive effect lasted in 54(71,1%) of patients, and the restenosis rate was as high as 28,9% (22 cases). In the stenting group, the long-term hypotensive effect was preserved in all the patients, and there were no cases of restenosis. Conclusions: high rates of technical and clinical success, as well as low rates of restenosis, allow the renal artery stenting procedure to be seen as the method of choice for renovascular hypertension. References 1. Клиническая ангиология в 2 томах. Под редакцией А.В. Покровского. М.: Медицина. 2004; 2: 94-114. 2. Алекян Б.Г., Бузиашвили Ю.И., Голухова Е.З. и др. Ближайшие и отдаленные результаты стентирования почечных артерий у больных с вазоренальной гипертензией. Ангиология и сосудистая хирургия. 2006;1: 55-62. 3. Carmo M., Bower T.C. Surgical мanagement of renal fibromuscular dysplasia. Challenges 11.in the endovascular era. Ann. Vasc. Surgery. 2005; 19: 208-217. 4. Baert A.L., Wilms G., Amery A., Vermylen J.,Suy R. Percutaneous transluminal renal angioplasty: initial results and long-term follow-up in 202 patients. Cardiovasc. Intervent. Radiol. 1990; 13: 22-28. 5. WongJ.M., Hansen K.J., Oskin T.C. et al. Surgery after failed percutaneous renal artery angioplasty.J. Vasc. Surg. 1999; 30: 468-483. 6. Yutan E., Glickerman D.J., Caps M.T. et al.Percutaneous transluminal revascularizationfor renal artery stenosis. Veterans affairs puget sound health care system experience. J. Vasc. Surg. 2001; 34: 685-693. 7. Петровский Б.В., Гавриленко А.В. 40-летний опыт реконструктивных операций при вазоренальной гипертензии. Ангиология и сосудистая хирургия. 2003; 2: 8-12. 8. Троицкий А.В., Елагин О.С., Хабазов Р.И. и др. Одномоментная реконструкция висцеральных ветвей аорты и почечных артерий. Ангиология и сосудистая хирургия. 2006; 2: 132-136. 9. Крылов В.П., Реут Л.И., Дергачева И.М. и соавт. Отдаленные результаты хирургического лечения вазоренальной гипертензии. Клиническая кардиология. 2004; 2: 34-39. 10. Bonelli F.S., McKusick M.A., Textor S.C. et al. Renal artery angioplasty: technical results and clinical outcome in 320 patients. Mayo. Clinic. Proc. 1995; 70: 1041-1052. 11. Surowiec S.M., Sivamurthy N., Rhodes J.M. et al. Percutaneous therapy for renal artery fibromuscular dysplasia. Ann. Vasc. Surg. 2003; 17: 650-655. 12. Galaria I.I., Surowiec S.M., Jeffrey M. Percutaneous and оpen renal revascularizations have equivalent long-term functional outcomes. Ann. Vasc. Surg. 2005; 25: 218-224.
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. References 1. Клиническая ангиология. Под ред. акад. Покровского А.В. Москва. М., 2004; т. 1, с.697-734 2. Caps M.T., Zierler R,E.,Polissar N.L. e.a. Risk of atrophy in kidneys with atherosclerotic renal artery stenosis. Kidney Int.1998; 53 (3):735-742. 3. Olin J.W., Melia M., Young J.R. e.a. Prevalens of atherosclerotic renal artery stenosis in patients with atherosclerosis elsewhere. Amer.J.Med. 1990; .88 (1):46-51. 4. Sharma S.,Gupta H.,Saxena A. Results of renal angioplastic in nonspecific aortoarteritis (Taka- yasu disease). J. Vasc. Interv. Radiol. 1998; 9:429-435. 5. Pokrovsky A.V., Sultanaliev T,A., Spiridonov A.A. Surgical treatment of vasorenal hypertension in nonspecific aortoarteritis (Takayasu disease). J.Cardiovasc. Surg. 1983; 24(1):111-118. 6. Keiffer E., Piquois A., Bertal A. B. Reconstructive surgery of the renal arteries in Takayasu”s disease. Ann.vasc.surg. 1990; 4: 156-165. 7. Liang P., Hoffman G.S. Advances in the medical and surgical treatment of Takayasu”s arteritis. Curr. Opin. Rheumatol.2005;17(1): 16-24. 8. Ковалев И.А., Варваренко В.И., Мурзина О.Ю. Случай неспецифического аортоартериита у ребенка 3 лет. Педиатрия. 2005; 2:.88-90. 9. Suk-Hee Yoo, Gi-Hyun Kim, Won-Ick Lee Successful percutaneous renal artery angioplasty and stenting for acute renal failure in a solitary functioning kidney caused by Takayasu”s arteritis. Korean Circ. J. 2010; 40(2): 414-417. 10. Вачев А.Н., Сухоруков В.В., Фролова Е.В. Хирургическое лечение больного молодого возраста с артериальной гипертензией при неспецифическом аортоартериите с поражением почечных артерий. Ангиология и сосудистая хирургия. 2011; 4: 148-151.
