Aim. Analysis of the structural and systole-diastolic characteristics of the left chambers of the heart in children with obstructive hypertrophic cardiomyopathy.Materials and methods. A comprehensive retrospective comparative echocardiographic study of children with obstructive HCM aged 1–17 years (n = 52) and a control group (n = 1060) of healthy children of the same age was performed.Results. The main indicators of the structural and systole-diastolic properties of the left chambers of the heart in children of two groups were analyzed. In addition, in patients with HCM, the correlation between parameters of systolic and diastolic function of the left ventricle and the thickness of the interventricular septum was assessed. Most of the indicators characterizing the systolic properties of the LV had no correlation with an increase in the thickness of the IVS. Diastolic parameters – the rate of myocardial relaxation during the rapid filling phase, determined by tissue Doppler mode (e), and LV filling pressure – statistically significantly correlated with an increase in IVS thickness.Conclusions. Echocardiography in children with obstructive HCM remains the gold standard for diagnosis, allowing a comprehensive assessment of the main structural characteristics of the heart chambers.

КЛИНИЧЕСКАЯ И ЭКСПЕРИМЕНТАЛЬНАЯ ХИРУРГИЯ■ РЕКОНСТРУКТИВНАЯ И МИКРОСОСУДИСТАЯ ХИРУРГИЯ Резюме Тетрада Фалло -это наиболее распространенный врожденный порок сердца синего типа.Реконструкция выходного отдела правого желудочка при данном пороке является процедурой, с которой ассоциированы основные причины повторных оперативных вмешательств.Несмотря на все усилия по разработке различных способов сохранения клапана легочной артерии, в 30-40% случаев требуется трансаннулярная пластика выходного отдела правого желудочка

Introduction. Atrial septal defects (ASD) are one of the most common congenital heart defects, accounting for about 10–15% of all congenital heart defects. Currently, endovascular treatments for ASD are considered the method of choice in most patients with secondary ASD. ASD occluders, after fixation on the atrial septum, close the shunt, eliminating the intercameral communication. However, these devices increase the stiffness of the septum, limit its mobility and presumably disrupt the mechanical function of the left atrium (LA).Aim: To study the effect of surgical and endovascular correction on the size, shape and function of the left atrium and left ventricle in children.Material and Methods. We retrospectively studied sequential echocardiograms of patients who underwent endovascular and surgical treatment of ASD in the period from 2006 to 2016 at the cardiology center in Tomsk, Russia. 756 patients with ASD were examined, 564 of them before and after endovascular closure and 192 after surgical correction. The duration of follow-up ranged from 1 day to 10 years, with an average of 3.6 years in the group receiving hardware treatment and 4.2 years in the group undergoing surgery. The control group consisted of 3393 healthy patients of the same age group. Echocardiographic images were obtained using an iE33 ultrasound scanner, Philips Ultrasound. Standard echo indicators of heart sizes and volumes were evaluated, including taking into account the body surface area and deviations of the studied parameters as a percentage of the predicted norm.Results. 15 days after ASD closure, both groups showed a significant increase in the volume of the left ventricle and a decrease in the right chambers. During follow-up in the group receiving the devices, left atrial shape index (LASI) was significantly reduced, while in patients undergoing surgery, there was no significant increase in LASI. A change in the shape of the left atrium and a decrease in its volume were combined with a change in the effort in the left atrium (LAEF), determined by the Manning method.Discussion. The study showed that both endovascular and surgical methods are effective in correcting ASD and lead to favorable results with respect to left atrial function. However, there is still uncertainty about the long-term effects after implanted devices used in endovascular procedures. Although these devices offer a minimally invasive solution, there is a problem associated with increased stiffness and limited mobility of the partition. Such changes can potentially alter the normal dynamics of atrial filling and contraction, affecting the overall function of the left atrium over time.Conclusion. Endovascular correction of ASD in 35% of children was accompanied by a change in the shape of the left atrium a decrease in sphericity and an increase in ellipsoid. Changes in the shape of the left atrium persisted in 22% of patients after transcatheter correction in the long term. These changes were not accompanied by any disorders of contractility and volume of the heart chambers. In the group of children after surgical correction of ASD, the contractility and volume of the heart chambers did not significantly differ from those in the device group.

The article presents a rare clinical case of a child of the first month of life with heart attack-like changes on the ECG and multiple rhabdomyomas in the heart, associated with tuberous sclerosis complex. The child was followed up for 11 months. The patient did not require therapy. Dynamic observation showed normalization of ECG parameters – no signs of myocardial infarction.

