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67.Детские болезни сердца и сосудов №3 2014

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Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
Л??б?кзбн╦ к ка??збн╦
ГЯККО ко. д.Г. е?мшнб??
Цк?блак? л? ка??збн╦рмш? ?б?збн╦лсрз╦
ЦЙ ? 03847 сз 25.01.2001 ?.
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грб т???? а??к?бл?. Гк с?л? ??рз╦
?зс?с ка??лк? лб осйбз ╥?з╦ а?лбрбл? ? т?о?з╦ мсот╦?зб?? нк╥с ?срт?ска?б?бл? н?╥?о ртсрс╥со ╥ба
т?б????кзбн╦лс?с ткр╦обллс?с ??а?б╞блк? ка??збн?.
Из?бзрз?бллсрз╦ а? ?срзс?б?лсрз╦
клыс?о??кк, рс?б?й??бхр?
? ?бмн?ол?? о?зб?к?н??, лбршз
?бмн?ос??збнк.
д??бр ?б??м?кк
119049, Есрм??, Цблклрмкх т?., 8
ГЯККО ко. д.Г. е?мшнб??,
сз?бн клзбннбмзш?н╦лсх
рс╥рз?бллсрзк
Мбнбысл ?б??м?кк (499) 236-92-87
Н?мр (499) 236-99-76
E-mail: izdinsob@yandex.ru
http: //www.bakulev.ru
К?к?бзбн╦рз?с с ?б?крз???кк р?б?рз??
о?ррс?сх клыс?о??кк ХЮ ? 77-14992
сз 03.04.2003 ?.
А??. ?б??м?кбх Ш╞мб?к? М.Ю.
Мбнбысл (499) 237-88-61
Цкз. ?б??мзс?, мс??бмзс?
Сб?о?╞бл?б?? М.Г.
Дсот╦?зб?л?? ?б?рзм? к с╥??╥сзм?
???ык?брмс?с о?зб?к?н?
Гбтс?с?кл? Е.г.
Гсоб? тс?ткр?л ? тб??з╦ 27.11.2014
Нс?о?з 60x88 1/8
Хб?. н. 85
Лрн. тб?. н. 83,6
Л?.-ка?. н. 7,65
Изтб??з?лс ? ГЯККО
ко. д.Г. е?мшнб??,
119049, Есрм??,
Цблклрмкх т?срт., 8
Мбн. (499) 236-92-87
ябзрмкб ╥снбалк рб???? к рсрш?с?
2014. ? 3. 1?68
ISSN 1810-0686
Мк??й 500 ?ма.
Хс?ткрлсх кл?бмр 84550
??????? ???????
?????? ? ???????
CHILDREN?S HEART
AND VASCULAR DISEASES
????????????? ??????-???????????? ??????
??????? 1 ??? ? ??? ??????
??????? ? 2004 ?.
.
3 2014
??????? ???????? ?.?. ???????
???????????? ????????
?.?. ?????????, ?.?. ???????,
?.?. ?????????, ?.?. ?????????, ?.?. ???,
?.?. ????????, ?.?. ???????,
?.?. ??????? (???. ???????? ?????????)
???????????? ?????
?.?. ???????, ?.?. ???????, ?.?. ??????,
?.?. ??????????, ?.?. ???????
?????? ?????? ? ???????? ????????????? ????????????? ??????? ???????,
??????????? ? ?????????? ?????????, ? ??????? ????????????? ??????????
???????? ??????????? ??????????? ?? ????????? ?????? ??????? ??????? ?
????????? ???? ?? ????????
?????? ??????? ? ?????????? ?????? ???????? ???????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
Nauchnyy tsentr serdechno-sosudistoy
khirurgii imeni A.N. Bakuleva
DETSKIE BOLEZNI
SERDTSA I SOSUDOV
CHILDREN?S HEART
AND VASCULAR DISEASES
Peer-reviewed scientific-practical journal
Published once in three months
.
Founded in 2004
3 2014
EDITORIAL BOARD
E.D. Bespalova,
E.L. Bockeria,
M.L. Ermolenko,
M.A. Zelenikin,
A.I. Kim,
I.V. Kokshenev,
M.R. Tumanyan,
K.V. Shatalov
(assistant editor)
EDITORIAL COUNCIL
A.A. Baranov,
N.N. Volodin,
Yu.F. Isakov,
L.R. Plotnikova,
M.P. Chernova
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
??????????
CONTENTS
????????? ?.?., ??????? ?.?. ?????????? ?????????????? ?????? ???????? ???????: ?????? ?
?????????? ????????????? ?????????
5
Mamadshoev B.D., Danilov T.Yu. Right ventricle ?
pulmonary artery conduit obstruction: methods and
results of surgical correction
12
Podzolkov V.P., Kokshenev I.V., Chiaureli M.R.,
Pursanov M.G., Samsonov V.B., Danilov T.Yu.,
Cheban V.N., Zemlyanskaya I.V. Elimination of
obstruction of pulmonary blood flow after arterial
switch operation with transposition of the great
arteries
19
Antsygin N.V., Movsesyan R.R., Shikhranov A.A.,
Kagan A.V., Chizhikov G.M., Yamgurov D.R.,
Tsytko A.L., Lubomudrov V.G. Comparison of surgical strategies in the treatment of aortic arch
obstruction in infants
26
Chernogrivov I.E., Chernogrivov A.E., Talysheva O.N., Bazylev V.V. Down syndrome and results
of surgical treatment for the complete atrioventricular septal defect
????????? ?.?., ???????? ?.?., ???????? ?.?.,
???????? ?.?., ???????? ?.?., ??????? ?.?.,
????? ?.?., ?????????? ?.?. ?????????? ?????????? ????????? ????????? ????? ???????? ????????????? ???????????? ??? ???????????? ????????????? ???????
??????? ?.?., ???????? ?.?., ???????? ?.?.,
????? ?.?., ??????? ?.?., ??????? ?.?., ????? ?.?., ?????????? ?.?. ????????? ????????????? ????????? ??? ??????? ?????????? ???? ????? ? ????? ??????? ???? ?????
??????????? ?.?., ??????????? ?.?., ???????? ?.?., ??????? ?.?. C?????? ????? ? ?????????? ??????????? ????????? ?????? ????? ???????????????????? ??????
?????????? ?.?. ???????????? ???????? ???????????????? ???????? ??? ???????? ?????????? ?
??????????? ???????? ?????? ??? ??????????
??????????? ????????????, ?????????????
???????? ?????????
????????? ?.?., ???????? ?.?., ???????? ?.?.,
?????? ?.?. ?????? ????????? ??????????????
??????????? ??????? ? ?????????? ????? ?????
???????? ????????????? ???????????? ? ???????? ? ????????????? ????????????? ???????
????? ?.?., ??????? ?.?., ???????????? ?.?.,
??????????? ?.?., ????????? ?.?. ????????
????????????? ??????? ???????? ? ?????????
???????????? ???????????? ? ????? ??????????????????? ??????? ?? ?????? ??????? ? ?????????? ??????????????????? ???????????????:
???????????????? ?????????
Milievskaya E.B. The relevance of the training programs for transfer of adolescents with congenital
heart defects from pediatric cardiology to adult
health care
38
Podzolkov V.P., Kokshenev I.V., Samsonov V.B.,
Mataev V.S. Succesfull mitral valve replacement
in patient after arterial switch procedure in late follow-up
42
Yurlov I.A., Kovalev D.V., Astrakhantseva T.O.,
Baryshnikova I.Yu., Podzolkov V.P. Mid-term
results of modified Fontan operation performed in
patients with visceral heterotaxy syndrome and concomitant common atrioventricular valve regurgitation
46
3
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
???????? ?.?., ??????????? ?.?., ????????? ?.?., ???????? ?.?. ?????????? ?????? ????????? ? ????????? ? ????? ???????? ??????????????????? ???????
???????? ?.?., ??????? ?.?., ???????? ?.?.,
???????? ?.?. ???????? ??????????? ??????? ????? ?????????? ????? ????? ?? ??????
Manouguian?Seybold?Epting
Nefedova I.E., Baryshnikova I.Yu., Berishvili D.O.,
Mumladze K.V. Left ventricular diverticulum with a
complete atrioventricular defect
50
54
????????? ?.?., ??????? ?.?., ?????? ?.?.,
?????????? ?.?. ???????? ?????????????? ???????????????? ??????? ? ?????????? ????? ?????
??????????? ????????? ??????? ????? ? ????????? ? ????????? ????? ???????? ???????, ?????????? ???????????? ??????????
57
??????? ??? ???????
61
4
Chiaureli M.R., Danilov T.Y., Samsonov V.B.,
Mavlyutov M.Sh. Plastic mitral valve after the
enlargement of the aortic root method Manouguian?
Seybold?Epting
Podzolkov V.P., Danilov T.Yu., Putyato N.A.,
Isomadinov Kh.G. Successful tricuspid valve
replacement late after radical correction of tetralogy
of Fallot in a patient with agenesis of the left pulmonary artery undergoing infective endocarditis
Instructions for authors
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
╘ ?.?. ?????????, ?.?. ???????, 2014
??? 616.131.3-007.272-089.168
?????????? ?????????????? ?????? ???????? ???????:
?????? ? ?????????? ????????????? ?????????
?.?. ?????????, ?.?. ???????
????? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ?
???????? ??? ? ???? ?.?. ???????); ?????????? ?????, 135, ??????, 121552,
?????????? ?????????
????????? ??????? ????????????, ????????;
??????? ????? ???????, ?????? ???. ????, ??????? ????. ????.; e-mail: tmr_dv@mail.ru
??????? ????????? ????????????????? ????????? ? ??????????????????? ???????? ??????? ????????? ????????? ??????
??????? ?????????? ??????? ??????. ??????????? ??????????? ? ??????????? ???????? ????????????????? ????????? ????????? ????????????????, ?????? ?? ?????????? ??????? ?????????? ??????? ?????? ???????? ??????? ?? ??????????. ??????????, ??????????? ? ?????????? ????????????????? ???????, ?????????? ????????????? ?????????? ????????? ????????.
? ?????? ???????????????? ??????? ????????????? ?????????? ????????????????? ?????????, ????????? ???????? ????????? ? ?????????? ????????? ????????????? ????????????, ??????? ??????????? ? ????????? ????? ?????? ?????????
?????????? ?????????????? ?????? ???????? ???????. ?????? ???????? ??????? ??????? ?????????????? ??????? ?????????
? ???????????????? ????????????????? ????????? ? ???????? ????? ???????????????????? ??????????? ??????????. ????????? ?????? ???????????????? ? ?????????? ??????????? ????????? ??????? ????????????? ????????? ?????????? ?????????????? ?????? ???????? ???????.
???????? ?????: ?????????? ?????????????? ?????? ???????? ???????; ????????? ????????; ????????????? ????????;
????????????? ????????.
RIGHT VENTRICLE ? PULMONARY ARTERY CONDUIT OBSTRUCTION:
METHODS AND RESULTS OF SURGICAL CORRECTION
B.D. Mamadshoev, T.Yu. Danilov
A.N. Bakoulev Scientific Center for Cardiovascular Surgery; Rublevskoe shosse, 135, Moscow,
121552, Russian Federation
Mamadshoev Broimsho Davletshoevich, Postgraduate;
Danilov Timur Yur'evich, MD, DM, Leading Research Associate
Widespread introduction of extracardiac conduits in cardiac surgery practice has made possible the correction of many complex congenital heart defects Design used in clinical practice extracardiac conduits are constantly improving, but so far the ideal prosthesis
pulmonary artery trunk does not exist. Complications arise in the late postoperative period, determine the need for reoperation.
In a review article analyzes the causes of dysfunction extracardiac conduits, the main indications for repeat surgery are presented,
the currently used methods for the correction of artificial pulmonary artery trunk obstruction are described. Particular attention is paid
to the tactics of surgical treatment of patients with implanted extracardiac conduit and risk factors of poor results of reoperations. An
assessment of the immediate and long-term results of surgical correction of various techniques of artificial pulmonary artery trunk
obstruction is presented in the article.
Key words: right ventricle to pulmonary artery conduit obstruction; redo surgery; conduit reconstruction; ?onduit replacement.
????????? ????????? ??????? ?????????? ??????? ?????? ?????????? ??? ??????????? ?????????????? ?????? ???????? ??????? (??) ? ???????? (?? ????. conduit).
??????? ?????????????? ?????? ?? ? ??????????? ???????? ??? ????????? ?????????? ???????
?????? ????? ???? ?????? ? 1963 ?., ????? W. Klinner
? R. Zenker ? ?????????? ??????????????? ??????? (????????) ?????????????? ?????? ?? ???????
??????? ????? ?????? ?????????? (??) ? ??
???????? ? ???????? ?????? ?? [1].
? ????? ?????? ?????? ???????? ?????????????? ?????? ?? ???? ????????? ?.?. ??????????? ?
1975 ?. ??? ????????? ??????? ?????. ??? ????
??? ????????????? ?????????? ?????? ? ??????????????? ???????? ╚Hancock╩ ????? ╚Medtronic╩
(???) [2].
? ?????????? ??????? ???????? ?? ????????????? ? ??????????? ???????? ????? ???????? ?????
????????? ??????????? ?????????????? ?????? ??.
???????????????? ??????????? ????????, ???????????? ??? ????????????? ????? ?????? ?? ??,
5
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
????? ?? ?????????, ?? ???????? ??? ???????????,
?? ??????? ??? ?????????? ???????, ? ????? ?? ???? ???????. ??????????? ? ????????? ????? ????????????????? ???????? ???????????????? ??
????????????? (????- ? ????????????) ? ?????????????, ?? ????????????????? ? ????????????
[3?5]. ????????? ?????????? ???????? ? ????????????? ????????? ? ?????????? ?? ???????????
???? ?????? ?????????, ??????????? ??? ????????????? ??? ???????? ????????? ????? ?? ? ??.
?????? ??? ???????????? ???? ????????? ???????? ????? ???????????, ?????????? ????????? ????????? ?? ???????. ???, ????????????? ?????????? ??????? ?????????? ?????? ???????????? ?????????????? ?? ???? ??????????? ????????? ? ??
???????? [1, 4, 6, 7]. ?????????????? ?????????
????- ? ???????????? ???????? ? ?????????????
?????? ???????? ? ????????????? ? ??? ?????????????? ????????. ??? ??????????? ???????? ????????????? ? ????? ?????? ??? ????? ????????
???????? ????????, ??? ????? ???????? ????????
?????????? ????????? ????????? [8]. ?????? ?????,
????? ???????, ??? ??????????? ??????????? ???
??????????? ???????, ????????? ???????? ???????
???????, ???????????? ??????????, ????? ??????? ?????????? ?????????????? ?????? ?? [5, 9,
10?13].
???????? ?????? ??????????? ???????? ?????????? ?????????????? ?????? ??, ?????????? ?
????????????? ?????????? ????????? ????????????? ????????????.
Хсм?а?лк? м ??тснлблк?
тс?зс?л?? стб???кх
????? ????????, ???????????? ????????? ? ?????????? ????????? ???????? ?? ?????? ?????????? ????????, ???????? ???????? ??????????????
???????? ????? ???????? ?????????? ? ??, ??????? ??? ?????????? ????????? ???????????????
??????????????, ?????????????? ?????? ????????, ???????????? ???????? ????????????, ? ?????
??????? ??? ????????? ????????????? ??????????????? ????????? ? ????????? ????? ??????. ????? ????, ??????? ? ????????? ????????????? ??
???????? ????? ?? ? ?? ??????? ?? ???????, ? ??????? ?? ?????????????, ????? ??? ???????????????? ? ???? ????? ????????????????? ???????.
?????????? ?? ??????????? ???? ??????????
??? ????????? ?????????? ???????? ????? ?? ?
?? ???????? ??????? ? ???????? ???????? ????????? ?????????????? ???????? ????? 70 ?? ??. ??. ???
????????? ??????????????? ??????????????, ? ????? ????? ?????????? ????????? (????? 50 ?? ??. ??.)
??? ????????? ? ???????? ????? ? ????????? ????????? ????????? ??????????????? [14].
? ????????????? M. Bielefeld ? ?????. [15],
M. Ruzmetov ? ?????. [16], M. Koh ? ?????. [17] ??????????? ??? ?????? ??????????????????, ????????6
???????? ????? ?? ? ??, ???? ?????? ? ??????????? ????????????? ?????????? 40?50 ?? ??. ??.
? ???????? ? ??, ??????????? ??? ?????? 75% ??
???????? ? ????? ?????????.
?????? ? ??? S. Mohammadi ? ?????. [18] ??????? ??????????? ????????? ????????? ????????
??? ????? ?????, ????? ??????????? ?????????
????????????????? ????? ?????? ???????? ?????
?? ? ??. ????? ??????? ????????????? ?????????
???, ??? ??????? ??????? ???????? ???????? ?????,
???????? ?? ????????????? ???? ????? ?????????
????? ?? ? ?? ??-?? ????? ??????? ???????????
??????? ??? ?????????? ?????? ????? ?????????. ?
????? ? ???? ????????? ? ????????? ????????? ??
????????????? ?????? ?? ? ??????????????? ??????? ?????? ???? ????? ????????: ??????????????
??? ????????? ???????? ? ?? ? ??????? ????????????? ???????? ????? 65?70 ?? ??. ??. ?? ????????? ? 40?50 ?? ??. ??. ? ??????????? ?????? ????????????.
?????? ??????????, ?????? ????????? ?????????? ???????? ???????? ???????? ????????????,
????????????? ???? ???????????????? ???????
????????, ???? ??? ???????????. M. Ruzmetov
? ?????. [16], J. Brown ? ?????. [19] ?????????? ?
???????? ????????? ??? ?????? ???????? ????????
???????????? 3?4 ??????? ? ???????? ??????????????? ????????? ??, ?????????? ??? ?????????? ??????????????? ??? ????????-???????????
??????????. ? ???????????? J. Dearani ? ?????.
[20] ????????? ? ?????? ???????? ? ?????????????? ? ??????????????? ??????? ? ????????????
????????? ???????? ???????? ??????????????
??????????? ? ??????????????? ????????? ??,
???????????????? ????????? ????? ??????, ????????? ? ???????????????? ???????????? ???????????????????? (???????????????) ??????? ? ???????? ????????????? ? ?????????? ????????. ???????? ?????????? ??, ????????????? ????????
?????????????, ???? ? ????????????? ?????????
??? ????????? ? ?????????? ?????????? ?????????????? ??? ???????????????? ????????????? ??
???????? ????? ?? ? ?? ???????? ? ????? ????????????? M. Homann ? ?????. [21], M. Bielefeld ? ?????. [15], Ch. Bermudez ? ?????. [22], Ch. Schreiber
? ?????. [13].
???? ????? ??. ?.?. ???????? ??????????, ???
??????? ??????? ??????????? ? ?? ? ????????? ?
?????????? ??????????????, ?? ???????????
???????????????? ???????, ???????????????
????????? ????????? ???????? ????? ??????? ??????????? ??????????? ? ?????????? ?????????
???????? [10?12].
Ебзс?? мс??бм?кк с╥рз?шм?кк
крмшррз?бллс?с рз?сн? Цд
???????? ?????????? ?????????? ????????? ?
?????????? ????? ????? ????????? ??????? ????-
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
?????? ??????? ?????? ??????? ?? ???? ????????????????? ????????, ????????? ??? ??????????????
?????????, ?????? ???????, ??????? ???????? ????????????, ????????????? ????????? ??????.
?????? ???????????? ??????????, ???????????
????????? ????????? ?? ?????????? ??????????
?????????????? ?????? ??, ??????????????? ? ???,
??? ?? ?????????? ??????? ?????? ?????? ???????? ???????????????? ???????? ??? ???? ????????
??????????????? ???????, ??????? ?????? ????
??????? ???????? ?? ????? ???????, ? ?????????
????????????? ???????? ???????? ??-??????? [1,
15, 18, 20]. ?????? ? ???, ???????? ?? ???????????? ??????? ??????, ????? ?????? ?????????????
????????? ?????? ?? ??? ????????? ???????? ?????????? ????? ???????????? ????????? ?? ????????? ? ????????? (???????????) ?????????? ??????. ??? ??????????? ????? ??????????? ??????????????????? ??????????????, ??????????
?????? ?????? ???????? ??? ?????????? ??????????????? ????????, ?? ??????? ???? ? ??????????? ???????. ????? ????, ???????? ????? ???????
??????? ??????? ??? ??????????, ??????? ???????? ????? ????????????, ??? ??? ?? ????????? ???????????, ? ????? ????????? ????? ????????????? ????? ????????? ????????? ?? ????? ??????????? ???????? ?????????? ????????? ????????? [18].
????????? ???????? ????????????? ?????????
?????????? ?????????????? ?????? ?? ????????
?????? ?????? ????? ????????????????? ????????
?? ?????, ? ????? ????????? ???????? ????????????? ?????????? ????????? ????????? ?????? ??,
???????? ? ?????? ?????? ?? [23].
?????????? ????????, ??? ?? ???? ?? ??????????? ??????? ?? ??????????? ???????? ?? ?????????? ???????? ?????????? ????????? ????????? ?
??????????? ?????????? ? ?????????? ???????.
???????????? ????????????? ??????????????
?????? ?? ???????? ?????????? ?????????????? ?
????? ??????????????? ????? ?????????? ?????????????? ?????????????? ?? ????????? ? ???????????? ??????????? ????????. ???, ? ???????????? J. Zachariah ? ?????. [24] ?????????????????
?????????????? ?????????????? ? ??????? ?????
??? ?? 30 ??? ???? ?????? ? ?????? ????????? ?
??????????? ???????? ?? ????????? ? ??????????, ????????????? ?????? ?????? ????????. ???????????, ??? ????????????, ??? ? ??????????, ????? ????? ?????? ? ?????? ????????? ? ?????????????? ????????? (11 ?? 129 ???????). ??? ????
????? ?????????? ? ?????? ??????????? ???????, ?
????? ??????? ?? ????????? ???????? ??? ????????? ????????????? ?? ???????? ?????? ?? ??????????? ?? ??????????? ????? ???????? ?????????, ???????????? ?????? ??????? ????????? ?????????? ?????????????? ?????? ??.
???????????? ?????????? ????????, ???????
?????????? ????? ??????? ??????? ?????????,
????? ?? ?????? ???????????. S. Mohammadi
? ?????. [18] ? ????? ???????????? ???????, ??? ????????, ???????????? ????????????? ?????????
?????? ??, ????? ????? ??????? ?????????? ???
?????, ??? ??????? ????? ?????? ????????, ???
???????? ??????????? ????? ??????? ????????????? ????????????? ??????????. J. Brown ? ?????.
[19] ? J. Zachariah ? ?????. [24] ???????? ? ??????????? ????????? ? ?????????? ????? ????? ????????????? ?????????? ???????? ???????? ???????????? ??? ??? ???? ??????? ????????????. ?????? ?????? ????????, ??? ? ??????????? ???????
????????? ??????????? ?????????? ? ????????????? ???????? ??????? ?????????? ?????????
?????????, ? ?? ??????????????? ??????? ??.
??????? ??????????????? ???????? ???????????? ? 1987 ?. G. Danielson ???????? ???????????? ????????????? ????????. ???????? ??????????? ? ?????? ???????? ????? ?????????????????
???????? ? ???????? ╚?????╩ ??? ????????? ????? ?????????????????? ???????? ??? ?????? ??????????????? ??????? [25, 26]. ??? ???? ????????????? ???????? ????? ???? ????????? ??? ? ???????????? ???????, ??? ? ??? ???, ? ? ????????
╚?????╩ ????? ??????????? ???????, ? ??? ????? ? ?
????????????, ?? ????????? ??????????.
????????????? ???????????? ?????? ????? ????????? ????????????? ???????????:
? ?????? ? ??????? ??????, ??????????????
?????????? (????????? ????), ? ????? ????????????????????????? ????????, ???????????? ? ???????? ╚?????╩, ?? ???????????? ??????????? ?????????, ?????????? ????? ?? ?????? ??????????
?????????;
? ??????? ????? ?????????? ?????? ?? ?? ? ??
????? ???? ?????? ????? ?????? ???????;
? ????? ????????? ?????????????? ?????????
???????? ???????, ??? ????????? ???????? ?????????????? ???????? ????? ?? ? ?? ? ????????? ?
??? ?????????????? ????? ? ?????? ???????;
? ?????????? ????? ??????????????? ???????
????? ???? ???????????? ??? ?????????? ?????????????? ?????? ?????? ? ????? ??;
? ? ??????????? ??????? ????????????? ?????
???? ????????? ??? ????????????? ?????????
?????.
????? ???????, ??????? ????? ?? ?? ? ??,
??????? ??????? ????????? ??????????, ???????
?????????, ?????????? ?????????? ??????? ???????? ????????????? ?????????? ????????????? ????? ?????? ?????????????, ??????????????? ??????? ?? ?????????? ? ?????? ??????? ?????????? ?
?????????? ??????? [20, 22, 26].
?????? ?????????? ???????????? ????????????? ???????? ?? ?????? ????????. ?????????? ??????????? ????????? ????? ??????????? ?????? ?????????? ?????????. ?????????? ????? (????????,
???????? ╚Hancock╝╩) ?????? ????? ?????????? ?
?????????? ????????? ??????, ? ??????? ?????
????? ???? ?????? ??? ?????? ????? ?????????.
7
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
?????????? ???????? ? ???????????? ?????????
(????????, ???????? ╚???╝╩), ??? ???????, ??????
?????????? ? ????????? ?????? ? ?????? ?????????? ?????? ?????, ? ????? ????? ?????????????
???????? ?????? ?????? ????????, ????? ????????
?????? ??????? ??? ????????? ?????????? ??????? ??? ?????? ???????? ??????. ? ????????? ??????? ??? ???????? ????? ???? ????????? ???
?????????? ??????????????????. ? ???????????
??????? ????? ?????????????? ?????? ?? ??????????? ???????? ??? ?????? ?????? ??-?? ????????????? ?????????? ???????????????? ???????? ?????????? ?????????? ?????????? ??????????
? ?????????? ?????????? ???? [11, 27]. ??? ????? ???????????? ??? ?????????? ????????????
????????????? ???????? ????? ???????? ????????? ???????????? ??? ??????? ?????????????
???????? [22].
?????????????? ???????? ??? ?????????? ?????????? ?????????????? ?????? ?? ???????? ??????????? ?????????????? ???????? ? ??????? ???
??????? ? ????????????. ? ??????? ?? ?????????
??? ?????????? ???????-?????????? ?????????????? ??? ?????????????? ?????? ???????????? ???????????? ?????????, ??? ??? ?????????????? ????????? ??????? ???????? ????? ?? ???????? ?????? ?????????? ????????? [18, 28]. ???????
????????????? ???????? ????? ????? ????????????
???????? ??????????, ??, ??? ???????? ?? ??????????? ???????????? ?. Fiore ? ?????. [29], ??? ?????????? ??????? ? ??????? ??????? ??????????????
??????????? ? ??????????? ? ??????? ???????.
??????? ??????????? ??????????? ?????????????? ???????? ??? ?????????? ?????????? ???????? ???????? ??, ??? ? ???????? ????? ????????? ???????????? ???????? ???????????? ???????? ?
?????????? ?? [30].
?????? ????????? ?? ??????? ???? (????????,
???) ?????????? ?? ?????????? ????????????
????????????? ???????? ? ??????? ???????????
?????? ?? ??? ????????? ?????????? ?????????????? ?????? ?? [20, 22]. J. Brown ? ?????. [19] ???
???????????? ?????????? ???????? ?????????????? ??????????? ?? PTFE. ?????? ????? ???????????? ????????, ??? ???????? ?????????? ??????????? ?? ???????? ? ???????? ?????????? ?????????????? ?????? ?? (??????????? ?? PTFE
????????? ? ???????). ???????? ?? ??, ??? ?? ???????? ??????????? ????????? ???????? ????????????, ???? ????? ???????????????? ??? ?????????,
??? ???????????? ????????????? ???????? ?????
?? ? ??.
Йбашн╦з?з? шрз??лблк? с╥рз?шм?кк мсл?шкз?
???????????? ?????? ? ??????????? ???????????? ?????????, ???????????? ????????? ????????? ?? ?????? ?????????? ???????? ????? ?? ?
??, ???????????????.
8
???????????? ??????????? ??? ????????? ???????? ????????? ????? ?? ? ?? ??????????? ????,
??? ??? ????????? ??????????? ????????, ??? ??????????? ????? ??????? ?????????? ????????? ???
??????????? ????????? ?????? [24]. ? ?????????????, ?????????????? ? XXI ?., ???????????? ??????????? ????????? ?? 0 ?? 9% [19?21, 31?34].
?????????? ???? ????????? ???????? ?? ???????? ????? ?? ? ?? ???????? ? ??????? ????. ?
????????? ?? ????? ?????????? ??????? ?????????? 446 ????????? ???????? ?? ?????????????
?????? ??. ?????????? ? ??????????? ?? ??? ????
?????????? ?????????????? ?????? ??. ????? ??????????? ??? ????????? ????????? ?? ???????? ?
???? ????? ????????? 4,9%. ????? ???????, ????????????? ? ?????? ? 1989 ?? 1992 ?., ????????????
??????????? ????????? 1,7%, ? ? ?????? ? 1993 ??
2000 ?. ??? ????????????? ??????? ????????
(n = 55) ????????? ??????? ?? ???? [20]. ???????????? R. Jonas ? ?????. [7] ? J. Stark ? ?????. [27]
????????????, ??? ???????? ????? ???? ????????
? ?????? ??????, ? ??????? ????????, ???????????? ????????? ?????????????? ???????, ????????
??????? ?????? ?????????. ? ????? ? ???? ??????
???????? ??? ?????? ??????????? ??? ??????????
????? ???????? ???????????? ?????????, ???????? ?? ?????????????? ?????????? ????? ??????
?????????.
? ????????? ??????????, ???????????? ???????????????? ????????????? ?????? ?????? ???????? ? ??? ????????????? ??????????, ??????
?????????????. ???, J. Zachariah ? ?????. [24] ??
??????? ???????? ???????? ? ????????????????
??????????? ????? ???????? ????????? ? ??????? ?
??????????? ????????. ? ?? ?? ????? ? ???????????? S. Mohammadi ? ?????. [18], ??????????? ?????????? ?????????? ?????????? ????????? ?????
?? ? ??, ???????? ????? ????????????? ?????????? ???????? ????? ????? ??????? ??? ?? ? ??
??? ??????? ?? ??????????, ??? ????????, ???????????? ?????? ???????? (? = 0,02), ? ???? ????????? ? ?????????? ?????????? ?? ??? ??????
?????????? (? = 0,05). ??????????? ?????????????? ???????? ? ??????? ??????? ?? ??? ??????????
?????????? ?????????????? ?????? ?? ? ????????? ????????????????? ???????, ?? ??????
Ch. Bermudez ? ?????. [22], ?? ????????? ?????????
??????? ?? ???????????????? ?????????? ?? ? ??.
?????????? ??????????? ? ??????? ?? ????????? ?????????? ???????? ????????? ??????????
?????? ?????????? ??????????? ?????????? ??
????????? ????? ?? ? ??.
???????? ???????????? ????????? ?????????
??????? ? ?????????? ??????? ????? ??????????
?????????? ?????????????? ?????? ?? ????????
??????????? ??????????? ?????????? ?????????
????????? ?????? ? ????????????????? ???????????????, ????????? ????? ??????, ?????????
??????.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
? ???????????? S. Mohammadi ? ?????. [18], ??????????? ?????????? ?????????? ?????????? ????????? ????? ?? ? ?? ?? ??????? ???????? ?????????? ????????? ????? ???????? 5,3,2 ????, ?????????? ??????????? ?? ?????????????. ?????? ?
???????????? J. Zachariah ? ?????. [24] ? ????? ??????????????? ???????? ?????????? ? 7,3 ???? (??
3,9 ?? 10,9 ????), ????? ???????????? ?? ??????
?????????????? ????????? 99% ????? 1 ???, 96%
????? 5 ??? ? 95% ????? 10 ???. ??? ????????? ??????, ????????? ? ???? ????????????, ????????? ?
?????? ?????????, ???????????? ?????? ????????,
?????? ?????? ?? ??????? ???? ?????? ????????????? ????????????. ?????????, ??????????? ????
?????????? ?????? ??? ?????????? ?????????? ???????? ????? ?? ? ??, ???? ??????? ??????? ???????, ????????????????? ??????????? ????? ????????? ?????? ? ???????? ???????? ? ????? ???????????? ?????, ??????? ? ???????????????
???????????? ????????????? ???????.
? ????????? Ch. Bermudez ? ?????. [22] ?????
?????????? ???????????? ????? ?????????????
???????? ???????????? ?????? ????? 5, 10 ? 15 ???
????????? ?????????????? 91; 91 ? 76%, ? ?????
???? ????????????? 11 ?????????? ???????. ????????? ?????????? ??????????? ???? ?????????
?????? (n = 3), ????????? ???????????????, ????????????? ???????? ???????????? (n = 3), ? ????????????? ????????-??????? (n = 1). ? 3 ???????
??????? ?????? ???? ??????????, ? ? 1 ?????? ??
??????? ? ????????? ??????????. ?????????, ???
????? 10-??????? ??????? ?????????? ???????????? ???? ???? ? ?????? ????????? ? ???????????????? ???????? ? ??????? ??????? ??. ??????
???? ?????????? ?? ???? ?????????????? ????????????? (p = 0,8). ? ?? ?? ????? ??????? ?? ?????????
???????? ??-?? ????????????????? ????????????
????????????? (???????? Danielson) ? ?????????
? ???????????????? ???????? ??????? ?? ?????
10 ??? ?????????? ???? ????, ??? ? ????????? ???
??????? ? ???????? ???????. ????? ??????? ?? ????????? ???????? ?? ???????? ????? ????????
Danielson ????? 5, 10 ? 15 ??? ????????? 97,6; 90,7
? 82%, ??????????????. ????????? ????????? ?????????? ???????? ?????????? ???????? ????????????, ??????????? ????? ???????????? ????????????? ???????? (n = 2), ?????? ? ???????????????
????????? ?????????? (n = 1) ? ?????????? ????????? ?????????? (n = 1). ??? 7 ????????? ?????????
? ?????????? ?? ????????, ?? ????????? ? ?????????????? ????????.
????????? ? ??????? ?? ?????????? ? ??????????? ?? ??????????? ??????? ????????? ?????????? ?????????????? ?????? ?? ????????? ?????????????. ???, ? ???????????? J. Zachariah ? ?????.
[24] ???????? ????????? ? ????? ???????? ???????
?? ????????? ???????? ?? ???????? ? ?????? ????????? ? ??????? ???????? ?? ????????? ? ???????
? ???????????? ??????????? ???????? (p = 0,07).
????? ??????? ?? ????????? ?????????? ?????????
99% ????? 1 ???, 80% ????? 5 ??? ? 39% ????? 10 ???.
? ???????????? S. Mohammadi ? ?????. [18], ????? ??????????? ?????????? ?????????? ?????????? ????????? ????? ?? ? ??, ??????? ?? ??????
????????? ???????? ??? ?????????? ???????? ???? ??????????? ???? ? ?????? ????????? ? ?????????????? ????????? ? 97,9 ╠ 2,0; 83,7 ╠ 3,0 ?
70,4 ╠ 6,0% ????? 3, 5 ? 8 ??? ??????????????, ??? ?
????????? ? ????????? ???????? ?????? ???????? ?
94,9 ╠ 2,0; 61,0 ╠ 4,0 ? 30,5 ╠ 8,0% ????? 3, 5 ? 8 ???
??????????????.
? ???????? ??????????? ????????????? (????????????????? ????? ??????) ????????? ????? ?????????? ?? ?????????? ????????? ????? ??????????, ??? ??????? ????????, ????????? ???????, ???
????????????????? ????????, ??? ??????, ???????
? ???????? ????????????? ????????? ? ??. [19, 20,
27, 32?35]. ?????????? ????? ????????, ??? ??????? ??????? ???????? ???????? ?????, ????????
?? ????????????? ???? ????? ????????? ????? ??
? ??, ???????????? ??? ??????????? ?????????
?????????? ??????? ?????? [18, 20?22, 31, 32].
???????? ???????? ???????? ?????????????? ????????? ???????? ???????? ?????????? ????? ????????????? ????? ?????????.
M. Bielefeld ? ?????. [15] ?????????? ????????
????? ??? ??????????? ?????? ????? ?????? ????????????????? ????????. ? ????????????
J. Zachariah ? ?????. [24] ??????????? ╚????????????╩ (???????????? ????? ?? ??????? ???????????
????) ????????? ??? ?????????? ???? ??????? ? ????? ???????? ???????? ??????? ?? ????????? ?????????? ? ?????????????. ?????? ? ??? T. Karamlou
? ?????. [36] ? B. Askovich ? ?????. [8] ??????????,
??? ??????????? ???????? ? Z-score ??? ???????? ????? 2,5 ????? ???? ??????? ? ??????????? ???????
??????? ?? ????????? ????????. ??? ?????? ????????? ?????????????? ??????? ??????????, ??? ??????? ?????????????? ????????? ?????? ??????????? ??????????????? ???????? ???????? ? ??,
??? ?????? ????????? ???????-???????????? ????????????? ? ???????? ?? ??.
??? ????? ???????? ????? ?????? ??????????
? ???????????? S. Mohammadi ? ?????. [18] ???????? ?????????? ??? ????????? ?????????? ?????????????? ?????? ?? ??????????? (p = 0,004),
??????? ????? ??????? ????????????????? ?????
??????, ??? ??????????? ? ???????????? ????????. J. Stark ? ?????. ????????? ?????????????, ???
????????????? ???????? ????? ????? ?????? ??????????? ????????????????? ????? ???????? ?
????? ??????? ??? ??????????? ??? ????????? ??????????? [27].
S. DeLeon ? ?????. [35] ????????, ??? ????????? ?? ??????? ??? ??????????????? ????? ??
????? ???? ???????????????? ?????????, ????????? ?? ????????????? ?????????????? ?????
?? ? ??.
9
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
????? ????????????? ?????????? ????????, ???? ??? ?????????? ??????? ? ???????? ????????
???????? ????????? ?????? ??, ? ????????????