Abstract: In patients with severe multiple trauma, posttraumatic period is often complicated by the development of polyorgan insufficiency, development of which is connected with morpho-functional changes of the liver parenchyma. Aim: was to identify dynamics of ultrasound signs of morphological and functional changes of liver in patients with multiple trauma. Materials and methods: performed analysis of ultrasound data obtained in dynamics, in 28 patients with severe multiple trauma. From the analysis, we excluded patients with blunt abdominal trauma with injury of liver. In first 2 days, 21 patients underwent surgical operations in treatment of craniocerebral trauma and trauma of musculoskeletal system. All patients underwent ultrasound examination of the abdominal cavity and retroperitoneal space to exclude possibility of appearance of free liquid; also estimated condition of liver, spleen, functional and morphological condition of the gastrointestinal tract. In first days after trauma, ultrasound examination was performed 2-3 times. Color duplex scanning of vessels of liver and spleen was performed once a day or every other day for 2-3 weeks of a traumatic period. Evaluated arterial and venous blood flow of liver by measuring the linear blood flow velocity (LBFV) and resistance index (RI), portal blood flow by measurement of linear and volumetric flow rate. Results: in all patients on admission to hospital, liver and spleen sizes had normal size. On the 3rd day after the injury, was revealed an increase in the cranio-caudal liver size by 2-4 cm and increased length of spleen by 5-8 cm, which lasts for 10-20 days. During dynamical ultrasound, 8 patients with 10-20 days against a background of increasing level of bilirubin and transaminases, in addition to increasing size of liver and spleen, we marked infiltration of tissues along hepatic veins with their narrowing and along branches of the portal vein with thickness from 0,25 to 0,7 cm. We marked LBFV decreasement by portal vein to 10-13 cm/sec and a volume flow to 250-400 ml / min, increased RI by hepatic artery In 3 patients in the liver parenchyma, we revealed avascular tissue regions with decreased echogenicity, indicating the formation of ischemic regions. Conclusion: during dynamical ultrasound in patients with severe multiple trauma, on day 3 after injury, were diagnosed morphological changes in liver parenchyma with violation of its hemodynamics. Further progression of the process observed for 10-20 days from the date of trauma: the growth of intrahepatic portal hypertension, increased peripheral resistance in arteries of liver parenchyma, the appearance of ischemic areas of liver parenchyma. The totality of above ultrasonic signs of hemodynamic disorders of liver, characterize organic hepatocellular insufficiency, which is a poor prognostic sign in the development of polyorgan insufficiency. References 1. Marushhak E.A. Povrezhdenija pecheni i selezenki u bol'nyh s zakrytoj abdominal'noj travmoj [Injury of liver and spleen in patients with blunt abdominal traums]. Avtoreferat Diss. kand. med. nauk. M. 2009; 31 [In Russ]. 