No abstract

Between December 1982 and August 2001, coil embolization of coronary artery-to-cardiac chamber fistula was attempted in 15 patients aged 11 months to 44 years (mean, 7.2 +/- 2.5 years). The fistulae connected the left anterior descending artery to the right ventricle in 4 patients, the right coronary artery to the right ventricle in 3, the right coronary artery to the right atrium in 3, the circumflex artery to the right ventricle in 2, the circumflex artery to the right atrium in 2, and the right coronary artery to the trunk of the pulmonary artery in 1. Complete fistula occlusion was achieved in 14 patients (93%); one had a residual shunt and underwent repeat embolization one year later, resulting in complete occlusion. There was one early death (7%) in a 4-year-old girl who developed femoral artery thrombosis and acute renal failure. Complications comprised migration of the coil into the pulmonary artery (2), femoral artery thrombosis (2), and perforation of the vessel wall by the guidewire (1) with immediate thrombosis and occlusion of the fistula (no coil was deployed). The 13 survivors with coils were followed up for 0.5 to 13 years; complete occlusion of the fistula was confirmed in all cases.

Palliative surgical treatment of CHDs associated with UAPA can be performed with a relatively low risk. Systemic-to-pulmonary artery shunt and transluminal balloon pulmonary valvuloplasty are methods of choice in patients with non-severe hypoplasia of the single pulmonary artery. The intravascular intervention is indicated more in patients with a prevailing valvular component of the pulmonary stenosis. Palliative reconstruction of the right ventricular outflow tract is a more favourable procedure for patients with a severe hypoplasia of the single pulmonary artery.

If unrepaired, concomitant moderate-to-severe atrioventricular valve regurgitation significantly worsens the results of the Fontan procedure. Longer observation is needed to define the strategy in patients with mild atrioventricular valve regurgitation that remained unrepaired during Fontan operation.

Vitamin D deficiency is widespread worldwide and present in about 30-50% of population. In most cases, this problem is associated with musculoskeletal system pathology: rickets in children, and osteomalacia or osteoporosis in adults. However, in recent years, convincing data was obtained on the links between vitamin D deficiency and cardiovascular pathology. Low Vitamin D levels in humans are associated with the unfavorable cardiovascular risk factors, such as arterial hypertension (AH), diabetes mellitus, and dyslipidemia, which are the predictors of the severe cardiovascular diseases, including strokes and infarctions. It has been demonstrated that vitamin D has a strong vasoptotective effect via endothelial dysfunction improvement, prevents blood vessels and myocardium remodeling, improves blood pressure parameters, reduces the risk of development of left ventricular hypertrophy, slows down fibrosis, reduces the risk of atherosclerosis, reduces insulin resistance, and also affects inflammation and immunity. This article provides data of Russian and foreign studies demonstrating the effect of Vitamin D deficiency on the development of atherosclerosis, AH, heart rhythm disorder and progression of chronic heart failure.

NomenclatureHistorical Pages lumen). We would like to comment on several issues related to congenital RPA-LA communication.The first classification of anatomical variants of this pathology known by this time was based just on the character of pulmonary veins drainage w2x. The publication of new cases of RPA-LA communication led to the broadening of the spectrum of eventual anatomical variants of this defect and to the necessity of a new classification. Our classification w3x is based on the following signs typical for this anomaly: a) the anatomy of pulmonary venous drainage wnormal (type 1), partial (type 2) or total (type 3) anomalous pulmonary venous drainagex; b) the location of anomalous communication origin from the RPA wthe proximal form with the communication originating from the RPA segment between the pulmonary trunk bifurcation and the site of RPA division into the lobar branches (type 1.1) and the distal form with anomalous communication originating from a lobar branch of the RPA (type 1.2); c) the presence (type 1.1A) or the absence (type 1.1.B) of aneurysm on the communication.The priority in surgical treatment of this pathology belongs to A. Blalock, who was the first in the world (14.07.1948) to ligate the anomalous communication in a 15-year-old boy w4x.From November 1999 through November 2009, five patients with RPA-LA communication were operated on in the Bakoulev Center for Cardiovascular Surgery. The age of patients ranged from 1 month 10 days to 10 years 7 months. w(95% CI)s3.5 years (0.11; 10.6)x, there were three boys. Before the operation, SaO 2 was 71.2"11.4% (54-83). All patients had normal pulmonary venous drainage, three of them had concomitant atrial septal defects (ASD) and one had ASD and patent ductus arteriosis (PDA). The correction was performed through median sternotomy, under extracorporeal circulation (ECC). Two patients (with types 1.1A and 1.1B in our classification) underwent ligation or clipping of the anomalous communication in the proximal segment, in one patient (with 1.2B type) the anomalous communication was ligated distally. In the youngest patient (with 1.1A type), the distal orifice of the anomalous communication was sutured from the left atrial cavity with the approach through the right atrium and the ASD. Along with the anomalous communication, ASD was closed in all four cases. The only girl with intact atrial septum (IAS) and 1.2A type of the defect underwent left atriotomy with subsequent suturing of the distal fistula orifice from the left atrium. The result in four patients was good: the shunt across communication was absent, SaO 2 was 96"1.5%. In one case (with IAS) the control echo revealed a moderate residual RPA-LA. Successful endovascular procedure with Sideris button device was made six months after the first operation.