S. Mohammadi ? ?????. [18] ????? ???????????????? ??????? ????????? ?????????, ??????????? ??
?????? ????????? ????????. ?????????? ???????????? ??????? ???????? ????????? ? ???? ??????? ?????? ??????? ???????? ?????????? ? ?????????? ???????? ?????????? ? ?????????? ??????
?????? ????????, ??????? ????? ???? ????????????. ??? ????? ???????? ? ?????????? ?????????????? ? ???????? ?????? ?? ?, ?????????????, ?
????? ???????? ???????? ????????? ????? ?? ?
?? ? ????? ??????? ???????? ?????????.
????? ???????, ?????? ???????????? ??????
??????????????? ? ????? ???? ???????, ?????????? ?????????????? ??????? ?????????? ?????????????? ?????? ??. ?? ?????????? ??????? ????????? ????????? ???????? ?????????, ???????????
????? ?????????? ?????????? ? ??????? ?????????????? ??????? ? ?????? ????????? ????????? ?
??????????? ???????????????? ????????? ?????
?? ? ??. ??????? ????? ???????, ?????????????
?? ?????? ?????????? ?????????????? ?????? ??,
?????????? ??? ??? ???? ??????????? ? ????????? ? ??????????? ???????????. ????????? ?????????? ???????????? ?????? ?? ????????? ???????
????????????? ?????? ? ???, ????? ?? ??????????? ??????? ???????? ??????????? ??? ??????????
????????? ???????????????? ? ?????????? ??????????? ? ???? ????????? ?????????.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
??????????
1.
2.
3.
4.
5.
6.
7.
8.
9.
10
????????? ?.?., ????????? ?.?., ??????? ?.?. ????????????????? ???????? ? ???????? ?????????? ???????
??????. ?.: ????? ??. ?.?. ???????? ????; 2000.
??????????? ?.?., ??????? ?.?., ???????? ?.?. ?????????????? ?????? ???????? ??????? ??? ??????? ?????. ??????? ????????. 1976; 5: 3?7.
??????? ?.?., ??????? ?.?., ???????? ?.?., ???????? ?.?.
?????????????? ?????? ? ???????? ???????? ???????: ????
????????????? ???????. ??????? ????????. 1977; 6: 83?90.
????????? ?.?. ?????? ???? ????????????? ?????????????? ????????? ??? ????????? ?????????? ??????? ??????.
??????? ? ????????-?????????? ????????. 1993; 5: 25.
Schlichter A., Kreutzer C., de Cassia Mayorquim R., Simon J.,
RomАn M., Vazquez H. et al. Five- to fifteen-year follow-up of
fresh autologous pericardial valved conduits. J. Thorac.
Cardiovasc. Surg. 2000; 119: 869?79.
Agarwal K., Edwards W., Feldt R., Danielson G., Puga F.
Clinicopathological correlates of obstructed right-sided
porcine-valved extracardiac conduits. J. Thorac. Cardiovasc.
Surg. 1981; 81: 591?601.
Jonas R., Freed M., Mayer J., Castaneda A. Long term followup of patients with synthetic right heart conduits. Circulation.
1985; 72:77?83.
Askovich B., Hawkins J., Sower C., Minich L., Tani L.,
Stoddard G. et al. Right ventricle-to-pulmonary artery conduit
longevity: is it related to allograft size? Ann. Thorac. Surg.
2007; 84: 907?12.
??????????? ?.?., ????????? ?.?., ????????? ?.?., ???????? ?.?. ???? ?????????????? ?????? ???????? ???????
? ????????? ????????-?????????? ???????? ??. ?.?. ????-
20.
21.
22.
23.
24.
25.
26.
27.
???? ??? ????. ??????? ? ????????-?????????? ????????. 1991; 9: 3?9.
????????? ?.?. ?????????????? ????????? ?????? ? ???????? ?????????? ??????? ??????: ???. ? ?-?? ???. ????. ?.; 1991.
????????? ?.?., ????? ?.?., ??????? ?.?., ???????????? ?.?., ????????? ?.?., ?????? ?.?. ? ??. ?????????
???????? ????? ??????????? ????????? ?????????? ??????? ??????. ??????? ? ????????-?????????? ????????.
1996; 6: 3?41.
???????? ?.?., ????????? ?.?., ??????? ?.?., ???????? ?.?., ???????? ?.?., ????? ?.?. ? ??. ?????????????
??????? ??? ?????????? ?????????, ????????????????
??????? ? ??????????? ???????? ??????. ??????? ? ????????-?????????? ????????. 2000; 4: 4?9.
Schreiber C., Eicken A., Balling G., Wottke M., Schumacher G., Un Paek S. et al. Single centre experience on primary
correction of common arterial trunk: overall survival and freedom from reoperation after more than 15 years. Eur. J.
Cardiothorac. Surg. 2000; 18: 68?73.
Kirklin J.W., Barratt-Boyes B.G. Cardiac Surgery. N.Y.:
Churchill Livingstone; 2004.
Bielefeld M., Bishop D., Campbell D., Mitchell M., Grover F.,
Clarke D. Reoperative homograft right ventricular outflow tract
reconstruction. Ann Thorac Surg. 2001; 71 (2): 482?7.
Ruzmetov M., Shah J., Geiss D., Fortuna R. Decellularized versus standard cryopreserved valve allografts for right ventricular
outflow tract reconstruction: A single-institution comparison.
J. Thorac. Cardiovasc. Surg. 2012; 143.(3): 543?9.
Koh M., Yagihara T., Uemura H., Kagisaki K., Hagino I.,
Ishizaka T. et al. Long-term outcome of right ventricular outflow tract reconstruction using a handmade tri-leaflet conduit.
Eur. J. Cardiothorac. Surg. 2005; 27: 807?14.
Mohammadi S., Belli E., Martinovic I., Houyel L., Capderou A., Petit J. et al. Surgery for right ventricle to pulmonary
artery conduit obstruction: risk factors for further reoperation.
Eur. J. Cardiothorac. Surg. 2005; 28: 217?22.
Brown J., Ruzmetov M., Rodefeld M., Vijay P., Turrentine M.
Right ventricular outflow tract reconstruction with an allograft
conduit in non-Ross patients: risk factors for allograft dysfunction and failure. Ann. Thorac. Surg. 2005; 80: 655?64.
Dearani J., Danielson G., Puga F., Schaff H., Warnes C.,
Driscoll D. et al. Late follow-up of 1095 patients undergoing
operation for complex congenital heart disease utilizing right
ventricle to pulmonary artery conduits. Ann. Thorac. Surg.
2003; 75: 399?411.
Homann M., Haehnel J., Mendler N., Un Paek S., Holper K.,
Meisner H. et al. Reconstruction of the RVOT with valved biological conduits: 25 years experience with allografts and
xenografts. Eur. J. Cardiothorac. Surg. 2000; 17: 624?30.
Bermudez C., Dearani J., Puga F., Schaff H., Warnes C.,
O?Leary P. et al. Late results of the peel operation for replacement of failing extracardiac conduits. Ann. Thorac. Surg.
2004; 77: 881?8.
????????? ?.?., ?????? ?.?., ???????? ?.?., ????? ?.?.
????????? ???????? ????? ????????? ?????????? ??????? ??????. ?.: ????? ??. ?.?. ???????? ????; 2013.
Zachariah J., Pigula F., Mayer J., McElhinney D. Right ventricular to pulmonary artery conduit augmentation compared
with replacement in young children. Ann. Thorac. Surg. 2009;
88: 574?80.
Danielson G., Downing T., Schaff H., Puga F., DiDonato R.,
Ritter D. Replacement of obstructed extracardiac conduits
with autogenous tissue reconstruction. J. Thorac. Cardiovasc.
Surg. 1987; 93: 555?9.
Cerfolio R., Danielson G., Warnes C., Puga F., Schaff H.,
Anderson B. Results of an autologous tissue reconstruction for
replacement of obstructed extracardiac conduits. J. Thorac.
Cardiovasc. Surg. 1995; 110: 1359?68.
Stark J., Bull C., Stajevic M., Jothi M., Elliott M., De Leval M.
Fate of subpulmonary homograft conduits: Determinants of
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
latehomograft failure. J. Thorac. Cardiovasc. Surg. 1998; 115:
506?16.
28. Downing T., Danielson G., Schaff H., Puga F., Edwards W.,
Driscoll D. Replacement of obstructed right ventricular-pulmonary arterial valved conduits with nonvalved conduits in
children. Circulation. 1985; 72: 84?7.
29. Fiore ?., Peigh P., Robinson R. Valved and nonvalved right ventricular-pulmonary arterial extracardial conduits. J. Thorac.
Cardiovasc. Surg. 1983; 86: 490?6.
30. Kanter K., Jason M., Parks W., Tam V., Sharma Sh.,
Williams W. et al. One hundred pulmonary valve replacements
in children after relief right ventricular outflow tract obstruction. Ann. Thorac. Surg. 2002; 73: 1801?7.
31. Tweddell J., Pelech A., Frommelt P., Mussatto K., Wyman J.,
Fedderly R. et al. Factors affecting longevity of homograft
valves used in right ventricular outflow tract reconstruction
for congenital heart disease. Circulation. 2000; 102: 30?5.
32. Forbess J., Shah A., St Louis J., Jaggers J., Ungerleider R.
Cryopreserved homografts in the pulmonary position:
determinants of durability. Ann. Thorac. Surg. 2001;71:
54?9.
33. Meyns B., Jashari R., Gewillig M., Mertens L., Komarek A.,
Lesaffre ?. et al. Factors influencing the survival of cryopreserved homografts: the second homograft performs as well as
the first. Eur. J. Cardiothorac. Surg. 2005; 28: 211?6.
34. Rodefeld M., Ruzmetov M., Turrentine M., Brown J.
Reoperative right ventricular outflow tract conduit reconstruction: risk analyses at follow up. J. Heart Valve Dis. 2008; 17:
119?26.
35. DeLeon S., Tuchek J., Bell T., Hofstra J., Hofstra J., Vitullo D.,
Quinones J. et al. Early pulmonary homograft failure from
dilatation due to distal pulmonary artery stenosis. Ann.
Thorac. Surg. 1996; 61: 234?7.
36. Karamlou T., Ungerleider R., Alsoufi B., Burch G., Silberbach M., Reller M. et al. Oversizing pulmonary homograft conduits does not significantly decrease allograft failure in children. Eur. J. Cardiothorac. Surg. 2005; 27: 548?53.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
Podzolkov V.P., Zelenikin M.A., Shatalov K.V. Extracardiac
conduits in congenital heart surgery. Moscow: Nauchnyy tsentr
serdechno-sosudistoy khirurgii im. A.N. Bakuleva RAMS; 2000
(in Russian).
Burakovskiy V.I., Chekanov V.S., Krasikov L.I. Pulmonary
artery replacement in correction of Tetralogy of Fallot.
Grudnaya khirurgiya. 1976; 5: 3?7 (in Russian).
Bukharin V.A., Chekanov V.S., Krasikov L.I., Makhmudov M.M. Pulmonary artery and pulmonary valve replacement:
the types of prostheses. Grudnaya khirurgiya. 1977; 6:
83?90 (in Russian).
Podzolkov V.P. Aortic homograft implantation for the correction of congenital heart defects: first experience. Grudnaya i
serdechno-sosudistaya khirurgiya. 1993; 5: 25 (in Russian).
Schlichter A., Kreutzer C., de Cassia Mayorquim R., Simon J.,
RomАn M., Vazquez H. et al. Five- to fifteen-year follow-up of
fresh autologous pericardial valved conduits. J. Thorac.
Cardiovasc. Surg. 2000; 119: 869?79.
Agarwal K., Edwards W., Feldt R., Danielson G., Puga F.
Clinicopathological correlates of obstructed right-sided
porcine-valved extracardiac conduits. J. Thorac. Cardiovasc.
Surg. 1981; 81: 591?601.
Jonas R., Freed M., Mayer J., Castaneda A. Long term followup of patients with synthetic right heart conduits. Circulation.
1985; 72:77?83.
Askovich B., Hawkins J., Sower C., Minich L., Tani L.,
Stoddard G. et al. Right ventricle-to-pulmonary artery conduit
longevity: is it related to allograft size? Ann. Thorac. Surg.
2007; 84: 907?12.
Burakovskiy V.I., Podzolkov V.P., Zelenikin M.A.,
Krasikov L.I. Experience ?f pulmonary artery replacement at
20.
21.
22.
23.
24.
25.
26.
27.
the Bakoulev Institute of Cardiovascular Surgery USSR
Academy of Medical Sciences. Grudnaya i serdechno-sosudistaya khirurgiya. 1991; 9: 3?9 (in Russian).
Zelenikin M.A. Pulmonary artery replacement in congenital
heart surgery: diss. Moscow; 1991 (in Russian).
Podzolkov V.P., Cheban V.N., Gadzhiev A.A., Astrakhantseva T.O., Amirkulov B.D., Drobot D.B. et al. Reoperation after
radical surgery for congenital heart disease. Grudnaya i
serdechno-sosudistaya khirurgiya. 1996; 6: 3?41 (in Russian).
Kokshenev I.V., Podzolkov V.P., Gadzhiev A.A., Barchukov A.Yu., Pursanov M.G., Yurlov I.A. et al. Surgical management in obstruction conduits implanted in patients with congenital heart disease. Grudnaya i serdechno-sosudistaya
khirurgiya. 2000; 4: 4?9 (in Russian).
Schreiber C., Eicken A., Balling G., Wottke M., Schumacher G., Un Paek S. et al. Single centre experience on primary
correction of common arterial trunk: overall survival and freedom from reoperation after more than 15 years. Eur. J.
Cardiothorac. Surg. 2000; 18: 68?73.
Kirklin J.W., Barratt-Boyes B.G. Cardiac Surgery. N.Y.:
Churchill Livingstone; 2004.
Bielefeld M., Bishop D., Campbell D., Mitchell M., Grover F.,
Clarke D. Reoperative homograft right ventricular outflow tract
reconstruction. Ann. Thorac. Surg. 2001; 71 (2): 482?7.
Ruzmetov M., Shah J., Geiss D., Fortuna R. Decellularized versus standard cryopreserved valve allografts for right ventricular
outflow tract reconstruction: A single-institution comparison.
J. Thorac. Cardiovasc. Surg. 2012; 143.(3): 543?9.
Koh M., Yagihara T., Uemura H., Kagisaki K., Hagino I.,
Ishizaka T. et al. Long-term outcome of right ventricular outflow tract reconstruction using a handmade tri-leaflet conduit.
Eur. J. Cardiothorac. Surg. 2005; 27: 807?14.
Mohammadi S., Belli E., Martinovic I., Houyel L., Capderou A., Petit J. et al. Surgery for right ventricle to pulmonary
artery conduit obstruction: risk factors for further reoperation.
Eur. J. Cardiothorac. Surg. 2005; 28: 217?22.
Brown J., Ruzmetov M., Rodefeld M., Vijay P., Turrentine M.
Right ventricular outflow tract reconstruction with an allograft
conduit in non-Ross patients: risk factors for allograft dysfunction and failure. Ann. Thorac. Surg. 2005; 80: 655?64.
Dearani J., Danielson G., Puga F., Schaff H., Warnes C.,
Driscoll D. et al. Late follow-up of 1095 patients undergoing
operation for complex congenital heart disease utilizing right
ventricle to pulmonary artery conduits. Ann. Thorac. Surg.
2003; 75: 399?411.
Homann M., Haehnel J., Mendler N., Un Paek S., Holper K.,
Meisner H. et al. Reconstruction of the RVOT with valved biological conduits: 25 years experience with allografts and
xenografts. Eur. J. Cardiothorac. Surg. 2000; 17: 624?30.
Bermudez C., Dearani J., Puga F., Schaff H., Warnes C.,
O?Leary P. et al. Late results of the peel operation for replacement of failing extracardiac conduits. Ann. Thorac. Surg.
2004; 77: 881?8.
Podzolkov V.P., Alekyan B.G., Kokshenev I.V., Cheban V.N.
Reoperation after correction of congenital heart disease. Moscow:
Nauchnyy tsentr serdechno-sosudistoy khirurgii im. A.N. Bakuleva RAMS; 2013 (in Russian).
Zachariah J., Pigula F., Mayer J., McElhinney D. Right ventricular to pulmonary artery conduit augmentation compared
with replacement in young children. Ann. Thorac. Surg. 2009;
88: 574?80.
Danielson G., Downing T., Schaff H., Puga F., DiDonato R.,
Ritter D. Replacement of obstructed extracardiac conduits
with autogenous tissue reconstruction. J. Thorac. Cardiovasc.
Surg. 1987; 93: 555?9.
Cerfolio R., Danielson G., Warnes C., Puga F., Schaff H.,
Anderson B. Results of an autologous tissue reconstruction for
replacement of obstructed extracardiac conduits. J. Thorac.
Cardiovasc. Surg. 1995; 110: 1359?68.
Stark J., Bull C., Stajevic M., Jothi M., Elliott M., de Leval M.
Fate of subpulmonary homograft conduits: Determinants
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Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
28.
29.
30.
31.
of latehomograft failure. J. Thorac. Cardiovasc. Surg. 1998;
115: 506?16.
Downing T., Danielson G., Schaff H., Puga F., Edwards W.,
Driscoll D. Replacement of obstructed right ventricular-pulmonary arterial valved conduits with nonvalved conduits in
children. Circulation. 1985; 72: 84?7.
Fiore ?., Peigh P., Robinson R. Valved and nonvalved right ventricular-pulmonary arterial extracardial conduits. J. Thorac.
Cardiovasc. Surg. 1983; 86: 490?6.
Kanter K., Jason M., Parks W., Tam V., Sharma Sh.,
Williams W. et al. One hundred pulmonary valve replacements
in children after relief right ventricular outflow tract obstruction. Ann. Thorac. Surg. 2002; 73: 1801?7.
Tweddell J., Pelech A., Frommelt P., Mussatto K., Wyman J.,
Fedderly R. et al. Factors affecting longevity of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease. Circulation. 2000; 102:
30?5.
32.
33.
34.
35.
36.
Forbess J., Shah A., St Louis J., Jaggers J., Ungerleider R.
Cryopreserved homografts in the pulmonary position: determinants of durability. Ann. Thorac. Surg. 2001;71: 54?9.
Meyns B., Jashari R., Gewillig M., Mertens L., Komarek A.,
Lesaffre ?. et al. Factors influencing the survival of cryopreserved homografts: the second homograft performs as well as
the first. Eur. J. Cardiothorac. Surg. 2005; 28: 211?6.
Rodefeld M., Ruzmetov M., Turrentine M., Brown J. Reoperative right ventricular outflow tract conduit reconstruction: risk
analyses at follow up. J. Heart Valve Dis. 2008; 17: 119?26.
DeLeon S., Tuchek J., Bell T., Hofstra J., Hofstra J., Vitullo D.,
Quinones J. et al. Early pulmonary homograft failure from
dilatation due to distal pulmonary artery stenosis. Ann.
Thorac. Surg. 1996; 61: 234?7.
Karamlou T., Ungerleider R., Alsoufi B., Burch G., Silberbach M., Reller M. et al. Oversizing pulmonary homograft conduits does not significantly decrease allograft failure in children. Eur. J. Cardiothorac. Surg. 2005; 27: 548?53.
????????? 10.06.2014
╘ ????????? ???????, 2014
??? 616.131-007.272-089.168:616.131/.132-007.41-089
?????????? ?????????? ????????? ?????????
????? ???????? ????????????? ????????????
??? ???????????? ????????????? ???????
?.?. ?????????, ?.?. ????????, ?.?. ????????, ?.?. ????????,
?.?. ????????, ?.?. ???????, ?.?. ?????, ?.?. ??????????
????? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩
(???????? ? ???????? ??? ? ???? ?.?. ???????); ?????????? ?????, 135,
??????, 121552, ?????????? ?????????
????????? ???????? ????????, ?????? ???. ????, ?????????, ???????? ???;
???????? ????? ??????????, ?????? ???. ????, ?????????^ ??????? ????. ????.;
???????? ?????? ?????????, ?????? ???. ????, ?????????, ??????? ????. ????.;
???????? ??????? ??????????, ?????? ???. ????, ?????????, ??????? ????. ????.;
???????? ?????? ?????????, ?????? ???. ????, ??????? ????. ????., e-mail: samsonof@yandex.ru;
??????? ????? ???????, ?????? ???. ????, ??????? ????. ????.;
????? ???????? ??????????, ?????? ???. ????, ??????? ????. ????.;
?????????? ???? ????????????, ?????? ???. ????, ??????? ????. ????.
????????. ? ?????????? ????? ????? ????????????? ????????? ???????????? ????????????? ??????? (???) ??????? ???????? ???????????? ???????? ? ?????????? ???????? ???????? ??????? (??).
????. ??????????? ?????????? ?????????? ??????? ?? ????? ????????????? ????????? ???????????? ????????????? ???????.
???????? ? ??????. ????????? ???????? ????????? 27 ??????? ? ????????????? ????????????? ??????? ? ??????????
????? ????? ????????????? ????????????. ? 18 ??????? ???????? ??????? ?? ?????? ?????? ??, ? 9 ? ??????? ?????? ??.
???????? ?????????????? ???????? ?? ?? ? 65,3 ╠ 19,6 ?? ??. ??., ?? ?????? ?? ? 30,2 ╠ 8,3 ?? ??. ??. ??????? ??????? ? ??????? ???????? 4,4 ╠ 2,3 ????. ???????? ????? ????????? ? ????????? ?????????? ? ? ??????? 4,2 ????.
??????????. ???????? ?? ???????????????????? ???????? ????????? 15 ???????, ???????????????? ????????? ????????????? (?????) ?????????? ???????? ?????? ? ?????? ?? ? 12. ??????????? ????????? 3,7% (???? 1 ???????). ????? ????????
???????? ???????? ?????????????? ???????? ?? ?? ???????? ? 62,4 ?? 18,9 ?? ??. ??., ????? ????? ????????? ???????? ?????????????? ???????? ????? ?????? ?????????? ? ??????? ?? ???????? ? 76,2 ?? 26,4 ?? ??. ??. ???????? ??????????????
???????? ??????????????? ? ????? ????? ???????? ? 30,2 ?? 18,7 ?? ??. ??.
12
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??????? ??????? ?????? ? ???????, ? 3, 2014
??????????. ?????? ?? ????? ????????????? ????????? ??? ????? ????????? ? ?????????? ?????????????? ????????? ?????? ??, ?????????? ??????? ??????? ??? ???????? ?????, ??????????? ??????????? ????????????? ??. ? ????????? ??????? ????? ?????????????? ????????????? ???????? ????????????? ??????? ??: ??????????????? ??????, ????????? ???????? ???????????????????? ??????? ? ???????? ????? ????????? ????????? ??????.
???????? ?????: ?????????? ????????? ?????? ??????? ?????????; ????????????? ????????? ???????????? ????????????? ???????; ????????? ????????.
ELIMINATION OF OBSTRUCTION OF PULMONARY BLOOD FLOW
AFTER ARTERIAL SWITCH OPERATION WITH TRANSPOSITION
OF THE GREAT ARTERIES
V.P. Podzolkov, I.V. Kokshenev, M.R. Chiaureli, M.G. Pursanov,
V.B. Samsonov, T.Yu. Danilov, V.N. Cheban, I.V. Zemlyanskaya
A.N. Bakoulev Scientific Center for Cardiovascular Surgery; Rublevskoe shosse, 135,
Moscow, Russian Federation
Podzolkov Vladimir Petrovich, MD, DM, Professor, Academician RAS;
Kokshenev Igor? Valer?evich, MD, DM, Professor, Chief Research Associate;
Chiaureli Mikhail R?mazovich, MD, DM, Professor, Chief Research Associate;
Pursanov Manolis Georgievich, MD, DM, Professor, Chief Research Associate;
Samsonov Viktor Borisovich, MD, DM, Leading Research Associate;
Danilov Timur Yur?evich, MD, DM, Leading Research Associate;
Cheban Vladimir Nikolaevich, MD, DM, Leading Research Associate;
Zemlyanskaya Inga Vladimirovna, MD, DM, Leading Research Associate
Introduction. In the long term after anatomic correction of transposition of the great arteries (TGA) the big problem is the patients
with residual stenosis of PA. Objective: To present the results of elimination of stenosis PA after anatomic correction transposition of
the great arteries.
Material and methods. In the Department of surgery of congenital heart defects in children older Bakulev Scientific Center of cardiovascular surgery re-operation was performed in 27 patients. In 18 cases the narrowing at the level of the trunk PA, 9 other narrow
branches of PA. The systolic pressure gradient on PA 65,3 ╠ 19,6 mmHg, on the branches of PA 30,2 ╠ 8,3 mmHg. The average age
of patients was 4,4 ╠ 2,3 years. The interval between primary and secondary operations averaged 4,2 years.
Results. In 15 patients performed plastic PA xenopericardial patch, 12 patients completed TLBA followed residual stenosis of the
trunk and branches of PA. Mortality was 3,7% (1 patient died). After open surgery, the systolic pressure gradient on PA decreased
from 62,4 to 18,9 mmHg., after total TLBA followed the systolic pressure gradient between the right ventricle and branches of PA
decreased from 76,2 to 26,4 mmHg. The systolic pressure gradient in the place TLBA followed fell from 30,2 to 18,7 mmHg.
Conclusion. Stenosis PA after anatomical correction TGA may occur as a result of insufficient allocation of branches in PA, the small
size of the patch to create a neoPA, inadequately completed the reconstruction of PA. In some cases, it may be the anatomical substrate subvalvular stenosis PA: infundibular stenosis, bulging structures atrioventricular valve in the outlet venous ventricle.
Key words: obstruction of the outflow tract of the right ventricle; anatomical correction transposition of the great arteries; re-operations.
г?б?блкб
?? ?????? ??????????, ? ?????????? ????? ????? ???????? ????????????? ???????????? ???
???????????? ????????????? ??????? (???) ?????????? ????????? ??????????: 1) ??????? ? ??????? ??????????????? ???????????; 2) ??????? ??????????? ?????? ????? ? ?????? ???????? ???????
(??); 3) ??????????????? ?????????????? (???????
?????????) ???????, ?????????? ????? ?????;
4) ?????????? ?????? ??????????????? ??????????? (????); 5) ??????????????? ?????? ????????? (??); 6) ????????? ????? ??????. ???????
????????? ???????? ?????????? ?? 5 ?? 10% [1, 2].
???????? ?????? ???????? ????????? ????????
????? ????????????? ???????????? ???????? ??????
??, ??????? ????????? ?????????? ???????????
????????? ?????? ??, ╚??????????????╩ ?? ?? ??-
?????? ??????????? ?????????? ????? ? ?????????? ????????? Lecompte. ??????? ???????? ?????
????? ??????? ??????? ?????????? ????????: ????????????? ????????? ?????? ??, ????????? ?????? ??????? ??? ???????? ?????, ??????????? ??????????? ????????? ? ??. ??? ??? ???????????
??????? ????? ???? ???????? ???????? ????????????? ??????? ??. ? ????????? ??????? ????? ?????????????? ????????????? ???????? ????????????? ??????? ???????? ???????: ???????????????
??????, ????????? ???????? ????????????????????
??????? ? ???????? ????? ??????? ?????????
(??), ????????? ???????????? ????? ??????????????? ??????????? [3, 4].
???? ???????? ????? ?????????? ???????? ?????
? ??????? ??????? ???? ????? ????????, ? ?????????? ?? ??????????? ?????????. ? 70% ????????? ????? ???????? ????????????? ????????????
13
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??????? ???????? ?????????????? ???????? ?????
?? ? ?? ????? 20 ?? ??. ??. ? 5?10% ??????? ????
???????? ?????????? ????? 40 ?? ??. ??., ? ??????
??? ???????? ????????? ? ?????????? ?????????
???????????? [5, 6].
???? ?????? ? ??????? ??????? ?????????????
? ??????????? ???????????????? ?????????? ?????????? ??????? ?? ????? ????????????? ????????? ???????????? ????????????? ???????.
Е?зб?к?н к обзс??
?? ?????? ? 2002 ?? 2014 ?. 27 ??????? ?????
????????????? ????????? ??? ????????? ????????? ????????. ??????? ??????? ????????? ?? 8 ???
?? 9 ???, ? ??????? ? 4,4╠2,6 ????. ???????? ?????
????????? ? ????????? ?????????? ???????? ??
6 ??? ?? 7 ???, ? ??????? ? 4,2╠1,6 ????.
?? ?????? ?????, ????? ????????????? ???????????? ? ???? 27 ??????? ??????????? ????????? ?????????? ??????????. ?????? ?? ??????? ? 27 ???????, ????????????? ???? ? ? 2, ????????????? ???? ? ? 2, ???????????????
??????????? ??????? ? ? 1, ???????????? ??????
????? ? ? 2.
??? ?????????? ??? ? 18 ??????? ?????????? ??????? ?? ?????? ?????? ??, ? 9 ? ???????
?????? ??. ??????? ?????? ?????? ? ????? ??
???????? ? 5 ?????????, ?????? ?? ? ? 2, ?????
?? ? ? 2 (???. 1). ????????? ?????????????? ???????? ? ?? ? ?????????????? ???????? ? ?? ????????? 0,87 ╠ 0,12, ????????????? ???????? ?
?? ? 87,2 ╠ 12,6 ?? ??. ??., ???????? ?????????????? ???????? ?? ?? ? 65,3 ╠ 19,6 ?? ??. ??., ??
?????? ?? ? 30,2 ╠ 8,3 ?? ??. ??.
?????? ? ??????? ??????????
????????? ????????????
????????? ?????????
????? ????????? ??????????????
?????????? (55,6%) ??????? ??????????? ?????? ?? ???????????? ??? ????????? ??????????
????????, ????????????, ????????? ?????. ??????????????? ?????????????? 2? ??????? ?????????? ? 6 ???????, 2? ? ? 1, ??? ??????????? ???????????????? ??????????????? ???????. ??? ???????? ?????????? ? III?IV ??????????????? ?????? ??
????????????? NYHA.
????????? 12 ????????? ???? ?????????? ???????? ????? ?????, ????????????????? ?????????? ?????????? ????????, ????? ???????? ???
????????? ? ?????, ?? ????? ???? ???????????.
?????????? ????????? ???? ????????? ??????????? ?? ?????????? ?? ???????????. ??? ???????? ??????????????? II ??????????????? ??????. ??????? ??????????? ? ??????? ?? ?????? ????????
123,2 ╠ 10,2 ?/?, ????????? ????? ?????????? ? ?????????? ? ? ??????? 95,3 ╠ 1,7%.
????? ????????? 38 ????????: 16 ??????? ? 1,
9 ? 2, 2 ? 3 ?????????????. ? 15 ??????? ????????? 22 (57,9%) ???????? ????????????? ?????????????, ? 12 ??????? ? 16 (42,1%) ????????? ??????????????? ????????.
? 15 ????????? ??????????? ???????? ????????? ????????, ?? ??? ? 5 ????????????? ??????????? ? ???????? ?????????????? ??????????????, ????????? ?????????? ?????, ?????????? ?
????????????????
????????????
?????????
Custodiol. ????? ?????????????? ??????????????
????????? 119,6╠18,2 ???, ????? ????????? ????? ?
61,3╠21,4 ???, ?????????? ??????????? ? 28 ╟?.
? ????????? 10 ??????? ???????? ??????????? ?
???????? ???????????? ????????. ????? ?????????????? ?????????????? ????????? 87,7╠19,2 ???
??? ?????????? ??????????? 32?34 ╟?. ??????????
???????? ? ???????? ????????? ????? ????????????? ??? ????????? ????????????? ???????.
??
??
??
??
??
?
?
?
???. 1. ??? ??????? ????? ???????? ????????????? ????????????, ?????? ????????????????:
? ? ? ????????????? ???????? ?????????? ????????????????? ?????????? ?????? ?? ? ??????????? ??? ???????? (???????); ? ? ? ??????? ???????? ??????????? ?????????? ?????? ?? ? ?? ??????? ? ??????? ?????????? (???????); ? ? ? ????????????? ???????? ??????????????? ??????? ????? ?? ? ??????? ?????? ?????? ? ????? ?? (???????)
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????? ?????? ?????????????? ?????????????? ?????????? ????? ??. ? 12 ??????? ????????????? ?????????? ?????????? ?????????? ?????? ??? ????????? ?????? ??, ??????? ?? ????
???? ??????? ?????? ?? ??? ??????? ?? ????????
????? ??. ? 4 ??????? ??? ???????? ?????? ??
?????? ??????????????? ?? ???????????????
?????. ??????????? ????????????? ????????
?????? ?? ???????? ? 3 ???????, ????????? ?????? ?? ? ?????? ?? ? ? 8, ????????? ?????? ??,
??????, ?????? ?????? ? ????? ?? ? ? 4. ? ???????? ????????????? ????????? ? 8 ??????? ????????????? ????????????? ???????? ???-????, ? 7 ?
?????????????.
? 2 ??????? ????????? ???????? ???????????
???? ????????? 3?4 ??, ? 2 ? ???????? ????,
?
? 1 ?????? ????????? ?????????????? ???????????
??????? ? ???????? ????? ????????????? ???????????.
????????? 12 ????????? ????????? ?????
?????????? ???????? ??: ?????? ?? ? 3 (??????????? ?????? ? 1 ?? ???), ?????? ?????? ? ?????
?? ? 5, ?????? ?? ? 2, ????? ?? ? 2 ?????????
(???. 2).
?????? ?????? ???????????? ????? ???????????? ????? ???????. ?????????????? ????????? ????????? ??????????? ??? ?????? ?????????
SPSS 11 ??? Windows. ?????? ???????????? ???
??????? ???????? ╠ ??????????? ??????????. ???
????????? ??????????? ?? ? ????? ???????? ????????????? ???????? ??????????, ???????? ??????? ???????????? ??? p < 0,05.
?
??
?????
?
?
???. 2. ??????????????? ????????? ???????? ?? ????? ????????????? ????????????:
? ? ??? ???????? ????????????? ? ????????????? ???????? ?????????? ?????? ?????? ? ????? ?? (???????); ? ? ????? ????? ?????? ? ????? ??
?????????? ?????????? ?????? ??; ? ? ??? ???????? ????????????? ? ????????????? ???????? ??????????? ?????????? ???????????? ??????
?????? ?? (???????); ? ? ???????? ????????????? ? ??????? ????????, ????????????? ????? ? ????? ??
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Йбашн╦з?з?
??????????? ????????? ????????????
????????????? ???????? ????????? ????????
????????: ??????? ??????????? ????????? ???????? ? ??????? ?????????, ??? ?????????? ????????? ????????????? ????????? ??? ???????????
? ????????? ???????? ?????? ? ????????????? ???????; ???????????? ?????? ?? ?? ???????? ??????????? ?????????? ?????. ?? ???? ???????
????? ?? ??? ?????????? ?? ?????????? ?????,
????? ?? ???? ??????????. ? 3 ??????? ??? ????????? ???????? ??? ????????? ????? ????????????? ?????????????? ????????? ?????? ?? ? ??????????????? ?????? ?????? ?????? ?? ?? ?????????? ?????. ? ????????? ??????? ????? ?
?????????? ?? ????????????? ?????????? ?????
? ??????? ?????????? ????? ??? ????????? ???
?????? ????????.
? 2 (7,4%) ??????? ????????? ??????????? ????? ?? ?????????? ??????? ??? ????????? ???????
?????? ?? ?? ???????? ????? ??. ? ????? ??????
??????????? ?????????? ??????? ???? ?????????????, ? ?????? ? ????????????? ?????????? ???????????????? ????????????.
???????????????? ??????????
????????? ????????????
????? ???????? ???????? ???????? ?????????????? ???????? ?? ?? ???????? ? 62,4 ?? 18,9 ?? ??. ??.
(? < 0,05).
?????? ????? ?????????? ??? ???????: ????????? ???????? ?????????????? ???????? ?????
?? ? ??????? ?? ???????? ? 76,2 ?? 26,4 ?? ??. ??.
(? < 0,05), ???????? ?????????????? ???????? ??????????????? ? ????? ????? ? ? 30,2 ?? 18,7 ?? ??. ??.
(? < 0,05).
? 2 ??????? ????????????? ????????? ?????
????????? ?????????? ????? ? ????????? ???????? (???. 3).
???????????? ??????????? ????????? 3,7%, ????
1 ???????.
??????????? ?????????? ?????????? ?????????????????? ??????? ????????????? ? 6 (22,2%)
???????. ? 3 (9,3%) ??????? ?????????????????
?????? ???????? ? ????????? ?????? ????????? ???????????????, ??? ???? ??????? ? ??????? ??????? ?????????? ? ???????????????? ?????????????? 2??3 ??????. ???????? 2 ?????? ????????????,
1 ?? ??? ??? ????????????, ????????? ?????????
??????????? ???????. ? 1 ?????? ??????? ?????????????, ??? ??????????? ?????????? ??????? ???
???????. ??????????????? ?????????? ???????? ?
2 ???????, ? 3 ??????? ? ????????????????? ??????? ?????????? ?????????? ???????????.
?? ???????????? ????? ? ????? ???????? ?? ?????????? ???? ??????? ??????????? ?????-????????????. ?? ???? ??????? ????? ?? ?? ? ?? ???
??????? ? ??? ????? ?? ???? ??????? ?????????
16
??
???. 3. ????? ???????????????? ???????? ? ????????????
???????? (???????) ?????????? ????? (??) ????? ????????
????????????? ????????????
?????????? ???????? ? ??. ? ????? ?? ?????? ???????? ?????????????? ???????? ?? ?? ????????
22,9 ╠ 14,3 ?? ??. ??., ????????? ???????? ? ?? ?
60,8 ╠ 10,3 ?? ??. ??. ?????????? ?????????? ???????? ??, ??????? ??????? ?? ?????????
64,3 ╠ 2,6%, ??????? ????????? ? 45,2 ╠ 2,8%. ??
?????????? ??? ??????? ???????? ? ?????????????????? ?????????, ?????? ?????????????. ??????? ????????? ????????? ??????? ? 22 (81,5%)
???????, ?????????????????? ? ? 4 (14,8%), ???????????????????? ? ? 1 (3,7%). ??????? ?????
?????????? ? ?????????? ????????? ? ????????
?????? 16,3 ╠ 1,6 (?? 9 ?? 34) ????????.
????????????? ??????????
????????? ????????????
????? 2?3 ???? ????? ????????? ????????