The widespread use of the term “cardiomyopathy” in modern cardiology dictates the need to systematize and concretize the use of this term. Based on the approximation of changes in the function, cavities and thickness of the walls of the chambers to known dilated, hypertrophic and restrictive cardiomyopathy, imaging methods in cardiology have made it possible to combine many pathological changes in the chambers of the heart into certain sets of visual perception and to form the concepts of phenotypes and phenotypes of most heart diseases. Aim: To develop quantitative criteria for phenotypic changes in the left ventricle (LV), which can be used to control the dynamics of the disease and evaluate the effectiveness of treatment based on the results of a retrospective analysis of a large volume of digital data of echocardiographic studies in patients with myocardial diseases and healthy individuals. Material and Methods. A retrospective analysis of echocardiography protocols for the period 2009–2021 was performed in 13023 healthy individuals aged 2 days to 59 years and 317 patients with various heart diseases: hypertrophic, dilated and restrictive cardiomyopathies, and LV non-compaction myocardium aged 4 days to 60 years. Results. Criteria have been developed and proposed for the quantitative assessment by Z-index of pathological phenotypes of the left ventricle, which have a high (more than 95%) negative specificity in healthy individuals of any age and a positive one in patients with cardiomyopathies. The ability to quantify the dynamics of the course of diseases occurring with manifestations of restriction, dilation and LV hypertrophy was shown.

выводного отдела левого желудочкаАктуальность.Гипертрофическая кардиомиопатия (ГКМП) -наследственное заболевание с выраженной клинической и генетической гетерогенностью, характеризующееся неуклонным прогрессированием.«Золотым стандартом» лечения данной патологии у детей является трансаортальная расширенная септальная миоэктомия

Aim. To compare structural and functional left ventricular (LV) changes in the early period of myocardial infarction (MI) within 20 years on the basis of the Emergency Cardiology Department of the Cardiology Research Institute (Tomsk). Material and methods . The study included two groups of patients who were treated at different periods of time with an interval of 20 years. Group 1 included 83 patients who had ST-segment elevation MI (STEMI) in 1997-1999, while group 2 — 83 patients with STEMI from 2019-2020. Echocardiography was performed during the first 72 hours from hospitalization and on the 7-10 th day. Depending on the increase in LV end-diastolic volume (EDV) by >15% by the 7-10 th day, the patients were divided into 2 subgroups: with remodeling (LVR+) and without remodeling (LVR-). Results. Patients of the 2 nd group were older, with a larger proportion of females and with a high incidence of risk factors for coronary artery disease compared with patients of the 1st group. In the early postinfarction period among patients of the 2 nd group, acute LV aneurysm, early postinfarction angina and Dressler syndrome developed less frequently. The proportion of adverse LV remodeling in patients of the 1st group was higher (32,8% vs 17%), and while the percentage of reverse remodeling was lower (10% vs 24%), p<0,05. Comparison of the absolute values of LV EDV, end-systolic volume (ESV) and ejection fraction (EF) at baseline and after 7 days, as well as their increase showed higher intensity of post-infarction remodeling in group 1 patients. In patients of the 1 st group, there was a progression of LV remodeling (Me ΔEDV — 12,2%) with a deterioration in LV contractility by the 7 th day (Me ΔESV — 14%), while in patients of the 2nd group during the first 7 days of MI, there were more stable LV EDV and ESV (p>0,05) and an increase in LVEF (p=0,03) before discharge. Conclusion. In the present era of primary percutaneous coronary intervention and pharmacological treatment of MI, early adverse LV remodeling develops less frequently and is characterized by less pronounced left heart dilatation.

Егунов О.А., Кожанов Р.С., Баянкина В.М., Соколов А.А., Кривощеков Е.В. Анализ непосредственных и отдаленных результатов хирургического лечения рекоарктации аорты. Детские болезни сердца и сосудов. 2022; 19 (1): 49–55. DOI: 10.24022/1810-0686-2022-19-1-49-55 HTML

