30 research outputs found
Global myocardial strain after the Ozaki aortic valve replacement in low-gradient critical aortic stenosis and heart failure: a case report
The article presents the results of 1,5-year follow-up after surgery of critical aortic stenosis by the Ozaki technique in a patient with severe heart failure using data on global longitudinal strain
Diagnostics of Fabry disease in arrhythmology practice: a case report
Heart failure in Fabry disease (FD) is unfavorable prognostic manifestation and cause of death. Given that the disease is rare in clinical practice, the low awareness of physicians about this pathology leads to its late diagnosis and the lack of pathogenetic therapy.Aim. To present a clinical picture of the cardiovascular phenotype in FD in order to increase the awareness of doctors about this disease.Material and methods. In this clinical case, an asymptomatic FD course up to 46 years of age and mani festation in the form of arrhythmia were observed. According to echo car dio graphy, severe left ventricular hypertrophy (myocardial mass index, 214 g/m2) without signs of left ventricular (LV) outflow tract obstruction and left atrial (LA) dilatation were revealed (LA volume index — 47 ml/m2). Right ventricular (RV) and LV systolic function was assessed using two-dimensional speckletracking strain echocardiography. Latent subclinical RV and LV systolic dysfunction was established.Results. Tandem mass spectrometry revealed a sharp decrease in alphagalactosidase activity of 0,03 umol/L/h (norm range, 0,80-15,00 umol/L/h), as well as an in creased Lyso-GB3 concentration of 95,18 ng/ml (normal range, 0,05-3,0 ng/ ml). A molecular genetic study of blood samples was carried out. By direct automatic sequencing of the GLA gene, a variant of the c.1229 C>T nucleotide sequence was identified, leading to the replacement of p.Thr4101le in the hemizygous state.Conclusion. This case shows the possibility and expediency of diagnosing FD in cardiology practice in patients with LV myocardial hypertrophy of unclear etiology, while atypical variants can be diagnosed only by molecular genetic testing
Child’s heart development and contractility from prenatal to postnatal period
This literature review analyzes current data on the main stages of child’s heart contractility development from prenatal to postnatal period. The presented information will expand the conventional ideas on the age-related cardiovascular physiology in children, supplementing with relevant knowledge about the patterns of left ventricular mechanics, and the mechanisms affecting child’s heart morphology. In addition, we consider the evolutionary feasibility of the simultaneous existence of various left ventricular mechanics models, which ensure the effective cardiac function in the postnatal period. This is very important for the work of neonatologists, pediatricians, pediatric cardiologists and therapists
Раскручивание левого желудочка у детей и подростков, рожденных доношенными
The aim of the study is to assess the left ventricle (LV) untwist in healthy children and adolescents born fullterm.Materials and methods. The analysis was carried out in 108 healthy children aged 2 months to 18 years, born full-term. LV untwist is assessed using Speckle Tracking Imaging at the basal and apical level.Results. Four types of LV untwist were identified in children and adolescents. We did not find relation between LV untwist and age, nor with LV index spherical in systole and diastole, LV myocardial mass. The relationship between LV untwisting and LV rotation in systole at basal and apical segments was revealed.Conclusion. The described features of LV loosening are apparently associated with processes of postnatal growth and maturation of heart tissues in children and adolescents.Цель исследования. Изучение раскручивания левого желудочка (ЛЖ) у здоровых детей и подростков, рожденных доношенными.Материалы и методы. Анализ выполнен у 108 здоровых детей в возрасте от 2 мес до 18 лет, рожденных доношенными. Раскручивание untwist ЛЖ оценено с помощью технологии «след пятна» Speckle Tracking Imaging-2D Strain на основе оценки скорости ротации ЛЖ в период ранней диастолы на уровне базальных и апикальных сегментов (RotRMV, RotRapex).