(? ??????? ????? 2,6 ╠ 0,5 ????) ??????????? 9
(33,3%) ?????????. ??????? ?? ?????? ???????????? ???????? ? ??????? 6,8╠1,1 ????. ? ???????? ?????? ????????? ???????? ? 4 ??????? ???????????
????? ?????? ? ?????? ??, ? 3 ? ???????? ???????????????????? ???????? ?????? ??, ? 2 ? ????????
????????? ?????? ?? ? ?????? ?? (??. ???????). ????????????? ???????? ? ?? ?? ?????? ?????? ????????? ???????? ????????? 109,6╠18,4 ?? ??. ??.,
????????????? ???????? ? ?? ? 23,6╠9,4 ?? ??. ??.,
???????? ?????????????? ???????? ????? ?? ? ?? ?
86,3╠22,5 ?? ??. ??. ? 3 ??????? ????????? ?????
?????? ? ?????? ?? (? 1 ?????? ?????????), ?
6 ??????? ? ???????? ????????? ?????? ?? ? ?????? ?? ???????? (? 3 ??????? ?????????). ????? ???????? ????????????? ???????? ? ?? ????????? 56,7 ╠ 12,4 ?? ??. ??., ????????????? ????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
Хс?зс?л?б стб???кк ? сз??нблл?б р?смк тсрнб ??зб?к?н╦лс?с тб?бмн??блк?
????????? ????????
??????:
???????? ? 4,2 ╠ 1,6 ????
??????? ? 4,4 ╠ 2,3 ????
??????:
???????? ? 2,6 ╠ 0,5 ????
??????? ? 6,8 ╠ 1,1 ????
??????:
???????? ? 3,3 ????
??????? ? 9 ???
?????
???????? ????????
????? ???????, n (%)
15 (55,6%)
12 (44,4%)
27 (100)
?/????? (n=1)
?/?? (n=2)
?/????? (n=3)
?/?? (n=3)
9 (33,3)
?
?/????? ? ?? (n=2)
2 (7,4)
? ? ? ? ? ? ? ? ? ? . ?/?? ? ????? ???????? ???????? ???????? ?? ???????? ? ???????? ?????????????? ??????????????,
?/????? ? ????? ???????????????? ????????? ????????????? ??.
? ?? ? 28,6 ╠ 11,8 ?? ??. ??., ???????? ?????????????? ???????? ????? ?? ? ?? ? 28,3 ╠ 10,3 ?? ??.
??. (? < 0,05).
????? 3 ???? ????? ?????? ????????? ????????
? 2 (7,4%) ??????? ???????? ????????? ???????
??????? ??. ??????? ??????? ?? ?????? ???????????? ???????? 9 ???. ????? ??????? ? ????????
????????? ???????? ????? ??????????? ?????
???????? ??, ? ????? ????????????? ???????? ??
???????? ? ???????? ?????????????? ?????????????? ? ????? ?????? ? ??????????? ???????? ?????
?? ? ?? ? ??????. ?? ????? ??????? ???????? ? ????? ?????? ??????????? ?????????? ????????
?????? ???????? ????????????? ???????? ???-????,
? ?????? ? ???????? ????????? ?????? ??, ?????? ?
?????? ????? ?? ???????????????????? ????????.
????? ???????? ???????? ?????????????? ????????
????? ?? ? ?? ???????? ? 93 ?? 25 ?? ??. ??., ????????????? ???????? ? ?? ? ?? 120 ?? 50 ?? ??. ??.
(? < 0,05).
И╥ршй?блкб
? ?????????? ????? ????? ????????????? ????????? ??? ??????? ???????? ???????????? ????????
? ?????????? ???????? ??. ?? ????? ?????? ???????? ????????? ??????? ????????????? ??????? ??:
? ?????? ? ??????? ?????????? ??, ??????? ??????????? ????????? ???????? ?????? ?? ? ???????
?????;
? ????????? ?????? ??????? ??? ??????????
????? ????????? ??, ??? ???? ??????????? ?????????? ?????? ?? ??????????????? ? ????????????? ??????, ????? ?????????? ? ??????????? ?????????? ?????? ??????? ??;
? ????????????? ????????? ?????? ??, ??? ??????? ?????????? ?????????? ?????? ? ?????? ??,
???????? ????? ???????????????? ???????? ? ??????? ?????????? ???????? ???????;
? ???????? ??????? ???????? ? ??????????? ??
?????????? ?????? ?????, ??? ???? ?????????? ????? ????? ?? ???????? ? ??????? ???????? [5, 7].
??? ?????????? ????????? ???????? ? ????????? ??????? ???????????? ???????? ?????. ???????? ????????? ? ????? ?????? ? ?????????????
??????? ?????? ??, ?? ????? ?????????? ???????????? ?????? ?????? ??. ???????? ??????????? ?
????? ???????? ?????????? ??????? ?????? ? ????? ??????? ????????? (?? 8 ??? ?? 4 ???), ????? ?????????? ????????????? ???????? ???????? ??
?????? ????????. ?????? ?????? ? ?????????????
?????????? ??? (????, ?????????? ??????????
?????? ??, ??????????????? ?????? ?? ? ??.). ?
???????? ??????? ???????? ?????????? ????????
???????? ? ???????? ?????????????? ?????????????? [8, 9].
??? ???????? ????????? ??????? ?? ????? ???????? ??????? ??????????? ????????? ? ???????????? ??????? ??? ????????????? ?? ??????????????? ????? ?? ??? ???????? ????? ??. ???????????? ???????? ?? ????????????????????
????????. ??? ?????????? ?????????? ?????? ?
?????? ?? ???????? ??????????? ???????? ?????
?? ? ??. ??? ???????????? ??????? ?? ??????????? ????????? ?????????? ???????? ?????? ?
???????? ?????? ??. ? ???????????? ??????????
????? ?????????????? ????????????? ???????
????????????? ? ???? ? ????????????? ????????
?????? ?????????? ??????? [10, 11]. ?? ????? ??????, ? 7,4% ??????? ???????? ??????????? ?????
?? ?????????? ??????? ? ???????? ?????? ??.
????????? ?????????? ?????? ? ??????? ???????? ???? ?????????? ????????? ? ??????????
????? (???????? ???????????? ?????? ??, ????????? ????????????? ??????? ? ???????????????
???????? ??, ????????? ??????? ?? ? ???????????
?????????? ?????? ??????? ??), ?????????? ???????? ?????????? ?????? ?? ? ??????? ?????? ???????? ??????? ?? ????? ???????? ????????, ?????????? ???????????? ??????? ??, ?????????, ?????????? ??????? ? ????????? ?????????? ???????
??, ?????????? ???????? ????? ?? ? ??.
?????????? ????????? ???????? ????? ????????? ??? ? ????????? ????? ?????? ???????????17
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
???????. ???????????? ??????????? ? ???????????
?? ???? ????????????? ?????????? ?? 3 ?? 8% [6, 9].
? ????? ???????????? ? ????????? ????? ?????
???????? ???? 1 (3,7%) ???????. ???????? ?????????? ?????? ????????? ??? ??????? ????????? ??
????????, ???????????? ? ?????????????? ????????????? ??-?? ??????????? ????????? ???????? ?
??????? ?????????, ???????? ???????????? ??????????????? [5].
? ???????? ??????? ???????????????? ????????? ????????? ????????, ??????????? ? ???????? ?????????????? ??????????????, ??????? ??????? ? ??????????????????. ??????????????? ??
?????? ??????? ?? ?? ????????? 2 ???????.
???????????????? ????????? ???????????????
???????? ???? ???????. ????????? ?????????????? ???????? ? ?? ? ?????????????? ???????? ?
?? ????????? ?? 0,61 ╠ 0,15. ????????? ????????????????? ?????? ???????? ??? ???????? ??????????.
????? ???????, ????????? ???????? ?? ?????
????????????? ????????? ??? ????? ??????? ??????????? ? ????????? ??????????? ?????????? ?
????????? ???????. ?????? ?? ????? ?????????
??? ????????? ? ?????????? ?????????????? ????????? ?????? ??, ?????????? ??????? ??????? ???
???????? ????? ? ??????????? ??????????? ????????????? ??. ? ????????? ??????? ????? ?????????????? ????????????? ???????? ????????????? ??????? ??: ??????????????? ??????, ????????? ???????? ???????????????????? ??????? ?
???????? ????? ????????? ????????? ??????.
6.
7.
8.
9.
10.
11.
References
1.
2.
3.
4.
5.
??????????
1.
2.
3.
4.
5.
????? ?.?. ???????????? ???????????? ??? ???????????? ????????????? ??????? ? ?????????? ??????? ???????? ??????? ? ????????? ?????? ?????? ?????????:
????????? ?????????????? ?????????? ╚????? ??????????? ? ????????????? ??????? ????????? ? ?????????????
????????????? ???????╩. ?.; 2007: 27?33.
Losay J., Touchot A., Serraf A., Litvinova A., Lambert V.,
Piot J.D. et al. Late outcome after arterial switch operation for
transposition of the great arteries. Circulation. 2001; 104
(12 Suppl 1): 121?6.
Kirklin J.W., Barratt-Boyes B.G. Cardiac Surgery. N.Y.:
Churchill Livingstone; 2013.
Mavroudis C. Pediatric cardiac surgery. Mosby; 2013.
????????? ?.?., ???????? ?.?., ???????? ?.?., ???????? ?.?., ??????? ?.?., ???????? ?.?. ? ??. ???????????????? ?????????? ?????????? ?????????? ????????? ???-
?????? ????? ???????? ???????? ? ????????????? ???????????? ??? ???????????? ????????????? ???????. ????????? ????? ??. ?.?. ???????? ????. 2014; 15 (3): 4
(??????????).
Vargo P., Mavroudis C., Steward R.D., Backer C.L. Late complications following the arterial switch operation. World J.
Pediatr. Congenit. Heart Surg. 2011; 2 (1): 37?42.
Paillole C., Sidi D., Kachaner J., Planche C., Belot J.P.,
Villain E. et al. Fate of pulmonary artery after anatomic correction of simple transposition of great arteries in newborn
infants. Circulation. 1988; 78 (4): 870?6.
????????? ?.?., ?????? ?.?., ???????? ?.?., ????? ?.?.
????????? ???????? ????? ????????? ?????????? ??????? ??????. ?.; 2013.
Stark J., deLeval M., Tsang V.T. Surgery for congenital heart
defects. John Wiley&Sons, Ltd; 2006.
Stark J., Pacifico A.D. Reoperations in cardiac surgery. N.Y.;
Heidelberg: Springer Verlag; 1989.
Doty D.B., Doty J.R. Cardiac surgery: Operative technique.
2-nd ed. Elsevier; 2012.
6.
7.
8.
9.
10.
11.
Il?in V.N. Arterial switch with transposition of the great arteries
with abnormal pulmonary valve and left ventricular outflow
tract. International Symposium ╚New Perspectives in the surgical treatment of patients with transposition of the great arteries.╩ Moscow; 2007: 27?33 (in Russian).
Losay J., Touchot A., Serraf A., Litvinova A., Lambert V.,
Piot J.D. et al. Late outcome after arterial switch operation for
transposition of the great arteries. Circulation. 2001; 104
(12 Suppl 1): 121?6.
Kirklin J.W., Barratt-Boyes B.G. Cardiac Surgery. N.Y.:
Churchill Livingstone; 2013.
Mavroudis C. Pediatric cardiac surgery. Mosby; 2013.
Podzolkov V.P., Kokshenev I.V., Chiaureli M.R., Samsonov V.B., Danilov T.Y., Pursanov M.G. et al. Immediate results
eliminate obstruction of pulmonary blood flow after surgery
Mustard and arterial switch with transposition of the great vessels. Byulleten? Nauchnogo Tsentra Serdechno-Sosudistoy
khirurgii im. A.N. Bakuleva RAMN. 2014; 15 (3): 4 (Suppl.)
(in Russian).
Vargo P., Mavroudis C., Steward R.D., Backer C.L. Late complications following the arterial switch operation. World J.
Pediatr. Congenit. Heart Surg. 2011; 2 (1): 37?42.
Paillole C., Sidi D., Kachaner J., Planche C., Belot J.P.,
Villain E. et al. Fate of pulmonary artery after anatomic correction of simple transposition of great arteries in newborn
infants. Circulation. 1988; 78 (4): 870?6.
Podzolkov V.P., Alekyan B.G., Kokshenev I.V., Cheban V.N.
Repeated operations after correction of congenital heart
defects. Moscow; 2013 (in Russian).
Stark J., deLeval M., Tsang V.T. Surgery for congenital heart
defects. John Wiley&Sons, Ltd; 2006.
Stark J., Pacifico A.D. Reoperations in cardiac surgery. N.Y.:
Heidelberg: Springer Verlag; 1989.
Doty D.B., Doty J.R. Cardiac surgery: Operative technique.
2-nd ed. Elsevier; 2012.
????????? 26.11.2014
18
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
╘ ????????? ???????, 2014
??? 616.132.14-007.272-053.36-089
????????? ????????????? ????????? ??? ???????
?????????? ???? ????? ? ????? ??????? ???? ?????
?.?. ???????1, ?.?. ????????1, ?.?. ????????1, ?.?. ?????1,
?.?. ???????1, ?.?. ???????1, ?.?. ?????1, ?.?. ??????????2
1 ???????
????????? ???????? ? 1; ??. ???????????, ?. 14, ?????-?????????, 198205,
?????????? ?????????;
2 ??????????? ?????????, ???-??????, 13034, ??????
??????? ??????? ??????????, ????????????;
???????? ????? ???????????, ?????? ???. ????, ?????????, ?????????? ??????????,
e-mail: movses@bk.ru;
???????? ??????? ?????????????, ????. ???. ????, ????????????;
????? ???????? ????????????, ?????? ???. ????, ?????????. ?????? ????;
??????? ???????? ??????????, ????. ???. ????, ????????????;
????? ?????? ??????????, ?????????;
??????? ??????? ?????????, ?????????? ??????????;
?????????? ????? ??????????, ????. ???. ????, ????????????
????????. ??????? ????? ??????? ???? ????? ? ????????????? ?????????? ???? ????? ? ??????????????? ???????? ??????????????? ??????????? (????) ?? ??? ??? ???????????? ????? ??????? ??????.
???????? ? ??????. ?????? ???? ??????? ????? ? ?????? ?????????? ?????????? ? ?????????????? ????????? ????????????? ?????????. ???????? 2 ??????. ????????? 1-? ?????? (n = 48) ??????????? ????????????? ????????? ????? ??????????????? ??????? ? ?????? ????? ????????; ????????? 2-? ?????? (n = 16) ? ??????????? ???????, ?????????? ?????????? ?????????? ???? ????? ? ????????? ???????? ??????? (??) ?? ?????? ?????????? ????????????? ? ???????? ???? ? ????????? ?? ? ?????????? ???????. ??? ?????? ?? ?????? ??????? ????????????? ???? ???????????, ??????? ??????? ????????
30,8 (?? 2 ?? 143) ? 26,6 ??? (?? 2 ?? 88), ????? ???? ? ??????? ? 3,45 ╠ 0,74 (2,0?5,6) ? 3,57 ╠ 0,71 (2,2?5,4) ??, ????? ????
????? 2,5 ?? ??????????? ? 7 (14,5%) ? ? 1 (6,25%) ???????? ? 1-? ? 2-? ??????? ??????????????. ????????????? ???? ???????? ? 2 ????? ?? 1-? ?????? ? ? 10 ? ?? 2-?. ?? ???? ??????? ????????????? ???? ????? ??????????? ? ?????????????? ??????? ??????????. ? 1-? ?????? ???????? ?????????????? ????? ????????? ???????????. ? ?????? ? ????????? ?????????? ??
????? ?????? ???????? ????????????? ???? ??????????? ????? ??????? ???????????, ??????? ??????????? ?????????? ???????? ???????. ?????? ???? ?????????????? ??????? ?????????? ? ???????? 4,57 ╠ 1,48 ??? ? ?????????? ? ???????? ????
? ???????? ??.
??????????. ?????????? ?????????? ?????????????????? ?????????? ???????????? ??????????? ? ????? ??????? ?? ????????? 9 ???, ??? ???? ?????? ????? ???? ??????? ?? ?????? ???????? ?? ???????? ???????? ????? ???????????????? ??????.
??????????. ????? ??????? ???? ????? ??? ?????????? ??????? ???????????????? ????????? ???????????????? ?????????
????????????? ????????? ?????????? ???? ????? ? ???????????????? ????.
???????? ?????: ?????????? ???? ?????; ?????????? ?????; ??????? ???? ?????; ?????? ??????????????? ???????????.
COMPARISON OF SURGICAL STRATEGIES IN THE TREATMENT
OF AORTIC ARCH OBSTRUCTION IN INFANTS
N.V. Antsygin1, R.R. Movsesyan1, A.A. Shikhranov1, A.V. Kagan1,
G.M. Chizhikov1, D.R. Yamgurov1, A.L. Tsytko1, V.G. Lubomudrov2
1 Children?s
2 Chest
Hospital ? 1, ul. Avangardnaya, 14, St. Petersburg, 198205, Russian Federation;
Disease Hospital, Al-Kuwait, 13034, Kuwait
Antsygin Nikolay Valer'evich, Cardiac Surgeon;
Movsesyan Ruben Rudol'fovich, MD, DM, Professor, Chief of Department;
Shikhranov Aleksey Aleksandrovich, MD, PhD, Cardiac Surgeon;
Kagan Anatoliy Vladimirovich, MD, DM, Professor, Head Phisician;
Chizhikov Gennadiy Mihajlovich, MD, PhD, Cardiac Surgeon;
Tsytko Andrey Leonidovich, Cardiologist;
Yamgurov Dmitriy Romanovich, Chief of Department;
Lubomudrov Vadim Germanovich, MD, PhD, Cardiac Surgeon
19
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
Objective. Treatment of infants with obstructive pathology of the aortic arch and associated VSD still represents a challenge.
Material and methods. In our study, we describe the experience in treating children with this pathology with the use of different surgical strategies: in Group I was included 48 children who underwent single-stage correction of associated defects; group II included
16 children who underwent a two-stage treatment, including the elimination of the obstruction of the aortic arch and pulmonary artery
(PA) banding at the time of primary intervention and closure of VSD with the PA band removal in the long term. Both groups at the
time of first intervention were comparable with mean age of 30.79 days (2 to 143), and 26.58 days (2 to 88) and mean weight
3,45 ╠ 0,74 (2.0?5,6) and 3,57 ╠ 0,71 (2,2?5,4); weight < 2.5 kg was observed in 7 (14.5%) and 1 (6.25%), respectively. In group I,
operations were performed through a median sternotomy. In two-stage strategy group at the first operation carried out reconstruction of the arc through lateral thoracotomy, which was supplemented by the pulmonary artery banding. The second stage of surgery
at the age of 4,57 ╠ 1,48 months included the closure of the VSD and PA plasty.
Results. The results showed the absence of in-hospital mortality in both groups over the past nine years. Low body weight of the child
at the time of surgery was not a risk factor for adverse outcome.
Conclusion. Based on the results, in the absence of severe somatic pathology, we believe the preferred single-stage strategy correction of aortic arch obstruction and associated VSD.
Key words: obstruction of the aortic arch; coarctation of the aorta; interruption of the aortic arch; ventricular septal defect.
г?б?блкб
?????????? ????????????? ????????? ?????,
?????????? ?????????? (??) ? ??????? ????, ????????? ? ??????????? ??????? ???????????????
? ?????? ? ?????? ???????? ????? ???????????????
? ???????????? ? ??????? ??????? [1, 2]. ?????????????, ??????????????? ? ??????????? ???? ????? ??????????????? ?????????? ???????? ??????
??????????????? ??????????? (????). ???, ???????? ???????????? ??????, ????????????? ?????????????? ???? ? ?? ???????????? ? 37%,
? ????????? ? ????????? ???? ????????? 73% [3?5].
?????? ?????? ????????? ??????????? ?? ?????
????????? ? ??????????????? ?????????? ?????????? ??? ???????? ? ?????????? ???????, ??? ? ????????????????? ???????. ?????? ? ?????? ??????????? ????????? ?????????????? ??????? ?????????????? ????????? ??????? ?? ??? ??? ????????
??????????, ??? ? ????????? ?????????? ? ?????? ????????????.
???? ????? ?????? ? ????????????? ?????? ???????????????? ??????????? ????????? ???????? ?
?????????????? ??????? ??? ????????? ??????????
???? ????? ? ???? ? ????? ??????? ???? ?????.
Е?зб?к?н к обзс??
? ???????????? ???????? 64 ??????? ? ??????????? ???? ????? ? ??????????????? ????,
??????? ? ?????? ? 2002 ?? 2014 ?. ???????????
??????????? ??????? ? ?????????????? ???? ????????????? ??????.
?????? ?? ????????? ?????????????? ?????????????, ??? ???????? ???? ????????? ?? 2 ??????.
? 1-? ?????? ????? 48 ?????, ??????? ????????????? ????????????? ????????? ????? ??????????????? ??????? ? ?????? ????? ????????. ?? 2-? ?????? ????? 16 ?????, ??????? ??????????? ??????????? ???????, ?????????? ?????????? ??????????
???? ????? ? ????????? ???????? ??????? (??) ??
?????? ?????????? ????????????? ? ????????
???? ? ????????? ?? ? ?????????? ???????. ???
?????? ?? ?????? ??????? ????????????? ???? ??????????? (????. 1).
20
???????????????? ??????????? ???????? ??????????? ?????????? ??????????????? ????????????, ?????????????? ??????? ??????, ???. ? ????
??????? ? ????? ????????? ???????? ???? ?????
??????????? ???????????? ?????????? (???. 1).
? 15 (23,4%) ????? ??????? ??? ????????? ? ????????????? ???????, ??? ????????? ?????? ?????? ???????, ?????????? ????????????? ??????????????? ??????? ? ?????????????????? ????????? ?
????????????? ??????????? ???????.
????????????? ????????????? ? 1-? ??????
???????? ????????????? ?????????? ??????????
???? ????? ? ???????? ????. ?? ???? ??????? ???????? ??????????? ? ?????????????? ? ????????
??????? ????????? ???????????. ?????????????
???????????? ??????????? ??????????????? ???????, ???? ? ?????????? ????? (???. 2), ?????????????? ????? ?????? ?????????????? ?????????????? ??????????? ? ?????? ?????????? ????????. ? ??????? ????????? ???????? ???? ???????
?????????????? ??? ???????????? ??????, ???? ??
??????? ????????????????? ? ??????? ??????????
???????????????? ??????, ? ?????? ? ? ?????????? ????? ????? ????? ???????? ??????? ? ???????????? ??????.
????? ?????????? ????????? ??????????? ??????????? ??????? ????????????? ???? ?????
(???. 3), ? ????? ???????? ????. ? 32 (66,6%) ??????? ???????? ??????????? ? ???????? ???????? ?????????? (18?20 ╟?) ? ?????????????? ??????,
??????? ????? ???????? ????????? 32,3╠3,9 ???.
? 15 (31,25%) ????? ???? ????????????? ???? ?????????? ?? ???????????? ??????????? ????????
????????? ????? ??? ????????? ???????????????,
? ? 1 (2,15%) ?????? ????? ????????? ??????? ? ??????????? ????? ?????????? ????????????? ??????? ????????? ???????????? ?????????? ?????????
??? ?????????????? ??????????????.
????????????? ???? ????? ??????????????
??????????? ???????????? ?????????? ?????
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?????? ?????????? ??????????????? ????????,
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p
38
30
8
?
????????, n
???????, n
26
18
8
?
???????, ???
30,0 ╠ 33,4 (2?143)
30,8 ╠ 35,3 (2?143)
26,6 ╠ 25,2 (2?88)
>0,05
????? ????, ??
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3,45 ╠ 0,74 (2,0?5,6)
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>0,05
8 (12,5)
7 (14,5)
1 (6,25)
>0,05
????? ???? ????? 2,5 ??, n (%)
???????? ???? ?????, n
?????????? ????? ? 50 ?????????? ????? ? 34, ?????????? ????? ? 16
??????? ???? ? 14
??????? ???? ? 14,
??? ? ? 2,
??? ? ? 11,
??? ? ? 1
????????????? ????, n (%)
12 (18,75)
2 (4,1)
10 (62,5)
<0,05
16 (25)
16 (33,3)
0
>0,05
2
?????????????
?????? ? 1
?????????? ??????
?????????? ????
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?
????????????? E1
?? ????????, n (%)
?????????????
??????????????? ?????????, n
????????????? ????????????
?????????, n (%):
??????? ?? ???????
???????????
??????? ?????
??????? ?????
???????????????????????????? ???????
??????? ?????
??????? ????????????
?
15 (23,43)
12 (25)
4 (8,3)
3 (6,2)
2 (4,2)
2 (4,2)
3 (18,7)
?
?
1 (6,25)
?
1 (2,1)
?
?
?
1 (6,25)
1 (6,25)
>0,05
5
4
3
4
2
3
2
1
1
?
?
???. 1. ?? ?????? ? ????????????? ???????:
? ? ?????????? ?????; ? ? ??????? ???? ?????, ??? ?; 1 ? ?????????? ??; 2 ? ?????????? ??; 3 ? ???????? ???????????? ??????; 4 ? ???? ??; 5 ? ????? ???????????? ???????
21
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???. 2. ????????? ???? ????? ? ??????????????? ???????:
???. 3. ????????????? ???? ?????:
1 ? ?????????? ?????; 2 ? ???????? ?????; 3 ? ???????? ????????????
??????; 4 ? ????? ???????????? ???????; 5 ? ?????????? ?????
1 ? ?????????? ?????; 2 ? ?????????????? ?????????; 3 ? ?????????? ?????
???????. ??????? ????? ?????????????? ?????????????? (??) ? ?????? ?????? ?????????
101,4 ╠ 26,8 ???, ????? ?????? ???????? ?
39,1 ╠ 11,2 ???. ? ????? ?????? ????????????? ?
????????? ???? ????? ? ????????? ???? ??????????? ???????? ?????????????? ???????, ??????????????? ?????????.
? ?????? ? ????????? ?????????? ?????????????? ??????? ?? ????? ?????? ???????? ???????????
????????????? ???? ?????, ??????? ???????????
?????????? ???????? ???????. ??? ?????????
?????????????? ?? ??????? ????????????? ???????????. ? 15 ??????? ????? ???????? ???? ?????????? ???????????? ?????? ??????????? ????????? ????? ????? ? ?????????? ?????? ????? ? ?????, ? 1 ??????? ???? ????????? ???????? ?????
???????????? ????????. ??????? ????? ????????? ????? ????????? 19,8 ╠ 5,8 ???. ????? ?????????? ?????????? ???? ?????????? ???????? ? ??????????? ????????? ?????? ???????? ??????? ???
????????? ????????? ????? ?????????? ? ???????
???????? ?????????? ????? ????????? ??????.
?????? ???? ?????????????? ??????? ?????????? ? ???????? 4,6 ╠ 1,5 ???. ??? ????????????? ?????????????? ?? ????????? ???????????. ????? ????????? ????????????? ??????? ??????????? ??????????? ????????? ?????, ????? ???, ???????????
??????? ?????????????? ??????????????. ??????
??????????????? ??????????? ?????????? ??????????????? ????????. ? 1 ?????? ???????????
?????? ?????????? ???????? ????????????? ???????? ????. ???????? ?????? ? ???????? ???????? ??????? ??????????? ?? ???? ???????, ?? ??? ?
15 ?????????????? ??????? ??? ?????????? ?????-
???? ??????. ? 1 ?????? ??????????? ???????? ????????? ??????? ? ??????????? ????????? ??????
????? ? ?????. ? ?????? ???????? ??? ????????
?????????? ?????? ?????????? ????? ??????? ????? ???? ? ????? ?????????? ????????? ?????????????????? ???????. ??????? ????? ?? ????????? 94,1 ╠ 49,0 ???, ????? ?????? ???????? ?
51,0 ╠ 37,1 ???.
?????????????? ?????? ???????????? ? ????
M ╠ ?, ???????????? ? n (%). ????????? ?????????????? ?????????? ??????????? ??? ?????? ???????? ???????????, ???????????? ? ??? ??????
??????? ???????? ??????.
22
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? ?????? ????????, ? ????? ???????????????? ??????, ?????? ?????????????? ??????? ????????????? ?????????? ?С????? ???????? ????????? ?????
??????????? ???????? ?? ????????? ? ??????? ????????? ????????? (????. 2), ??? ?????????? ? ?????????? ??????? ????????????? ?????????? ??????, ?????????? ????????? ? ?????????????????
?????????? ? ?????? ??????????.
??????????? ?????????? ??????????? ? 1-? ?????? ? 7 (14,58%) ?????????; ? 2 ????? ????????????
?????? ? ??????? ?????????? ?????????? ?????????? ????????????? ? ?????? ????? ??????????????:
????????? ???? ????????? ???????? ? ???? ????????? ????????????? ???? ????? ? ???????? ?????????????? ??????????????.
???????????? ??????????? ? 1-? ?????? ????????? 4,1% (n = 2), ?? 2-? ?????? ??????? ??????????
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p
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45,4 ╠ 30,7 (18?119)
0,001
1,66 ╠ 1,65 (0?5)
0,01
5,1 ╠ 3,2 (2?11)
0,01
5,1 ╠ 4,4 (0,1?19)
????? ?????????? ? ??????????, ???
11,7 ╠ 8,3 (2?37)
??????????? ??????????, n (%):
????? ?????? ?????????
????????????, ???????
???????????? ?????? ?????
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7 (14,58%)
2 (4,16)
2 (4,16)
2 (4,16)
1 (2,08)
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0
0
0
0
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??
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??
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??????
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p
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2002?2005 ??.
5 / 23*
2 / 23*
0 / 9*
0 / 9*
??
2006?2014 ??.
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0 / 25*
0 / 7*
0 / 7*
??
*????? ????? ?????????.
?????? ?? ????. ???????? ?????????? ?????? ?
?????? ?????? ????? ?????? ????????? ??????????????? ? ?????????? ????????? ?????? ? ?????? ????????????????? ???????, ?? ?????? ?????? ? ??????????????? ???????????? ??????????????? ?
???????, ???????? ????????????? ????????? ????????????? ???? ????? ?????????? ??????????????? ????????? ????????????? ???????. ??????? ????????, ??? ??? ????????? ?????? ????????? ??
2005 ?., ? ?? ????????? 9 ??? ???????????? ??????????? ????????????? (????. 3). ?? ?? ?????????
???????? ?????????? ????? ????????????? ????????????? ???????? ? ???????????? ? ????? ???????.
????? ?????????? ???????????, ??? ? ????? ???????????? ?????? ????? ???? (????? 2,5 ??) ?? ???????? ???????? ????? ???????????????? ??????,
??? ???? ???????????? ????????? ???????????
???????.
И╥ршй?блкб
??????? ????? ??????? ???? ????? ? ??????????
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??? ??? ???????????? ??????? ??????.
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??????? ???????? ??????? ???????????? ? ??????
????????????? ???????????, ??????? ?????????
???????????? ????????? ??????? ? ?????????? ??????????? ????? ??? ?????????????? ?????????????
[6, 7]. ??? ?????????????? ????? ???????? ????????????? ?????????? ????? ?????? ?????????? ?????? ? ???????????? ????????????, ? ????? ??????-
?????? ???????????? ???????, ??? ??????? ??? ? ??????????????? ????????? ?????? ? ????? ? ??????????????????? ???, ??? ? ?? ????????????? ??????????????? ??????? ? ?????????????????? ?????????
? ????????????? ???????? ??????????? ?????? [8,
9]. ? ????? ???????????? ?? ?? ??????? ??????????? ????? ????? ????????????? ????????????? ???????? ? ???????????? ????????????, ???, ????????,
??????????? ???????????? ????????? ?????? ?????????, ??? ?? ????? ??????? ????????, ??? ? ??????
????? ????????????? ?????? ?????????????? ??????? ????????? ????????????? ???????? ??????????????? ?????????????? ? ?????????? ?????????? ????????? ??????? ?? ???????????????? ?????.
????????????? ??????? ? ?????????????? ???????, ????????????? ? ????????????? ??? ????????? ????????? ??????????????? ???????,
????? ??? ????????????? ????????????, ??? ? ??????????. ???, ????????? ?????????? ??????? ???????? ?????????? ????? ??????? ? ????? ?????????? ??????????????, ??????????? ???????? ????????????? ?????????????? ?????????????? ?
??????????? ??????? ????? ??????????? ?????????????? ?? ?????? ?????? ????? ???????
[10?12]. ?????? ??????? ??? ??????? ????????????? ????????? ????????? ? ???????? ???????????????? ??? ??????? ????????????? ????? ? ??????
?????????????? ???????????, ??? ?????????????? ?????????????, ???????????????? ????????,
???????????? ???????????????, ?????? ????? ????
??????? ?? ?????? ???????? ? ?????? ??????? ???????????????? ????????? [10, 13]. ? ????? ????23
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???? ?? ????? ?????????????? ????????? ????????? ? ????? ? ?????????????? ???? ? ????? ?????????????? ????? ?????????????. ??? ???? ??????????? ??????????? ?? ??????????? ????????
[14, 15]. ???????? ???????? ??????????? ????????? ???????? ???????? ????????????? ??????????
????????? ???????? ? ?????????? ??????? ??? ???????? ???? ?/??? ?????????? ????? ???????????? ????????? ???????? ???????, ??? ????? ?????? ?? ????? ????? ????????????? ??????????? ?
?????????? [11, 16]. ? ?? ?? ????? ?????????? ????? ?????? ?????????????????? ?????????? ???????????? ??????????? ? ????????????? ?????????? ? ?????? ?????? ?? ???? ?????? ??????????.
? ???? ???????, ????????????? ???????????
????????? ????????? ??????????? ???????????? ?
??????? ????? ?????????, ? ??? ????? ?????????
????????????? ??????????????? ?????????. ???????????? ??? ?????????? ????????????? ????????? ??????????? ????????????? ??????????
????????? ???????????? ? ?????????? ???????,
??? ??? ???? ?? ???? ???????? ????????????? ???
? ???????????, ??? ? ? ?????????-?????????????
??????? [17, 18]. ???????, ??????, ???????????,
??? ?????????????? ????????? ????? ??????? ???
? ????? ?????? ????????????? ???????, ??? ? ? ????? ?????? ???????????? ?????????????????? ???????. ???????? ?????????????? ???????, ??? ????????????? ?????? ????????? ??????? ?????????? ???? ?????????? ????????????? ??????????
???????????? ???????? ???????, ?????????? ?????????? ??????, ????????????????? ??????????
?????????? ????????? [12]. ??? ??????????????
? ?????? ???????????? ? ??????? ????????????????? ???, ?????????? ???????, ? ??? ?????????, ? ??????? ?????????? ? ???????? ??????????
?????? ?????? ?????????.
?????????? ???????????? ????? ? ???????? ????????????? ??????? ????????? ??????????? ???????? ?????????? ??? ????? ?????????????? ?????????? ???????, ??? ?????????????? ????????????
? ???????????? ??????????? ??? ????????????????
? ?????????? ???????????, ??? ? ??????? ????????????? ? ?????????? ??????? [17, 19, 20]. ? ?????
???????????? ???????????? ??????????? ?????????? ?????? ??? ????????????? ?????????, ??????????? ?? 2005 ?., ? 4,1%, ??? ????????????? ??????? ??????????, ? ????????????? ? ????? ??????? ??
????????? 9 ???.
? ????????? ????? ??????? ???????? ????????? ???????? ???????? ??? ?????????? ????????????? ????????? ? ?????? ?????? ?????????.
?????????? ?????????????????? ????????????
╚Boston Circulatory Arrest Trial╩ ?????????????????? ??????????? ????? ?????????????????? ?????????????? ?????? ? ???????????? ????????? ?????,
??? ???? ???? ????????, ??? ????????? ?????????????? ? ???????? ???????? ?????????? ?? ?????
??? ?? 35 ??? ????? ??????????? ??????? ?? ????24
?????? ??????? ?????????????? ???????? [21, 22].
??? ???????????? ???? ?????? ???????? ?????????????? ????????? ? ????? ???????? ????????????? ??????????? ???????????? ???????? [23]. ? ??
?? ????? ??? ????? ????????????? ?????????? ???????? ??????? ? ??????????? ????????????????
??????? ??? ??????????? ?? ??????? ???????? ????? ????? ???????? ? ?????????? ??????? ? ?? ????????????? ????????????? ?????????????? ??????
?? ????? ??????????????????? ???????? ? ??????
???????? ??? ???????? ????????? ??????-???????????? ???????? ??????? [24, 25]. ????????, ???
??????? ? ????????? ?????????? ????????, ????????????? ?????????????? ?????? ? ?????????????????? ?????????????? ??????. ??????????
???????????, ??? ?? ?????????? ??????? ?? ??????????? ??????? ?????????????? ????????????????? ????????????, ?????????? ??????????????
?????????? ?????????? ??????????????? ?????????? ????????? ????????????? ??? ??? ???? ????????. ? ????? ?????? ?? ?? ???????? ????? ??????? ? ??????????????? ??????? ? ????? ????? ????????????? ????????? ????????? ???????? ??
???????????? ?????, ?????? ?????? ?????? ???????
??????????? ???????????? ? ??????? ??????????
???????????.
????????? ??????????? ????????????? ????????? ? ???????? ??????? ????????, ???????????
???????????? ????????? ??????????? ??? ??????????, ??? ? ?????????????? ???????????? ???????
????????????? ? ?????? ?????????? ?????????.
г??с??
??????????????? ?????????? ? ????? ???????????? ??????????, ???? ??????? ????????? ??????. ????????????? ? 23% ??????? ?????????????
??????? ???????? ??????? ???????????? ???????
??? ???????????????, ??? ? ?????????????? ???????
??????? ? ?? ????????? ????????????? ??????????????. ???????????? ??????????? ? ?????? ??????????? ????????? ??????? ?? ???? ?????? ?????????? ?????????????, ? ? ?????? ????????????? ????????? ????????? ????? 5%, ??? ???? ?? ?????????
9 ??? ????????? ?????? ?????????????. ??????????
????? ????????? ??????? ?????????? ???????????
?????????? ??? ?????????????? ??????? ? 21 ??
8% ?? ????????? 5 ???. ?????? ????? ???? (?????
