[INFECTIOUS ENDOCARDITIS IN PREGNANT WOMEN].

A case of primary infectious endocarditis with the lesion of mitral valve in a pregnant woman is reported The diseases was caused by meticillin-resistant Staphylococcus aureus. Special attention is given to inefficiency of beta-lactame antibiotics against this infection and beneficial effect of daptomycin therapy. This observation confirms literature data about high frequency of thromboembolic complications of S aureus-induced infectious endocarditis due to the production of various coagulases and von Willebrand factor-binding protein by these microorganisms. An increase of coagulation caused by S. aureus is mediated through activation of prothrombin, factor XIII, and fibrin-binding fibronectin. It requires prescription of direct thrombin inhibitor pradax that proved to yield good results in the treatment of our patient. It is concluded that infectious endocarditis in pregnant women is characterized by an atypical clinical picture due to impaired immunity associated with rapid progression of the process after delivery, high frequency of thromboembolic and DIC syndromes.

[Peculiarities of pregnancy management after multiple stenting of coronary arteries].

This paper describes the strategy for pregnancy and labour management in women with the history of myocardial infarction after multiple stenting of coronary arteries using stents with cytostatic coating. The authors discuss a broad range of diseases underlying coronary lesions in young pregnant women receiving antiaggregation therapy. Neither multiple stenting nor intake of aspirin and ticlopid provoked teratogenic effect.

[A newly diagnosed intraventricular septal defect in a pregnant woman presenting with pulmonary hypertension].

This clinical description of pregnancy follow-up and labour management in women with severe pulmonary hypertension caused by an interventricular septum defect is intended to familiarize practicing physicians with the methods for maintaining pregnancy and ensuring spontaneous delivery despite the said pathology. Indispensable conditions for the attainment of these goals include thorough clinical and laboratory control, comprehensive analysis of possible complications, efficacious epidural anesthesia, and correct choice of medicines.

[Pregnancy management and spontaneous labor in heart diseases: present-day solution to the dilemma].

AIM: to study cardiac rhythm variability (CRV), to optimize pregnancy management tactics and to choose a delivery procedure. SUBJECTS AND METHODS: Ninety-six 19-to-37 year-old (mean age 28.3 +/- 9.4 years) women at 35-39 weeks gestational age were examined. All the women were diagnosed as having congenital or acquired (rheumatic) heart disease. Their hemodynamics and CRV were analyzed according to the type of hemodynamic overload, for which purpose three patient groups were formed: 1) volume overload; 2) pressure overload; and 3) combined overload. A control group comprised 40 healthy pregnant women. Before and 2-3 days after delivery, all the women underwent 24-hour Holter cardiac rhythm monitoring with the estimation of the temporary and spectral parameters of CRV. RESULTS: In antepartum heart diseases accompanied by volume overload, there was a tendency for total CRV (SDNN 95.4 +/- 15.8 msec versus 125.5 +/- 17.8 msec in the controls) to decrease and for sympathetic activity to significantly increase (SDANN 65.7 +/- 13.7 and 109.9 +/- 14.7 msec, respectively; p < 0.05). When pressure overload (a moderate gradient) developed, the temporary parameters of total CRV, sympathetic and parasympathetic activities did not differ from those in the control group. Heart diseases attended by pressure overload and a high gradient were characterized by a significant reduction in total CRV (100.5 +/- 24.6 msec; p < 0.05) as compared with those in patients having a moderate pressure gradient, with a declining trend for total spectrum power, Group 3 patients showed a reduction in all the indices reflecting the temporary and spectral characteristics, suggesting a considerable rise in sympathetic activity and a decrease in total autonomic spectrum power. CONCLUSION: Based on SRV studies, indications for prolonged pregnancy and spontaneous or, in some cases, surgical delivery can be assessed in pregnant women with heart diseases.

[Characteristics of a 24-hour rhythm of blood pressure in patients with chronic renal failure on peritoneal dialysis].

AIM: To analyse 24-h rhythm of blood pressure (BP) and its influence on the rate and severity of left ventricular hypertrophy (LVH) in patients with chronic renal failure (CRF) on replacement therapy (peritoneal dialysis - PD). MATERIAL AND METHODS; 70 CRF patients on PD were studied. Their examination included clinical, biochemical tests, automatic 24-hour blood pressure monitoring, transthoracic echocardiography. RESULTS: Non-dipper and night-peaker disorders of BP 24-hour pattern were registered in 81.4% patients irrespective on hypertension severity. Left ventricular myocardial hypertrophy was 87.7% in patients with disturbed 24-h BP rhythm and 53.8% (p = 0.015) in normal BP rhythm. LV myocardial mass index median was 223 and 129 g/cm2 (p = 0.026), respectively. Concentric and excentric models of LV hypertrophy occurred with the same rate in normal and disturbed 24-h rhythm of BP. CONCLUSION: CRF patients on PD are characterized by disorders of 24-h BP rhythm independent of hypertension severity. Night-peaker pattern of BP is a risk factor of development and/or progression of LV hypertrophy.

[Heart disease and pregnancy: grounds for confidence in the safe outcome].

Indications for prolongation of pregnancy and spontaneous delivery in women with congenital and acquired heart disease are proposed based on original observations and literature data. Special attention is given to risk factors of an undesirable outcome of pregnancy for mothers with high functional class cardiac insufficiency, high blood pressure gradient, and severe pulmonary hypertension with mitral valve and aortic stenosis.

[Treatment of arterial hypertension in patients with bronchial asthma]. / Lechenie arterial'noi gipertenzii u bol'nykh bronkhial'noi astmoi.

Treatment of arterial hypertension in patients with concurrent chronic obstructive diseases of the lungs has limits in prescription of antihypertensive drugs. STAMLO--long-acting calcium antagonist--is proposed for monotherapy of mild and moderate hypertension in patients with bronchial asthma. The drug decreases hypertension in the greater and lesser circulation, improves bronchial permeability.

[Characteristics of the course of complicated myocarditis]. / Osobennosti techeniia oslozhnennogo miokardita.

Twenty one patients (15 males and 6 females, mean age, 35.0 +/- 1.6 years) with myocarditis combined with symptoms of Stages II-III circulatory failure were examined. This group of patients was identified as a high-risk group as to an unfavourable outcome of myocarditis. Within the follow-up from 3 to 36 months, all the patients died: the case of death was arrhythmia in 17 and circulatory failure in 4. The unfavourable prognosis of the disease was evidenced by high pulmonary capillary pressure and pulmonary end-diastolic pressure that exceeded 20 mm Hg the cardiac index that was less than 31/min.m-2. The ratio of left ventricular end-systolic and end-diastolic volumes to the left ventricular cross-shortening were important signs of the unfavourable prognosis, i.e. death of congestive circulatory failure. In addition to complications of myocarditis such as sudden ventricular fibrillation, progressive congestive circulatory failure and thromboembolism, there were more rare complications such as development of left ventricular aneurysms and damage to the endocardium as abacterial endocarditis.

[Various factors determining the fatal outcome in myocarditis]. / O nekotorykh faktorach, opredeliaiushchikh letal'nyi iskhod pri miokarditakh.

A study of 38 patients with infectious-allergic myocarditis included clinical laboratory investigation, echocardiography, catheterization of the right heart compartments and the pulmonary artery and endomyocardial biopsy. It has identified adverse factors contributing to fatal outcome: increased end-diastolic pressure in the pulmonary artery, low cardiac output, signs of macrofocal fibrosis and small ejection fraction.