[Ischemic stroke associated with patent foramen ovale: hospital database analysis]. / Ishemicheskii insul't, assotsiirovannyi s otkrytym oval'nym oknom: analiz dannykh gospital'nykh registrov.

OBJECTIVE: To analyze clinical and instrumental characteristics of patients with ischemic stroke (IS) due to paradoxical embolism according to the data of hospital registers of Moscow and Perm. MATERIAL AND METHODS: A comprehensive study of 114 patients, aged 18 to 55 years, with IS by the mechanism of paradoxical embolism was carried out. All patients underwent clarification of the cause of IS (electrocardiography, ultrasound scanning of the brachiocephalic arteries, CT or MRI of the brain, CT or MR angiography, transthoracic and/or transesophageal echocardiography). The presence of right-left shunt blood flow (RLS) was confirmed by transcranial dopplerography with a bubble test. The clinical significance of patent foramen ovale (PFO) was assessed according to The PFO-Associated Stroke Causal Likelihood Classification System (PASCAL). RESULTS: Clinical and instrumental characteristics of patients with IS due to paradoxical embolism were obtained from two hospital registries. In both groups, the leading trigger for the development of IS was the Valsalva phenomen (>20%), the share of other provoking factors did not exceed 10%. Significant differences between the analyzed groups related to the ultrasonic characteristics of RLS/PFO: patients with a grade 4 shunt predominated in the Research Center of Neurology (RCN) population, while patients with a grade 3 shunt predominated in the City Clinical Hospital (CCH) №4 group. At the same time, there were twice as many patients with aneurysm of the interatrial septum in the CCH №4 group. In accordance with the PASCAL classification, in 93% of RCN patients, PFO can be considered as a probable cause of IS, while in the CCH No. 4 group, a probable causal relationship was traced only in 51% of cases, in 18% of patients, the role of an anomaly in the development of stroke was unlikely. CONCLUSION: The analysis showed that the primary screening of RLS in a regional vascular center allows classifying PFO as a probable cause of IS in only half of the patients. For a more accurate selection of patients for whom endovascular occlusion of the PFO will be most effective, an in-depth examination in a specialized hospital is recommended.

[Pulmonary arteriovenous shunt - a rare cause of recurrent stroke due to paradoxical embolism]. / Legochnyi arteriovenoznyi shunt ­ redkaya prichina retsidiviruyushchikh narushenii mozgovogo krovoobrashcheniya po mekhanizmu paradoksal'noi embolii.

Paradoxical embolism is one of the mechanisms of ischemic stroke in patients younger than 45 years of age, due to opening between the right and left chambers of the heart through a patent foramen ovale, an atrial or ventricular septal defect, pulmonary arteriovenous malformations (PAVMs), etc. The PAVMs are structurally abnormal vessels that provide direct capillary-free communication between the pulmonary and systemic circulations, and hence an anatomic "right-to-left" shunt. Most pulmonary malformations are congenital and associated with hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease). This publication highlights the issues of pathogenesis, clinical presentation, diagnosis and treatment of this pathology, and also describes a clinical case in which multiple PAVMs caused repeated ischemic strokes.

[ASSESSMENT OF LIVER FUNCTION WITH TRANSESOPHAGEAL ECHOCARDIOGRAPHY HEART SURGERY WITH CARDIOPULMONARY BYPASS].

AIM OF THE STUDY: evaluation of arterial and venous liver circulation during cardiopulmonary bypass (CPB) using the method of transesophageal echocardiography (TEE). MATERIALS AND METHODS: 62 patients undergoing reconstructive cardiac surgery with CPB were analyzed. During all the stages of treatment we performed monitoring of mean arterial pressure, heart rate and central venous pressure. TEE was performed using specialized Philips iE-33 3-D matrix multifrequency probe X7-2t in transgastral position. Ultrasonic and dopplerographic measuring of blood flow in hepatic artery and veins was performed before sternotomy, in 30 minutes after starting CPB and after stopping CPB during sternal closure. The speed of bloodflow in hepatic artery, hepatic veins, biochemical blood analysis was evaluated, i.e. lactate level, AST ALT ratio before the intervention, during CPD and in early postoperative period RESULTS: Correlation between blood flow in liver vessels and dynamics of biochemical analysis. It is considered to that this change during procedures with CPB may be linked with liver insufficiency during first hours of evaluation. In other words reduced blood flow in liver vessels may be one of the liver insufficiency early symptoms and is one of factors that require correction during operative and early postoperative period. So dynamic follow-up of hepatic circulation may be used as a method of early diagnostics of functional organ disorders.