2,5 ??) ?? ???????? ???????? ????? ?????????? ??????. ???????? ?? ???????? ?????????????, ??
???????, ??? ??? ?????????? ??????? ????????????
????????? ????? ????????????? ????????? ????????????? ?????????, ??? ????????? ????????? ????????????? ???????????? ?? ?????? ?????? ?????
??????? ? ?????? ?????? ???????????? ?????????????. ??? ??????? ????????????? ????, ????????
??????????? ?? ??????????? ????????, ???????????
???????????? ????????? ??????. ??????? ? ?????? ??????? ?????????????? ??????? ?????? ????
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??????? ??????? ?????? ? ???????, ? 3, 2014
???????? ?? ????????? ?????? ?????????????????
????????? ????????, ???????? ? ?????????? ???
???? ?????, ??? ? ????????????? ???????????????
???????.
17.
??????????
18.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
STS Congenital Heart Surgery Executive Summary Jul 2008 ?
Jun 2012. Primary Diagnosis Neonates (0?30 days).
Available at: http://www.sts.org/sts-national-database/database-managers/executive-summaries.
Teo L.L., Cannell T., Babu-Narayan S.V., Hughes M.,
Mohiaddin R.H. Prevalence of associated cardiovascular
abnormalities in 500 patients with aortic coarctation referred
for cardiovascular magnetic resonance imaging to a tertiary
center. Pediatr. Cardiol. 2011; 32: 1120?7.
Jonas R.A., Quaegebeur J.M., Kirklin J.W., Blackstone E.H.,
Daicoff G. Outcomes in patients with interrupted aortic arch
and ventricular sepatiental defect. A multiinstitutional study.
Congenital Heart Surgeons Society. J. Thorac. Cardiovasc.
Surg. 1994; 107 (4): 1099?109.
Quaegebeur J.M., Jonas R.A., Weinberg A.D., Blackstone E.H., Kirklin J.W. Outcomes in seriously ill neonates with
coarctation of the aorta. A multiinstitutional study. J. Thorac.
Cardiovasc. Surg. 1994; 108: 841?51.
??????? ?.?., ??????? ?.?., ??????? ?.?., ????? ?.?.
????????????? ????????? ???? ????? ? ????????? ? ???????? ??????????????? ??????????? ? ?????????????:
???????????, ?????????????, ????????????? ???????.
??????? ??????? ?????? ? ???????. 2006; 6: 31?6.
Brown K.L., Ridout D.A., Hoskote A. Delayed diagnosis of
congenital heart disease worsens preoperative condition and
outcome of surgery in neonates. Heart. 2006; 92 (9):
1298?302.
Landis B.J., Levey A., Levasseur S.M., Glickstein J.S.,
Kleinman C.S., Simpson L.L. et al. Prenatal diagnosis of congenital heart disease and birth outcomes. Pediatr. Cardiol.
2013; 34 (3): 597?605.
Levey A., Glickstein J.S., Kleinman C.S., Levasseur S.M.,
Chen J., Gersony W.M. et al. The impact of prenatal diagnosis
of complex congenital heart disease on neonatal outcomes.
Pediatr. Cardiol. 2010; 31 (5): 587?97.
Axt-Fliedner R., Kawecki A., Enzensberger C., Wienhard J.,
Degenhardt J., Schranz D. et al. Fetal and neonatal diagnosis
of interrupted aortic arch: associations and outcomes. Fetal
Diagn. Ther. 2011; 30 (4): 299?305.
Miyamoto T., Yoshii T., Inui A. Staged repair for aortic arch
reconstruction and intracardiac repair following bilateral pulmonary artery banding in 3 critical patients. Interact.
Cardiovasc. Thorac. Surg. 2013; 16 (6): 892?4.
????? ?.?. ????????????? ??????? ????????????? ?
?????????? ????????????? ?????????? ???? ????? ? ????????? ? ???????? ??????????????? ???????????: ???. ...
????. ???. ????. ?.; 2011.
Walters H. L., Ionan C. E., Thomas R. L., Delius R. E. Singlestage versus 2-stage repair of coarctation of the aorta with ventricular septal defect. J. Thorac. Cardiovasc. Surg. 2008; 135
(4): 754?61.
Sudarshan C.D., Cochrane A.D., Jun Z.H., Soto R., Brizard C.P.
Repair of coarctation of the aorta in infants weighing less than
2 kilograms. Ann. Thorac. Surg. 2006; 82 (1): 158?63.
Bonnet D., Patkai J., Tamisier D., Kachaner J., Vouhe P.,
Sidi D. A new strategy for the surgical treatment of aortic
coarctation associated with ventricular septal defect in infants
using an absorbable pulmonary artery band. J. Am. Coll.
Cardiol. 1999; 34: 866?70.
Gaynor J.W. Management strategies for infants with coarctation and an associated ventricular septal defect. J. Thorac.
Cardiovasc. Surg. 2001; 122: 424?6.
Takayama H., Sekiguchi A., Chikada M., Noma M., Ishizawa A., Takamoto S. Mortality of pulmonary artery banding in
19.
20.
21.
22.
23.
24.
25.
the current era: recent mortality of PA banding. Ann. Thorac.
Surg. 2002; 74: 1219?24.
Tlaskal T., Vojtovic P., Reich O., Hucin B., Gebauer R., Kucera V.
Improved results after the primary repair of interrupted aortic
arch: impact of a new management protocol with isolated cerebral perfusion. Eur. J. Cardiothorac. Surg. 2010; 38: 52?8.
Kostelka M., Walther T., Geerdts I. et al. Primary repair for aortic arch obstruction associated with ventricular septal defect.
Ann. Thorac. Surg. 2004; 78: 1989?93.
Kobayashi M., Ando M., Wada N., Takahashi Y. Outcomes
following surgical repair of aorticarch obstructions with associated cardiac anomalies. Eur. J. Cardiothorac. Surg. 2009; 35
(4): 565?8.
Mishra P.K. Management strategies for interrupted aortic arch
with associated anomalies. Eur. J. Cardiothorac. Surg. 2009;
35: 569?76.
Bellinger D.C., Jonas R.A., Rappaport L.A., Wypij D.,
Wernovsky G., Kuban K.C. et al. Developmental and neurologic status of children after heart surgery with hypothermic
circulatory arrest or low-flow cardiopulmonary bypass. N.
Engl. J. Med. 1995; 332: 549?55.
Bellinger D., Wypij D., duPlessis A., Rappaport L., Jonas R.,
Wernovsky G. et al. Neurodevelopmental status at eight years
in children with dextra-transposition of the great arteries: the
Boston Circulatory Arrest Trial. J. Thorac. Cardiovasc. Surg.
2003; 126: 1385?96.
Asou T., Kado H., Imoto Y., Shiokawa Y., Tominaga R., Kawachi Y. et al. Selective cerebral perfusion technique during aortic
arch repair in neonates. Ann. Thorac. Surg. 1996; 61:
1546?8.
Visconti K.J., Rimmer D., Gauvreau K., del Nido P., Mayer J.E.
Jr, Hagino I. et al. Regional low-flow perfusion versus circulatory arrest in neonates: one-year neurodevelopmental outcome. Ann. Thorac. Surg. 2006; 82: 2207?11.
Fuller S., Rajagopalan R., Jarvik G.P., Gerdes M., Bernbaum J., Wernovsky G. et al. Deep hypothermic circulatory
arrest does not impair neurodevelopmental outcome in
school-age children after infant cardiac surgery. Ann. Thorac.
Surg. 2010; 90: 1985?94.
References
1.
2.
3.
4.
5.
6.
7.
STS Congenital Heart Surgery Executive Summary Jul 2008 ?
Jun 2012. Primary Diagnosis Neonates (0?30 days).
Available at: http://www.sts.org/sts-national-database/database-managers/executive-summaries.
Teo L.L., Cannell T., Babu-Narayan S.V., Hughes M.,
Mohiaddin R.H. Prevalence of associated cardiovascular
abnormalities in 500 patients with aortic coarctation referred
for cardiovascular magnetic resonance imaging to a tertiary
center. Pediatr. Cardiol. 2011; 32: 1120?7.
Jonas R.A., Quaegebeur J.M., Kirklin J.W., Blackstone E.H.,
Daicoff G. Outcomes in patients with interrupted aortic arch
and ventricular sepatiental defect. A multiinstitutional study.
Congenital Heart Surgeons Society. J. Thorac. Cardiovasc.
Surg. 1994; 107 (4): 1099?109.
Quaegebeur J.M., Jonas R.A., Weinberg A.D., Blackstone E.H., Kirklin J.W. Outcomes in seriously ill neonates with
coarctation of the aorta. A multiinstitutional study. J. Thorac.
Cardiovasc. Surg. 1994; 108: 841?51.
Bockeria L.A., Tumanyan M.R., Abramyan M.A., Esayan
A.A. Obstructive lesions of the aortic arch combined with ventricular septal defect in infants: embryology, classification, surgical tactics. Detskie bolezni serdtsa i sosudov. 2006; 6: 31?6.
Brown K.L., Ridout D.A., Hoskote A. Delayed diagnosis of
congenital heart disease worsens preoperative condition and
outcome of surgery in neonates. Heart. 2006; 92 (9):
1298?302.
Landis B.J., Levey A., Levasseur S.M., Glickstein J.S.,
Kleinman C.S., Simpson L.L. et al. Prenatal diagnosis of congenital heart disease and birth outcomes. Pediatr. Cardiol.
2013; 34 (3): 597?605.
25
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
Levey A., Glickstein J.S., Kleinman C.S., Levasseur S.M.,
Chen J., Gersony W.M. et al. The impact of prenatal diagnosis
of complex congenital heart disease on neonatal outcomes.
Pediatr. Cardiol. 2010; 31 (5): 587?97.
Axt-Fliedner R., Kawecki A., Enzensberger C., Wienhard J.,
Degenhardt J., Schranz D. et al. Fetal and neonatal diagnosis
of interrupted aortic arch: associations and outcomes. Fetal
Diagn. Ther. 2011; 30 (4): 299?305.
Miyamoto T., Yoshii T., Inui A. Staged repair for aortic arch
reconstruction and intracardiac repair following bilateral pulmonary artery banding in 3 critical patients. Interact.
Cardiovasc. Thorac. Surg. 2013; 16 (6): 892?4.
Esayan ?.?. Surgical treatment of infants with congenital
obstructive pathology of the aortic arch combined with ventricular septal defect: dis. Moscow; 2011.
Walters H. L., Ionan C. E., Thomas R. L., Delius R. E. Singlestage versus 2-stage repair of coarctation of the aorta with ventricular septal defect. J. Thorac. Cardiovasc. Surg. 2008; 135
(4): 754?61.
Sudarshan C.D., Cochrane A.D., Jun Z.H., Soto R., Brizard C.P.
Repair of coarctation of the aorta in infants weighing less than
2 kilograms. Ann. Thorac. Surg. 2006; 82 (1): 158?63.
Bonnet D., Patkai J., Tamisier D., Kachaner J., Vouhe P.,
Sidi D. A new strategy for the surgical treatment of aortic
coarctation associated with ventricular septal defect in infants
using an absorbable pulmonary artery band. J. Am. Coll.
Cardiol. 1999; 34: 866?70.
Gaynor J.W. Management strategies for infants with coarctation and an associated ventricular septal defect. J. Thorac.
Cardiovasc. Surg. 2001; 122: 424?6.
Takayama H., Sekiguchi A., Chikada M., Noma M., Ishizawa A., Takamoto S. Mortality of pulmonary artery banding in
the current era: recent mortality of PA banding. Ann. Thorac.
Surg. 2002; 74: 1219?24.
Tlaskal T., Vojtovic P., Reich O., Hucin B., Gebauer R., Kucera V. Improved results after the primary repair of interrupted
18.
19.
20.
21.
22.
23.
24.
25.
aortic arch: impact of a new management protocol with isolated cerebral perfusion. Eur. J. Cardiothorac. Surg. 2010; 38:
52?8.
Kostelka M., Walther T., Geerdts I. et al. Primary repair for aortic arch obstruction associated with ventricular septal defect.
Ann. Thorac. Surg. 2004; 78: 1989?93.
Kobayashi M., Ando M., Wada N., Takahashi Y. Outcomes
following surgical repair of aorticarch obstructions with associated cardiac anomalies. Eur. J. Cardiothorac. Surg. 2009; 35
(4): 565?8.
Mishra P.K. Management strategies for interrupted aortic arch
with associated anomalies. Eur. J. Cardiothorac. Surg. 2009;
35: 569?76.
Bellinger D.C., Jonas R.A., Rappaport L.A., Wypij D.,
Wernovsky G., Kuban K.C. et al. Developmental and neurologic status of children after heart surgery with hypothermic
circulatory arrest or low-flow cardiopulmonary bypass. N.
Engl. J. Med. 1995; 332: 549?55.
Bellinger D., Wypij D., duPlessis A., Rappaport L., Jonas R.,
Wernovsky G. et al. Neurodevelopmental status at eight years
in children with dextra-transposition of the great arteries: the
Boston Circulatory Arrest Trial. J. Thorac. Cardiovasc. Surg.
2003; 126: 1385?96.
Asou T., Kado H., Imoto Y., Shiokawa Y., Tominaga R., Kawachi Y. et al. Selective cerebral perfusion technique during aortic
arch repair in neonates. Ann. Thorac. Surg. 1996; 61:
1546?8.
Visconti K.J., Rimmer D., Gauvreau K., del Nido P., Mayer J.E.
Jr, Hagino I. et al. Regional low-flow perfusion versus circulatory arrest in neonates: one-year neurodevelopmental outcome. Ann. Thorac. Surg. 2006; 82: 2207?11.
Fuller S., Rajagopalan R., Jarvik G.P., Gerdes M., Bernbaum J., Wernovsky G. et al. Deep hypothermic circulatory
arrest does not impair neurodevelopmental outcome in
school-age children after infant cardiac surgery. Ann. Thorac.
Surg. 2010; 90: 1985?94.
????????? 19.09.2014
╘ ????????? ???????, 2014
??? 616.124.4-089.168:616.899.65
C?????? ????? ? ?????????? ??????????? ?????????
?????? ????? ???????????????????? ??????
?.?. ???????????, ?.?. ???????????, ?.?. ????????, ?.?. ???????
???? ╚??????????? ????? ????????-?????????? ????????╩ ????????? ??; ??. ???????, 6,
?????, 440071, ?????????? ?????????
??????????? ????? ??????????, ?????? ???. ????, ????????-?????????? ??????;
??????????? ??????? ??????????, ?????? ???. ????, ?????????? ??????????;
e-mail: acher77@mail.ru;
???????? ?????? ??????????, ????-???????;
??????? ??????? ???????????, ?????? ???. ????, ??????? ????
26
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
????. ???????? ???????????? ? ?????? ????????, ???????? ?? ?????????? ??????????? ????????? ?????? ????? ???????????????????? ?????? (???) ? ????? ??????? ???? ?????.
???????? ? ??????. ?????????????? ??????? 68 ???????, ??????? ? ?????? ? 2009 ?? 2014 ?. ????????? ??????????? ????????? ?????? ????? ???????????????????? ??????. ???? ???????? 2 ??????: ? 1-? ?????? ????? 58 (85,3%) ????????? ?
?????????? ??? ? ???????? ?????, ?? 2-? ?????? ? 10 (14,7%) ????????? ? ??? ? ?????????? ??????? ????????. ? ????????????? ??????? ? ??????????? ??????? ??????? ????? ????????? ????? 3 ??? (? = 0,33). ? ????? ??????? ??? ????????? ????????? ?????? ??????????? ????????????? ????????.
??????????. ? ?????? ????????????????? ??????? ???????? 2 (3,4%) ????????? ?????? (1-? ??????; ?=0,52). ????????, ???
???????? ??????? ??????????????? ?? ?????????? ?????????? ??-??????? ???? ????? ?????????? ?? 2-? ?????? (?=0,01).
??? ??????? ??????????? ?????????? ????????? ??? ?С????? ???????????? ???????? ? ????????? ??????? ????????? ??????? (?=0,003; r=0,35). ?? ?????? ?????????????? ?????????????? ???????, ????????????? ??????????? ???????? ????? ???????? ???????? ????????? ?????????? ???????????????. ????? ????????, ??? ????????? ??????? ?? ?????????? ?? ??????????
??????? ????????? 44% ?? 2-? ?????? ? 100% ? 1-? ?????? (???-???????? ????, ?=0,03). ?????????? ??????? ????????? ????????? ???????????? ?? 2-? ?????? ????? ??????? ? ???????? ????? ????????, ??? ???????? ??????????? ??????????? ???????
??????????? ?????????? (?=0,001; ?? ? 40,8; 95% ??: 6,9?269,5) ? ??????? ??????????? ????? ??????? ??-???????
(?=0,001; ?? ? 27,4; 95% ??: 4,8?143,1). ???????? ?? ?????????? ?????????????? ??????? ? ??????????? ?????????????? ???????? ?? (?=0,3) ?? ?????? ?????? ?????????? ?????? ?????????????? ? ?????????? ????? ? 1-? ?????? ? ???? ????????? ???????? ??????????? ???????????.
??????????. ?????????? ??????? ??? ???????? ???????? ??????????? ? ????? ? ??????? ????? ????, ??? ? ????? ? ?????????? ??????????. ?????? ?????????? ????????? ???????????? ?? ?????????? ?????????? ???? ? ????????? ? ??????????
??????????? ???????, ??? ??????????? ????? ??????? ??????????????? ?????????????? ????????????? ???????? ??????????? ??????? ? ??????? ???? ??????.
???????? ?????: ?????? ????? ???????????????????? ??????; ??????? ?????; ??????????? ?????????.
DOWN SYNDROME AND RESULTS OF SURGICAL TREATMENT
FOR THE COMPLETE ATRIOVENTRICULAR SEPTAL DEFECT
I.E. Chernogrivov, A.E. Chernogrivov, O.N. Talysheva, V.V. Bazylev
Federal Center of cardiovascular surgery, ul. Stasova, 6, Penza, 440071, Russian Federation
Chernogrivov Igor? Evgen?evich, MD, DM, Cardiovascular Surgeon;
Chernogrivov Aleksey Evgen?evich, MD, DM, Chief of Department;
Talysheva Oksana Nikolaevna, Pediatrician;
Bazylev Vladlen Vladlenovich, MD, DM, Head Physician
Objective. To study genetic and other factors affecting the results of operations for the repair of complete atrioventricular septal
defect in infants.
Material and methods. A total of 68 patients in the infant age underwent repair between 2009 and 2014. Of those, 58 (group I) had
Down syndrome (85.3%), 10 (group II; 14.7%) had normal chromosomes. In the analyzed groups in most cases age was about
3 months (? = 0.33). In both groups, the correction of the main congenital heart disease included two-patch technique.
Results. There were observed two deaths (only I group; 3.4%) in the early postoperative period but no difference in mortality was
found between groups (? = 0.52). It was found that the initial degree of mitral insufficiency component AV valve was more sever in
group 2 (? = 0.01). At discharge, the same parameter found even greater intergroup difference with the statistic value of the effect of
moderate degree (? = 0.003; r = 0.35). According to data of logistic regression analysis the statistically significant differences
between the groups were related to the substrate mitral insufficiency. The presence of Down syndrome was not found as a risk of
mitral valve reoperation because the actual freedom from mitral valve reoperation was 44% in group II compared to 100% in I group
(log-rank test p=0,03). Children without Down syndrome had significantly higher prevalence of reoperations as they had next factors: not completely sutured cleft of neo-anterior mitral component (? = 0.001; OR, 40.8; 95% CI 6.9-269.5) and the lack of tissue
components of the bridging AV-leaflets (? = 0.001; OR, 27.4; 95% CI 4.8-143.1). Despite the lack of statistical difference in value of
the arterial pulmonary pressure (? = 0.3) according to the method of Kaplan-Meier in mid-term follow-up, in contrast, in group I there
are some patients have persisted pulmonary hypertension.
Conclusions. Although clinical outcomes were similar the long-term prognosis for the regression of pulmonary hypertension in children with Down syndrome is worse than children with a normal karyotype. However, the probability of re-operations on the mitral
component was higher in patients with a normal chromosome set due to the individual anatomical variations of the mitral valve in this
group of patients.
Key words: complete atrioventricular septal defect; Down syndrome; surgical treatment.
?????? ????? ???????????????????? ??????
(???) ? ?????????? ????? ?????? (???), ????????????????? ??????????????? ??????????????
???????????????. ????????? ????????????? ?????? ???????? ??????? ??????????????, ??????????????? ??????????? ? ????????? ????????
??????????-????????????? ?????????? ????????.
??????????????????? ????? ??????????? ? 2?6%
???? ??????? ???. ???????????? ??????? ??????
?????? ? ????????? ????????? ??????????????? ?????????????? ??????? ????????? ??????? ???????? ??????????? (??) [1, 2]. ??? ?????? ??????????
????? ????????? ? ???????????? ????????? ? ????????? ?? 21-? ????????? (??????? ?????). ?? ???????????? ?????? ? 75?80% ??????? ??????? ????? ?????????? ? ??? [3, 4]. ??? ???? ??? ???????????? ??????????????? ? ??????? ???????? ?????
?? ?????????? ????????????? ????????? ??????
27
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
????? ??? [5, 6]. ???????? ????????????? ???????? ??????? ??????, ??????, ??????????? ????????? ?????????, ?????????? ????????? ????? ?
??????? ?????????? ????????, ? ??????????? ?????????? ??????????? ?????. ???????????? ??????? ??????? ???????????? ????????? ? ?? ???????
????????? ????????, ??????? ???????? ??????????
??????? ? ????????? ? 10?25% ??????? [1, 5, 7, 8].
?????? ????????? ????????????, ?????????? ???????? ???????? ????????? ? ???????? ????????,
???????? ?? ?????????? ????????? (??????? ???
????????? ??????, ????????????? ????????????
???????? ? ??.) [4?6, 9, 10]. ???? ?????? ???????????? ? ??????? ???????????? ? ?????? ???????,
???????? ?? ?????????? ??????????? ?????????
?????? ????? ???????????????????? ?????? ? ????? ??????? ???? ?????.
Е?зб?к?н к обзс??
?????? ?????? ???????????? ????? ??????????????? ????????????? ????????????, ??????????
68 ???????, ??????? ? 2009 ?? 2014 ?. ? ??????????? ?????? ????????-?????????? ????????
(?. ?????) ????????? ????????????? ?????????
?????? ????? ???. ?????????? ????????? ? ???????????? ??????? ??????? ?????? ????? ??? ?
?????????? ??????????? ????????? ??????. ?? ???????????? ??????????? ???????? ?? ???????
? ?????? ????????????? ?????????? (??????? ?????????? ?????????, ???????????????? ?????????? ??????, ?????????? ?????? ?? ??????????), ?
????? ??????? ?? ????????????? ????????, ???
??????? ?????????? ????????? ???????????????? ?????????.
???????????? ???????? ????????? ?????????
???????????? ?????? ????????-?????????? ???????? (?. ?????).
???????????? ????????????? (????????? ???????? ???????) ?????????????? ??????????? ????????? ? 7 (10,2%) ???????.
???? ???????? 2 ??????: ? 1-? ?????? ????? 58
(85,3%) ????????? ? ??? ? ????????? ? ?????????
?????, ?? 2-? ?????? ? 10 (14,7%) ????????? ? ???
? ?????????? ??????? ????????. ?? ???? ???????
??????? ???????? ????? ????????? ?? ?????????
?????????? ?????-???????? ? ???????????? ??????????? ????????????????.
?? ????????? ?????????????? ???????? ??????
???????????????????? ??????? ???????? ???? ???????? ? ????????? ????? ?? ????????????? ????????: ??? ? ? 30 (51,7%) ? 1-? ? 3 (30%) ?? 2-?
??????, ??? ? ? 3 (5,2%) ? 3 (18,2%), ??? ? ? 23
(39,6%) ? 6 (60%) ??????????????, ?? ??? ????
??????? ??????????? ????? ?? ??????? ?????????? ?? 2-? ?????? ?????????? ????, ??? ? 1-? ?????? ? 4 (36,6%) ? 3 (5,2%) ?????? ??????????????
(? = 0,02). ?????????? ? ???????? ? ??????????????????? ??????? ??????????? ?? ????????, ?????28
??? ? ??????????? ?????? ????????-??????????
???????? (?. ?????).
?????? ? ?????? ????????????? ????? ????????? ??????????? ? ?????????????? ?????????????? ??????????????. ?????? ???????? ??????????? ????????????????? ????????? ╚?????????╝╩.
?? ???? ??????? ??? ????????? ??????????? ????????????? ????????, ??????? ??????????? ? ???,
??? ?????? ??????????????? ???????????
(????) ?????????? ?????????? ?????????????
???????? ?? PTFE, ????? ???? ?????????? ????? ??
?????????? ????????????? ???????? ???????????
?????????? ?????? ???????????????????? ??????? [11]. ???? ???????????? ????? ???? ????????????, ????? ? ???? ??????? ??????????? ???????????? ?????????? ?????? ??????????? ???????. ??????? ????????????? ?? ??????? ????????????
???????? ?????? ????????? (??), ? ????? ???????? ????????? ??????????? ??????????. ????????????? ??????? ??????????? ?????????? ??????
???????????????????? ??????? ??????????? ?????????????? ??? ?????? ?????????????? ?????.
????????????? ??????????? ?????????? ?????????? ? ????????? ?????????????????? ????????
??? ? ???? ???????? ??????????? ????????? ??????????? ??????? ?? ???????? ????. ????? ?????????? ???? ????????? ????????? ?? ??????????????? ?????????????? ???????? ???????????
?????????? ??? ?????? ????????, ??? ???????,
?????????? ????? ???? ??????????? ? ???????????? ????????? ??????? ????????? ??????????????????? ??????? ?????? ?????????????? ???????
??????????? ????. ??? ????????????? ?????????? ????????????????? ????????????? ??????
?????????? ?????? ??-??????? ?????????????
????????? ???????????: ????????? ?????????????? ???? ? ??????? ????????, ???????? ?????????????? ??????????? ? ???? ???????, ?????????? ?????? ?????????????? ?????????? ??????
(??) ??????????? ??????????. ????????? ??????
?????????? ?????? ?????????????? ???????????
(????) ???????? ?? ????????????? ? ???????????
??????????? ?????? ?? ???? ??????? ? ???????
??????? ??????????. ? ????????? ??????? ????????????? ????????????? ?? ??????????????? ?????????? ? ????????? ????????????? ????????????? ???????????.
????????????????? ?????????????? ?????
??????????? ???? ?????????. ??????????? ??????????? ????????? ??????????? ? ???????????????
?????????? ?????? ???????????????????? ???????, ??????????????? ??????? ?? ???? ? ????, ?????????????? ??????? ????????.
? ?????? ? ?????????? ????????????????? ???????? ??????????? ????? ? ??????????? ??????? ???????? ???????????, ?????????????? ??????? ??????????, ??????????? ?????????????
??????? ???????? ? ????????? ?????? ?? ?????????? ????????.
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???????? ?????????? ??????????? ????????????? ? ????? ?? 5 ??? (??????? ??????? ??????????
553 ???). ????????????? ??? ???????? ????? ???????? ????????.
??????? ???????????? ?? ? ???????? ??????????? ? ?????? ?????????, ??????????????? ??????????? ????????? ??????????? (ESC) ? ??????????? ????????? ?? ??????????? ??????????
(ERS), ?????????? ????????????? ????????? ??
?????????????? ?????? ? ?????? [12]. ? ???????????? ? ???????????? ?????????????? ??????? ??
????????????, ???? ??????? ???????? ? ????????
??????? ? ????????? ????? ?? ??????????? ??????????? ???????????? ?????????? 25 ?? ??. ??. ? ????.
??? ???? ???????????? ??????????? ???????? ? ???????? ??????? ??????? ?????????????? ????????????, ??? ?????? ???????? ???????? ? ?? ???????? ?? ??????? [13]:
???????? ????. = 0,61 в ???????? ??????. +
+ 2 ?? ??. ??.
?????????????? ??? ????????????? ????????
? ?? 35 ?? ??. ??. ??????? ???????? ??????????
25 ?? ??. ??.
? ????????????? ??????? ? ??????????? ???????
??????? ????? ????????? ????? 3 ??? (?=0,33). ????????????? ??????????? ??????? ?? ???????????
?????? ??????????? ?? ?? ???????. ? ????? ???????
??????????? ???????? ???????? ????: 36 (62,1%) ?
1-? ? 7 (70%) ?? 2-? (?=0,55). ???????????? ????????? ????? ??????????? ?????????? ? ?????????? ????? ???????? ????? ??? ???????????? ??????????, ??
??? ?????? ??????????? ?????????? (?????????? ???????? ??????? ??????, ??? ??? ??????????????? ?
?????? ??????????? ?? ????? 20% ??????? ?? ?????????????? ????????). ??????? ???????????? ????????????? ???? ?????????????? ???????????, ????????????? ????? ???????? ?? ??????? ??????????
??????? ?? ???, ? ????????? ?????????? ? ??????????? ???????, ????? ? ???????????? ??????????
????????? (????. 1).
????????? ?????????????? ?????? ???????????
? ?????????????? ?????? ???????????? ???????????
Statistica 6.0 StatSoft (StatSoft, Inc. Tulsa USA) ? SPSS
Statistics (Statistical Package for the Social Sciences,
version 21, IBM corporation). ?????????????? ??????
???????????? ? ???? ???????? ???????? ? ???????????? ?????????? ??? ??????? ????????? ?????????-
К???лкзбн╦л?х ?л?нка мнклк?брмк? ??лл?? тс ??штт?о
??????????
???????????
1-? ??????
(n = 58)
2-? ??????
(n = 10)
????????
???????????
(Z)
М?╥нк?? 1
????????
?????????
(t)
r*
Cohen
p
???????; ?? 25?75%, ???????╠SD
???????, ???
94; 42?182
105; 64?291
1,21
?
0,15
0,25
????? ????, ??
5,3╠3,7
4,2╠1,1
?
0,97
0,13
0,32
??????????????? ?? ?? ????????
1,0╠0,87
1,8╠1,0
?
2,4
0,31
0,01
??????????????? ?? ?? ????????
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?
1,2
0,08
0,18
43; 22?92
0,04
?
0,003
0,73
0,05
?
0,009
0,13
16; 9?23
1,67
?
0,20
0,06
0,04╠0,04
0,02╠0,03
?
1,12
0,15
0,25
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?
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1,06
?
0,13
0,31
?
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0,03
0,76
????? ???, ?
????? ?????????? ? ????, ???
????? ?????????? ? ??????????
?/? (????????)
???? ?????????? ? 1-? ???,
?/?, ???/??/???
???? ???????? ? 1-? ???,
?/?, ???/??/???
???????????? ???, ?
????? ????????? ??, ???
????? ??, ???
38,3; 21?95
4,4; 2,6?10
9; 7,4?15,4
67,5; 40?115
89,2╠28,5
137,6╠128
5; 3?12,2
88; 51,5?144
88,3╠17,7
122,2╠22
?
0,41
0,06
0,74
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?
1,22
0,16
0,22
???????????, ╟?
34,3╠3,2
???????? ? ??????. ??? ???????
39; 27,1?42,3 38; 32?47
??????????????? ?? ??? ???????
0,58╠0,4
??????????????? ?? ??? ???????
0,51╠0,3
???????? ? ?? ? ???. ???????
30; 25?33
0,76
?
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0,67
?
3,0
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0,003
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?
0,4
0,06
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2,08
?
0,26
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? ? ? ? ? ? ? ? ? ? . ?? ? ?????, ??? ? ????????????? ?????????? ??????, ??? ? ???????????????? ?????????, ?? ? ??????????
??????, ?? ? ??????????????? ??????, ???? ? ????????? ?????????? ? ??????????? ???????, *? ????? ???????? ??????? (r)
?? Cohen ??? ??????????? ??????? (????? ?????????) ??? r=Z/?N (????? ???????????).
29
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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К???лкзбн╦л?х ?л?нка мнклкмс-?бос???ык?брмк? ??лл?? тс ??штт?о
??????????
???? ???????? ????
?????????????
??????? ?? ?????? ????????
????? 3 ???
?? ?? ????? 4 ???
???????? ??????? ? ????????
???????? ????????? ?? 2010 ?.
М?╥нк?? 2
1-? ??????
n (%)
2-? ??????
n (%)
?????????
??????
(95% ??)
?2
???????????
???????*
p
36 (62,1)
2 (3,4)
7 (70)
1 (10)
1,4 (0,4?5,0)
0,8 (0,7?1,1)
0,32
0,81
0,07
0,12
0,55
0,37
11 (18,9)
25 (43,1)
6 (10,3)
16 (27,5)
6 (60)
5 (50)
1 (10)
2 (20)
1,0 (0,4?2,4)
0,9 (0,4?1,3)
0,91 (0,1?6,9)
0,6 (0,1?2,5)
0,21
0,1
0,06
0,36
0,02
0,04
0,07
0,07
0,86
1,0
1,0
0,69
*?????? ???????? ??????? ??? ???????????? ??????? ??? ?????????????? ???????.
?? ????????????? (????? ???????? ????????? ????????? ????????? ??????) ?╠m. ??? ????????????? ????????? ?????????? t-???????? ?????????.
??? ??????????? ????????????? ???????? ?????????????? ?????? ???????????? ??? ????????? ???????? (?) ? ???????????????? ?????????? 25?75%,
??? ???? ??? ????????????? ????????? ??????????
????????????? U-???????? ???????????. ??? ?????????????? ????????? ?????????? ?????? ????????????????? ????? ?????????????? ????????? ? ????????? (???? ???????). ???????? ????????? ???????????? ??? ????????? ???????? p<0,05 ??? ??????
??????????????? ??????.
???????, ????????? ? ??????? ???????, ????
??????? ? ??????????? ????????????? ????????????? ???????, ?? ???????? ???? ???????? ?????????
?????? (??) ? 95% ????????????? ???????? (??).
???????????? ?? ??????? ??????????????? ? ??????? ?????? ?????????????? ? ?????????? ?????????? ????????????? ??????? ?? ??????????? ??????????? ?????????? ???????. ??????????? ?????????????? ??????? ???????????? ? ???????? 1 ? 2.
??? ????? ?? ??????????? ??????? ??????? ??????????? ?????????? ???????? ??????? ? ???? ?????????????? ????????? ??????????, ??????? ????? ????????? ???????? ??????????? ??????????.
????? ?????????? ???????? ??????? ??????? ??
???????????? ??????????????? ??????? ? ??????????? ??? ??????????? ??????? ??? ?????????????? ??????? (??? ?????? ??-???????), ???????? ??????? (r)
?? Cohen ??? ??????????? ??????? ??? ??????????
????????????? (??? ?????? ?????????) ??? r=Z/?N
??? ???????????? ????????????? ?????? (??? ?????? ???????????). ??? ????????????????? ?????????????? ?????????????? ??????? ??????????? ????????
???? ???????????? ??? ??????????? ?????-?????????. ???????? ??????? ? ???????? 0,1?0,3 ??????????????? ??? ??????, ? ???????? 0,3?0,5 ? ??? ?????????, ? ??? ???????? ????? 0,5 ? ??? ???????.
Йбашн╦з?з?
????? ? ?????? ????????????????? ??????? ???????? 2 (3,4%) ????????? ??????, ??? ???????? ?
??????? ????? (1-? ??????) (? = 0,52). ? ????? ???30
???? ??????? ????????? ?????? ????? ??? ? ??????????? ????? (???) ? ???. ? ???? ??????? ??
???????? ?????????? ?????????? III?IV ??. ? ????????? ????????? ??????????????? IV ?? ?? ROSS,
??????? ???????? ???????????.
????????????????? ?????????? ? ?????? ????? ???????? ? 58,8% ??????? (40 ?? 68). ?????????? ???????? ???????, ????????????? ???????????? ??????????? ??????? ? 8 (11,7%) ????????? ?
?????????? ? 3 (4,4%) ????????? ? ?????????????? ???????????? ? 2 ???????. ???????? ??????????????? ???????? ? 2 (2,9%), ??????????? ??????????????? ? ???????????????? ??? ? 5 (7,3%)
?????????, ????????? ???????????????, ????? ????????? ?????????? ???, ? 13 (19,1%) ?????????.
????????? ????????? ????? ???? ?????????????
? 11 (16,1%) ???????, ?? ??? ? 8 (11,7%) ????????
????????? ??????????????????? ???????????? ?
?????????????? ????????? ???????? ???????????????????????. ? ??????????? ?? ???? ???????
????????????? ????????? ????. ???????? ??????????????? ?????????? ??????????? ? 3 (4,4%),
??????? ???????? ????????? ???? ? ? 2 (2,9%) ???????, ??? ???? ? 1 ?????? ????????????? ??????????? ??????????? 2-????????? ???. ? 1 ?????? ? ???????? ????? ?????????? ??? ????????? ???????
??????????? ?????????? ?? ??????? ????????????? ?????????. ?? ??????? ???????? ????? ????????????????? ?????????? ????????????? ??????????? ???????? ????? ???????? ?? ????????
(? = 0,53).
??????? ????????, ??? ??????? ??? ???????????? ?????? ???? ??????????? ?? ???????? ???????-??????????????? ???????????. ?????? ????????, ??? ???????? ??????? ??????????????? ?? ?????????? ?????????? ??-??????? ???? ?????
?????????? ?? 2-? ??????, ??? ????? ?????????????? ?????????? (? = 0,01). ??? ???? ????? ????????? ?????? ? ????? ??????? ???????? ???????????
???????? ??????? ?????????? ???????????? ??
????????? ? ?????????????? ??????? (? = 0,001).
?????? ??? ??????? ??????????? ?????????? ????????? ??? ??????? ???????????? ???????? ? ????????? ??????? ????????? ??????? (? = 0,003;
r = 0,35) (??. ????. 1).
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
?? 2-? ?????? ????????????? ?????????? ????
????????? ??????? ????? ??????? ?????? ??-???????, ????????? ????????????? ????????????????? ????????????? ? ????????????? ??????????
??????????? ??????? ??? ?????? ????????????
???? (????. 3). ????? ???????, ?? ?????? ?????????????? ??????? ????????????? ????????????
????????? ???????? ??? ???????????, ????????????????? ? ????? ???????? ????????????? ????????? ?????????? ??????????????? ?? 2-? ?????? (???