Результаты. Выделено четыре типа раскручивания ЛЖ у здоровых доношенных детей и подростков в возрасте от 2 мес до 18 лет. При первом типе скручивания ЛЖ значения раскручивания выше по сравнению со вторым, третьим и четвертым типами скручивания у здоровых детей и подростков, рожденных доношенными. Не установлено зависимости раскручивания от возраста, индекса сферичности и массы миокарда ЛЖ у здоровых детей и подростков, рожденных доношенными. Выявлена взаимосвязь величины раскручивания ЛЖ с ротацией ЛЖ в систолу на уровне базальных, апикальных сегментов.Заключение. Описанные особенности раскручивания ЛЖ, по-видимому, связаны с процессами постнатального роста и созревания тканей сердца у детей и подростков
Эволюционирование торсионных механизмов в детском возрасте: современный взгляд на природу вращательной механики левого желудочка
Highlights. The hypothesis of the evolution of LV twisting types is proposed, which is based on the gradual transformation of LV twisting types as a prerequisite for postnatal growth and development of heart chambers in healthy children and adolescents. In the future, the transition of one type of LV twist to another will enable us to diagnose the predominance of growth and maturation of the fibrous skeleton, apex, vortex cordis, trabecular apparatus, as well as creating projections of the individual development and growth of the heart in childhood and adolescence.Abstract. Modern data on the nature of the mechanics of the left ventricle (LV) in postnatal ontogenesis in healthy children and adolescents born full-term are fundamental, since they allow not only to determine ontogenetically conditioned variants of individual development of contractile-rotational mechanisms of LV in the process of growth and development, but also, if necessary, make it possible to identify subclinical dysfunction in the early stages, monitor the effectiveness of complex therapeutic and rehabilitation measures. The article analyzes newly established fact of the absence of static character of the selected various forms of LV twisting into a systole and the ability of their transformation in the process of growth and development. This fact forms the basis of the author's original hypothesis of “the evolution of LV twisting models”, which provides the optimal ontogenetic growth of the child and adolescent heart in the postnatal period. The hypothesis of “evolution of left ventricular twisting types” is based on modern knowledge about multifaceted processes at the tissue level, the mechanics of LV in the individual rate of development and growth of the heart in childhood and adolescence.Основные положения. Предложена гипотеза эволюционирования типов скручивания ЛЖ, которая основана на трансформации типов скручивания ЛЖ как обязательном условии постнатального роста и развития камер сердца у здоровых детей и подростков. В перспективе переход одного типа скручивания ЛЖ в другой позволит диагностировать преобладание роста и созревания фиброскелета, верхушки, vortex cordis, трабекулярного аппарата, а также создавать карты индивидуального темпа развития и роста сердца в детском и подростковом возрастах.Резюме. Современные данные о характере механики левого желудочка (ЛЖ) в постнатальном онтогенезе у здоровых детей и подростков, рожденных доношенными, имеют фундаментальный характер, поскольку позволяют не только определять онтогенетически обусловленные варианты индивидуального развития контрактильно-ротационных механизмов ЛЖ в процессе роста и развития, но и при необходимости дают возможность выявлять на ранних этапах субклиническую дисфункцию, контролировать эффективность комплексных терапевтических и реабилитационных мероприятий. В статье подробно проанализирован впервые установленный факт отсутствия статичности выделенных различных форм скручивания ЛЖ в систолу и способности их трансформации в процессе роста и развития. Данный факт положен в основу авторской оригинальной гипотезы эволюционирования моделей скручивания ЛЖ, обеспечивающего оптимальный темп индивидуального онтогенеза детского и подросткового сердца в постнатальный период. Гипотеза эволюционирования типов скручивания левого желудочка основана на современных знаниях о многогранных процессах на тканевом уровне, механике ЛЖ при индивидуальном темпе развития и роста сердца в детском и подростковом возрастах
