The paper describes the case of surgical treatment of hypertrophic obstructive cardiomyopathy. Extended resection of the interventricular septum, resection of three secondary (pathological) chords of the anterior leaflet of the mitral valve and mobilization of the papillary muscles of the mitral valve have been carried out using the Ferrazzi procedure. An objective improvement of echocardiography parameters and improvement of well-being with disappearance of dyspnea in moderate exercise and dizziness have been achieved after the operation.
Stent thrombosis is a dangerous life-threatening condition, which is more frequent during the first month after stent implantation. Currently, there are several possible schemes for preventing stent thrombosis with clopidogrel and stronger P2Y12 receptor inhibitors. The article describes the clinical case of stent thrombosis in a patient with clopidogrel resistance against the background of carrying the allelic variant of the gene CYP2C19*2, a «slow metabolizer of clopidogrel». Despite the recommended use of high doses of clopidogrel to improve the clinical outcome in patients with a homozygote CYP2C19*2 (*2/*2), this clinical case showed high doubtfulness of such tactics. In such cases, the use of more potent inhibitors of P2Y12 receptors is justified, since it allows improving clinical outcomes of mechanical revascularization.
This study demonstrates some limitations in assessing of diagnostic tests: bicycle ergometry, treadmill test, stress echocardiography, daily ECG monitoring, as well as multispiral CT with determination of coronary calcium that makes possible to confirm or exclude coronary artery disease in women. Two clinical cases are presented. The data on stratification of cardiovascular risk are included.
Malignant tumors of the heart are very rare in clinical practice. The causes of the disease so far have not been established. Therefore, a rare clinical case of in vivo diagnosis of primary cardiac tumor (angiosarcoma, complicated by ventricular tachycardia refractory to antiarrhythmic treatment) is of a clinical interest.
The aim – to explore morphological changes of coronary arteries with severe tortuosity in children. Four autopsy cases of severe coronary artery tortuosity are presented: three cases of intrauterine fetal death (two male patients and one female, at the gestation age of 28, 29 and 39 weeks) and the autopsy case of one-year-old boy. Morphological changes of the coronary arteries were examined by standard histological and histochemical methods (hematoxylin-eosin, Masson’s trichrome, Hart’s elastic stainings). Severe tortuosity of the anterior descending coronary artery was prevalent (in three cases). Detection of tortuous coronary arteries in fetuses, who died prenatally, indicates the congenital genesis of this vascular anomaly.
Heart rhythm disorder is a frequent concomitant disease of cardiovascular and extra-cardiac pathology. A rare variant of heart rhythm disorder, which is not typical for newborns and young people, is atrial fibrillation. Frequency of atrial fibrillation is less than 1 %. The main purpose is analysis of clinical case in newborn with atrial fibrillation. Diagnostic and search effective methods of treatment atrial fibrillation in newborn’s is an actual problem in child cardiology. In this article described successful case of treatment life-threatening atrial fibrillation in newborn by electric cardioversion without cardiovascular pathology. Electric cardioversion in newborn’s with supraventricular tachycardia, which have hemodynamic disorders, is safe and effective therapy method.
Acute coronary syndrome with ST segment elevation remains a serious problem in cardiology and often determines the level of in-hospital mortality. Later, the patient’s admission to reperfusion therapy can lead to deterioration of the immediate and long-term results of treatment. The most difficult problem with percutaneous reperfusion therapy STEMI patients is no-reflow syndrome, i.e. the absence of myocardial perfusion after restoration of the arterial blood flow. Taking into account the data of the clinical case, no-reflow syndrome can be diagnosed even when the coronary artery is open (after spontaneous opening), under the presence of visible parietal thrombi and after long period of complete obstruction of the vessel lumen. However, the full restoration of blood flow is necessary and in the later period (up to 24 hours from the onset of symptoms) in the presence of the clinic ischemia and lack of positive dynamics of ECG. As shown in the illustrated clinical cases, restoration of blood flow in the infarct-related coronary artery, even in the presence of the syndrome «no-reflow» is able to restore myocardial function during short period of observation.
A clinical case of ST-elevation acute myocardial infarction has been presented. Apart from standard drug therapy, percutaneous coronary reperfusion with manual aspiration of thrombi was performed with further histological examination of the obtained materials. Clot formation appeared long before the development of acute myocardial infarction in this patient. It was also demonstrated an important role of inflammation at the initial step of thrombus formation in this case. But earlier coronary arteries were affected by xenobiotics.
The treatment of thrombosis in STEMI patients is one of the most important tasks. Systematic approach is a key element of the reperfusion therapy success. The approach to the invasive treatment should be differentiated, first and foremost based on angiographic assessment of thrombosis.
The maximum effect thrombotic masses aspiration from the infarct-related vessel is achieved in patients with large, floating thrombi of all ages. Efficient removal of the coronary thrombi using contemporary aspiration catheters is the auxiliary procedure providing timely reperfusion therapy in patients with STEMI, reducing distal embolization and improving myocardial perfusion. Accumulation of experience with these catheters and more detailed assessment of the immediate and long-term postoperative results are necessary to make conclusion about their effectiveness and safety in clinical practice.
Several cases of the successful catheter radiofrequency ablation (RFA) of atrial fibrillation in patients aged 40–54 years with severe heart failure and left ventricle systolic dysfunction due to long-term arrhythmia are presented. Procedures were performed due to low efficacy of the drug treatment. Follow-up duration was 1 to 3 years. Left ventricle systolic function restoration after RFA was observed. All patients stopped prophylactic antiarrhythmic therapy and most of them needed no medication treatment afterwards. All patients returned to fully socially active life. Sinus rhythm preservation tactics is more preferable and must take priority, especially in younger patients. RFA is one of the most wide-spread catheter procedures with proven efficacy, being enough patient-safe. It significantly improves quality of life, and today it becomes the most wide-spread of radical arrhythmia treatment. Stable sinus rhythm preservation is more constant in younger patients with less advanced myocardium structure changes and without advanced concomitant pathology.