???????? ?????). ??? ???? ? ???? ????????? ??
???? ?? ?????? (n = 6, ??? 60%) ??????? ????????
??????????? ??????????? ?????????? ??????? ???????? ?? ??????? ? ????? ? ???????????? ?????????????? ????????????????? ???????.
????? ???? ????????? ?????????? ?????? ??????? ?????????????? ?????????????? ???????????????? ??????? (????. 4) ???????????, ??????? ????????
????????????? ???????????? (p< 0,05) ??? ?? ????-
??? ? ????????????? ????????? ????????? p (< 0,1)
??? ?????? ?????? ?????????????? ???????.
?? ??????????? ?????????????? ??????????????
??????? ???????? ????? ???????? ????? ????????
????????? ?????????? ??????????????? ?? ??? ??
???????????. ??? ???????? ???????????? ????????
??????????? c ?????????????? ?????????????????
??????? ????????????? ??????????? ??????? ????? ???????? ?? ??????? ????????? ?? ??????????.
?????????? ???????? ???????????? ?? ?????????? ??????? ? ?????????? ?????, ???????? ??????? ??????????, ?????????? ????????, ??? ????????? ??????? ?? ?????????? ?? ?????????? ???????
????????? 44% ?? 2-? ??????, ????? ??? ? 1-? ??????
?? ??? ?? ?????? ??????? ?????? ?????????? ???
????? 100% (???-???????? ????, p = 0,03) (???. 1).
?????????? ????????? ???????????? ????????????? ? ????? ???????: 1 (1,7%) ?????? ? ?????? ????? ? ????????? ????? ? 3 (40%) ?????? ? ??????
М?╥нк?? 3
Ллк???к?лзл?х ?л?нка обй??шттс??? ??анк?кх, ртсрс╥л?? ?нк?з╦ л? кр?с? а?╥снб??лк?
??????????
????????? ???? ?????
?????????????????
????????????? ??
??????? ????? ???????
??? ? ?? ????????
????? ???? ?? ?????? ????????
????? 2,5 ??
??????? ????????????? ???
??????????? ? ????????
?????????? ??? (????? 7 ???)
????? ?????????? ? ????
????? 10 ???.
???????????? ??? (????? 7 ???)
????????? ??, ???:
?????120
????? 90
?????? ???????????
?????????? ???????????
????????????? ??????????
????????????? ??????????
?? ??
??????????????? ?? 2 ??.
? ???? ?/?
??????????????? ?? 3 ??.
? ???? ?/?
?????? ????????? ?????? ??
???????????? ?? (>35 ?? ??. ??.)
?????????? ??????? ??-???????
?? ????????? ??????
??????????? ???????
1-? ??????
(n = 58),
n (%)
2-? ??????
(n = 10),
n (%)
2 (3,4)
2 (20)
4 (6,8)
3 (5,1)
23 (39,6)
6 (60)
6 (60)
6 (60)
2 (3,4)
6 (10,3)
2 (3,4)
12 (20,6)
0
2 (20)
1 (10)
0
19 (32,7)
12 (20,6)
5 (8,6)
20 (34,4)
2 (3,4)
2 (3,4)
1 (1,7)
?????????
??????
0,81*
95% ??
r
p
0,5?1,4
0,28
0,1
2,7?24,7
3,5?38,6
0,8?2,7
0,54
0,58
0,14
0,0001
0,0001
0,32
1,03
1,3
0,89*
1,3
0,9?1,3
0,3?1,9
0,8?1,1
1,3?1,4
0,08
0,12
0,12
0,21
0,51
0,57
0,38
0,08
3 (30)
1 (10)
0,78
1,14
0,3?2,5
0,8?1,3
0,034
0,12
0,7
0,38
0
4 (40)
0
0
3 (30)
1,0
1,2
1,05
1,05
17,8
1,0?1,2
0,5?2,6
0,9?1,2
0,9?1,2
1,8?146,8
0,12
0,034
0,08
0,08
0,44
0,33
0,78
0,52
0,52
0,01
0,45
0,02
8,3
11,3
1,3
0
2 (20)
0,81*
4 (6,8)
5 (50)
6,8
2,3?20,3
0,46
0,003
3 (30)
1 (10)
1 (11,1)
3 (30)
0,78*
0,93
1,6
16,6
0,47?1,0
0,8?1,2
1,2?2,3
1,8?146,8
0,53
0,18
0,28
0,48
0,002
0,28
0,06
0,02
6 (60)
16,6
3,8?70,7
0,68
0,0001
0
1 (1,7)
23 (39,6)
1 (1,7)
2 (3,4)
0,48?1,0
? ? ? ? ? ? ? ? ? ? . r ? ??????????? ??????? (???????? ???????), *?????? ??? ??????? 1-? ??????. ????????? ??????????? ??
??, ??? ? ????. 1.
31
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
М?╥нк?? 4
Ешн╦зк???к?лзл?х ?л?нка ?а?коср??ак ?блбзк?брмк? обй??шттс??? ??анк?кх к ?сстб???кслл??,
стб???кслл?? к тсрнбстб???кслл?? ы?мзс?с?, ртсрс╥л?? ?нк?з╦ л? кр?с? а?╥снб??лк?
??????????
?????????????? ?????? (n=68)
????????? ???? ?????
????????????????? ????????????? ??
??????? ????? ???????
?????????? ??? (????? 7 ???)
????????????? ??????????
????????????? ?????????? ?? ??
??????????????? ?? ?/?:
> 2 ??.
> 3 ??.
???????????? ?? (>35 ?? ??. ??.)
?????????? ??????? ??-???????
?? ????????? ?????? ??????????? ???????
??????????????? ?? ?? ????????
????? ?????????? ? ?????????? ?/?, ????????
??????????????? ?? ??? ???????
?????????
??????
95% ??
R2 (????.
?????-?????????)*
?
6,8
20,5
27,4
0,4
24,5
14,8
0,81?55,8
3,9?97,8
4,8?143,1
0,42?3,4
2,3?268,1
1,3?179,6
0,12
0,34
0,39
0,04
0,31
0,22
0,06
0,0001
0,0001
0,19
0,008
0,03
12,8
24,6
0,35
24,5
40,8
5,7
0,18
37,1
2,8?62,6
2,3?268,7
0,04?3,0
2,4?268,7
6,9?269,5
1,4?25,8
0,2?1,4
3,4?376,0
0,45
0,34
0,08
0,31
0,46
0,30
0,08
0,41
0,002
0,01
0,29
0,01
0,0001
0,02
0,09
0,003
*?????? ??? ??????? 2-? ??????.
????? ? ?????????? ?????????? (?=0,006). ?? ??? ?
2 ??????? (??????? 1 ???????? ?? 1-? ??????) ????????????? ?????????? ????????????? ????????????? ??????????, ??????? ???? ???????????? ????????-???????? ??????, ? ? ?????? ?????? ???????? ?????????? ??????? ???????????? ?????????
??????????? ???????. ????????? ????????? ????????????? ???????? ??????????? ??????? ? ???????????, ??? ??? ???????????, ? 2 ??????? ?? 2-? ??????. ?????? ???????? ?????? ??????????? ????????
??????????? ??????? (??). ??? ?? ????? ????? 3 ???? ????? ????????? ????????? ????????? ???????-
??????? ?? ???????????? ???????? ╚??????╩
? 21. ? 1 ?????? ????????? ????????????? ?? ??
????????????? ????? 1 ??? ????? ????????? ??????. ??? ??????? ??????? ??? ?? ??????????? ????
?????????????, ?? ??????? ???? ??????????? ????
????????? ????? ?????, ????? ???? ?????????
?????? ??????? ?? ??????????????? ?????????.
?? ?????? ??????????????? ???????, ??????????
?????????? ??????? ????????? ???????????? ??
?? ? ?????? ????? ? ?????????? ?????????? ????? ??????? ? ???????? ????? ????????, ??? ?? ?????? ??????????? ??????????? ??????? ?????????-
1,0
1-? ??????
???????????????
??????? ?? ??????????
0,8
0,6
0,4
2-? ??????
0,2
0,0
,0
32
500,0
1000,0
1500,0
?????, ???
2000,0
???. 1. ????????? ??????? ?? ?????????? ?? ??????????
??????? ? ?????????? ?????. ???????? ????????? ?????:
???????? ???????: ??-??????? = 5,6, ? = 0,018; ???????? ??????-????: ??-??????? = 6,1, ? = 0,013; ???????? Log-rang
(Mantel-Cox): ??-??????? = 4,6, ? = 0,03
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
1,0
2-? ??????
???????????????
??????? ?? ??
0,8
0,6
0,4
1-? ??????
0,2
0,0
,0
500,0
1000,0
1500,0
?????, ???
2000,0
???. 2. ????????? ??????? ?? ???????? ??????????? (????????????? ???????? ? ?? ????? 35 ?? ??. ??.) ? ??????????
?????. ???????? ????????? ?????: ???????? ???????: ????????? = 2,8, ? = 0,09; ???????? ???????????: ??-??????? = 3,4, ? = 0,06; ????-???????? ???????? (Mantel-Cox): ????????? = 4,1, ? = 0,04
1-? ??????
1,0
2-? ??????
???????????????
????????????
0,8
0,6
0,4
0,2
0,0
,0
500,0
1000,0
1500,0
?????, ???
2000,0
?? ?????????? (? = 0,001; ?? ? 40,8; 95% ??:
6,9?269,5) ? ??????? ??????????? ????? ???????
??-??????? (? = 0,001; ?? ? 27,4; 95% ??:
4,8?143,1). ??? ????? ?????????? ??????????
? ??????????? ????????, ??? ??? ???????? ???????
(R2) ????????? 0,39 ? 0,46 ??????????????.
?????? ??????????? ? ????????????????? ??????? ? ?????? ????????? ???????? ?????? ???????? ???????? ?????????????? ???????? ? ????????
??????? (????). ???????? ?? ??, ??? ?? ?? ???????? ?????????????? ??????? ? ??????????? ????
(p=0,3), ?????????? ????????, ??? ?? ?????? ?????? ?????????? ?????? ?????????????? ? ?????????? ????? ? ???? ????????? 1-? ?????? ?? ???????????. ?????????, ?? ????????? ??????? ? ????-
???. 3. ???????????? ???????????? ? ?????????? ?????.
???????? ????????? ?????: ???????? ???????: ??-??????? = 0,34, ? = 0,55; ???????? ???????????: ??-??????? = 0,34, ? = 0,55; ????-???????? ???????? (Mantel-Cox):
??-??????? = 0,34, ? = 0,55 (?? ???? ??? ??????????? ???????? ?? ???? ?????????)
??? ?????????? ?????????? ???????? ? ????????
??????? ? ?????????? ??????? ??????????, ????
?????????? ?????? ? ?????? ? ????????? ?????.
?? 2-? ?????? ??????? ???????????? ?? ?? ???????? (???-???????? ???? p=0,04) (???. 2).
? ???????????????? ??????? ?????? 2 (2,9%)
???????? ?? 1-? ??????, ??????? ????? ???????????? ????????? (???. 3). ???????? ??????????
?????? ? ????? ??????? ????????? ??????????????? ?? ?? ???? ???????????????? ?????????.
???????? ?? ?????????? ????????????? ??????????? ??????? ????? ???????? ?? ?????????? ?????????? ???????????? (p=0,55) ?? ?????? ??????
??????????????, ?????? ??, ????????, ????????
?????? ? ??????????????? ??????.
33
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
И╥ршй?блкб
??????? ???????? ???????? ?? ?????? ??????????? ????????? ??? ????????? C.W. Lillehei ?
?????. ? 1954 ?. ? ???????? ????????????? ??????????????. ? ??????????? 60 ??? ? ???? ??? ???????? ??????? ???? ?????????????? ??????? ???.
??? ?? ????? ??????? ???????????? ? ??????? ???
?? ?????????, ??? ?????????????? ??????????? ????????? ??????? ???????????, ??????????? ???
[14]. ?????????????? ??? ???????????? ?????
????????????? ???????, ??????????? ?????????
??? ????????? ??????????? ????????? ??????,
?????????? ??????????? ?????????, ??????? ??????? ?????????? ????????? [15]. ??????????
???????? ???????? ???????????? ???? ??????????
????????? ???????????? ????? ????????? ?????????, ??????? ??????????? ?????????????? ???????? ? ??????? ???????? [7]. ???????? ?? ??? ??? ??????, ???????? ??? ?????????? ????????.
???????????? ????????? ???????? ?????? ???????????? ???????????, ??????? ? ????????? ???????? ????????? ?? 1,5 ?? 3,5% [16, 17]. ?? ?????????? ?????? ???? ??????????? ??????????
????????????????? ???????? (EACTS), 30-???????
??????????? ?????????? ??????? 7%. ? ????? ???????????? ?????? ??????????? ????????? 2,9%. ??
?????? ??????????, ????????? ???????????? ???????????? ??????????? ???????? ??????? ?????????? ?????? ????????, ???????? ???????????, ?????????? ??????????????? ??????????? ???????
[17?19]. ? ?????????????? ???? ?????? ?????????
?????? ? ????? ??????? ????? ???? ??????? ? ?????????? ????????????????? ???????? ?????.
????? ????, ?????????? ???????????????? ??????, ? ??????? ?????????????? ??????? ????????
????? ?? ?????? ? ?????????? ?????????? ?????????????? ??????? ?????? ????? ???. ???, ?? ??????
???? ???????, ???????? ?????? ??????????? ???????? ????? ? ????? ??????? ????????????????? ???????????? [9, 16]. ?????? ?????? ?????? ??????? ?
???????????? ????? ??????????????? ? ???, ??? ??????? ????? ?? ???????? ??????????? ????????,
???????? ?? ????????????????? ??????????? ? ??????? ????????? ???????????? [20, 21].
?? ????? ???????????, ???????? ???????? ?
????????????? ??????? ???????? ?????? ????????????? ???????? ????????? ??????. ? ?????? ??????? ? ????????? ????? ???????? ?????? ?????
???????????? ? ????????? ?????? ?????????? ???????????. ? ?????? ????????? ??? ???????????? ????????? ????????????? ????????? ????? ????????????, ??? ???????????? ??????? ????????? ??? ?????????????, ???????? ?????????? ????????. ????
?????????? ?? ???????????? ??????, ??????? ???????? ?????? ?? ??????, ????????????, ??? ??????? ???????? ????? ?? ???????? ???????? ?????
?????????? ?? ?????????? ???????. ??? ???? ?????
?? ?????? ???????? ???????????? ?? ??????????
34
??????? ? ?????????? ??????? ???? ???????? ??????????? [10]. ?????? ?????????????? ?? ?????????????? ????????, ??? ????????? ??????? ??????????? ???? ??? ?????????? ????????, ??? ????????
???????? ????? ?????????? ????? ?????????
?????. ??? ???? ??????????? ????????? ???????? ? ????????? ? ????????? ????? ???? ?????????? ???? (?? ? 0,29; 95% ??: 0,13?0,65) [5].
????????? ?????? ?????????????? ?? ????????? ?????? ? ????????????? ??? ? ?????? ???????? ? ????? ?????????? ???????????? ?? ???????? ? ??????? ??? ????????, ? ????? ? ????? ?????? ?????????? ╚?????????????╩ ???????? ?
??????? ? ????????? ????? (29% ?????? 5%). ?
???? ?? ??????????????? ???????????? ?????????? ??????? ? ????????????? ??????????? ????????? ?????????? ????? ?????? ?????????? ?
?????? ??????? ??? ??????????? ??????????
(13% ?????? 2%). ????? ????????, ??? ? ?????????
?????? ?????????? ???????? ??????????? ???????? ?? ???????? ??????????? ?????????? ????
(21% ?????? 71%) [8]. ??? ??? ???????? ????? ???????????? ????? ?? ????????????? ???????????
????????????? ????????? ? ????????? ╚????????????╩ ??????? ???????? 21-? ????????? ?? ?????????? ??????????????????? ????????????. ???????? ?? ???, ?????????????? ???? ?????? ??
??????? ???????????????? ??????????. ???????
???????? ????? ????? ??????????? ??? ??????
??? ?/??? ?????????????? ???????, ?? ????? ?????????? ????????????, ?????? ????????? ????????????. ???, ? ?????? M. Reller ? ?????., ??????????? ??????? ???????????????? ????? ? 1958
?? 1998 ?., ? ??????? ????? 3965 ????????? ? ???
(?? ??? 289 ? ????????? ?????). ???? ????????,
??? ?????????? ??????????? ? ??????? 20 ??? ???
??????? ???????? ???? ???? ?????? ??? ???????
????????????????? ?????? ??? (20% ?????? 5%,
? = 0,04) [6].
????? ???????, ????? ?? ?? ??????????? ?????
?????? ????????????? ??? ???????? (????????????? ????????????????? ????????????? ? ?????????? ?? ?????????? ?????????? ? ?????????? ???????, ??????? ????? ???????, ???????????? ??????????????? ??????????? ??????? ? ?? ?????????
?????? ??????????? ???????? ???????) ??? ??????????? ??? ??? ???????? ??????? ??? ?????????????? ?????????? ?????????? ????? 0,9, ?? ??? ? ???????????? ??????? ????????? ??????????????.
??? ?? ????? ???????? ??????? ? ???????? 0,3?0,5
????? ??????????????? ??? ????????? ??? ????
???????? (?? ????????? ??????? ???????????, ???????? ????? ??????? ? ??????????????? ??????????? ??????? 3 ??????? ? ????) ? ?????? ??? ????????????? ???????????.
? ???? ????? ????? ?????????, ??? ??????? ????? ?? ???????? ??????????? ?????????? ? ????????? ??????? ??? ? ??????, ??? ? ? ?????????? ????????????????? ??????? [22, 23]. ????? ????-
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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???????? ???????? ??? ????????? ????? ?????????
??????? ????????, ??? ???? ??????????? ?? ???
????????, ??? ????????? ?????????? ??????????? ?
????? ?? 3 ?? 6 ??? [16, 19], ??? ????????? ? ?????? ??????? ? ??????? ??????? ????????? ?? ?????? ????????? ??? ? ???????? 3 ???.
?????? ???????? ?????????????? ??????????
?? ???????? ???????? ?????????????? ??????????? ????????? ?????? ????? ?? ???? ??????????????? ??. ?? ?????? ???? ???????, ???????????
????????? ? ?????? ?????????? ? ????????? ?????? 1 ????. ????????? ??? ????, ??? ??????? ????? ???????? ????????? ???????? ????? ????????
??????????? ????????? ? ????? ????? ?????????????? [3, 24]. ????????????? ??????, ????????
???????? ? ????? ? ??????? ????? ???????? ??????????? ????????? ????? ??????????????, ??? ?
????????? ? ?????????? ??????????. ?????? ??
?????, ??????????? ???? ????????? ?????? ????? ??? ? ????????? ? ????????? ????? ?? ?????? ????????? 4 ???. ? ????????? ????? ????????????? ? ?????? ????????? ?????? ?????
??? ???????? ?????????????? ???????? [16, 22].
???????? ?? ???????????? ???????? ?????? ????????????????? ?????????? ? ?????????? ?????
??????? ????????????? ??????????? ??, ???????
????????????????? ?????????? ? ??????????
????? ???????? ?????????? ???????. ? ????? ???????????? ? ????????? 1-? ?????? ????????? ???????????? ???? ??????, ??? ?? 2-? (? = 0,008). ???? ???????? ???????, ????????????? ???????
????????? ???????????? ?? ??: ???????? ??????????? ??????????? ??????? ??????????? ?????????? (? = 0,0001; ?? ? 40,8), ??????? ????? ??????? (? = 0,0001; ?? ? 27,4), ?????????????????
????????????? ?? (? = 0,0001; ?? ? 20,5). ?????????? ?????????? ????? ? ??????? ?????? ??????? [25, 26]. ????????????? ?? ?????? ????????????? ?????????? ? ????? ????? ?????????? ????????????? ? 2 (2,9%) ???????. ?? ??????
??????????, ????????? ????? ????????: ??? ? ?????? ??-??????? ?? ????????, ?????? ????????
??????????? ?? ?????????? ?????????? (?????????? ???????? ??????? ??????????? ??????? ? ??????????????? ???????????, ??? ???????? ???????? ????????? ?????? ??) [5, 8]. ? ????? ???????????? ????????????? ??????????? ????? ?????
??????????? ??????????? ? ??????????? ?? ???????? ?????? ?? ? ?????????? ????? ?? ????????, ??? ????? ?????????????? ? ?????????????
?????? ??????? [27?29].
??? ??????????? ? ????? ? ??????? ????? ????, ???
? ????? ? ?????????? ??????????. ?????? ?????????? ????????? ???????????? ?? ?????????? ?????????? ???? ?????? ? ????????? ? ??????????
??????????? ???????, ??? ??????????? ???????
?????????????? ????????????? ???????? ??????????? ??????? ? ???? ?????? ???????.
??????????
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
А?мн??блкб
? ?????????????? ???? ???????????? ???????
?????????? ?????????????? ??????? ????????? ?
?????? ?????? ???????????????????? ?????? ? ??????????? ?? ??????? ???????????? ?????????. ????????, ??? ?????????? ??????? ??? ???????? ?????-
15.
??????? ?.?., ???????????? ?.?. ???????????????????
?????. ???????? ? ??????????? ????????????? ?????????.
?.: ????? ??. ?. ?. ???????? ????; 2005: 88.
??????????? ?.?., ??????? ?.?. (???.). ????????-?????????? ????????: ???????????. ?.; 1989.
Clapp S., Perry B.L., Farooki Z.Q., Jackson W.L., Karpawich P.P., Hakimi M. et al. Down?s syndrome, complete atrioventricular canal, and pulmonary vascular obstructive disease. J. Thorac. Cardiovasc. Surg. 1990; 100: 115?21.
Freeman S.B., Taft L.F., Dooley K.J., Allram K. Populationbased study of congenital heart defects in Down syndrome.
Am. J. Med. Genet. 1998; 80: 213?7.
Al-Hay A.A., MacNeill S.J., Yacoub M., Shore D.F.,
Shinebourne E.A. et al. Complete atrioventricular septal
defect, Down syndrome, and surgical outcome. Risk factors.
Ann. Thorac. Surg. 2003; 75: 412?21.
Reller M., Morris C.D. Is Down syndrome a risk factor for poor
outcome after repair of congenital heart defects? J. Pediatr.
1998; 132: 738?41.
??????? ?.?., ??????? ?.?., ??????????? ?.?., ????????? ?.?., ??????? ?.?., ??????????? ?.?. ??????????
?????????????? ??????????? ??????? ? ????? ??????? ????????. ??????? ??????? ?????? ? ???????. 2008; 2: 60?6.
Atz A.M., Hawkins J.A., Lu M., Cohen M.S., Colan S.D.
Surgical management of complete atrioventricular septal
defect: associations with surgical technique, age, and trisomy
21. J. Thorac. Cardiovasc. Surg. 2011; 141 (6): 1371?9.
DOI:10.1016/j.jtcvs.2010.08.093.
Masuda M., Kado H., Tanoue Y., Fukae K. Onzuka T.,
Shiokawa Y. et al. Does Down syndrome affect the long-term
results of complete atrioventricular septal defect when the
defect is repaired during the first year of life? Eur. J.
Cardiothorac. Surg. 2005; 27: 405?9.
Suzuki T., Bove E.L., Devaney E.J., Ishizaka T. et al. Results of
definitive repair of complete atrioventricular septal defect in
neonates and infants. Ann. Thorac. Surg. 2008; 86: 596?602.
McGoon D.C., DuShane J.W., Kirklin J.W. The surgical treatment of endocardial cushion defects. Mayo Clinic Surgery.
1959; 46: 185.
Galie N., Hoeper M.M., Humbert M., Torbicki A. Guidelines for
the diagnosis and treatment of pulmonary hypertension the
task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the
European Respiratory Society (ERS), endorsed by the
International Society of Heart and Lung Transplantation
(ISHLT). Eur. Heart J. 2009; 30: 2493?537.
Fisher M.R., Forfia P.R., Chamera E., Housten-Harris T., Champion H.C., Girgis R.E. et al. Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension. Am. J. Resp. Crit. Care Med. 2009; 179: 615?21.
??? ?.?., ?????? ?.?., ??????? ?.?. ?????????????? ??????????????? ????????? ???????????????????? ???????
??? ?????. ?????? ?? ??? ?? ??????????: ?????????
II ????????????? ??????????? ?? ??????? ?????????????? ╚??????????????????? ????????????╩. ?????????,
8?10 ????. 2014 ?.
Wilcox B.R., Jones D.R., Frantz E.G., Brink L.W., Henry G.W.,
Mill M.R. et al. Anatomically sound, simplified approach to
repair of ?complete? atrioventricular septal defect. Ann.
Thorac. Surg. 1997; 64: 487?94.
35
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
36
Desai A.R., Branco R.G., Comitis G.A., Maiya S., Vyas D.B.,
Vaz Silva P. et al. Early postoperative outcomes following surgical repair of complete atrioventricular septal defects: is down
syndrome a risk factor? Pediatr. Crit. Care Med. 2014; 15 (1):
35?41.
Lange R., Guenther T., Busch R., Hess J. The presence of
Down syndrome is not a risk factor in complete atrioventricular septal defect repair. J. Thorac. Cardiovasc. Surg. 2007;
134: 304?10.
Bakhtiary F., Takacs J., Cho M.Y., Razek V. DДhnert I.,
Doenst T. et al. Long-term results after repair of complete atrioventricular septal defect with two-patch technique. Ann.
Thorac. Surg. 2010; 89: 1239?43.
Xie O., Brizard C.P., d?Udekem Y., Galati J.C., Galati J.C.,
Kelly A. et al. Outcomes of repair of complete atrioventricular
septal defect in the current era. Eur. J. Cardiothorac. Surg.
2014; 45 (4): 610?7.
Morris C.D., Agile D., Reller M. Down?s syndrome affects
results of surgical correction of complete atrioventricular
canal. Pediatr. Cardiol. 1992; 13: 80?4.
Pozzi M., Remig J., Fimmers R., Urban A.E. Atrioventricular
septal defects. Analysis of short- and medium-term results. J.
Thorac. Cardiovasc. Surg. 1991; 101: 38?42.
Kobayashi M., Takahashi Y., Ando M. Ideal timing of surgical
repair of isolated complete atrioventricular septal defect.
Interact. Cardiovasc. Thorac. Surg. 2007; 6: 24?6.
Rizzoli G., Mazzucco A., Maizzza F., Daliento L. Does Down syndrome affect prognosis of surgically managed atrioventricular
canal defects? J. Thorac. Cardiovasc. Surg. 1992; 104: 945?53.
Yamaki S., Yasui H., Kado H., Yonenaga K., Nakamura Y.,
Kikuchi T. et al. Pulmonary vascular disease and operative
indications in complete atrioventricular canal defect in early
infancy. J. Thorac. Cardiovasc. Surg. 1993; 106: 398?405.
Malhotra S.P., Lacour-Gayet F., Mitchell M.B., Clarke D.R.,
Dines M.L., Campbell D.N. et al. Reoperation for left atrioventricular valve regurgitation after atrioventricular septal defect
repair. Ann. Thorac. Surg. 2008; 86: 147?51; discussion
151?2.
Patel S.S., Burns T.L., Kochilas L. Early outcomes and prognostic factors for left atrioventricular valve reoperation after
primary atrioventricular septal defect repair. Pediatr. Cardiol.
2012; 33: 129?40.
Krasemann T., Debus V., Rellensmann G., Rukosujew A.,
Scheld H.H., Vogt J. et al. Regurgitation of the atrioventricular
valves after corrective surgery for complete atrioventricular
septal defects?comparison of different surgical techniques.
Thorac. Cardiovasc. Surg. 2007; 55: 229?32.
Tayfun G.A., Novick W.M., Connie A., Pierce R.N.,
Watson D.C. Left ventricular outflow tract obstruction after
partial atrioventricular septal defect repair. Ann. Thorac. Surg.
1999; 68 (5): 1723?6.
Van Arsdell G.S., Williams W.G., Boutin C., Coles J.G.,
Trusler G.A., Rebeyka I.M. et al. Subaortic stenosis in the
spectrum of atrioventricular septal defects. J. Thorac.
Cardiovasc. Surg. 1995; 110: 1534?42.
Bogers A.J., Akkersdijk G.P., de Jong P.L., Henrich A.H.
Takkenberg J.J. van Domburg R.T. Results of primary twopatch repair of complete atrioventricular septal defect. Eur. J.
Cardiothorac. Surg. 2000; 18: 473?9.
Dodge-Khatami A., Herger S., Rousson V., Comber M.,
Knirsch W., Bauersfeld U. et al. Outcomes and reoperations
after total correction of complete atrio-ventricular septal
defect. Eur. J. Cardiothorac. Surg. 2008; 34: 745?50.
Formigari R., Di Donato R.M., Gargiulo G., Di Carlo D.,
Feltri C., Picchio F. et al. Better surgical prognosis for patients
with complete atrioventricular septal defect and Down?s syndrome. Ann. Thorac. Surg. 2004; 78: 666?72.
Najm H.K., Williams W.G., Chuaratanaphong S.,
Watzka S.B., Coles J.G., Freedom R.M. Primum atrial septal
defect in children: early results, risk factors, and freedom from
reoperation. Ann. Thorac. Surg. 1998; 66: 829?35.
34.
35.
36.
37.
Hoohenkerk G.J., Bruggemans E.F., Rijlaarsdam M.,
Schoof P.H., Koolbergen D.R., Hazekamp M.G. et al. More than
30 years? experience with surgical correction of atrioventricular septal defects. Ann. Thorac. Surg. 2010; 90: 1554?61.
Pontailler M., Kalfa D., Garcia E., Ly M., Le Bret E., Roussin R.
et al. Reoperations for left atrioventricular valve dysfunction
after repair of atrioventricular septal defect. Eur. J.
Cardiothorac. Surg. 2014; 45: 557?63.
Ten Harkel A.D., Cromme-Dijkhuis A.H., Heinerman B.C.,
Hop W.C. Development of left atrioventricular valve regurgitation after correction of atrioventricular septal defect. Ann.
Thorac. Surg. 2005; 79: 607?12.
Tweddell J.S., Litwin S.B., Berger S., Friedberg D.Z.,
Thomas J.P., Frommelt M.W. et al. Twenty-year experience
with repair of complete atrioventricular septal defects. Ann.
Thorac. Surg. 1996; 62: 419?24.
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Bockeria L.A., Gorbachevskiy S.V. Atrioventricular cannel
defect. Anatomy and surgical features. Moscow: Nauchnyy
tsentr serdechno-sosudistoy khirurgii im A.N. Bakuleva
RAMN; 2005: 88 (in Russian).
Burakovskiy V.I., Bockeria L.A. (eds). Cardiovascular
Surgery: Guidelines. Moscow; 1989 (in Russian).
Clapp S., Perry B.L., Farooki Z.Q., Jackson W.L., Karpawich P.P., Hakimi M. et al. Down?s syndrome, complete atrioventricular canal, and pulmonary vascular obstructive disease. J. Thorac. Cardiovasc. Surg. 1990; 100: 115?21.
Freeman S.B., Taft L.F., Dooley K.J., Allram K. Populationbased study of congenital heart defects in Down syndrome.
Am. J. Med. Genet. 1998; 80: 213?7.
Al-Hay A.A., MacNeill S.J., Yacoub M., Shore D.F.,
Shinebourne E.A. et al. Complete atrioventricular septal
defect, Down syndrome, and surgical outcome. Risk factors.
Ann. Thorac. Surg. 2003; 75: 412?21.
Reller M., Morris C.D. Is Down syndrome a risk factor for poor
outcome after repair of congenital heart defects? J. Pediatr.
1998; 132: 738?41.
Bockeria L.A., Shatalov K.V., Vasilevskaya I.V.,
Arnautova I.V., Chernova M.P., Podashevskaya T.M. Results
of mitral valve replacement in children of yearly age. Detskie
bolezni serdtsa i sosudov. 2008; 2: 60?6 (in Russian).
Atz A.M., Hawkins J.A., Lu M., Cohen M.S., Colan S.D.
Surgical management of complete atrioventricular septal
defect: associations with surgical technique, age, and trisomy
21. J. Thorac. Cardiovasc. Surg. 2011; 141 (6): 1371?9.
DOI:10.1016/j.jtcvs.2010.08.093.
Masuda M., Kado H., Tanoue Y., Fukae K. Onzuka T.,
Shiokawa Y. et al. Does Down syndrome affect the long-term
results of complete atrioventricular septal defect when the
defect is repaired during the first year of life? Eur. J.
Cardiothorac. Surg. 2005; 27: 405?9.
Suzuki T., Bove E.L., Devaney E.J., Ishizaka T. et al. Results
of definitive repair of complete atrioventricular septal defect
in neonates and infants. Ann. Thorac. Surg. 2008; 86:
596?602.
McGoon D.C., DuShane J.W., Kirklin J.W. The surgical treatment of endocardial cushion defects. Mayo Clinic Surgery.
1959; 46: 185.
Galie N., Hoeper M.M., Humbert M., Torbicki A. Guidelines
for the diagnosis and treatment of pulmonary hypertension the task force for the diagnosis and treatment of
pulmonary hypertension of the European Society of
Cardiology (ESC) and the European Respiratory Society
(ERS), endorsed by the International Society of Heart and
Lung Transplantation (ISHLT). Eur. Heart J. 2009; 30:
2493?537.
Fisher M.R., Forfia P.R., Chamera E., Housten-Harris T., Champion H.C., Girgis R.E. et al. Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
hypertension. Am. J. Resp. Crit. Care Med. 2009; 179:
615?21.
Kim A.I., Metlin S.N., Penyaeva E.V. Variability of morphological changes of the atrioventricular valve in atrioventricular
septal defect. Does this affect the outcome?: 2-nd All Russian
congress of the pediatric cardiac surgery ╚Atrioventricular
communication╩. Russia. Astrakhan? 8?10 September 2014.
(in Russian).
Wilcox B.R., Jones D.R., Frantz E.G., Brink L.W., Henry G.W.,
Mill M.R. et al. Anatomically sound, simplified approach
to repair of ?complete? atrioventricular septal defect. Ann.
Thorac. Surg. 1997; 64: 487?94.
Desai A.R., Branco R.G., Comitis G.A., Maiya S., Vyas D.B.,
Vaz Silva P. et al. Early postoperative outcomes following surgical repair of complete atrioventricular septal defects: is down
syndrome a risk factor? Pediatr. Crit. Care Med. 2014; 15 (1):
35?41.
Lange R., Guenther T., Busch R., Hess J. The presence of
Down syndrome is not a risk factor in complete atrioventricular septal defect repair. J. Thorac. Cardiovasc. Surg. 2007;
134: 304?10.
Bakhtiary F., Takacs J., Cho M.Y., Razek V. DДhnert I.,
Doenst T. et al. Long-term results after repair of complete atrioventricular septal defect with two-patch technique. Ann.
Thorac. Surg. 2010; 89: 1239?43.
Xie O., Brizard C.P., d?Udekem Y., Galati J.C., Galati J.C.,
Kelly A. et al. Outcomes of repair of complete atrioventricular
septal defect in the current era. Eur. J. Cardiothorac. Surg.
2014; 45 (4): 610?7.
Morris C.D., Agile D., Reller M. Down?s syndrome affects
results of surgical correction of complete atrioventricular
canal. Pediatr. Cardiol. 1992; 13: 80?4.
Pozzi M., Remig J., Fimmers R., Urban A.E. Atrioventricular
septal defects. Analysis of short- and medium-term results. J.
Thorac. Cardiovasc. Surg. 1991; 101: 38?42.
Kobayashi M., Takahashi Y., Ando M. Ideal timing of surgical
repair of isolated complete atrioventricular septal defect.
Interact. Cardiovasc. Thorac. Surg. 2007; 6: 24?6.
Rizzoli G., Mazzucco A., Maizzza F., Daliento L. Does Down syndrome affect prognosis of surgically managed atrioventricular
canal defects? J. Thorac. Cardiovasc. Surg. 1992; 104: 945?53.
Yamaki S., Yasui H., Kado H., Yonenaga K., Nakamura Y.,
Kikuchi T. et al. Pulmonary vascular disease and operative
indications in complete atrioventricular canal defect in early
infancy. J. Thorac. Cardiovasc. Surg. 1993; 106: 398?405.
Malhotra S.P., Lacour-Gayet F., Mitchell M.B., Clarke D.R.,
Dines M.L., Campbell D.N. et al. Reoperation for left atrioventricular valve regurgitation after atrioventricular septal defect repair.
Ann. Thorac. Surg. 2008; 86: 147?51; discussion 151?2.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
Patel S.S., Burns T.L., Kochilas L. Early outcomes and prognostic factors for left atrioventricular valve reoperation after
primary atrioventricular septal defect repair. Pediatr. Cardiol.
2012; 33: 129?40.
Krasemann T., Debus V., Rellensmann G., Rukosujew A.,
Scheld H.H., Vogt J. et al. Regurgitation of the atrioventricular
valves after corrective surgery for complete atrioventricular
septal defects?comparison of different surgical techniques.
Thorac. Cardiovasc. Surg. 2007; 55: 229?32.
Tayfun G.A., Novick W.M., Connie A., Pierce R.N.,
Watson D.C. Left ventricular outflow tract obstruction after
partial atrioventricular septal defect repair. Ann. Thorac. Surg.
1999; 68 (5): 1723?6.
Van Arsdell G.S., Williams W.G., Boutin C., Coles J.G.,
Trusler G.A., Rebeyka I.M. et al. Subaortic stenosis in the
spectrum of atrioventricular septal defects. J. Thorac.
Cardiovasc. Surg. 1995; 110: 1534?42.
Bogers A.J., Akkersdijk G.P., de Jong P.L., Henrich A.H.
Takkenberg J.J. van Domburg R.T. Results of primary twopatch repair of complete atrioventricular septal defect. Eur. J.
Cardiothorac. Surg. 2000; 18: 473?9.
Dodge-Khatami A., Herger S., Rousson V., Comber M.,
Knirsch W., Bauersfeld U. et al. Outcomes and reoperations
after total correction of complete atrio-ventricular septal
defect. Eur. J. Cardiothorac. Surg. 2008; 34: 745?50.
Formigari R., Di Donato R.M., Gargiulo G., Di Carlo D.,
Feltri C., Picchio F. et al. Better surgical prognosis for patients
with complete atrioventricular septal defect and Down?s syndrome. Ann. Thorac. Surg. 2004; 78: 666?72.