A screening for serum markers of arbovirus infections in healthy blood donors from the Volgograd Region
Volgograd region is considered to be endemic West Nile fever (WNF) area due to the established circulation of the West Nile virus (WNV) therein. Some previous independent studies examining samples collected on the territory of the Volgograd region revealed markers related to the California serogroup (CSG), Sindbis and Ukuniemi viruses. WNF, CSG, Sindbis and Ukuniemi fever mainly being asymptomatic posing thereby a threat of virus spread due to transfusiological manipulations along with vector-borne transmission are manifested by diverse clinical signs. The study was aimed at detection of antibodies specific to West Nile, tick-borne encephalitis, California serogroup (Tyaginya, Inko), Sidbis, and Ukuniemi viruses in blood donors from the Volgograd region. For this, 404 blood sera samples collected from blood donors residing in the Volgograd as well as the Volgograd region were examined by ELISA. It was found that percentage of blood serum samples positive for arbovirus-specific antibodies was 18.32%. Among the, 67 out of 404 (16.58%) samples contained anti-WNV antibodies, 3 out of 279 (1.08%) samples — to tick-borne encephalitis virus, 1 out of 92 (1.09%) — to California serogroup fever and Ukuniemi viruses, and 2 out of 92 (2.17%) — to Sindbis fever virus. Importantly, the peak number of IgG and IgM WNV-positive samples was found among residents of Volgograd (29 out of 110, 26%) and Oktyabrsky district (7 out of 25, 28%). In addition, anti-Sindbis, Ukuniemi and CSG virus antibodies were detected in blood serum samples from blood donors residing in the Kalachevsky region and the city of Volgograd. Analyzing age-related distribution and percentage of seropositive subjects in each age group showed as follows: the lowest percentage (14.5%) was positive for anti-WNV, Sindbis, Ukuniemi and CSG virus antibodies in blood donors aged 32–41 years, whereas the peak percentage (25%) — in the subjects aged 52–61 years. Thus, virus specific antibodies detected in healthy individuals in the aforementioned region evidence about potential recovery after asymptomatic infections. In this regard, further research is required to determine a role of the such arboviruses in the structure of regional infectious diseases. The data obtained suggest a need to continue serological arbovirus monitoring in the Volgograd region
Клиническая эффективность пневмококковой конъюгированной 13-валентной вакцины у детей раннего возраста
Objective: Our aim was to study the clinical efficacy of pneumococcal conjugate 13-valent vaccine (PCV13) in children aged less than 3 years.Methods: retrospective comparative study of the incidence of acute respiratory infections (ARI), otitis and pneumonia during the first three years of life in 184 children vaccinated with PKV13 and 186 unvaccinated peers.Results: 91 of 184 children (49.4%) were vaccinated during the 1st year of life, 61 (33.2%) — during the 2nd year, and 32 (17.4%) — during the 3rd year. Number of ARI per 1 child among children vaccinated in the 1st year of life was 5.5 times less than among unvaccinated children (0.42 and 2.31 cases); frequency of otitis during the second year of life was 6.8 times less (7.6% and 52.1%, р < 0,01), and during the third — 34.7 times less (1.1% and 38.2%, р < 0,01). All children vaccinated before the age of 1 were 6.3 times less (1.1% and 6.9%) ill with pneumonias. Additionally it was noted that number of ARI per 1 person among children, vaccinated during the 1st year of life, during the third year of life was lower than among children vaccinated later (0.42; 1.02; 2.03 respectively). There also was a significant in otitis number between children vaccinated during the first and the third years of life (1.1 and 15.6% р < 0,01).Conclusion: to reduce the incidence of ARI, otitis and pneumonia in children, it is necessary to vaccinate children with PCV13 in the age under 1 year. «Catching up» immunization of the second and third years of life is effective, but to a lesser extent.Цель исследования: изучить клиническую эффективность вакцинации против пневмококковой инфекции конъюгированной тринадцативалентной вакциной (ПКВ13) детей в возрасте до 3 лет.