ЦЕЛЬ ИССЛЕДОВАНИЯ Проанализировать структурно-функциональные изменения сердца у детей с аномалией Эбштейна после конусной реконструкции трикуспидального клапана (ТК). МАТЕРИАЛ И МЕТОДЫ В исследование включен 41 пациент с конусной реконструкцией ТК. У всех пациентов выполнена оценка эхокардиографических параметров ТК, левых и правых камер сердца до операции, в раннем и отдаленном послеоперационном периоде. Площади камер сердца оценены с помощью МРТ у 10 пациентов до операции и 15 — в отдаленном периоде. Средний период наблюдения составил 35 [12; 64] мес, максимальный — 8 лет. РЕЗУЛЬТАТЫ По данным эхокардиографии объем правого предсердия уменьшился до 186% [136; 199], размер правого желудочка — до 115% [105; 128] от нормативного. Индекс конечного диастолического объема (КДО) левого желудочка (ЛЖ) возрос с 38 [33; 45] до 46 [39; 51] мл/м2, индекс конечного систолического объема ЛЖ — с 11 [7; 13] до 15 [12; 17] мл/м2. КДО и конечный диастолический размер ЛЖ увеличились в отдаленном послеоперационном периоде до 99 [89; 109] и 100% [88; 111] от нормы соответственно. Пиковый и средний градиенты давления на ТК в отдаленном периоде наблюдения составили 8 [5; 9] и 4 [3; 5] мм рт.ст. соответственно. Трикуспидальная недостаточность была в пределах 1 ст. у 30 (93,7%) пациентов. Систолическое давление в правом желудочке снизилось с 31 [23; 39] до 22 [20; 24] мм рт.ст.. Исключение атриализованной части правого желудочка увеличило его функциональную площадь. ВЫВОД Конусная реконструкция позволяет получить компетентный ТК с минимальными градиентом давления и недостаточностью, увеличить эффективную площадь поверхности правого желудочка и снизить систолическое давление в нем. В результате увеличивается преднагрузка на ЛЖ, и восстанавливается его сферичность.

ЦЕЛЬ ИССЛЕДОВАНИЯ Оценить непосредственные и отдаленные результаты операций артериального переключения у пациентов с D-транспозицией магистральных артерий (D-ТМА). МАТЕРИАЛ И МЕТОДЫ Проведен ретроспективный анализ пациентов с D-ТМА после операций артериального переключения, выполненных в НИИ Кардиологии Томского НИМЦ за период с 2006 по 2021 г. В исследование были включены 98 пациентов, которые были разделены на три группы: 1-я группа — 54 (55,1%) больных с простой ТМА, 2-я группа — 35 (35,7%) пациентов с ТМА и дефектом межжелудочковой перегородки, 3-я группа — 9 (9,2%) детей с ТМА и сочетанной патологией. Возраст пациентов варьировал от 1 сут до 20 мес (медиана 11 [7; 25] сут). Среднее время наблюдения за пациентами составило 10 лет. Оценивали демографические, до-, интра- и послеоперационные данные, отдаленную выживаемость и данные эхокардиографии через 1 год, 5 и 10 лет после операции. РЕЗУЛЬТАТЫ Госпитальная летальность составила 6,1%. Отдаленной летальности не было. Основной причиной летальности была острая коронарная недостаточность. Недостаточность неоаортального и неолегочного клапанов в течение 10-летнего периода наблюдения варьировала в пределах 1—2 ст. Значимый стеноз клапана легочной артерии, потребовавший хирургической коррекции, выявлен у 6 (6,1%) пациентов. ВЫВОД В настоящий момент операция артериального переключения является «золотым стандартом» радикальной коррекции D-ТМА с удовлетворительными непосредственными и отдаленными результатами. Тем не менее, всем пациентам, перенесшим операцию артериального переключения, требуются пожизненное наблюдение кардиолога и регулярная эхокардиография.

Congenital heart disease occurs in the population with a frequency of 8 per 1000 live births. Information on the incidence of various congenital heart defects in newborns in connection with the widespread introduction of prenatal ultrasound diagnostics and an increase in its accuracy allows for planning pregnancy and management of newborns with critical heart defects. The aim of this study wasto retrospectively study the incidence of various congenital heart defects according to echocardiographic studies among newborns in the framework of the experience of one clinic over the period from 2009 to 2019. In the clinic of the Science Research Institute of Cardiology, echocardiographic studies were performed in 34298 children aged 1 day to 17 years, the average age was 3.68 years, the median 2.0 years. The newborns accounted for 4.6% of them (n = 1607). The results of echocardiographic studies were analyzed in 1607 newborns aged from 1 to 27 days. In 247 (15.3%) of the examined no congenital defects were detected, 1360 newborns had various congenital heart diseases. It was found that the most common anomaly in newborns were interventricular septal defects (37%), more than 60% of all interventricular septal defects were clinically insignificant small muscle defects. It has been shown that the incidence of congenital heart defects in newborns with complex prenatal diagnosis (coarctation of the aorta, double outlet right ventricle) has increased in recent years. A decrease in the incidence of atrioventricular septal defect was observed over the past five years. The possibilities of neonatal cardiac surgery in a particular clinic influenced the structure of the occurrence of individual congenital heart disease due to prenatal pregnancy planning and surgical tactics.