Najm H.K., Williams W.G., Chuaratanaphong S.,
Watzka S.B., Coles J.G., Freedom R.M. Primum atrial septal
defect in children: early results, risk factors, and freedom from
reoperation. Ann. Thorac. Surg. 1998; 66: 829?35.
Hoohenkerk G.J., Bruggemans E.F., Rijlaarsdam M.,
Schoof P.H., Koolbergen D.R., Hazekamp M.G. et al. More
than 30 years? experience with surgical correction of atrioventricular septal defects. Ann. Thorac. Surg. 2010; 90: 1554?61.
Pontailler M., Kalfa D., Garcia E., Ly M., Le Bret E., Roussin R.
et al. Reoperations for left atrioventricular valve dysfunction
after repair of atrioventricular septal defect. Eur. J.
Cardiothorac. Surg. 2014; 45: 557?63.
Ten Harkel A.D., Cromme-Dijkhuis A.H., Heinerman B.C.,
Hop W.C. Development of left atrioventricular valve regurgitation after correction of atrioventricular septal defect. Ann.
Thorac. Surg. 2005; 79: 607?12.
Tweddell J.S., Litwin S.B., Berger S., Friedberg D.Z.,
Thomas J.P., Frommelt M.W. et al. Twenty-year experience
with repair of complete atrioventricular septal defects. Ann.
Thorac. Surg. 1996; 62: 419?24.
????????? 25.11.2014
37
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
╘ ?.?. ??????????, 2014
??? 614.253.22:616.12-007-053.1-053.6
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??? ???????? ?????????? ? ??????????? ????????
?????? ??? ?????????? ??????????? ????????????,
????????????? ???????? ?????????
?.?. ??????????
????? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ?
???????? ??? ? ???? ?.?. ???????); ?????????? ?????, 135, ??????, 121552,
?????????? ?????????
?????????? ????? ?????????, ????. ???. ????, ???. ???????? ?????,
e-mail: elena_miliev2004@mail.ru
????????. ???????? ????? ?????????????? ??????? ?????????? ??????? ?????? (???) ????????? ? ??????????? ?????????? ? ??????????? ????????????. ?????????? ? ???????? ?????????? ? ??? ??? ?????????? ??????????? ????????????, ????????????? ???????? ?????????, ??????? ?С?????? ???????? ?? ??????? ??????????? ? ????????. ???? ???????????? ?
??????? ???????, ???????? ?? ????????????? ????????? ? ??????????? ????????? ? ???.
???????? ? ??????. ???????????????? ??????, ??????????? 182 ????????? ?????????? ? ??? ? ???????? ?? 18 ?? 25 ???,
??????? ? ??????? ???? ????????? ????????, ???????????? ? ?? ??????????????? ???????, ??????????? ? ??????????????????? ??????????. ?????????? ????????? ? ???????????? ????? ??????? ? ?????????? ????????? ??????????? ??, ?????????? ????? ??? ????? ???????? ?? ?????? ??? ? ???????? ?? 18 ???. ??????? ???????, ???????? ?? ?????????? ????????
????????? ?????????? ? ??? ??????????? ????????????, ????????????? ????????? ? ???????????.
??????????. ???????? ???????, ?? ??????? ???????? ?? ??????????? ? ??????????????????? ??????????, ??? ?? ???? ????????? ????????, ??? ?????????? ????????????? ???????????? ? ???????????? ? ?????????????? ?????????? (n = 34), ?????????? ???????????? ??? ??????? ? ?????? (n = 29), ?????????? ? ????????????? ?? ????? ?????????? (n=16), ????????
?????????? ?????? ?? ????? (n = 14), ??????? ?????????? (n = 13).
???????????? ??????????? ? ??????????, ? ??? ????? ?? ????? ??????????, 80,2% ???????? ??????? c ???. ?????? ???????? ????????? (67,8%) ??????????? ?? ????? ?????????? ? ???????????, ??????????????? ???????? ?????????. ?? 95 ?????????? ????? ?????????????? ??????? ??? 69 (72,6%) ??????????? ?? ????? ?????????? ? ???????????, ???????????????
???????? ????????? ? ??????????? ??????????. ??? ???????? ????????? ?? ???????? ??????? ??? ?? ???????? ????????????????? ???????????????? ??????. ?? ????? ?????????? ??????????? ????????? ? ?????? ?????????? ?????????????
??????????, ???????????????????? ?? ???????? ???.
??????????. ????????????? ??????????? ????????? ??????????? ?????? ??????????? ???????????????? ?????????? ??????????? ?? ??????? ???????? ?????????, ????????? ? ??????? ????????????? ??????? ???.
???????? ?????: ?????????? ????? ??????; ?????????; ??????? ? ??????? ??????????????? ??? ????????? ?????????; ???????? ??????? ? ?????????? ??????? ??????.
THE RELEVANCE OF THE TRAINING PROGRAMS FOR TRANSFER
OF ADOLESCENTS WITH CONGENITAL HEART DEFECTS FROM PEDIATRIC
CARDIOLOGY TO ADULT HEALTH CARE
E.B. Milievskaya
A.N. Bakoulev Scientific Center for Cardiovascular Surgery; Rublevskoe shosse, 135,
Moscow, 121552, Russian Federation
Milievskaya Elena Borisovna, MD, PhD, Deputy Chief Physician
Introduction. Patients after surgical treatment of congenital heart disease (CHD) require life-long monitoring of medical specialists.
Preparations for the transfer of adolescents with CHD under the supervision of medical professionals serving the adult population
requires more attention from the state and society. The purpose of this study ? the study of the causes affecting timely access to cardiologists in patients with CHD.
Material and methods. The study included data questionnaires completed 182 adult patients with CHD in age from 18 to 25 years,
which operations were performed in childhood, compared with statistical charts of these patients stored in the cardiac surgery hospital. Inclusion criteria were the presence of discharged patients have Russian citizenship, carrying out one or more operations on the
UPU under the age of 18 years. Studied factors influencing the compliance of planned visits to medical specialists, timely access to
cardiologists in patients with CHD.
Results. The main reasons that patients are not observed in the cardiac surgery hospital, where he carried out the operation, named:
no need for consultation, in accordance with the recommendations of the cardiologist (n = 34), the lack of financial resources to trav-
38
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
el to Moscow (n = 29), in the Cardiology Center observation of residence (n = 16), ignorance of the mechanisms appointment (n=14),
long-distance (n = 13). Periodically a cardiologist, including the place of residence, 80.2% of adult patients with CHD. More than half
of patients with CHD (67.8%) observed in the community cardiologists to advise the adult population. Of the 95 adolescents after
surgical treatment of CHD 69 (72.6%) observed in the community cardiologists, providing surveillance of adult patients with cardiac
disease. A number of adult patients with complicated forms of CHD do not receive skilled cardiac care. Residence the majority of
patients with this pathology in both groups advise cardiologists, not specializing in issues of the CHD.
Conclusion. It is advisable to develop a strategy for the organization of a new direction training cardiologists ? to management adult
patients who underwent surgical treatment in childhood CHD.
Key words: congenital heart disease; adolescents; transfer to adult health care; grown-up congenital heart patient.
г?б?блкб
? ????????? ????? ????????? ????????? ? ?????????????? ??????????? ????? ????? ?????????????? ??????? ?????????? ??????? ?????? (???) ???????? ?? ????????? ???????? [1]. ?????? ?? ?????
????????? ????????? ? ??????????? ??????????
??????????? ????????????, ?????????? ??????????
???????????????? ? ???????????? ????????????,
?????? ????????????? ??????????, ? ? ???? ???????
? ????????? (?????????) ????????????? ?????????
??????. ??? ? ??????, ??? ? ?? ??????? ??????????
????????, ????????? ? ??????????? ??? ???? ??????????? ????????????????? ??????????? ??????
??? ???????? ????????? ? ???, ??????????????? ??
????????? ? ????????????. ????? ???????? ?? ?????????? ? ??????????? ??????????, ? ?????? ??
????? ???????? ??????????? [2]. ????????? ? ??????? ???? ? ??? ????????? ? ????? ?????????, ? ?????? ??????-?????????? ??????? ?? ????? ????????
?? ????????? ?????????? [3]. ? ????? ? ???? ?????????? ? ???????? ?????????? ? ??? ??? ??????????
??????????? ????????????, ????????????? ???????? ?????????, ??????? ?С?????? ???????? ?? ??????? ??????????? ? ????????.
? ?????? ??????????? ???????, ????????? ? ????????????? ?????????? ? ??????? ???????????????? ?????? ?? ???? ???????????????????? ?????????? ???????????????? ???????? ???????? ??????????, ?????????? ???????? ?? ?????? ???, ???
?????????? ??????????? ????????????, ????????????? ???????? ?????????. ?????????? ???????? ????????? ????????? ?????????? ? ??? ? ?????? ?????????.
Е?зб?к?н к обзс??
? ???????????? ????? ?????? ?????, ??????????? 182 ????????? ?????????? ? ??? (98 ??????,
84 ???????) ? ???????? ?? 18 ?? 25 ???, ???????
???????? ???? ????????? ? ???????, ????????????
?? ??????????????? ??????? ???? ???????, ??????????? ? ??????????????????? ??????????. ?????????? ????????? ? ???????????? ????? ??????? ?
?????????? ????????? ??????????? ??, ?????????? ????? ??? ????? ???????? ?? ?????? ??? ?
???????? ?? 18 ???.
??????? ???????, ???????? ?? ??????????
???????? ????????? ??????????? ????????????,
????????????? ????????? ? ??????????? ????????? ? ???.
??????? ??? ??? ??????? ?????????? 48 ????????? ? ?????? ???????????????, 27 ? ? ???????? ?? 29 ???? ?? 1 ????, 8 ? ?? 1 ???? ?? 3 ???,
57 ? ?? 3 ?? 14 ???, 42 ? ?? 14 ?? 18 ???. ? 182 ????????? ??? ???????????? ?????????? ??????????, n:
?????? ??????????????
??????????? (????) . . . . . . . . . . . . . . . . . . . . . . 43
?????? ???????????????
??????????? (????) . . . . . . . . . . . . . . . . . . . . . 30
?????? ??????????? ??????? . . . . . . . . . . . . . . . . 29
???????? ???????????? ?????? (???) . . . . . . 18
????????? ?????? ???????? ??????? (????) . . 11
??????? ????? (??) . . . . . . . . . . . . . . . . . . . . . . . . 9
????? ? ????????? ????????
??????????????????? ????? (?????) . . . . . . . . 6
?????? ??????????? ??????? . . . . . . . . . . . . . . . . 5
?????????? ????? . . . . . . . . . . . . . . . . . . . . . . . . . 4
???????? ???????? (??) . . . . . . . . . . . . . . . . . . . 4
??????? ?????????? ???????
?? ??????? ????????? (??? ?? ??) . . . . . . . . . . . 4
???????????? ?????? ????????? . . . . . . . . . . . . 4
?????????? ????????? ??????
??????? ????????? . . . . . . . . . . . . . . . . . . . . . . . . . 3
??????? ???????????????? ??????? (???) . . . . . 3
??????? ???????? ??????? (???) . . . . . . . . . . . . . 2
????????? ?????????? ?????? ???????? ??? . . . 2
??????????????? ???????????????? ??????? . . . . 2
??????????????? ????????????
????????????? ??????? (????) . . . . . . . . . . . . . . 1
???????????? ????????? (??) . . . . . . . . . . . . . . 1
??????? ???? ????? . . . . . . . . . . . . . . . . . . . . . . . . 1
????? ???????? ????????? ? ??? ????????? ?
??????????? ??????????? ?????? (n = 96, ???
52,7%), 43 (23,6%) ? ? ???????????, 19 (10,5%) ?
? ??????-??????????, 11 (6,0%) ? ? ?????, 11
(6,0%) ? ? ??????-????????, 2 (1,2%) ? ? ?????????
??????????? ??????.
????? ????, ???????????????? ??????, ??????????? ?????????? 107 ?????????? ????? ?????????????? ??????? ??? (49 ???????, 58 ?????????).
??????? ????????? ?? ???? ?????? ???????? ?? 15
?? 17 ??? (????????????).
??????? ??? ??? ??????? ?????????? 32 ????????? ? ?????? ???????????????, 11 ? ? ????????
?? 29 ???? ?? 1 ????, 10 ? ?? 1 ???? ?? 3 ???, 45 ? ??
3 ?? 14 ???, 9 ? ?? 14 ?? 17 ???.
39
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
? ????????? ???? ????????? ????????, n:
?????? ?????????????? ??????????? . . . . . . . 33
?????? ??????????????? ??????????? . . . . . . 15
?????? ??????????? ??????? . . . . . . . . . . . . . . . . 17
???????? ???????????? ?????? . . . . . . . . . . . . 16
??????? ????? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
????????? ?????? ???????? ??????? . . . . . . . . . . 5
?????? ??????????? ??????? . . . . . . . . . . . . . . . . 3
????? ? ????????? ????????
??????????????????? ????? . . . . . . . . . . . . . . . . . 2
??????? ???????? ??????? . . . . . . . . . . . . . . . . . . . 2
??????? ?????????? ??????? ?? ??????? ????????? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
???????????? ????????? . . . . . . . . . . . . . . . . . . . 2
??????????????? ?? . . . . . . . . . . . . . . . . . . . . . . . 1
?????????? ????? . . . . . . . . . . . . . . . . . . . . . . . . . 1
Cortriatriatum (??????????????? ??????) . . . . . . . 1
???????? ???????? ?????????? ??????? . . . . . . . 1
??????? ?????????? ?????? ??????? ?????? . . . . 1
? ??????????? ??????????? ?????? ?????????
65 (60,7%) ????? ?????????? ? ???.
???????????? ?????????????? ???????????????. ??? ???????? ?????????????? ?????? ??????????? ???????, ??? ???????????? ?????? ? ?????????? ???????? ? ????.
Йбашн╦з?з?
???????? ???????? ? ??????????? ???????? ??????. ??????????? ?????????? ????????
????????? ? ??? ????????, ??? ??? ?? ?????????
?? ???????????? ? ????? ??. ?.?. ????????
(n = 142, ??? 78,0%). ???? ??????? ???????, ??
??????? ???????? ?? ??????????? ? ??????????????????? ??????????, ??? ?? ???? ????????? ????????, n:
?????????? ????????????? ????????????
? ???????????? ? ?????????????? ?????????? . . . 34
?????????? ?????????? ????????????
??? ??????? ? ?????? . . . . . . . . . . . . . . . . . . . . . . 29
??????? ?? ??????? . . . . . . . . . . . . . . . . . . . . . . . 23
?????????? ? ?????????????
?? ????? ?????????? . . . . . . . . . . . . . . . . . . . . . . 16
???????? ?????????? ?????? ?? ????? . . . . . . . 14
??????? ?????????? . . . . . . . . . . . . . . . . . . . . . . . 13
?????????? ? ??????????? ?? ?????
?????????? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
???????? ?????????????? . . . . . . . . . . . . . . . . . . . 5
?????? ?? ???????????? ????????????,
??????? ?????? ????? ? ???? . . . . . . . . . . . . . . . . 1
?????? ???????????? . . . . . . . . . . . . . . . . . . . . . . 1
???????????? ??????????? ? ??????????, ? ???
????? ?? ????? ??????????, 146 ???????? ???????
? ???. ?????? ???????? ????????? ? ??? ??????????? ?? ????? ?????????? ? ???????????, ??????????????? ???????? ????????? ? ??? ????????
99 (67,8%) ???????????? (???. 1). ????? ??? 19 ????????? ? ?????????? ?????, ??? ?? ??, ??,
???, ??, ??????? ???? ?????.
40
7
6
99
34
?????????, ??????? ????? ????????? ?????????
?????????? ?? ??????
????????
??????? ?????????
???. 1. ?????????? 146 ???????? ????????? ? ??? ? ??????????? ???????????? ?? ????? ??????????
? ????? ????????? ????? ?????????????? ??????? ???, ??????? ?? ??????????? ? ???????????
(36, ??? 19,8% ?? ???? ?????? ???????) ?????????? ???????? 8 ??????? ? ?????? ??????????, ???
???, ?????? ??????????? ???????, ??? ?? ??,
?????, ????. ? ??????? ??????????? ?????????? ??????????? 3 ???????? ????? ???????? ?? ?????? ????, 1 ??????? ????? ??????????? ???, 1 ?
? ??? ????? ???????? ??????? ? ???????????
?????????????????? ????????, 1 ? ????? ?????????????? ??????????? ???????.
????????? 15?17 ??? ? ??????????? ???????? ??????. ????? ????? ?????????? ? ??? ????????? ?? ???????????? ? ????? ??. ?.?. ????????
(40, ??? 37,8%). ???? ?????????? ????, ??? ? ?????? ???????? ????????? (22,0%), ??? ???????????????? ????? ????????????????? ? ?С????? ???????? ?? ??????? ????????? ? ??????????? ?? ???????. ???????? ???????? ? ??? ????? ????????????
?? ???? ????????.
?? 107 ?????????? ????? ?????????????? ??????? ??? ?? ??????????? ? ??????????, ? ??? ?????
?? ????? ??????????, 12 (11,2 %) ?????????, ??? ???? ??????? ?????????? ? ?????? ???????? ???????.
?? 95 ?????????? ????? ?????????????? ???????
??? 69 (72,6%) ??????????? ?? ????? ??????????
11
15
69
?????????, ??????? ????? ????????? ?????????
??????? ?????????
???????
???. 2. ?????????? 95 ?????????? ? ??? ? ??????????? ???????????? ?? ????? ??????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
? ???????????, ?????????????? ??????????
???????? ????????? ? ??????????? ??????????.
??????? ?????????? ????? ?????????? 15 ?????????? ? ??? ?? ????? ?? ??????????. ?? ????????
??? 11 ?????????? ??????????????? ? ?????????
?? ????? ?????????? (???. 2).
И╥ршй?блкб
????? ???????, ?????????? ???????????? ??????????????? ? ??????? ?????????? ? ????????? ???????????? ?????????? ? ?????? ???????? ? ??? ??
????????? ? ??????? ??????? ??????????, ??????????? ??? ?????? ?????????. ??? ???????? ????????? ?? ???????? ??????? ??? ?? ???????? ????????????????? ???????????????? ??????. ?? ?????
?????????? ??????????? ????????? ? ?????? ?????????? ? ????? ??????? ????????????? ??????????,
?? ?????????????????? ?? ???????? ???.
??? ?????????? ???????? ????? ? ?????????? ?
??? ??? ?????????? ??????????? ????????????,
????????????? ???????? ?????????, ??????????
????????? ???? ????????? ? ???? ????????. ? ???????????????? ????????? ????????, ???????? ??
?????? ?????? ????? ????????, ?????????? ???????? ????????? ????? ? ???. ?????????????, ?????
????????? ???????? ?????? ???????? ????????.
? ?????? ??????? ???????????? ?? ??????? ???????? ?????? ?????? ? ?????????? ????????? ?????????? ????? ?????????????? ??????? ??? ????????????, ?????????? ?? ???????????. ??????????,
????? ???????????? ???????? ?????????????.
?? ???? ???????, ???? ??????? ? ??? ?????????
??? ?????? ????? ?????, ????? ?????? ?????????
?? ??????? ????? ????????, ??????? ??? ?????????? ????????????? ????????? ?? ???????????????? ?????? ?? ?????????? ???? ?????. ???, ? ???????????? ???????? ?????? ??????? ?????? ??? lifelong congenital cardiac care (LLCCC) [4]. ??????
??????????? ???????????? ?????? ????????? 500
????? ? ???????? ?? 2 ?? 18 ??? (??????? ???????
10 ???), ???????????? S.M. Fernandes ? ?????., ???????, ??? 81% ????????? ???????? ?????????????
LLCCC ??? ?? ????? [4]. ?????? ????????, ??? ?
25% ????? (n = 126) ???? ????????? ???????? ?????????? ?????, ???????? ??????? ??? ?? ????????? 28% ????????? (n = 141), ?? ?????? ?? ??????????? 134 (27%) ???????. ???????? ????????????? ???????????? ??? ??? ????????? 20% ?????
(n = 99). ????? ???????? ???? ?????????? ????????? (44%) ????????, ???, ????? ?? ???? ?????????
????????????????? ????????, LLCCC ????? ?????????????? ?? ????????????? ?? ??? ? ?????????
?????????, ? ?? ???????? ???????????? ? ?? ????????????, ???????? ????? ???????? ?????????,
????? ???, ????????, ???????? ? ??????????? ???????? ??????. ?????? ????????????, ??? ??????????? ?????????? ????????? (93%) ???????,
??? ??????? ?? ???????? ?????????? ????????? ??-
?????????? ???????????????? ??????, ??????? ??????????? ?? ?????, ????? ??? ????? ????????? [4].
???????? ? ????? ??. ?.?. ???????? ?????????? ????????????? ??????? ????? 3000 ?????????
? ??? ? ??????? ? ???????? ?? 18 ???. ????? 85%
????? ????? ??????? ????? ??????? ?? ???????????????????? ?????????? ?? ????? ??????????
?? ??????? ?????? ? ?????????? ???????, ? ?????
???????? ????????? ? ?? ??????? ????????????
???????????? ?????? [5].
????????? ????? ? ??????????? ????????????????? ???????????????? ?????? ????? ?????
?????????????? ??????? ??? ???? ??????????? ?
?????? ?? ???? ????? ??. ?.?. ???????? ?? ?????????? ????????? ??? ? ???? ?.?. ??????? ???????
???????????????? ?????. ???????????? ??????? ?
?????? ???????????????? ????? ?? ?????? ????
???????????? ????? ? ??? ??????????????? ?????
???????? ? ??????? ????? ????????????, ??????????? ? ??????????????????? ?????????? [6].
???????? ?? ???? ???????? ?????????????????
?????? ???????? ???????? ?????????? ? ??? ? ??????? ????????? ??????????????? ??????????????
????????????.
????????? ?????? ???????? ???????? ????????
?????????? ? ??? ??? ?????????? ??????????? ????????????, ????????????? ???????? ?????????,
????? ????????????? ????? ??? ????????? ????? ?
???, ???????? ? 2009 ?. ?? ???? ????? ??. ?.?. ???????? [7], ?????? ??????? ?????????? ????????? ?
??????? ???????????????? ?????? ? ?????????????
?? ?????? ?????????? ? ????????? ????? ???????? ??
??? ????, ?? ? ????????? ??????????? ????? ? ??????? ?????????, ??????? ??????? ???. ?????????????, ????? ??? ???????? ????? ???? ??????????
??????? ?????????? ?? ????????, ??????????? ????
???????, ? ????? ???????????? ??????????? ???????, ???????? ???????????? ??????????? ????????
????????? ? ???. ?????????? ?????????? ???????
????? ????? ? ?????? ?????????? ????? ????????
?????? ????????? ? ????????? ? ???? ?????.
А?мн??блкб
????????, ??? ?????? ???????? ????????? ????? ?????????????? ??????? ??? ??????????? ??
????? ?????????? ? ???????????, ??????????????? ???????? ?????????, ?????????? ?????????
????? ???????? ? ???????? ????? ????????????,
??????? ?????? ???????? ??????? ???????????,
?????????? ?? ?????? ????????, ?????????? ????????????? ??????????.
????? ????? ?????????? ? ??? ????????? ??
???????????? ? ????? ??. ?.?. ????????, ? ????
?????????? ????, ??? ? ?????? ???????? ?????????,
??? ????? ????????????????? ? ?С????? ????????
?? ??????? ????????? ? ??????????? ?? ???????.
??? ?????????? ???????? ????? ? ?????????? ? ???
??? ?????????? ??????????? ????????????, ??41
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
??????????? ???????? ?????????, ??????????
????????? ???? ????????? ? ???? ????????.
??????? ??????? ??????????? ? ???????? ???????? ????????? ?????????. ? ?? ?? ????? ????????? ? ???, ????????? ?????????, ?????????? ??
?????? ???????, ? ?????? ?????????? ?????????????????? ???????????????? ?????? ?? ????? ??????????. ????????, ????????? ????????????? ???????? ????? ????????????? ?????-??????????,
???????? ???????? ??????? c ???, ? ???????????
??? ????????? ? ??????????? ??????????, ????????? ? ???????, ? ?????????? ?????????? ?????? ?
???????, ??????? ??? ?????????????, ??? ? ??????????????? ??????? ? ???.
????????????? ????????? ?? ????????? ? ??????????? ????????-?????????? ???????? ? ???????????? ?????? ???????????????? ????????? ???????????????? ????????? ????????????? ???????????
????????? ??????????? ?????? ??????????? ???????????????? ?????????? ??????????? ?? ???????
???????? ?????????, ????????? ? ??????? ????????????? ??????? ?????????? ??????? ??????.
??????????
1.
2.
3.
4.
Birkeland A.L. Psychosocial aspects of living with congenital
heart disease. Child, Family, and professional perspectives.
Sweden: Print & Media, Ume?; 2012. 51 ?.
??????? ?.?. ???????????? ???????????? ?? ???????
???????? ????????? ? ??????????? ???????? ??????. ?.:
????? ??. ?. ?. ???????? ????; 2010. 358 ?.
Berghammer M. Living with a congenital heart disease:
Adolescents? and young adults? experiences. Gothenburg,
Sweden: Komendiet; 2012. 83 ?.
Fernandes S.M., Verstappen A., Ackerman K., Adams E.E.,
Barton C., Breitinger P. et al. Parental knowledge regarding
5.
6.
7.
lifelong congenital cardiac care. Pediatrics. 2011; 128:
e1489?95.
??????? ?.?., ?????????? ?.?., ???????? ?.?., ???????? ?.?. ?????????????? ??????????? ???????????????? ?????? ????????? ????? ?????????????? ??????? ?????????? ??????? ??????. ?????????? ??????? ???????? ?????????. 2014; 38.
???????? ?.?., ?????????? ?.?. ??????????????? ??????
???????????????? ?????? ????? ? ??? ? ??. ?????????
????? ??. ?.?. ????????. 2014; 15 (6): 258 (??????????).
????????, ?.?., ?????????? ?.?. ?????????????? ??????? ??????????? ???????????? ????????, ?????? ?????
??? ????????? ????? ? ??????????? ???????? ??????.
??????? ??????? ?????? ? ???????. 2009; 2: 8?11.
References
1.
2.
3.
4.
5.
6.
7.
Birkeland A.L. Psychosocial aspects of living with congenital
heart disease. Child, Family, and professional perspectives.
Sweden: Print & Media, Ume?; 2012. 51 ?.
Bockeria L.A. National guidelines on the management of adult
patients with congenital heart disease. ?.: Bakoulev Scientific
Center for Cardiovascular Surgery; 2010. 358 p.
Berghammer M. Living with a congenital heart disease:
Adolescents? and young adults? experiences. Gothenburg,
Sweden: Komendiet; 2012. 83 ?.
Fernandes S.M., Verstappen A., Ackerman K., Adams E.E.,
Barton C., Breitinger P. et al. Parental knowledge regarding lifelong congenital cardiac care. Pediatrics. 2011; 128: e1489?95.
Bockeria L.A., Milievskaya E.B., Krupyanko S.M., Manerova O.A. Geographical availability of cardiology care to patients
after surgical treatment of congenital heart disorders.
Sotsialnye aspekty zdorov?ya naseleniya. 2014; 38.
Krupyanko S.M., Milievskaya E.B. Organizational models of
rehabilitation care for children with CHD in Russia. Byulleten?
Nauchnogo Tsentra Serdechno-Sosudistiy Khirurgii imeni
A.N. Bakuleva. 2014; 15 (6): 258 (??????????).
Krupyanko S.M., Milievskaya E.B. Information resources to
ensure patient safety, the project School for parents of children
with congenital heart disease. Detskie bolezni serdtsa i sosudov. 2009; 2: 8?11.
????????? 24.11.2014
╘ ????????? ???????, 2014
??? 616.126.42-089.843-77:616.131/.132-007.41-089.168
?????? ????????? ?????????????? ???????????
??????? ? ?????????? ????? ????? ????????
????????????? ???????????? ? ????????
? ????????????? ????????????? ???????
?.?. ?????????, ?.?. ????????, ?.?. ????????, ?.?. ??????
????? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ?
???????? ??? ? ???? ?.?. ???????); ?????????? ?????, 135, ??????, 121552,
?????????? ?????????
42
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
????????? ???????? ????????, ?????? ???. ????, ?????????, ???????? ???;
???????? ????? ??????????, ?????? ???. ????, ?????????;
???????? ?????? ?????????, ?????? ???. ????, ??????? ????. ????., e-mail: samsonof@yandex.ru;
?????? ?????? ?????????, ????. ???. ????, ????. ????.
???????????? ??????? ?????????? ???????? ????????????? ?????????? ?????????????? ??????????? ??????? ????? 9 ???
????? ????????????? ????????? ?????? ???????????? ????????????? ???????. ?????????? ??????? ????? ??????? ?????
7 ??? ????? ????????? ????????. ?? ????? ??????, ???????? ???????? ???????? ??????????????? ???????? ????????? ??????????? ??????? ? ?????? ??????????? ???????? ???????. ? ?????????? ?????????? ????????? ??????????????? ??????? ??
4 ???????, ? ???????? ?? ???? ?????????? ?????????? ??????.
??? ???????????? ????? 7 ??? ????? ????????? ???????? ???????? ???????? ????????? ?????????? ??????????? ???????.
?????? ??????? ??????????? ????????? ????????, ????????? ?????????? ???????? ??????, ?????????? ????????? ????????
???????????, ????????? ????????? ???????? ? ???????? ??????????????? ??????????, ?????????? ????????? ??????????????
??????? ??????? ????? ? ??????? ??????????? ???? ????????? ???????? ???????? ?????? ??????????? ??????? ??? ?? ????????? ???.
???????? ?????: ?????????????? ??????????? ???????; ?????????? ?????? ??????; ???????????? ????????????? ???????.
SUCCESFULL MITRAL VALVE REPLACEMENT IN PATIENT
AFTER ARTERIAL SWITCH PROCEDURE IN LATE FOLLOW-UP
V.P. Podzolkov, I.V. Kokshenev, V.B. Samsonov, V.S. Mataev
A.N. Bakoulev Scientific Center for Cardiovascular Surgery; Rublevskoe shosse, 135, Moscow,
121552, Russian Federation
Podzolkov Vladimir Petrovich, MD, DM, Professor, Academician RAS;
Kokshenev Igor? Valer?evich, MD, DM, Professor;
Samsonov Victor Borisovich, MD, DM, Leading Research Associate;
Mataev Victor Sergeevich, MD, PhD, Research Associate
Distinctive feature of this case report is the necessity of mitral valve replacement due to anterior leaflet cleft followed by annular dialation in 9 years after complete repair of the transposition of great arteries.
In 7 years after surgery, mild prosthesis dysfunction had being evaluated, with no signs of pulmonary hypertension, mild peak and
median gradients. Also, we have not discovered signs of patient/prosthesis mismatch. Thus, it was decided to delay redo mitral
replacement for few more years.
Key words: mitral valve replacement; congenital heart disease; transposition of the great arteries.
??????????????? ??????????? ??????? ?????????
??????? ??????????? ? ????????? ??????? c ????????????? ????????????? ??????? ????? ????????
????????????? ????????????. ? ??????????? ??????? ??????????????? ??????????? ???????????? ?????????? ???????: ??????????, ???????????? ???????, ??????? ?????????? ???????, ?????????? ????
? ??????????? ????. ????? ????, ???????????????
????? ?????????? ? ?????????? ??????????? ??????? ??? ????????? ????????? ??????, ????????????? ???????????, ???????????????? ???????????
?????????? ?? [1, 2].
???? ?????? ? ??????????? ?????? ?????????
?????????????? ??????????? ??????? ????? 9 ???
????? ???????? ????????????? ???????????? ?
???????? ? ????????????? ????????????? ???????.
? ? ? ? ? ? ? , 9 ???, ???????? ? ??????? ? ???????? ?? ?????????? ????????????, ??????. ?? ?????? ???????????? ????????????? ??????? ? ??????? ??????????????? ??????? ???????? ???????? ? ??????????? ???????????? ?????????????.
??? ???????????? ????? 3 ???? ???????? ????????? ??????????????? ??????????? ??????? ?? 2 ???????. ?? ???? ??????? ??????????? ? ??????????????? ?????? ?????????????, ??????????? ??????-
??? ???????? ???? ???????, ? ????? ? ??? ?? ???????? ?????? ???? ????????????.
? ??????????? ????????? ????????????? ???
??????? ???????, ?????????? III ??????????????
????? ?? NYHA. ?????? ??????? ??????-???????.
??? ???????? ?????? ????????????? ????????????? ??? ? ????????? ?????????????? ? ????????????????? ?????????? ????? ?? ???????. ??????? ??????????? ? 131 ?/?, ????????? ????? ?????????? ? ?????????? ? 96%. ?????? ????????? ??
1,5 ?? ?? ???? ???????? ????.
?????? ???: ????????? ????, ????????? ????????????? ??? ?????? ??????????, ???????????
?? ? ???????? ??????? ?????? ????? ????? ????.
?????????????? ??????? ??????: ???????? ??????? ?? ???????, ???? ?????? ????????? ?? ????
?????? ? ????? ???????, ??? ? 59%.
?????? ?????: ????????? ????? ???????? ????????????? ???????????? ??? ?????? ????????????
????????????? ???????. ????? ??????? ?? ????????????? ?????? ?????????, ??????? ??????? ???????? 57%. ??????? ??????????? ??????? ?????????,
????? ????????, ?????????, ???????? ???????
??????????. ??????? ?????????? ?????? ? 43 ??,
??????????????? ??????????? ??????? 3?4 ???????.
43
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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?????? ?????? ?????????? ? 37 в 42 ??. ??????????
?????? ??????????????, ??????? ???????? ????????, ??????? ?????????? ?????? ? 26 ??, ??????????????? ??????? ? 1?2 ???????. ???????? ?????
?????????? ??????? ?? ?????????? ?????, ???????
?? ????????? ??????? ?????????, ??????? ???????
???????? ??????? ????????????? ?????????. ???????? ?????????????? ???????? ????? ?????? ?????????? ? ???????? ???????? ???????? 14 ?? ??. ??.
???????? ????????? ????????????? ?????
?????? ? ???-???????????? ??? ??????? ????????
??????????????? ??????????? ??????? 4 ??????? ?
??????????????? ??????????? ??????? 2 ???????,
?????????? ????? ????????????. ?????????????
???????? ? ?????? ????????? ? 21 ?? ??. ??., ? ???????? ??????? ? 18 ?? ??. ??., ????????????? ???????? ? ????? ? 107 ?? ??. ??.
???????? ????????? ?????????????? ??????????? ??????? ???????????? ???????? ╚St. Jude╩
? 27 ? ???????? ?????????????? ??????????????
(115 ???), ?????????? (28 ╟?), ????????? ?????????? ????? (64 ???) ? ???????????????? ???????????? (?????????).
????? ???????? ????? ?????????? ????? ? ???????????? ????????? ?????? ?? ?? ???????? ??????????? ????????? ???????????? ???????? ?????????????????? ???????? ????? ?????????? ?????. ?????? ? ??????????? ??????? ???????????
????? ?????????????? ???????????. ?????????
?????? ??????? ??????????? ?????????. ???????
??????? ???????????? ????????, ????????, ??????
??????? ????????? ??????? ??????? ? ??????? ?????? ?????????, ???????? ??????? ?????????? ?? ?????????? ??????. ???????????????? ?????????????
???????? ???????????. ??????? ??????? ????????, ????????? ?????????????? ??????????? ??????? ???????????? ???????? ╚St. Jude╩ ? 27 ?? ??????????? ????????.
????? ?????????? ???????? ??????????????
??????????????, ???????????? ???????????? ?
????????? ???????? ??????? ??? ????????? ? ????????? ??????????. ?????????? ????????? ????? 8 ?
????? ????????. ?? 11-? ??? ????? ???????? ??????? ??????? ?? ????????? ? ??????????????????
?????????. ??? ???????, ?? ?????? ?????, ??????? ??????? ?????? ????????? ????????? 60%, ??????? ???????? ?? ??????? ? 7 ?? ??. ??., ??????? ?
2,4 ?? ??. ??. ??????? ???????????? ?????????
??????? ? 2,4 ??/?2. ???????????? ?? ??????????
??????? ? 1,5 ???????.
????? 7 ??? ????? ????????? ???????? ???????
????? ??????????. ???????????? ???????, ????? ??
???????????. ????????????????? ????????? ?????????? ????????. ??? ? 2,8. ?????????????? ??????? ??????: ???????? ????? ?????????, ??? ?
53%. ?????: ?????? ?????? ?????????? 60 в 50 ??,
??????? ??????? ?????? ????????? ? 57%. ???????? ????????????? ????????? ??????? ????????????? ??????????, ??????????????? ????????? ?????44
????????? ?????? ?? ??????? ? ??????. ??????? ???????? ?? ??????? ? 20 ?? ??. ??., ??????? ? 10 ?? ??. ??.
??????? ???????????? ????????? ??????? ?
1,35 ??/?2. ?????? ?????? ?????? ?? ?????????, ????????? ???????? ? ?????? ????????? ? 30 ?? ??. ??.,
???????? ?????????????? ???????? ????? ?????? ?????????? ? ???????? ???????? ???????? 6 ?? ??. ??.
??????????????? ???????????????? ??????? ?
1,5 ???????. ??? ????????? ??????? ?????????????? ??????? ????????? ?????????????? ?????, ???
??????? ???????? ????????? ??????????? ????????
?????? ??????? ?? ???? ???????????? ??????? ? ???????????? ??????? ???????. ??????? ???????? ??
??????? ???????? 14 ?? ??. ??., ??????? ? 8,5 ?? ??. ??.
??????? ???????????? ????????? ??????? ?
1,64 ??/?2. ????? ?????????? ???????? ?????, ???????? ???????????? ????????? ???????? ?? ?????? ????????????, ?????????? ?????????? ?????????? ?? ??????? ?????? ?? ???????? ??????
??????? ??????????? ??????? ???????????? ? ?????????? ???????????? ??????????.
?? ?????? J. Kirklin [1], J. Stark [3], ? ???????