Методы: ретроспективное сравнительное исследование заболеваемости острыми респираторными инфекциями (ОРИ), отитами и пневмониями на протяжении первых трех лет жизни у 184 детей, привитых ПКВ13, и их 186 непривитых сверстников.Результаты. На 1-м году жизни вакцинирован 91 ребенок из 184 (49,4%), на 2-м — 61 (33,2%), на 3-м — 32 (17,4%). У привитых на первом году жизни по сравнению с непривитыми число ОРИ на 1 ребенка на третьем году жизни было в 5,5 раз меньше (0,42 и 2,31 случая), частота отитов на втором году жизни — в 6,8 раз меньше (7,6 и 52,1%; р < 0,01), на третьем — в 34,7 раз меньше (1,1 и 38,2%; р < 0,01). Пневмониями за все три года привитые до одного года болели в 6,3 раза меньше (1,1 и 6,9%). Дополнительно было отмечено, что у детей, вакцинированных на первом году жизни, на третьем году число ОРИ на 1 человека было меньше, чем у привитых позже (0,42; 1,02; 2,03 соответственно на первом, втором и третьем году наблюдения), также достоверно различалось число отитов между привитыми на первом и третьем годах (1,1 и 15,6%; р < 0,01).Заключение. Для снижения заболеваемости детей ОРИ, отитами и пневмониями необходима вакцинация ПКВ13 в возрасте до одного года. «Нагоняющая» иммунизация на втором и третьем годах жизни эффективна, но в меньшей степени
Влияние миэктомии с пластикой митрального клапана на трехмерную модель клапана и обструкцию в выводном отделе левого желудочка у больных гипертрофической кардиомиопатией
Aim. To assess the effects of combined myectomy with mitral valve repair on a three-dimensional model of the mitral valve in patients with obstructive hypertrophic cardiomyopathy.Methods. 24 patients with obstructive hypertrophic cardiomyopathy and left ventricular outflow obstruction over 50 mm Hg at rest were recruited in a study. Eight patients underwent combined myectomy with mitral valve repair according to the Carpentier method. Seven patients underwent the Alfieri's edge-to-edge repair, and nine patients underwent secondary chordae resection using the Ferrazzi’s technique. Before combined myectomy and two weeks after it, all patients underwent standard transthoracic echocardiography and real-time 3D transesophageal imaging of the mitral valve, followed by quantitative 3D reconstruction of the mitral valve and calculation of the annulus, the leaflets, and the aorto-mitral angle.Results. Despite the selected mitral valve repair technique, we observed a decrease in the LVOT obstruction gradient. There were no differences in the residual obstruction gradient between the selected mitral valve repair technique. Patients with obstructive hypertrophic cardiomyopathy, who underwent combined myectomy and posterior mitral leaflet plasty valve according to the Carpentier approach, reported a correlation of a decrease in the LVOT obstruction with the non-planar angle (r = -0.83; p = 0.040), sphericity index (r = 0.83; p = 0.04) and a decrease in the velocity excursion of the annulus (r = 0.94; p = 0.005). Patients who underwent the Alfieri's edge-to-edge repair demonstrated that the residual LVOT obstruction gradient depended on the annulus height (r = 0.90; p = 0.04) and the ratio of this height to the commissural diameter of the annulus ( r = 0.90; p = 0.04). After secondary chordae resection, a decrease in the LVOT obstruction gradient correlated with the sphericity index (r = 0.77; p = 0.03), the anterolateral-posteromedial annulus diameter (r = -0.72; p = 0.04), the anterior (r = -0.78; p = 0.02) and posterior (r = -0.78; p = 0.02) leaflets, the ratio of the total leaflet length to the anteroposterior diameter of the annulus (r = -0.83; p = 0.01), the area (r = -0.76; p = 0.0з) and the mitral valve tenting height (r = -0.95; p = 0.00). Conclusion.Combined myectomy with mitral valve repair is the method of choice in the treatment of patients with obstructive hypertrophic cardiomyopathy. The comparison of three mitral valve repair techniques did not reveal any differences in the residual LVOT obstruction gradient. However, the Alfieri's edge-to-edge repair may be considered as the most physiological technique to repair dynamic LVOT obstruction.Цель. Оценить влияние миэктомии с пластикой митрального клапана (МК) на трехмерную модель клапана у больных обструктивной гипертрофической кардиомиопатией (ГКМП).