Янулевич О.С., Кожанов Р.С., Егунов О.А., Соколов А.А., Кривощеков Е.В. Хирургическое лечение фибромы левого желудочка у новорожденного. Детские болезни сердца и сосудов. 2022; 19 (2): 128–33. DOI: 10.24022/1810-0686-2022-19-2-128-133 HTML

ОСОБЕННОСТИ ЭХОКАРДИОГРАФИЧЕСКОГО ИССЛЕДОВАНИЯ У БОЛЬНЫХ С ЗАВЕРШЕННОЙ ГЕМОДИНАМИЧЕСКОЙ КОРРЕКЦИЕЙ ВРОЖДЁННЫХ ПОРОКОВ СЕРДЦА С ФУНКЦИОНАЛЬНО ЕДИНСТВЕННЫМ ЖЕЛУДОЧКОМ Соколов А.А. 1 , Кривощеков Е.В. 1 , Сморгон А.В. 1 .Ковалев И.А. 2 1 -Томский НИМЦ, НИИ кардиологии.г.Томск, Россия. 2 -«Научно-исследовательский клинический институт педиатрии имени академика Ю. Е. Вельтищева» ФГАОУ ВО РНИМУ им

Objective. To evaluate the results of surgical correction of Ebstein anomaly by cone reconstruction in the early and late postoperative periods of observation. Material and Methods. The study included 35 patients with Ebstein anomaly aged 18 years and younger. The average age of patients was 5.5 [2; 10] years; weight was 23.4 [12.5; 27.5] kg; and height was 112.7 [90; 137] cm. All patients underwent surgical treatment for Ebstein anomaly by cone reconstruction, including four cases (11.4%) requiring the creation of a bidirectional cavopulmonary anastomosis. The echocardiographic parameters of the heart were studied in the preoperative, early postoperative, and long-term observation periods. The main emphasis was on the evaluation of tricuspid valve (TV) function indicators, including TV regurgitation degree, pressure gradient, Z-score, and size of the valve ring expressed as percentages of reference stature-weight values. The electrocardiographic records of patients were evaluated to analyze cardiac rhythm disturbances. The maximum period of observation was eight years. Results . The indexed sizes of the right atrium and right ventricle significantly decreased and the left ventricular end-diastolic index and stroke volume increased in the early postoperative period. In the long-term period of observation, there was an increase in the fibrous ring of TV ( p < 0.05), whereas the tricuspid pressure gradient and regurgitation did not change over time. Atrioventricular conduction disorders were not detected among patients in the early postoperative period. The bidirectional cavopulmonary anastomosis was created in the presence of the following conditions: the TV mean pressure gradient was more than 8 mmHg; the pressure gradient between the right and left atriums was above 1.5.

Rupture of the interventricular septum (MVP) as a complication of acute myocardial infarction is a rare event and associated with high mortality without timely surgical treatment. We present a case of a 68 year old patient who had an acute myocardial infarction with ST segment elevation complicated by a rupture of MVP. In this article we discusse the difficulties of patient management with this pathology and the problem of choice of treatment tactics.

Aim . To evaluate the informational and diagnostic significance of the myocardial Tei index. Patients and methods . The study assessed data of echocardiographic studies of 9,256 patients aged 1 month to 60 years, 1,350 healthy individuals, and 7,906 patients with various cardiovascular diseases with abnormal volume-capacitive characteristics of the heart (congenital heart defects, different types of cardiopathy, and hypertensive disease). Results . The cutting points of the normal values of the indicator were established. Data showed that the Tei index did not reflect changes in the pumping function of the left ventricle and did not depend on the contractility of the left ventricle (LV), but it had direct significant correlation with the left ventricular filling pressure, both in normal and pathological conditions. Correlation was more significant in adult patients. Conclusion . Normal values of the Tei index less than 0.5 were observed in more than 95% of practically healthy individuals of any age. The maximum sensitivity and specificity of the myocardial performance index was found in patients with restrictive and dilated cardiopathy and common atrioventricular connection.

Rupture of the interventricular septum (MVP) as a complication of acute myocardial infarction is a rare event and associated with high mortality without timely surgical treatment. We present a case of a 68-year-old patient who had an acute myocardial infarc‑ tion with ST-segment elevation complicated by a rupture of MVP. In this article we discusse the difficulties of patient management with this pathology and the problem of choice of treatment tactics.