? ??? ?? ???????? ????????? ????????? ??????????? ??????? ??????????? ? 20?30% ???????, ???????? ? ??????? ? ?????? ???: ?????????? ?????????? ??????, overriding ? straddling ???????,
???????? ??????? ? ???????? ??, ????????? ????
????????? ??????? ? ????????? ???????, ???? ?
??????????? ????. ?? ?????? ???????, ?????? ????????? ????? ???? ???????????? ? ?????????
????????? ?? ????? ????????? ????????????? ????
? 3?6% ???????. ? ?????????? ????? ????? ????????????? ????????? ?????????? ???????????????
??????????? ??????? ??????????? ????? ?????. ?
???????? ???????????? ?? ?????????????? ??? ?????????? ??????????? ????????????? ??????? ???? ?? ???????????. ? ???????????? ??????????
??????????? ????????? ???????? ?????????????
????? ??????? ? ?? 2?5 ??????? [4?6].
???????????? ??????? ?????????? ????????
????????????? ?????????? ?????????????? ??????????? ??????? ????? 9 ??? ????? ?????????????
????????? ???????????? ????????????? ???????,
?????????? ??????? ????? ??????? ????? 7 ??? ????? ????????? ????????. ?? ????? ??????, ???????? ???????? ???????? ??????????????? ????????
????????? ??????????? ??????? (?????? ??????????? ???????? ???????, ???????? ????????????
???????????? ????????), ? ????? ??????????
?????????? ???????.
?????? ???????? ???????????????? ?????????? ??????????????? ????? ????????????? ???????????? ??????????? ? ?????? A. Serraf [5]. ?????? ????????? 38 ???????, ??????? ???????????
????????? ????????? ????????. ? 1 ???????? ??????? ??????????? ???????? ??????? ???????????
??????? ? ?????????? ??????????????? ??????? ??
???? ?????????? ?????????? ??????. ? 3 ??????
??????? ?????????? ??????????????? ???? ????-
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
??????? ??????? ???? ???????? ???????, ????????
????????????????? ???????, ??????????? ???????? ??????????? ????? ? ?????????? ??????????
??????????????? ? ?????? ????????.
?? ????? ??????, ??? ? ?? ?????? ?????? ???????????? ??????????, ??????????? ? ?????? ?????
????????????????? ??????????? ??????? ??? ????????? ??? ?????????? 6?9%, ??????? ???? ???????????????? ? ?? 6 ?? 12 ??? [4, 7, 8]. ???????? ????????????? American College of Cardiology/
American Heart Association, ??? ??????? ?????????
???????????????? ?????????? ???????? ??????
?????????? ? ?????? ?????????, ????????? ??? ????????????? ??????? ? ???????? ???????? ??????????? ?????????? ????????? ????????? ???????? ??? ?????????????? ???????? ???????????
?????????? ?????? ????????? ? ????????? ????????? ????? ?????? [9]. ? ???????? ???????????????? ???????????, ?????????? ???????? ????????? ?????????????? ????????????, ????????? ??????????? ??????? ? ??????? ????????? ??
?????????? ??????? (????? 5?7 ? ????? 15 ?? ??. ??.
??????????????), ? ????? ?????????? ??????????? ??????? ????????? ??????? ??????? (?????
1,25 ??2/?2) [7, 10, 11].
? ?????????? ??????? ???????? ?????????????? ???????? ??????????????? ?????? ? ????????????? ??????????? ???????????? ?????????? ??
?????????? ????????????????? ??????????? ???????.
??????????
1.
2.
3.
4.
5.
6.
7.
8.
Kirklin J.W., Barratt-Boyes B.G. Cardiac Surgery. N.Y.:
Churchill Livingstone; 2013.
Mavroudis C. Pediatric cardiac surgery. Mosby; 2013.
Stark J., DeLeval M., Tsang V.T. Surgery for congenital heart
defects. John Wiley, Sons, Ltd; 2006.
????????? ?.?., ?????? ?.?., ???????? ?.?., ????? ?.?.
????????? ???????? ????? ????????? ?????????? ??????? ??????. ?.; 2013.
Serraf A., Roux D., Lacour-Gayet F., Touchot A., Bruniaux J.,
Sousa-Uva M. Reoperation after the arterial switch operation
for transposition of the great arteries. J. Thorac. Cardiovasc.
Surg. 1995; 110: 892?9.
Raju V., Burkhart H., Durham L., Eidem B., Philips S., Li Z.
Reoperation after arterial switch: 27-year experience. Ann.
Thorac. Surg. 2013; 95: 2105?13.
????????? ?.?., ???????? ?.?., ???????? ?.?., ???????? ?.?., ????????? ?.?., ????? ?.?. ? ??. ????????? ? ???????????????? ?????????? ???????????????? ??????????? ??????? ??? ?????????? ??????? ??????. ??????? ?
????????-?????????? ????????. 2011; 6: 4?9.
Pibarot P., Dumesnil G. Prosthesis-patient mismatch: definition, clinical impact, and prevention. Heart. 2006; 92:
1022?29.
9.
10.
11.
Bonow R., Carabello A., Chatterjee K., de Leon C. Jr., Faxon P.,
Freed D. et al. ACC/AHA 2006 guidelines for the management
of patients with valvular heart disease: a report of the American
College of Cardiology/American Heart Association Task Force
on Practice Guidelines (writing committee to revise the 1998
Guidelines for the Management of Patients With Valvular Heart
Disease): developed in collaboration with the Society of
Cardiovascular Anesthesiologists: endorsed by the Society
for Cardiovascular Angiography and Interventions and
the Society of Thoracic Surgeons. Circulation. 2006; 114:
84?231.
Magne J., Mathieu P., Dumesnil G., TannИ D., Dagenais F.,
Doyle D. et al. Impact of prosthesis-patient mismatch on survival aftermitral valve replacement. Circulation. 2007; 115:
1417?25.
Tanne D., Kadem L., RИgis Rieu, Pibarot P. Hemodynamic
impact of mitral prosthesis-patient mismatch on pulmonary
hypertension: an in silico study. J. Appl. Physiol. 2008; 295:
1916?26.
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Kirklin J.W., Barratt-Boyes B.G. Cardiac Surgery. N.Y.:
Churchill Livingstone; 2013.
Mavroudis C. Pediatric cardiac surgery. Mosby; 2013.
Stark J., DeLeval M., Tsang V.T. Surgery for congenital heart
defects. John Wiley, Sons, Ltd; 2006.
Podzolkov V.P., Alekyan B.G., Kokshenev I.V., Cheban V.N.
Reoperation after repair of congenital heart defects. Moscow;
2013 (in Russian).
Serraf A., Roux D., Lacour-Gayet F., Touchot A., Bruniaux J.,
Sousa-Uva M. Reoperation after the arterial switch operation
for transposition of the great arteries. J. Thorac. Cardiovasc.
Surg. 1995; 110: 892?9.
Raju V., Burkhart H., Durham L., Eidem B., Philips S., Li Z.
Reoperation after arterial switch: 27-year experience. Ann.
Thorac. Surg. 2013; 95: 2105?13.
Podzolkov V.P., Samsonov V.B., Chiaureli M.R., Kokshenov I.V., Ermolenko M.L., Cheban V.N. et al. Indication and
short-term of mitral valve replacement in congenital heart
defects. Grudnaya i serdechno-sosudistaya khirurgiya. 2011;
6: 4?9 (in Russian).
Pibarot P., Dumesnil G. Prosthesis-patient mismatch: definition, clinical impact, and prevention. Heart. 2006; 92:
1022?29.
Bonow R., Carabello A., Chatterjee K., de Leon C. Jr., Faxon P.,
Freed D. et al. ACC/AHA 2006 guidelines for the management
of patients with valvular heart disease: a report of the American
College of Cardiology/American Heart Association Task Force
on Practice Guidelines (writing committee to revise the 1998
Guidelines for the Management of Patients With Valvular Heart
Disease): developed in collaboration with the Society of
Cardiovascular Anesthesiologists: endorsed by the Society for
Cardiovascular Angiography and Interventions and the Society
of Thoracic Surgeons. Circulation. 2006; 114: 84?231.
Magne J., Mathieu P., Dumesnil G., TannИ D., Dagenais F.,
Doyle D. et al. Impact of prosthesis-patient mismatch on survival aftermitral valve replacement. Circulation. 2007; 115:
1417?25.
Tanne D., Kadem L., RИgis Rieu, Pibarot P. Hemodynamic
impact of mitral prosthesis-patient mismatch on pulmonary
hypertension: an in silico study. J. Appl. Physiol. 2008; 295:
1916?26.
????????? 24.11.2014
45
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
╘ ????????? ???????, 2014
??? 616-077.45-089:616.126.4-007-089-036.8
???????? ????????????? ??????? ????????
? ????????? ???????????? ???????????? ? ?????
??????????????????? ??????? ?? ?????? ???????
? ?????????? ??????????????????? ???????????????:
???????????????? ?????????
?.?. ?????, ?.?. ???????, ?.?. ????????????, ?.?. ???????????, ?.?. ?????????
????? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ?
???????? ??? ? ???? ?.?. ???????); ?????????? ?????, 135, ??????, 121552,
?????????? ?????????
????? ???? ?????????????, ????. ???. ????, ????????????;
??????? ??????? ??????????, ?????? ???. ????, ??????? ????. ????., e-mail: kovalevdv@mail.ru;
???????????? ??????? ????????, ?????? ???. ????, ??????? ????. ????.;
??????????? ????? ???????, ????. ???. ????, ??????? ????. ????.;
????????? ???????? ????????, ?????? ???. ????, ?????????, ???????? ???
? ????????? ?????????? ??????? ?????? ??????? ???????????? ???????????? ?????????? ????? 3%, ??? ???? ? 69% ???????
????? ??????????? ??????????????? ??????????????????? ????????. ??????? ??????????????? ????????? ? ???????????
??????? ???????????? ?????????? ??????????? ???????????????? ????????? ??????, ??????? ? ????? ???????? ???????????????? ???????? ????????????????? ?????????. ?????? ????????????? ??? ?????? ????????? ??????????????????? ???????????? ?????????? ????? ????????????? ?? ??????????????????? ??????? ? ??????????? ??????????? ???? ????? ????????
???????. ? ?????? ??????????? ??????????? ?????? ???????? ????????? ??????????????? ?????? ????????????????????
??????? ??? ?????????? ???????? ??????? ? ???????? ? ????????? ???????????? ???????????? ? ??????? ???????????????? ??????????? ????????.
???????? ?????: ???????????? ????????? ??????; ???????? ???????; ????? ??????????????????? ??????; ???????? ???????????????????? ???????.
MID-TERM RESULTS OF MODIFIED FONTAN OPERATION PERFORMED
IN PATIENTS WITH VISCERAL HETEROTAXY SYNDROME AND CONCOMITANT
COMMON ATRIOVENTRICULAR VALVE REGURGITATION
I.A. Yurlov, D.V. Kovalev, T.O. Astrakhantseva, I.Yu. Baryshnikova, V.P. Podzolkov
A.N. Bakoulev Scientific Center for Cardiovascular Surgery; Rublevskoe shosse, 135, Moscow,
121552, Russian Federation
Yurlov Ivan Aleksandrovich, MD, PhD, Cardiac Surgeon;
Kovalev Dmitriy Viktorovich, MD, DM, Senior Research Associate;
Astrakhantseva Tat?ana Olegovna, Leading Research Associate;
Baryshnikova Irina Yur?evna, MD, PhD, Yunior Research Associate;
Podzolkov Vladimir Petrovich, MD, DM, Professor, Academician RAS
The incidence of the visceral heterotaxia syndrome in the congenital heart structure is about 3%. Atrioventricular valves regurgitation
is usually found in 69% of these patients. Biventricular correction in most cases is impossible because of complex intracardiac
lesions, and univentricular correction is more preferable. The associated intervention on the AV valve is considered to increase risk
of Fontan procedure This article is aimed to present a case of successful correction with good midterm result of the common AV valve
regurgitation together with modified Fontan operation in a patient with the visceral heterotaxia syndrome.
Key words: single ventricle; Fontan operation; common atrioventricular valve; atrioventricular valve plasty.
? ????????? ?????????? ??????? ?????? ??????? ???????????? ???????????? ?????????? ????? 3%
[1], ??? ???? ? 69% ??????? ????? ??????????? ??????????????? ??????????????????? (??) ????????
46
[2]. ? ??????????? ??????? (55?80%) ??? ??????????? ???????? ??? ?????? ????????? ?????? A?-???????. ??????? ??? ???????? ???????????????, ????????? ?????????? ? ??????? 1 ???? ????????? 85%
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
[3]. ??? ???????????? ?? ?????? ???????? ????????
???????????? ??????, ?? ? ????? ??????????????
???????????? ???????????? ???????? ???????? ?
?????? ????????? ??????, ? ????? ?? ????????????.
???? ?? ???????????? ?????? ??????????? ???????????????? ?????????, ??????????? ??? ??????? ??????? ?? 40% [4]. ??????? ??????????????? ????????? ? ??????????? ??????? ???????????? ??????????
??????????? ???????????????? ????????? ??????,
??????? ? ????? ???????? ????? ???????????????
????????????????? ?????????. ?????? ????????????? ? 27?69% ????????? ??????????????????? ???????????? ??? ?????? ????????? ?????????? ????? ????????????? ?? ??-??????? ? ??????????? ??????????? ???? ????? ???????? ??????? [3, 5, 6]. ???????
???????? ???????????????? ????????? ? ?????????
? ???????????????? ??-???????? ???????? ???????
? ?????????? ?? ????????? ?????, ? ?????????? ???
?????????? ??????? ??????????????? ??-????????
????? ???????? ?????????? ? ????????? ????????? ?
???????? ?????? ??????? ??????.
???? ??????? ????????? ? ??????????????????
?????? ???????? ????????? ??????????????? ?????? ??-??????? ??? ?????????? ???????? ??????? ? ???????? ? ????????? ???????????? ???????????? ? ??????????? ??????? ????????????????
????????? ????????.
???????, 18 ???, ???????? ? ??????? ? ????????
?? ????????????, ?????? ??? ????????, ??????. ?
???????? 10 ??? ???????? ??? ???????? ???????????? ??????????????? ????????????????? ????????? (????), ????? ???? ????????? ????????????
????? ?????????? ??????????? ? 72 ?? 84% ? ????????? ??????? ??????????? ??????????. ? ??????????? ???? ? ?????? ??????? ?????????? ??????????? ????????? ????????? ? ?????????? ???????, ??? ? ????????? ??????? ? ??????????????.
??? ??????????? ???? ???????? ? 184 ??, ?????
???? ? 51 ??, ??????? ??????????? ???? ? 1,72 ?2,
?????????? ? 212 ?/?, ????????? ????????????
????? ?????????? ? 78%, III ?? ?? NYHA.
?????? ???????????????: ????? ?????????? ?
????????????? ???????????? ?????? ?????????
(??), ?????? ????????? ??????????????? ??????
(????) ? 87 ??/?2, ??????? ?? ????? ???????????????. ??????? ??????? ????????????? ????????????? ????????? ? 63%. ??????? ????? ?????????????? ??-?????? ? ??????? ?????????? ?????????
(??? ? ?? ????????), ??????? ?????????? ?????? ?
42 ??. ?? ????? ??-??????? ?????????? ???????????? 4 ???????, ??????????????? ???????????, ?
????? ?? ?????????? ?????????? (???. 1, ?). ???
?????????????? ???????????? ??????? ???????
??????? ???????? ?????????? ?????????.
??? ?????????? ????????????? ? ??????????????????????? ???????????? ?????? ??????????????? ????????????? ?????????????? ????????-????????????? ?????? ? ?????? ??????????? (???
??????? ?????? ? ??????), ?????????? ????? ? ???????? ??????? ?? ?? (????? ????????????? ??????? ?????). ???????? ? ???????? ??????? (??) ????????? 13/7 ?? ??. ??. (??????? ? 9 ?? ??. ??.), ???????? ?????????????? ???????? ? ????????????
???????????? ?????? ????????? ? 5 ?? ??. ??., ???????-???????????? ?????? (Nakata) ? 396 ??2/?2,
?????? McGoon ? 1,7.
? ?????????? ???????????? ????????????? ??????????? ???????: ??????? ???????????? ???????????? ? ?????? ???????????, ?????????????
?????????????? ????????-????????????? ??????, ????? ???????? ????????????????? ?????, ??????????????? ?????? ??-??????? 4 ???????, ?????????? ?????? ?????????, ????? ??????????, ??????? ?????????? ??????? ?? ??, L-?????,
??????????????? ?????? ???????? ???????, ?????????? ??????? ????? ????, ????????? ????? ????????? ????????????? ???? ? 2000 ?.
???????? ????????? ???????? ??????? ? ??????????? ?????????????????? ???????? PTFE ? 22
? ????????? ?????? ??-??????? ? ?????????????
???????????? ?????????? ?????????? ??? ? ???????? ??????? ? ???????? ?????????????? ???????-
??
??
?
?
???. 1. ??????????????? ???????? ? ????????? ???????????? ????????????, ????? ? ????????????? ???????????? ??????
?????????? ?? (?) ? ????? 6 ??? ????? ???????? (?). ???????? ?????? ????? ???????????? ?? ????? ??-???????
47
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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???. 2. ????????????????? ????. ????? ???????? ??????
??-???????:
?
??????? (205 ???), ?????????? (26 C╟) ? ???????????????? ???????????? (78 ???, ?????????). ?? ???????????? ???????? ??????? ???????? ???????????
?????? ?????????? ?????????? ???, ?????????? ? ????? ?????????? ????????? ?????? ?? 1 ?? ??????????
????? ?????? ????? ???? (???) (???. 2, ?). ????????? ??? ?????????????? ? ??????? 4 ???????? ??????. ?????? ?????? ?? ?????????? ?????? ??????????? ???????? ?????????? ????? ?????????? ???????? ??????????, ???? ?????? ????????? ??????????
???, ? ??? ? ????????????????? ????????? ?? PTFE
? 22. ????????? ?????? ????? ????????? ????? ?
???????????? ??????????? ???????????????? ????????????? ?? ????? ??-???????. ???????? ??????? ??????????? ? ???????? ???????? ? ?????? ??????? ??????????? ?????????? ?????? ??-??????? (????????? ?????????? ?????? ?????? ??-??????? ???
????????????????? ????? ??????????). ? ?????????? ?????? ???????????????? ?????????? ??????
??-??????? ???? ??????? ?????? ?????????? ? ????
??????? ????????????? ????? ?? PTFE. ????????? ????? ??? ????????? ????? ????????? ?????????
27 ??. ????????????????? ????? ?????? ??-???????
???????? ??? ??????? ????????????? ???????
(???. 2, ?). ?????????????? ?????? ??????????? ??????????? ??????????? ?????? ???????? ? ?????? ???????? ???????. ?????? ?? ???????? ?? ???????? ??
?? ????? ??????????? ?????????????????? ???????? ?
?????? ?? (???. 2, ?).
????? ?????????????? ????????? ????????????
? ???????? ?????????? ??????? ????. ?????? ????????????????? ?????? ???????? ? ?????????
????????? ????????? ???????????????, ????????48
? ? ????? ??? ?????? ????? ??????????, ???????? ??????? ?????????
?????????? ??? (??) ? ?????? ????? ???? (???), ?? ? ????? ??????????; ? ? ??? ?????? ??-??????? ????? ??????????? ???????????? ?????????, ???????? ??????? ??????? ?????????? ?? PTFE; ? ? ????????????????? ??? ?????? ????? ??????????? ????????, ???????? ??????
??????? ?? PTFE, ?????????????????? ????????? ? ??????????? ?????????? ??? ? ???, ???????????? ? ? ?????? ??
????? ? ?????????? ???????????? ?? ??????????? ? ??????????????? ???????? ? ??????? 4 ???.
???????????? ??? ????????? 70 ?, ??????????
? ???? ? 4 ???. ??????? ??????? ????????????????
????????? ? ??????????????? ????: ????????? ?
0,06 ???/??/???, ??????? ? 5 ???/??/???. ???????
??????? ????????????? ????????? ????? ????????
????????? 52%, ? ?? ?????? ??????? ? 58%. ??????????????? ?????? ??-??????? ?? ?????????
1 ???????. ????????? ??????????? ????? ?????????? ????? ???????? ????????? 93%.
??????? ??? ?????????? ????? 6 ???. ???????
??????? ?????????? 1 ???? ??????? ???????? ?????????, ? ????? ? ??? ???????????? ?????????? ???????? ????? ?? ??????????. ????????? ????????
??????????????? I ?? ?? NYHA. ?? ??? ? ????????
??????????????? ????????? ????, ????????? ??????????? ????? ?????????? ? 98%. ??????
?????: ???? ?? ? 72 ??/?2, ?? ?? ? 68%, ??????? ?????? ??-??????? ?????? ?????????, ???????
?????????? ?????? ? 35 ??, ??????????? ???????????? ?? ??-??????? 1 ??????? (??. ???. 1, ?).
? ????????? ???? ????????? ??????? ??????????
?????, ????????????????? ?? ????????? ??????????? ???????????????? ????????? ??? ???????? ???????????? ???????????? [7?10]. ?? ??????
A. Hashmi ? ?????., 93% ????????? ? ????????? ???????????? ???????????? ? ?????? ??????????? ???????? ??????????? ?? ???????????????? ?????????
[8]. ?????? ??????????? ???? ? ???????? ??????? ? ? ???? ????????????? ???????????? ????? ????????? ?????? 22% ???????, ??? ???? ???????????
?????????? 21%. F. Cetta ? ?????. ???????? ? ?????-
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
??? ??????????? ??? ?????????? ????????????????
????????? ? ????????? ? ????????????? ? 61% ?
1980-? ????? ?? 15% ? ????????? ???? [7]. ?? ??????
P.J. Bartz ? ?????., ??????????? ??? ?????????? ???????? ??????? ? ???????? 1980-? ????? ???????? ??
50% ? ???? ? 2004 ?. ????????? 9,5%. ????????? ???????????? ? 5, 10 ? 15 ????? ????????? 64, 57 ? 53%
?????????????? [9]. ?????????? ?????? ??????????? ???, ??? ? ??????????? ??????? ? ????????? ???????????? ???????????? ? ???????????????? ????????????? ???? ??????????? ???????? ????????
??????? ?????: ?????????? ??????????????? ?????????, ?????????? ???, ???????? ????????? ?
???????? ???, ??????????????? ??, ?????? ???????
??????? ??????, ???????? ??????????????? ??????? [5?11]. ??????? ???????? ? ????????? ???????????? ???????????? ? ????????????? ???????????? ?????????? ???????? ???????? ???????????
??????????? ??? ???????????????? ?????????.
?????????????? ?????? ????????? ?? ???? ?????????. ??-??????, ??????? ??????? ???????????
???????????????? ? ???????????????? ?????????
???????? ? ?????????? ???????? ??????? ????????,
???????? ???????? ??????? ????????? ? ????????
18 ???. ??-??????, ??????? ??????? ????????? ?????????? ???????????? ?????? ??-???????, ?????????
??????????????? ???????????????? ?????????????.
??????? ????????, ??? ? ????????? ????? ???
????????????? ???????? ????????? ??-????????????. ?? ????????? ???? ??? ?????? ? ?????? ???????? ?????????? ???????????? ?? ????? ??-??????? ??????????? ?????????. ?? ?????? ????? ???
?????????? ????? ?????????? ???????????? ????????????? ???????????????? ??? ?????? ????????,
???????? ? ??????????? ???????. ? ??????????
????? ???????, ??? ???????????????? ??-??????????????? ???? ????? ?????????? ?????????? ????????? ?????????? ?????? ? ???????????? ????
?? ?????? ????????, ??????? ????? ?????????
?????? ?????????????? ?? ?? ???? ??? ?????????
?? ????????????????. ? ????????? ???? ?????????
??????????????? ??????????? ? ???????????????
???????? ?????? ??-???????, ? ????????? ? ???????? ??? ???????? ?????????????????? ??????????
?????? ??-??????? ????????????? ???????? PTFE
? ???????????? ????????? ????? ?????????? ??????
?? ?????? ??????? ?????????? PTFE ? ???????????
????????? ??????? ?? ?????????? ??? ???????? ????????. ????? ????? ??? ????????????? ??????????? ?????????? ??? ?????????? ???????????? ?????
???????????? ????????? ??????? ???? ?? ???????.
???? ?????? ?????? ???????? ??????????????, ?
????????? ???????????? ?????????? ???????????
?????? ????????? ?????????? ???????????? ? ???????? ?????????, ???? ?????????? ?? ???????
??????? ??????????? ????????????? ???????????
??????? ?????????? ??-????????????, ??????????
??????? ????? ??????????? ??????????. ? ??????-
??? ????? ????????? ??????, ? ??????? ???????????? ???????? ???????? ?????????? ??-????????????, ????????????? ? ???????????????? ???? ?
???? ??????????? ??????? ?? ???? ??????? ? ???????????? ???? ????????? ????????? [12].
?????????? ? ????????? ????? ???????? ???????? ?????? ??????????? ?????? ?????????? ????????????: ?? ????? ????????? ????, ????? ?????????
??????? ??? ??? ?? ??????????. ?? ????? ?? ???
??? ??????, ??? ????? ??????? ??????????????? ??????? ????????? ?????????, ?? ?????????? ??????
????????? ? ???????????????? ????????? ? ??????
??????????? ???????? ?????????? ??-????????????
? ??????????? ?? ???????? ???????, ?????????? ?????????. ??? ???? ??? ???? ???????? ???????????
???????????????? ????????? ? ?????????? ???????
?????????? ??-??????????????? ? ????? ???????
????????? ??????? ????????? ????????? ?? ????????
? ??????? ???? ??????? ? ?????????? ????????.
?????????? / Refereces
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Rubino M., Van Praagh S., Kadoba K., Pessotto R., Van
Praagh R. Systemic and pulmonary venous connections in
visceral heterotaxy with asplenia: Diagnostic and surgical considerations based on seventy-two autopsied cases. J. Thorac.
Cardiovasc. Surg. 1995; 110: 641?50.
Imai Y., Takanashi Y., Hoshino S., Terada M., Aoki M., Ohta J.
Modified Fontan procedure in ninety-nine cases of atrioventricular valve regurgitation. J. Thorac. Cardiovasc. Surg. 1997;
113: 262?9.
Peoples W.M., Moller J.N., Edwards J.E. Polysplenia: a rewiew
of 146 cases. Pediatr. Cardiol. 1983; 4: 129?37.
Koh M., Yagihara T., Uemura H., Kagisaki K., Hagino I.,
Ishizaka T. et al. Biventricular repair for Right Atrial Isomerism.
Ann. Thorac. Surg. 2006; 81: 1808?16.
Stamm C., Friehs I., Duebener L.F., Zurakowski D., Mayer
J.E., Jonas R.A. et al. Improving results of the modified Fontan
operation in patients with heterotaxy syndrome. Ann. Thorac.
Surg. 2002; 74: 1967?78.
Kim Soo-Jin, Kim Woong-Han, Lim H.G., Lee Chang-Ha, Lee J.Y.
Improving results of the Fontan procedure in patients with heterotaxy syndrome. Ann. Thorac. Surg. 2006; 82: 1245?51.
Cetta F., Feldt, P.W., O?Leary P.W, Mair D.D., Warnes C.A,
Driscoll D.G. et al. Improved early morbidity and mortality
after Fontan operation: the Mayo Clinic experience, 1987 to
1992. J. Am. Coll. Cardiol. 1996; 28: 480?6.
Hashmi A., Abu-Sulaiman R., McCrindle B.W., Smallhorn J.F., Williams W.G., Freedom R.M. Management and
outcomes of right atrial isomerism: a 26-year experience. J.
Am. Coll. Cardiol. 1998; 31: 1120?6.
Bartz P.J., Driscoll D.J., Dearani J.A., Puga F.J., Danielson G.K., O?Leary P.W. et al. Early and late results of the modified Fontan operation for heterotaxy syndrome: 30 years of
experience in 142 patients. J. Am. Coll. Cardiol. 2006; 48:
2301?5.
Yurlov I.A., Podzolkov V.P., Zelenikin M.M., Kovalev D.V.,
Babaev G.K., Putiato N.A. ?t all. Experience with bidirectional cavopulmonary anastomosis and modified Fontan operation
in patients with single ventricle and concomitant visceral heterotaxy. Interact. Cardiovasc. Thorac. Surg. 2011; 12: 563?8.
Culbertson C.B., George B.L., Day R.W., Laks H.,
Williams R.G. Factors influencing survival of patients with heterotaxy syndrome undergoing the Fontan procedure. J. Am.
Coll. Cardiol. 1992; 20: 678?84.
Misumi Y., Hoashia T., Kagisakia K., Kitanob M., Kurosakib K., Shiraishib I., Yagiharaa T., Ichikawaa H. Long-term
outcomes of common atrioventricular valve plasty in patients
with functional single ventricle. Interact. Cardiovasc. Thorac.
Surg. 2014; 18: 259?65.
????????? 26.11.2014
49
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
╘ ????????? ???????, 2014
??? 616.124.2-007.64:616.126.4-007.274
?????????? ?????? ????????? ? ?????????
? ????? ???????? ??????????????????? ???????
?.?. ????????, ?.?. ???????????, ?.?. ?????????, ?.?. ????????
????? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ?
???????? ??? ? ???? ?.?. ???????); ?????????? ?????, 135, ??????, 121552,
?????????? ?????????
???????? ?????? ??????????, ????. ???. ????, ??????????? ??????????? ??????????;
??????????? ????? ???????, ????. ???. ????, ??????? ????. ????.,
e-mail: jatropha@mail.ru;
????????? ????? ????????, ?????? ???. ????, ??????? ????. ????.;
???????? ???? ????????, ?????? ???. ????, ?????????, ?????????? ??????????
?????????? ?????????? ?????? ????????? ???????? ?????? ??????? ?????? ? ??????????????? ?????????????? ???????????? ?? ????????? ??????. ? ????????, ??? ???????, ???????? ???????????. ??????????????? ???????????? ???????????? ????? ???? ????? ??????????, ??? ?????????????, ??????? ? ???? ??????. ??????? ????? ???? ?????????? ? ??????? ???????????????, ??-??????????? ? ???. ?? ???????? ?????? ??????? ???????? ??????? ? ?????????? ????????????, ????????????? ? ??????? ????? ???????????? ?????? ?????? ????????? ? ????????? ? ?????? ?????? ???????????????????? ??????.
???????? ?????: ?????????? ?????? ?????????; ?????? ????? ???????????????????? ??????; ???????????????; ??-???????????.
LEFT VENTRICULAR DIVERTICULUM WITH A COMPLETE
ATRIOVENTRICULAR DEFECT
I.E. Nefedova, I.Yu. Baryshnikova, D.O. Berishvili, K.V. Mumladze
A.N. Bakoulev Scientific Center for Cardiovascular Surgery; Rublevskoe shosse, 135, Moscow,
121552, Russian Federation
Nefedova Inessa Evgen?evna, MD, PhD, Deputy Chief of Department;
Baryshnikova Irina Yur?evna, MD, PhD, Junior Research Associate;
Berishvili David Olegovich, MD, DM, Chief Research Associate;
Mumladze Koba Vazhaevich, MD, DM, Professor, Chief of Department
Congenital left ventricular diverticulum is a rare cardiac malformation characterized by a localized outpouching from the cardiac
chamber. The patient is usually asymptomatic. However, complications like embolism, arrhythmia and, rarely, rupture can be the initial presentation. Diagnosis can be established by echocardiography, CT angiography, and MRI. We report infant with congenital left
ventricular diverticulum located in medium part of the inferior wall associated with complete atrioventricular defect.
Key words: left ventricular diverticulum; complete atrioventricular defect; echocardiography; CT-angiography.
?????????? ????????? (??????????) ?????? ????????? (??) ???????? ?????? ????????? ??????,
????? ???????????? ? ??????? ??????????? ???????? ??????. ? ???????????? ??????????, ????????
?????? PubMed, ? ????????? ????? ??????? ?? ????? 70 ??????? ??????? ??????????? ? ?????????????? ?????????. ? ??????????? ??????? ?????? ????????? ????????????, ??????? ?????? ????????????, ???????? ??????????????? (?????), ??????
?????? ???? ? ?? ??????????? [1, 2]. ? ????? ????????? ?? ???????? ???????? ????????? ???????
??????????? ?????? ????????? ? ???????? ? ?????
???????? ??????????????????? ??????? (?????).
? ? ? ? ? ? ? ? ????? ???????? ??????????????????? ??????? ? ???????? 4 ?????? ????????? ????????? ???????? ??????? ? ????????? ?????????
50
????????????? ???????. ??? ???????? ?????????????? ????? 7 ??? ?? ????? ?????????????????
????????????????????? ???????????? ??? ???????
?????????? (???????????????) ?????? ?????????,
??????????????? ?? ??? ???????????? ??????
(???. 1). ?? ??????????? ???????????????? ???????????? ?????????? ???? ???????????? ??????? ??????????? ?????? ?????????, ????????????? ? ???????? ?????? ?????????. ?????? ? ???????????? ???? ??????????????? ????????? ???????
??????? ????????????? ? ???????? ?????? ??????,
??????? ?? ????? ??????????? ?????????? (???. 2).
??????? ????????? ??????????? ????????? ?????? ????????? ???????????????????? ?????? ????????????? ??????? ? ???????? ?????? ???????? ???????. ????? ??????????? ????????? ????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
?
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???. 1. ???????????????? ???????????????, ?????????? ??????? ? ???????? 2 ?????. ? ??????? ????? ???????????? ?????? ?????? ????????? ??????????????? ????????? ???-??????????? ???????? 6 в 8 ?? (???????), ?????????? ??????? ? ??????????? ?? ???? ?????????? ?????:
? ? ????? ?????????????? ????????; ? ? ????? ??????????????? ???????
*
?
?
???. 2. ???????????????? ???????????? ?????????? ??????? ?????? ? ?????????????????:
? ? ???????? ??????? ??????? ????????????? ?????? ? ????????????? ????? ?? ?????????? 5 ?? ?? 1,8 в 1,3 ?? ? ?????? ???????? ?????? ? ??????? ????? ?? ?????????? 2?3 ?? ?? 1,5 в 1,6 ?? (???????); ? ? ??????????????? ?????????? ???????? ? ???????????? ??????????? ????? ???????
(????????, ?????????? ??? ?????????) ?? ???????????? ?????? ?????? ????????? ?? ?????? ??????? ????????? (?????????)
? ??????? ????????? ?????? ???? ?????????? ?? ??????? ???????????? ??????????? ? ??????????????
??????????? ?????? ?????????. ??????? ???????
????????? ? ?????????? ?? ??????? ?????? ????????? ????? ???????????? ??????? ?? ???????. ??????????? ?????? ??????????? ????? ??????? ???????? ?????? ???????? ?????? ????????? ????? ????? ???????? ??????, ? ????? ???????? ? ????????
?????????????? ???????. ???????? ??????? ?????
?????????? ??? ?????? ???????????, ?????? ????
???????? ??????????????? ????????? ? ?????? ??
??????? ??? ?????????? ???????????????? ???????. ????? ??????? ????????????? ????? ??????????. ????????????????? ?????? ???????? ??? ??????????. ????? ???????? ??????? ??????? ?? ??????? ????????? ??????? ??????? ? ??????? ???
???????????? ????? 10 ?. ??????? ???????? ?? ?????????? ?? 10-? ??? ????? ????????.
?????????? ??????????/????????? ?????? ????????? ???????? ????? ?????? ??????? ??????, ??51
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
??????? ?? ??????????????? ??????????? ????????? ? ????????. ??????? ╚?????????? ?????????╩ ?
╚?????????? ??????????╩ ?????? ????????????
?????????? ???????? ???? ??? ????????, ???? ???
??????????? ?????? ?????????. ??? ??????? ?????? ????? ? ?????????? ???????????? ?????????????? ??????? ? ?????????? ??????????? ?????????? ??? ??????????. ??? ??????????????? ???????????? ?????? ??????? ???????? ??? ??? ????
???????? [2, 3]. ? ????????????????? ????? ????????? (?????????? ??? ?????????????) ? ??????????? ??????? ? ??????? ??????, ??????? ?????????????? ??????????. ??? ????????? ?????? ????? ??????? ? ????????????? ???????????
?????????? ??? ???????????????. ?????? ???????????????? ??????????? ???????? ???? ??? ??????????????? ????????????. ???????? ??????
(70%) ??????????? ???? ?????????????? ??????????? ?????? ? ??????? ????????, ????????? ? ????
????? ?????? ?????? ????????? ????????? ??????????? ??????? [3]. ????? ???????, ???????????
?????????????? ????????? ??? ????????? ?????????????? ???????, ?? ??????? ?????????????, ??????????????????? ?????? ? ??????????? ??????????? ????? ???????? ?????????? ????????????.
????????? ?????????? ???????????? ??? ???????? ?? ?????? ????. ????????, ??? ???????? ????????? ? ?????????? ?????????? ??????????????
???? ??? ???????????????? ???????? ???????? ???????? ?????? ??? ??????? ?????????? ??????, ????????, ?????????? ?????????????? ????????, ???
????????? ? ??????????? ?????????????????
????????? ????? ?????????????? ????????????
?????? ????????? [4].
??????????? ??????????? ???????????? ?????????? ? ????????? ???????????? ????????
??????? ?????? [5], ???????? ??????????? ???????? ??????. ????? ???????????? ????????? ?
???????????? ???????? [6], ????????? ?????? ?????? ??? ??????? ????????? ??? ???? ? ????? ?????????? [2]. ???????? ????? ?????????? ??????
????????? ??????????? ? ????????? ? ?????????
Cantrell [5]. ????? ??????????, ??????? ????????????? ??????????? ? ?????????. ? ???????? ???
??????? ? ???????????? ????????? ????????.
????? ????, ????????? ????? ????? ????????? ???
????????? ????????????? ??????????, ????????????? ?????????????? ??? ?????? ??????? ??????.
?? ?????? ??????? ??????? ??????????? ??????????? ??? ????????? ?????????????? ??????????
???????? ?????????? ??????? [3]. ??????? ?????
??????? ????? ????????? 60% ??? ?????????????
??????????? ?????????? ?????????????? ???????
?????? ?????????.