Б локаторы ангиотензиновых рецепторов (БРА)относительно новый класс препаратов, вошедший в клиническую практику лишь с конца 90-х годов XX века. Первоначально БРА (сартаны) рассматривались в качестве альтернативы ингибиторам ангиотензинпревращающего фермента (АПФ) и назначались лишь при непереносимости последних [1, 2]. Однако исследования последних лет радикально изменили представления об этой группе препаратов и привели к экспоненциальному росту частоты применения БРА в различных клинических ситуациях [3-6]. В последние годы частота применения сартанов в США и Европе увеличилась в 2 раза, а в нашей стране-в 10 раз [6]. Функционирование ренин-ангиотензинальдостероновой системы (РААС) на разных этапах сердечно-сосудистого континуума Открытие компонентов, механизмов действия и эффектов РААС стало основополагающим в формировании представлений о возникновении и прогрессировании большинства сердечно-сосудистых заболеваний (ССЗ). При этом сформулированная V. Dzau и E. Braunwald в 1991 г. концепция сердечно-сосудистого континуума, описывающая качественные переходы от генетически обусловленных и поведенческих факторов риска (ФР) развития ССЗ и их осложнений вплоть до терминальной стадии сердечной недостаточности и смертельного исхо

ВведениеПатогенетическая роль ренин-ангиотензин-альдо-стероновой системы (РААС) в развитии и прогресси-ровании сердечно-сосудистых заболеваний в настоя-щее время является общепризнанной. С течением времени открываются все новые и новые тканевые и ге-модинамические эффекты как отдельных ее компо-нентов, так и конечного продукта этой цепи -альдо-стерона. В связи с этим применение антагонистов аль-достерона при различных клинических состояниях, сопровождающихся явлениями гиперальдостерониз-ма, становится все более обоснованным. История применения блокатора РААС спиронолактонаПервым препаратом, механизм действия которого связан с блокадой РААС, стал антагонист альдостеро-на спиронолактон. Сам альдостерон -стероидный гормон коры надпочечников был открыт в начале 1950-х годов. С этого же времени начали активно из-учать его физиологические и патофизиологические эф-фекты Значение ренин-ангиотензин-альдостероновой системы в патогенезе различных клинических состояний хорошо изучено. Рассматривается ведущая роль блокаторов альдостероновых рецепторов, в частности, спиронолактона, в лечении больных с первичным гиперальдостеронизмом, резистентной артериальной гипертензией, отечным синдромом в рамках хронической сердечной недостаточности, нефротического синдрома и портального цирроза печени. Освещается развитие представлений о кардио-, вазо-и нефропротективном действии этой группы препа-ратов и возможностях их влияния на прогноз пациентов.Ключевые слова: антагонисты альдостерона, спиронолактон, хроническая сердечная недостаточность, артериальная гипертензия, цирроз печени. The importance of renin-angiotensin-aldosterone system in pathogenesis of different clinical conditions is studied well. The key role of aldosterone receptor blockers, particularly spironolactone, in treatment of such conditions as primary hyperaldosteronism, resistant hypertension, edematous syndrome in congestive heart failure, nephrotic syndrome, and portal cirrhosis is considered in the article. Development of ideas about cardio-, vaso-and nephroprotective effects of these drugs is highlighted as well as their influence on patient prognosis.