2. Abdominal'naja travma: rukovodstvo dlja vrachej (Pod red. A.S. Ermolov M.Sh. Hubutija, M.M. Abakumov) [Abdominal trauma: manual for physicians]M.: Vidar, 2010; 504 [In Russ]. 3. Travmaticheskaja bolezn' i ee oslozhnenija ( Pod red. 4. Gajduk S.V. Kliniko-patofiziologicheskoe obosnovanie rannej diagnostiki sindroma poliorgannoj nedostatochnosti i visceral'nyh oslozhnenij u postradavshih s politravmoj [Clinical-pathophysiological rationale of early diagnostics of polyorgan insufficiency and visceral complications in patients with polytrauma]. Avtoreferat Diss. kand. med. nauk. SPb., 2009; 47 [In Russ]. 5. Gajduk S.V., Sosjukin A.E., Bojarincev V.V. Travmaticheskaja bolezn' i sindrom poliorgannoj disfunkcii - aktual'nye problemy mediciny kriticheskih sostojanij [Traumatic disease and syndrome of polyorgan dysfunction - actual problems of medicine of critical conditions]. Vestnik Rossijskoj Voenno-medicinskoj akademii. 2008; 1(21): 66-70 [In Russ]. 6. Zolotokrylina E. S. Voprosy patogeneza i lechenija poliorgannoj nedostatochnosti u bol'nyh s tjazheloj sochetannoj travmoj, massivnoj krovopoterej v rannem post- reanimacionnom periode [Questions of pathogenesis and treatment of polyorgan insufficiency in patients with severe multiple trauma, massive bloodloss in early postreanimation period]. Anesteziologija i reanimatologija. 1996; 1: 9-13 [In Russ]. 7. Cibuljak G.N. Obshhaja hirurgija povrezhdenij: rukovodstvo [General surgery of trauma: manual]. SPb.: Gippokrat. 2005; 646 [In Russ]. 8. Chastnaja hirurgija mehanicheskih povrezhdenij (Pod redakciej G.N.Cibuljak) [Particularistic surgery of mechanical injury.].SPB.: Gippokrat. 2011; 570 [In Russ]. 9. Saenko V.F. Desjaterik V.I., Perceva T.A., Shapovaljuk V.V. Sepsis i poliorgannaja nedostatochnost [Sepsis and polyorgan insufficiency]'. Krivoj Rog: Mineral. 2005; 441[In Russ]. 10. Tokmakova T.O.,Kameneva E.A., Grigor'ev E.V. Narushenie mikrocirkuljacii kak prichina poliorgannoj nedostatochnosti u postradavshih s tjazheloj cherepno-mozgovoj travmoj[Microcirculatory disorders as a reason of polyorgan insufficiency in patients with severe craniocerebral trauma]. Politravma. 2011; 4: 47-50 [In Russ]. 11. Gel'fand E. B., Gologorskij V.A., Gel'fand B.R. Abdominal'nyj sepsis: integral'naja ocenka tjazhesti sostojanija bol'nyh i poliorgannoj disfunkci [Abdominal sepsis: estimation of severity of condition of patients and polyorgan disfunction]. Anesteziologija i reanimatologija. 2000;3:29-34 [In Russ]. 12. Chappell D., Jacob M., Hofmann-Kiefer K. et al. A rational approach to perioperative fluid management. Anesthesiology. 2008; 109(4): 723-740. 13. Brealey D., SingerM. Multiorgan dysfunction in the critically ill: epidemiology, pathophysiology and management. J. Royal Coll. Physic. Lond. 2000; 34(5): 424-427. 14. Baker S.P, O'Neill B., Haddon W. Jr., Long W.B. The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974; 14(3): 187-196. 15. Trusov O.A. Patologicheskaja anatomija i patogenez poliorgannoj nedostatochnosti pri ostroj arterial'noj neprohodimosti konechnostej i peritonita (na materiale rannih autopsij)[Pathological anatomy and pathogenesis of polyorgan insufficiency in case of acute arterial failure of limb and peritonitis (based on early autopsy)]. Avtoreferat Diss. dokt. med. nauk. M., 2002; 41[In Russ].