Материалы и методы. Исследованы 24 пациента с ГКМП и обструкцией в выводном отделе левого желудочка (ВОЛЖ) более 50 мм рт. ст. в покое, которым выполнены миэктомия с пластикой МК по методике A. Carpentier (n = 8), O. Alfieri (по типу «край в край», n = 7) и резекцией вторичных хорд по Р. Ferrazzi (n = 9). Всем пациентам до и в течение двух недель после c-очетанной операции выполнены стандартная трансторакальная эхокардиография и чреспищеводная трехмерная визуализация МК в реальном масштабе времени с последующей трехмерной количественной реконструкцией МК и расчетом показателей фиброзного кольца (ФК), створок и аортально-митрального угла.Результаты. Независимо от метода пластики МК наблюдалось снижение градиента обструкции в ВОЛЖ. Не выявлено различий в величине резидуального градиента обструкции между применяемыми методиками пластики. У больных ГКМП после миэктомии в сочетании с пластикой задней створки МК по A. Carpentier величина снижения обструкции в ВОЛЖ коррелировала с непланарным углом (r = -0,83; p = 0,040), индексом сферичности (r = 0,83; p = 0,04) и снижением скорости движения ФК (r = 0,94; p = 0,005). У пациентов после пластики МК по типу «край в край» (O. Alfieri) резидуальный градиент обструкции в ВОЛЖ связан с высотой ФК (r = 0,90; p = 0,04) и отношением этой высоты к комиссуральному диаметру ФК МК (r = 0,90; p = 0,04). После резекции вторичных хорд величина снижения градиента обструкции в ВОЛЖ коррелировала с индексом сферичности (r = 0,77; p = 0,03), переднелатеральнозаднемедиальным диаметром ФК (r = -0,72; p = 0,04), углом передней (r = -0,78; p = 0,02) и задней (r = -0,78; p = 0,02) створок, отношением суммарной длины створок к переднезаднему диаметру ФК (r = -0,83; p = 0,01), площадью (r = -0,76; p = 0,03) и высотой (r = -0,95; p = 0,00) тентинга створок МК.Заключение. Миэктомия в сочетании с пластикой МК является предпочтительным способом лечения пациентов с ГКМП. При оценке трех методов пластики МК не выявлено различий в резидуальных градиентах обструкции в ВОЛЖ. Наиболее физиологичными технологиями коррекции динамической обструкции ВОЛЖ следует считать методики по типу «край в край»
A new class of glycomimetic drugs to prevent free fatty acid-induced endothelial dysfunction
Background: Carbohydrates play a major role in cell signaling in many biological processes. We have developed a set of glycomimetic drugs that mimic the structure of carbohydrates and represent a novel source of therapeutics for endothelial dysfunction, a key initiating factor in cardiovascular complications. Purpose: Our objective was to determine the protective effects of small molecule glycomimetics against free fatty acidinduced endothelial dysfunction, focusing on nitric oxide (NO) and oxidative stress pathways. Methods: Four glycomimetics were synthesized by the stepwise transformation of 2,5dihydroxybenzoic acid to a range of 2,5substituted benzoic acid derivatives, incorporating the key sulfate groups to mimic the interactions of heparan sulfate. Endothelial function was assessed using acetylcholineinduced, endotheliumdependent relaxation in mouse thoracic aortic rings using wire myography. Human umbilical vein endothelial cell (HUVEC) behavior was evaluated in the presence or absence of the free fatty acid, palmitate, with or without glycomimetics (1µM). DAF2 and H2DCFDA assays were used to determine nitric oxide (NO) and reactive oxygen species (ROS) production, respectively. Lipid peroxidation colorimetric and antioxidant enzyme activity assays were also carried out. RTPCR and western blotting were utilized to measure Akt, eNOS, Nrf2, NQO1 and HO1 expression. Results: Ex vivo endotheliumdependent relaxation was significantly improved by the glycomimetics under palmitateinduced oxidative stress. In vitro studies showed that the glycomimetics protected HUVECs against the palmitateinduced oxidative stress and enhanced NO production. We demonstrate that the protective effects of preincubation with glycomimetics occurred via upregulation of Akt/eNOS signaling, activation of the Nrf2/ARE pathway, and suppression of ROSinduced lipid peroxidation. Conclusion: We have developed a novel set of small molecule glycomimetics that protect against free fatty acidinduced endothelial dysfunction and thus, represent a new category of therapeutic drugs to target endothelial damage, the first line of defense against cardiovascular disease