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.

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Abstract:

The authors report 44 successful implantations of original retrieval Nitinol stent-filters, unique "closed" design of which comprehensively described in the article. All the devices placed for pulmonary embolism (PE) management in patients with lower extremity and pelvic deep vein (DV) thrombosis. Authors announce absolute efficiency of their stent-filters for PE prophylaxis, and the procedure itself declared to be safe and minimally invasive.

Stent-filter implantation into iliac veins compared to standard filter placement in inferior vena cava (IVC) excludes risks of total infrarenal IVC thrombosis - the major complication of such procedures. It is also associated with early DV recanalization, that in sum radically reduces disability rate. Moreover, in case of IVC abnormalities, kinking or external compression stent-filter into iliac position remains the only option for endovascular PE management. All the above can be mentioned as advantages of using stent-filters.

At the same time authors observe that stent-filters quick incorporation into vessel wall prevented endovascular retrieval of the device in quite a number of cases. Persistent PE threat, requiring prolonged antithrombotic therapy under endovascular protection, might also contribute for low retrievability of the device. 

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Abstract:

The review presents literature data on the heparin-induced thrombocytopenia, its forms, the pathogenesis of condition and its clinical manifestations. Consideration of options for treatment of this complication and provisions recommendations of the American College of specialist doctors in diseases of the chest (ACCP), adopted at the IX Conference on antithrombotic therapy and prevention of thrombosis in 2012. 

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