? ????????? ? ??????????? ?????????????/???????????, ??? ???????, ??????????? ????????, ??? ?????????? ??????????? ??????????? ???????????. ???? ????? ????????? ?????????? ???????? ??? ?????????? ????? ??? ??-???????????,
52
???????????? ?? ?????? ?????? ???????????. ?
?????? ??????? ??? ??????????? ????? ??????? ????????? ????????? ?????, ?????????? ????????.
???????? ?????????????, ???? ???? ???????
?????? ???????????, ? ?????? ???? ?????????
?????? ???????? [7, 8].
?????????????? ????????????????? ??????????? ??????? ??????, ??? ??? ???????????? ???????
??????????? ??????????? ????????? ?? ??????
??????? ? ??????????? ????????? ???????? ?????????????? ?? ?????????? ???? ?????. ???????? ?? ??, ??? ???? ???????????????? ?????????
??????????, ?????????? ??????, ? ??????? ??
?????????? ??? ????????????? ????????, ?????
????????? ??????? (???????? ??? ?????????????
??? ?????). ?????? ?????? (?????? ???????????)
???????? ????? ??????????? ??? ????????????, ????????????? ? ????????? ???????. ????????? ????????, ??? ???????????? ??????????? ?? ??????
?????? ???? ???????? ? ????????? ??????. ????????, ??? ??????? ? ????????????? ?????????
????????????/???????? ? ???? ??????? [7, 8].
????????? ?????, ????? ??? ?????????? ? ??????????? ?????????? ???????? ??????? ???????????, ??????? ????? ????????? ? ????????? ????????? ?????? ? ??????????? ????????? ???????.
?? ??? ????????? ???????????? ??????????? ?????
??????? ???????????? ???? ?????????? ??????????, ??????? ???????????? ? ?????????? [7, 8]. ?
??????????? ????????? ? ???????????????? ??????? ???????????? ??????????? ?????????????
??????? ?????????? ?????? ?? ??????? ???????????? ???????????.
????????? ??????? ??????? ??? ????? ??????
?????????? ??????????? ???????????, ??? ???
?????? ??????????? ???????? ???????????? ╚?????????????????╩, ? ?????? ????? ? ????????????
??????? ???????????? [6?8].
???????? ??????? ??????????? ???????????
??-?? ??? ?????? ?????????????????? ?? ?????????. ????? ???????, ?????? ??????? ????????????? ?? ??????????? ???????????. ??? ?????????
??????????? ??????????? ? ??????????, ?????????????? ????????????? ?? ?????? ??? ??????? ???????????, ?????? ???? ?????????? ?????? ? ??????????? ?????????? ????????? ??? ?????????????? ?? ???????????????? ? ????????????
??????? [9]. ? ????????? ? ????????????? ???????????? ????????? ????????????? ??????? ???????? ???????. ? ??????????? ?? ???????????? ??????? ????????? ?????????? ?????????? ???????????????? ????????????? ????????, ?????
???????? ???????, ????????? ?????????????,
??????? ??? ????????? ?????? [9]. ??? ?? ?????
?????? ??????, ???????? ?? ???????? ?????????
?????? ??????????? ? ???????????? ????????????????? ??????? ? ??????????? ???????, ??????????? ?????????????? ??????? ? ????????????? ??????????, ???? ??????? ????????? ? ??????? ??
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
?????????? [7]. ?????????????? ? ????????????
??????????? ?????? ???? ??????? ?? ????????
??? ??????? ????????. ????????, ??? ????????
???????????? ??????? ????????? ????, ??? ???
???????????? ?????????? ???? [8, 9]. ????????????? ??????? ?????? ??????????? ? ?????? ???? ?????? ? ?????? ?????????? ??????.
? ????? ?????? ?? ????? ???? ????????? ?????? ? ?????????? ????? ???????, ??? ???? ?????????? ??????????? ?????????. ??? ???? ?? ????, ???
???????? ??????? ? ?????????, ????????????? ????? ???????? ? ???????? ?????????????? ??????????????, ?????? ????????????? ???????? ? ?????????? ??????? ?????? ?????? ????????? ? ??????? ???????????? ???????????. ?????????
???????????? ??????? ????? ??? ??????????? ????
????????????? ? ?????? ??????????? ??????? ??????????, ???????? ?? ???????? ?????????? ???????? ???????? ?????? ? ????? ? ????????? ???????.
???????, ??? ???????? ?????? ?????? ? ?????????? ???????????? ?????? ????????? ? ??????
?????? ???????????????????? ?????? ??????? ???
?????????? ?????? ? ?????? ????????? ? ???????????? ????????? ??????????? ? ??????? ????? ?????????.
??????????
1.
2.
3.
4.
5.
??????????? ?.?., ??????? ?.?. (???.) ????????-?????????? ????????: ???????????. ?.: ????????; 1989.
Zhang Y.L., Shen E., Wu Z.H., Xue X.P., Zhang W.X.
Echocardiographic findings on congenital left ventricular
diverticulum and aneurysm: Two rare cases and literature
review. Echocardiography. 2010; 27: 344?7.
Ohlow M.A., Secknus M.A., Geller J.C., von Korn H., Lauer B.
Congenital left ventricular aneurysms and diverticula.
Pathophysiology, clinical relevance, and treatment. Med. Klin.
2007; 102: 358?65.
Prefumo F., Bhide A., Thilaganathan B., Carvalho J.S. Fetal
congenital cardiac diverticulum with pericardial effusion: Two
cases with different presentations in the first trimester of pregnancy. Ultrasound Obstet Gynecol. 2005; 25: 405?8.
Singh N., Bera M.L., Sachdev M.S., Aggarwal N., Joshi R.,
Kohli V. Pentalogy of Cantrell with left ventricular diverticulum:
6.
7.
8.
9.
a case report and review of literature. Congenit. Heart Dis.
2010; 5 (5): 454?7.
Sivriog?lu A.K., Sag?lam M., Ozturk E., Incedayi M., Sonmez G., Mutlu H., Karaman B. Association between myocardial hypertrophy and apical diverticulum: more than a coincidence? Diagn. Interv. Radiol. 2013; 19: 400?4.
Marijon E., Ou P., Fermont L. Diagnosis and outcome in congenital ventricular diverticulum and aneurysm. J. Thorac.
Cardiovasc. Surg. 2006; 131: 433?7.
Gowitt G.T., Zaki S.A. Rupture of a cardiac diverticulum resulting in sudden death. Am. J. Forensic. Med. Pathol. 1988; 9:
155?8.
DiBardino D.J., Charaf-Eddine A., Gaymes C., Sheth M.,
Rivard A., Salazar J.D. Left Ventricular Diverticulum: How We
Do It. WJPCHS. 2013; 4 (3): 318?21.
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
Burakovskiy V.I., Bockeria L.A. (eds.) Cardiovascular surgery: Guidance. M.: Medicina, 1989.
Zhang Y.L., Shen E., Wu Z.H., Xue X.P., Zhang W.X.
Echocardiographic findings on congenital left ventricular
diverticulum and aneurysm: Two rare cases and literature
review. Echocardiography. 2010; 27: 344?7.
Ohlow M.A., Secknus M.A., Geller J.C., von Korn H., Lauer B.
Congenital left ventricular aneurysms and diverticula.
Pathophysiology, clinical relevance, and treatment. Med. Klin.
2007; 102: 358?65.
Prefumo F., Bhide A., Thilaganathan B., Carvalho J.S.
Fetal congenital cardiac diverticulum with pericardial effusion:
Two cases with different presentations in the first trimester
of pregnancy. Ultrasound Obstet Gynecol. 2005; 25:
405?8.
Singh N., Bera M.L., Sachdev M.S., Aggarwal N., Joshi R.,
Kohli V. Pentalogy of Cantrell with left ventricular diverticulum:
a case report and review of literature. Congenit. Heart Dis.
2010; 5 (5): 454?7.
Sivriog?lu A.K., Sag?lam M., Ozturk E., Incedayi M., Sonmez G., Mutlu H., Karaman B. Association between myocardial hypertrophy and apical diverticulum: more than a coincidence? Diagn. Interv. Radiol. 2013; 19: 400?4.
Marijon E., Ou P., Fermont L. Diagnosis and outcome in congenital ventricular diverticulum and aneurysm. J. Thorac.
Cardiovasc. Surg. 2006; 131: 433?7.
Gowitt G.T., Zaki S.A. Rupture of a cardiac diverticulum resulting in sudden death. Am. J. Forensic. Med. Pathol. 1988; 9:
155?8.
DiBardino D.J., Charaf-Eddine A., Gaymes C., Sheth M.,
Rivard A., Salazar J.D. Left Ventricular Diverticulum: How We
Do It. WJPCHS. 2013; 4 (3): 318?21.
????????? 08.10.2014
53
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
╘ ????????? ???????, 2014
??? 616.126.42-089.844:616.132-007.63-089
???????? ??????????? ??????? ????? ??????????
????? ????? ?? ?????? MANOUGUIAN?SEYBOLD-EPTING
?.?. ????????, ?.?. ???????, ?.?. ????????, ?.?. ????????
????? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ?
???????? ??? ? ???? ?.?. ???????); ?????????? ?????, 135, ??????, 121552,
?????????? ?????????
???????? ?????? ?????????, ?????? ???. ????, ?????????, ??????? ????. ????.;
??????? ????? ???????, ?????? ???. ????, ??????? ????. ????.;
???????? ?????? ?????????, ?????? ???. ????, ??????? ????. ????.,
e-mail: samsonof@yandex.ru;
???????? ????? ??????????, ??????
????? ?? ?????????? ???????? ?????????? ????? ????? ?? ?????? Manouguian?Seybold-Epting ???????? ???????????????
??????????? ??????? (??), ?????? ????????? ??????? ??????? ?? ??????????????? ?????????. ? ????????????? ??????????
??? ?? ??????????? ?????, ??????????? ???????????????? ??????? ?????????????? ??????????????? ??, ? ????? ? ??? ???????????? ??????????? ??????????.
???????? ?????: ???????? ??????????? ???????; ??????????????? ??????????? ??????? ????? ???????? Manouguian?
Seybold-Epting; ?????????? ?????? ??????.
PLASTIC MITRAL VALVE AFTER THE ENLARGEMENT OF THE AORTIC
ROOT METHOD MANOUGUIAN?SEYBOLD-EPTING
M.R. Chiaureli, T.Y. Danilov, V.B. Samsonov, M.Sh. Mavlyutov
A.N. Bakoulev Scientific Center for Cardiovascular Surgery; Rublevskoe shosse, 135, Moscow,
121552, Russian Federation
Chiaureli Mikhail R?mazovich, MD, DM, Chief Research Associate;
Danilov Timur Yur?evich, MD, DM, Leading Research Associate;
Samsonov Victor Borisovich, MD, DM, Leading Research Associate;
Mavlyutov Marat Shamil?evich, Surgeon
One of the complications of surgery of the aortic root enlargement method Manouguian?Seybold-Epting is mitral insufficiency (MI),
correction methods which depend on the morphological changes. In our literature we have not met papers devoted to reconstructive
techniques restore failure MI, and therefore represent their own observation.
Key words: plastic mitral valve; mitral valve insufficiency after surgery Manouguian?Seybold-Epting; congenital heart defects.
?????????? ????? ????? ??? ????? ?????????
?????? ????????? ????????? ?????????????? ??????????? ??????? ???????????? ????????, ??????????????? ???????? ? ??????? ??????????? ????
???????? [1?4]. ????? ????, ? ????????? ????????
???????? ? ?????????? ????????? ??????????
?????? ?????????? ????? ????? ????????? ?????????????? ? ?????????? ??????? ?????? ?????????
???????? ? ?????? ????????????? ????? ???????
[5]. ????? ?? ???????? ???????????????? ???????
????????????? ????? ????? ???????? ????????
?anouguian?Seybold-Epting. ???????????????? ?
?????????? ?????????? ???? ???????? ??????????????? ?????? ????????????, ???????????????
???????? ??????? ?? ?????????? ? ??????????????????? ???????????? ???????????? [6?8]. ?????
????????? ??????????, ??????????? ????? ????
????????, ???????? ????????????????? ???????54
????? (1?5% ???????), ?????????? ?????? ??????????? ??????? (2?6%), ????????????? ???????
(0?0,4%), ????????? ?????????? (0?3%), ??????
??????????????????? ??????? (3?4%) ? ?????????? ?????????? ????? (0?0,3%). ???????? ??????
??????????? ???????? ??????????????? ??????????? ??????? (??), ??????? ????? ?????????? ??-??
?????? ???????, ? ????? ??????????? ??? ?????????? ???????? ??????? ?? [5, 6, 8, 9].
? ????????????? ?????????? ?? ?? ?????????
?????, ??????????? ????????????? ?? ????? ????? ???????????? ?????????? ????? ????? ?? ?????? Manouguian?Seybold-Epting ? ??????????????? ??????????? ??????? ? ????????? ? ???, ? ?????
? ??? ???????????? ??????????? ??????????.
? ? ? ? ? ? ? , 11 ??? 5 ???, ???????? ? ??????? ?
???????? ?? ?????? ? ??????? ???????????? ???
?????????? ????????.
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??????? ??????? ?????? ? ???????, ? 3, 2014
?? ???????? ????????, ??? ?????????? ?????
?????? ? ?????? ??????????????? ???????????
(????), ????????????? ???????????? ??????
?????, ??????????????? ??????????? ???????
(??) ? ?????????? ? ????????. ? 3 ???? ????????
???? ????????? ???????? ????, ????????? ????????????? ???????? ? ???????? ??. ?????? 8 ???
??-?? ????????????????? ???????????????? ???????? ? ???????????????? ?????????? ??????????????? ????????? ????????? ???????? ?? ? ???????
???????????. ?????? 6 ??? ??????? ????? ??? ???????????????? ? ?????????? ?????????? ????????????????. ??? ????????? ?????? ?? ???????? ????????????? ??? ?????????????? ????????????
???????? St. Jude Medical ? 19. ???????? ?????
????????? ?????? ??, ?????? ???????? ?????????
17 ??, ???????? ????????? ?????????? ?????
????? ?? ?????? ?anouguian?Seybold-Epting.
?????? ???????? ????????????????? ??????, ??????? ??? ??????? ?? ?????????? ? ?????????????????? ?????????. ?????? ????? ??? ? ????????
????? ????????? ??????, ? ????? ? ??? ?? ??? ?????
???????????????? ? ?????????.
??? ??????????? ???????????? ????????
110/60 ?? ??. ??. ?????????????? ???? ?????? ?????????, ? ???????? ??????????? ??????? ? ?????????? ??????? ???????, ????????????? ????????????? ??? ? ??????? ???????? ??????.
?????? ???: ????????? ???? ? ??? 78 ? ??????
? ?????????? ????????????? ???????????????,
????????????? ??? ?????? ????????? ?????, ???????? ??????? ?????? ????? ????? ????, ???????? ??????????? ?????? ????????? ? ?????? ??????????.
?????????????? ??????? ??????? ??????:
???????????? ?????????? ???? ?????? ? ??????????? ?? ???? ?????????? ????? ??????? ??????
(??? ? 62%).
?????? ?????: ??????????????? ??, ????????????? ?????????? ?????????? ?????? (43 ??) ? ????? ????????? ? ???????? ??????? ? ??????? ????????? ????????? 4?5 ?? ??????. ?????????? ?????????? ?????? ?????????? ?? 55 ??. ????????
????????????? ????????? ??????? ?? ? ?????? ??????, ?????????????? ???????? ????????? 20 ?? ??. ??.
???????? ??????? ?????? ?????????: ????????
?????????????? ?????? ? 5,2 ??, ???????? ????????????? ?????? ? 3,5 ??. ??????? ??????? ??????
????????? ?????????? 61%. ??? ?????????? ???????????? ? ?????????????? ???????? ????? ? ? ???????? ??????????? ????????.
???????? ????????? ???????? ??????????? ???????. ?????? ? ?????? ????????????? ???????????
????????? ?????????????, ??????? ???? ???????
?? ?????. ??????? ?? ???? ???????? ??????????
???????? ??????? ? ???????? ???????????, ??????? ????????? ? ??????????? ????????. ????????
??????????? ? ???????? ?? (136 ???), ??????????
(trec ? 28 ╟C) ? ???????????????? ????????????
(Custodiol). ????? ????????? ?????????? ????? ?
60 ???. ?????? ? ?? ????????????? ????? ?????????????? ???????????. ??? ??????? ?? ?????????? ????????? ?????????? ?????? ?? 45 ?? ?
??? ????????? ? ???? ???????? ??????? ? ???????
????????? ???????, ??????????? ?????? ?????.
????????, ??? ??????? ???? ?????????? ?????????,
??? ?????????? ??????????????? ????????? ?
????????? ?????????????, ?????? ???? ????????? ???????? ????????? ? ???????, ??????? ? ???? ????? ??????????? ???????????? ?????. ????? ???? ????????? ????????????? ?? ?? ??????
??????? ?????????? ??? ?????? ??????? ?? PTFE.
?????? ????? ???????? ??????? ?????????????
??????? ???????.
? ?????? ????????????????? ??????? ?????????? ??????? ????????? ????????? ???????????????. ????????? ???????????? ??????????????
??????????? (0,03 ???/??/???) ? ???????????
(0,8 ???/??/???). ??? ???? ???????????? ????????
?????????? 115/70 ?? ??. ??., ??????????? ???????? ???????? ? 9 ?? ??. ??. ?? ?????? ?????, ????????????? ??????? ??????????? ??????? ????
?????????????????? ? ???????????? ?? ?????????
1 ???????. ?? 2-? ??? ????? ???????? ??????? ???
???????????? ? ????????? ? ????????????? ?????????. ????? ???????????? ??????????????? ???????, ??????????? ????????????, ??????????????????, ????? ?????????? ????? ? ??????????, ? ????? ???????????????? ???????, ??????? ???
??????? ?? ?????????? ? ?????????????????? ?????????. ??????????????????? ???????????? ????? ???????? ?? ??????? ???????? ?????????? ???? ?????? (??? ? 58%). ??? ????? ??????????
?????????? ?????????????? ??????????? ??????
(???? ? 61%), ???????????? ?? ?? ?? 1 ???????,
?????????????????? ?????????? ??????????????
???????????? ?? ?? (???????? ?????????????? ???????? ????? ????? ?????????? ? ?????? ?????????
22 ?? ??. ??.).
?????????????? ?? ? ????? ???????? ?????????? ????????? ? ??????????? ??????????????.
?????????? ????????? ??????? ?????????? ? ????????????? ????? ????? ? ??????????????? ??
?????????? ?? ???????????? ????????????????
??????????? ? ?????????? ????????????? ????????
?? ??. ????? ????, ??????????? ??????? ??????????? ???????? ??????? ?????????? ???? ????????? ????????????? ?????? ???????, ????????????? ???????????? ?????? ???????. ?????? ? ???
?????????? ?????????? ?????? ?? (? ????? ?????? ?? ?????? Manouguian?Seybold-Epting) ?????
???????? ? ???? ??????????, ????????? ????????????? ????????? [2, 8]. ?????????? ??????????????? ????????? ??????? ????????????, ?? ?????? ??????????, ???????? ???????? ?????? ??????????? ??????????? ??????? ????? ????????
Manouguian?Seybold-Epting ? ????????? ? ???????? 4?14% [6, 8]. ???????? ??????? ????????? ???????? ??????????????? ?? ????? ???? ????? ?????55
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
??, ????????????? ? ???????? ??????? ??, ?? ?????????? ??? ?????????? ??????????? ????????
??????? ?? ????? ????????????? [5, 6, 8]. ????????
?????????? ????????? ? ? ?????? ????????. ??????????????? ?? ???? ??????????? ???????? ????
????????? ? ???? ???????? ???????, ??? ?????? ?
??????? ?????????? ????????????? ????????
?????????????? ????? ????????????? ?????? ??
??????????.
? ???????????? ?????????? ??????? ????? ????????? ?????????, ? ??????? ???????? ??????????????? ?? ???????? ?????????? ???????? ??????? ??-?? ?????????? ?????????, ???????????????
??? ????????????? ????? ????? (????????????? ??????? ???? Gore-Tex), ??? ??????????????? ? ??????????? ??????? ?? ??????????????, ??? ?? ???????? ??? ?????????? ??????? ?? ????????????? [9,
10]. ? ????? ?????????? ??????? ?? ?????????????? ???? ??????????, ???, ????????, ??????????? ????????? ??????????? ???????, ?????????
? ??????? ??????????? ?????????????. ? ?????????? ?????????? ????? ??????? ????????? ?
?????????? ?????????? (?? 7 ?? 10 ???) ?? ?????????? ? ????????? ?????????? ????????????????
????? ???????? Manouguian?Seybold-Epting ??? ??
???????????????? [7, 10]. ? ????? ?? ?????? ??????????????? ?? ?????? ???????????????, ??? ????????? ?????????? ? ?????????? ?????????????.
?????????? ????? ???????? ???????????? ?
????????? ?????????? ??????????? ???????? ?????????? ??????? ??????????????? ?? ? ????????????? ?? ?????????.
6.
7.
8.
9.
10.
References
1.
2.
3.
4.
5.
??????????
1.
2.
3.
4.
5.
Konno S., Imai Y., Iida Y., Nakajima M., Tastsuno K. A new
method for prosthetic valve replacement in congenital aortic
stenosis associated with hypoplasia of the aortic valve ring. J.
Thorac. Cardiovasc. Surg. 1975; 70: 909?17.
Manouguian S., Seybold-Epting W. Patch enlargement of the
aortic valve ring by extending the aortic incision into the anterior mitral leaflet: new operative technique. J. Thorac.
Cardiovasc. Surg. 1979; 78: 402?12.
Nicks R., Cartmill ?., Bernstein L. Hypoplasia of the aortic
root: the problem of the aortic valve replacement. Thorax.
1970; 25: 339?46.
Yamaguchi M., Ohashi H., Imai M., Oshima Y., Hosokawa Y.
Bilateral enlargement of the aortic valve ring for valve replacement in children. New operative technigue. J. Thorac.
Cardiovasc. Surg. 1991; 102: 202?6.
????????? ?.?., ???????? ?.?., ???????? ?.?., ???????? ?.?., ??????? ?.?., ??????? ?.?. ? ??. ????? ?????? ?
?????????? ???????? Manouguian?Seybold-Epting ? ??????? ? ??????????? ???????? ??????????? ???????. ???-
???? ??????? ?????? ? ???????. 2011; 4: 35?42.
De Pepo A.P., Zeitani J., Nardi P., Iaci G., Polisca P., De
Paulis R. et al. Small ╚functional╩ size after mechanical aortic
valve replacement: no risk in young to middle-age patients.
Ann. Thorac. Surg. 2005; 79: 1915?20.
Kawachi Y., Tominaga R., Tokunaga K. Eleven-year follow-up
study of aortic or aortic-mitral annulus-enlarging procedure by
Manouguian?s technique. J. Thorac. Cardiovasc. Surg. 1992;
104: 1259?63.
Kirklin J.K., Barrat-Boyes B.G. Cardiac surgery. New York:
John Willey. 2003.
????????? ?.?., ???????? ?.?., ??????? ?.?., ????????? ?.?. ???????????????? ??????????? ??????? ? ????????? ??????????? ????? ????? ?? ?????? Manouguian?
Seybold-Epting. ????????? ????? ??. ?.?. ????????
????. 2012; 2: 80?4.
Imanaka K., Takamoto S., Furuse A. Mitral regurgitation late
after manouguian?s anulus enlargement andaortic valve
replacement. J. Thorac. Cardiovasc. Surg. 1998; 115: 727?9.
6.
7.
8.
9.
10.
Konno S., Imai Y., Iida Y., Nakajima M., Tastsuno K. A new
method for prosthetic valve replacement in congenital aortic
stenosis associated with hypoplasia of the aortic valve ring. J.
Thorac. Cardiovasc. Surg. 1975; 70: 909?17.
Manouguian S., Seybold-Epting W. Patch enlargement of the
aortic valve ring by extending the aortic incision into the anterior mitral leaflet: new operative technique. J. Thorac.
Cardiovasc. Surg. 1979; 78: 402?12.
Nicks R., Cartmill ?., Bernstein L. Hypoplasia of the aortic
root: the problem of the aortic valve replacement. Thorax.
1970; 25: 339?46.
Yamaguchi M., Ohashi H., Imai M., Oshima Y., Hosokawa Y.
Bilateral enlargement of the aortic valve ring for valve replacement in children. New operative technigue. J. Thorac.
Cardiovasc. Surg. 1991; 102: 202?6.
Podzolkov V.P., Chiaureli M.R., Kokshenev I.V., Samsonov V.B., Danilov T.Y., Nosachev A.M. et al. A new approach
to step Manouguian?Seybold-Epting in patients with congenital aortic valve. Detskie bolezni serdtsa i sosudov. 2011; 4:
35?42 (in Russian).
De Pepo A.P., Zeitani J., Nardi P., Iaci G., Polisca P., De
Paulis R. et al. Small ╚functional╩ size after mechanical aortic
valve replacement: no risk in young to middle-age patients.
Ann. Thorac. Surg. 2005; 79: 1915?20.
Kawachi Y., Tominaga R., Tokunaga K. Eleven-year follow-up
study of aortic or aortic-mitral annulus-enlarging procedure by
Manouguian?s technique. J. Thorac. Cardiovasc. Surg. 1992;
104: 1259?63.
Kirklin J.K., Barrat-Boyes B.G. Cardiac surgery. New York:
John Willey. 2003.
Podzolkov V.P., Samsonov V.B., Danilov T.Yu., Medvedeva O.I. Reprosthesis aortic valve with the re-expansion of the
aortic root method Manouguian?Seybold-Epting. Byulleten?
Nauchnogo Tsentra Serdechno-Sosudistoy khirurgii im.
A.N. Bakuleva RAMS. 2012; 2: 80?4 (in Russian).
Imanaka K., Takamoto S., Furuse A. Mitral regurgitation
late after manouguian?s anulus enlargement andaortic valve
replacement. J. Thorac. Cardiovasc. Surg. 1998; 115:
727?9.
????????? 20.11.2014
56
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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╘ ????????? ???????, 2014
??? 616.126.46-089.843-77:616.1-053.1-089:616.131-007.21:616.126-022.7
???????? ?????????????? ???????????????? ???????
? ?????????? ????? ????? ??????????? ?????????
??????? ????? ? ????????? ? ????????? ?????
???????? ???????, ?????????? ????????????
??????????
?.?. ?????????, ?.?. ???????, ?.?. ??????, ?.?. ??????????
????? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ?
???????? ??? ? ???? ?.?. ???????); ?????????? ?????, 135, ??????, 121552,
?????????? ?????????
????????? ???????? ????????, ?????? ???. ????, ?????????, ???????? ???;
??????? ????? ???????, ?????? ???. ????, ??????? ????. ????.;
?????? ?????? ???????????, ????. ???. ????, ??????? ????. ????.;
?????????? ???????? ????????????, ????????, e-mail: isomadinov-76@mail.ru
??? ???????????? ????????? ? ?????????? ????? ????? ??????????? ????????? ??????? ????? ? ??????? ?????????? ??????? ?????????? ??????????, ??? ????????? ??????? ?????????? ????????? ????????? ????????????? ???????? ??? ??????????????? ?????????. ????? ?????????? ??????? ??????????? ??????????????? ???????????????. ???????? ??????? ????????? ????????????? ??????????????? ???????????????? ??????? ????? ????????? ??????? ????? ???????? ?????????? ??????????? ??????? ? ????????????????? ???????? ???????????????? ??????? ? ??????????? ?????????? ??????? ?????????,
????????????? ????????? ?????????? ???????? ????????????, ???????? ????????????? ?????? ?? ?????? ???????????????
??????????? ? ?????????? ??????????? ????????? ?????? ??????? ?????????. ????????? ????????? ????????? ????? ????????????? ?????????? ????????? ?????? ? ????????? ??????? ?????????? ?????? ? ??????? ????? ? ????????? ????? ???????? ???????, ??????????? ???????????? ???????????? ???????????????? ??????? ? ?????????? ????????????????? ???????.
???????? ?????: ??????? ?????; ???????? ????? ???????? ???????; ???????????? ??????????; ??????????????? ???????????????.
SUCCESSFUL TRICUSPID VALVE REPLACEMENT LATE AFTER RADICAL
CORRECTION OF TETRALOGY OF FALLOT IN A PATIENT WITH AGENESIS
OF THE LEFT PULMONARY ARTERY UNDERGOING INFECTIVE ENDOCARDITIS
V.P. Podzolkov, T.Yu. Danilov, N.A. Putyato, Kh.G. Isomadinov
A.N. Bakoulev Scientific Center for Cardiovascular Surgery; Rublevskoe shosse, 135, Moscow,
121552, Russian Federation
Podzolkov Vladimir Petrovich, MD, DM, Professor, Academician of RAS;
Danilov Timur Yur?evich, MD, DM, Leading Research Associate;
Putyato Niyole Al'fonsovna, MD, PhD, Leading Research Associate;
Isomadinov Khayrullo Gulomzhanovich, Postgraduate
Study of long-term results in patients after complete repair of tetralogy of Fallot, in a fairly large number of cases reveals complications, in which repeated surgery or intervention is indicated. Tricuspid valve insufficiency takes the important place of these complications. The most frequent cases of tricuspid valve insufficiency after complete repair of tetralogy of Fallot are iatrogenic leaflet or
subvalvular apparatus injury, and right ventricle deterioration as the result of severe pulmonary regurgitation, residual ventricular septal defect and the leftover obstruction of the right ventricle outflow tract. This report is dedicated to a rare congenital heart anomaly ?
tetralogy of Fallot with left pulmonary artery agenesis, complicated by tricuspid valve infective endocarditis in the late follow-up.
Key words: tetralogy of Fallot; left pulmonary artery agenesis; infective endocarditis; tricuspid insufficiency.
??????????? ????????? ??????? ????? (??) ??????? ??????????? ??? ????? ??? 55 ??? [1]. ? ????????? ????? ?????????? ?????????????? ???????
????? ??????????? ?????? ?????? ??????????????? ?????? ???????????? ???????????? ? ?????????
?????? ?????????? ??????? ??????????????????
???????. ?????? ? ??? ??? ?????????????? ???????,
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????? ????????????? ??????? ?????????????????
??????????, ????????? ?????????? ????????????? [2, 3]. ????? ??????? ?????????? ???????
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??????, ??? ??????????? ??????????? ?????????????????? ??????? [4, 5].
???? ????????? ? ??????????? ???????? ?????? ????????????? ????????? ??????????????? ??,
??????????? ? ?????????? ????? ????? ??????????? ????????? ?? ? ???????????? ?????? ????????
????????.
? ? ? ? ? ? ? , 25 ???, ????????? ? ????????? ? ???????? ?? ?????? ? ??????? ???????????? ???
?????????? ????????, ????? ?????? ???????????.
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?????? ? ?? ? ????????? ????? ???????? ??????? ?
?????????? ? ????????. ? 10-?????? ???????? ? ????? ? ?????????? ???????????? ??????????? (????????? ???????????? ????? ?????????? ? 80%) ? ????????????? ????????? ???????????? ?????? ???????? ??????? ??????? ???? ????????? ????????????
(??? ???????? ??????? ??????????????? ???????????) ????????????? ????????? ?????? ??????? ????????? (??) ???????????????????? ????????. ????? 13 ??? ??????? ????????? ??????????? ????????? ?? ? ????????? ????????? ?????? ?? ? ??????
???????? ??????? (??) ???????????????????? ???????? ? ??????? ???????????????? ????????
(??? ? 40 ?? ??. ??., ?? ? 100 ?? ??. ??.). ?????? 4 ?????? ????? ??????? ? ????????? ???????? ????????? ??????????? (?? 38?39 ╟?) ? ??????? ? ???????? ?????????? ? ???????, ?? ?????? ???? ???
???? ????????????????? ? ????????? ?? ????? ??????????, ??? ?? ????????? ??????????? ?????????
? ?????? ???????????? ???????????? ??? ????????? ??????????? ??????? ????????????? ???????????. ????? ???????????? ???????, ???????????
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???????? ????. ?????? ???: ????????? ???? ?
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??? ??????????????? ????????? ???? ? ???
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????? ???????????????? ???????, ????????? ???????? ?? ?????????? ? ?????????????????? ?????????. ??????????????????? ???????????? ?????
???????? ?? ??????? ???????? ?????????? ????
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???? ????????? ?????????. J. Kobayashi ? ?????.,
?????? ? ?????????? ????? ????? ??????????? ????????? ?? ?????? ????? 133 ?????????, ?????????? ??????????????? ???????????? ? 48% ???????, ??? ???? 19% ????????????? ????????? ?????
????????? ? ?????????? ???????????? [4]. ??
?????? A. Rocchini ? ?????., ??????? ?????????????
????????? ??? ?????????? ??????????????? ???????????? ? 102 ?????????, ???????????? ????????????? ? ??? ???????? ?????? ? ?????????? ??????? ????? ????????? ??, ????????? 11% [6].
J. Coles ? ?????., ?????????? ? ?????????? ???????
????? ?????????? ???????????? ??????? ?? ?????,
???????????????? ? ????????????? ????????, ???????, ??? ??????????????? ???????????? ??????????? ? 19% ??????? [7].
????? ?? ???????? ?????? ?????? ????????????? ??????????????? ?? ? ?????????? ??????? ????? ????????? ??????? ???????????? ???????? ?????????? ??????????? ??????? ?? ? ??? ????????????? ????????. ???? ????? ??? ???????????
???????????? ????????? ??????? ?? ??????? ??????????????? ??????????? (????), ??????????
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??????????? ??? ????????? ????, ???????????
??????? ?? ???? ?? ?? ????????? ?????? ??, ? ??
???? ??????? ??????? [2, 3, 8]. ?????? ??????????
?????? ?????????? ????????????? ?????????? ??????????????? ??, ???????? ????????? ??? ?????
??????????? ???????? ??? ????????? ???????????????? ??????? ?? [4].
??? ????? ???????? ????????????? ??????????????? ???????????? ? ????????? ????? ?????????
??? ? ??????????? ????????? ?????? ?? ????????
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????????????????? ????. ?????????????? ??????. ?????????? ? ???? ???????? ??????? ??????? ? 6?7 ?? ? ????????
(?????? ???????) ? ???????????? ?????? ????????? (?????
???????)
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???? ?????????????? ???????? ? ????????? ????????? ?????????? ?????? ?? ???????? ? ????????
??????????????? ???????????? ???? ??? ???????????? ?????????? ? ?????????????? ?? [5, 9].
? ??????????? ????????? ?? ? ?????? ?? ??-??
?????????????? ?????????? ?? ?????? ????? ???????? ? ??????????? ??????? ????, ????????? ????????? ??????? ? ?????? ??????????????? ?????????? ?????????? ? ????????????? ???????? [8].
???????????? ?????????? ? ????????? ? ??????????? ???????? ?????? ??????????? ? 4,0?4,7%
??????? ?? ?????? ????? ????????? ???????? ???????? [10, 11]. ?????????, ??? ??????? ???????????
?????? ?????? ??????????? ???? ?????????????
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? ????? ??????????. ???????? ????? ???????????? ?????????? ????????? ???????????? ???????
??????????? ?????? (27,1 ?????? ?? 10 000 ???????????) ? ??????? ??????????????? ???????????
(14,5 ?????? ?? 10 000 ???????????) [12]. ?????
????, ? ?????? ??????????? ????? ?????????????
????????????? ??????????? ?????? ? ??????? ?
???????????? ??????????? ???????? ?????? [13].
?????? ? ?????????? ????? ????? ?????????????
????????? ?? ???????????? ?????????? ????????
?????? ??????????? ? ????????? ???????? ????????????? 7 ??????? ?? 10 000 ???????????. ??
????????????????? ????????, ??????????????
???????? ???????????, ?????????? ???????? ????? ???????????? ???????? ? ??????? ???????? ?
???????? ??????????? ??????, ? ????? ?????????
???? (???????, ?????? ????????), ??????? ?????
???????????? ?? ????? ???????? ??? ??? ??????????? ???????????. ???????????? ???? ? ?????????? ?????????????????? ??????????? ??????? ?????????? ?????? ????????? ? ????????? ?????????????? ????. ??? ??? ??????? ??????? ? ? ?????
?????????, ? ??????? ???????????? ??????????
?????? ???????? ????????? ??????????????? ??.
??? ?????????? ??????????????? ??????????????? ????????????? ?????? ??????????? ??? ???????????????? ???????? (????????????? ????????????, ???????? ????? ??????? ???????, ?????????
???????? ???????????? ? ???????????????? ??????? ? ??.), ??? ? ?????????????? ??????? [10].
Y. D?Udekem ? ?????. ??????? ????????? ???????
??????????????? ???????????????, ????????????? ???????????? ????????????, ??????? ?????????? ????????????? ???????, ??? ????????? ???????? ????????????? ??????????? ??????-????
59
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
?????????? ????????? [14]. ? ?? ?? ????? ??? ????????? ????????? ????????? ????????????? ?????? ?????????? ?????? ???????? ???? ?????????????? ?????? ? ????????, ? ??????????? ????????? ??????? ????????? ????? ?????????
?????????????? ???????. ? ????? ?????? ? ???????????? ??????? ???? ????????? ??? ??????? ??
(???????? ? ??????????) ? ??????????? ???????????????? ??????????? (??????? ?????????, ?????????? ? ???? ???????, ?????????? ??????????
???????, ????? ???? ?? ??????????? ????). ??????????? ????????? ??????? ????????? ??????????????? ??????????????? ??? ????? ??????? ?????????? ??????? ??????? ? ????????????????? ????????, ?? ??? ??????, ??????? ???????????
?????????????? ???????.
? ?????????? ???????? ?? ????????, ??? ??????????? ?????????????? ??????? ????? ????????? ?????????? ???????????? ??? ??????????? ??????, ???? ??????? ????? ??????? ?????????????? ??????????????? ???????????????. ?????? ?
??? ???????? ??????? ????????? (25 ???) ? ??????? ?????? ????????????????? ??????? (31 ??)
????????? ????????? ?? ?????????? ??????????????? ???? ?????? ???????.
11.
12.
13.
14.
References
1.
2.
3.
4.
??????????
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Lillihei C.W., Cohen M., Warden H.E., Read R.C., Aust J.B.,
Dewall R.A. et al. Direct vision intracardiac surgical correction
of the tetralogy of Fallot, pentalogy of Fallot, and pulmonary
atresia defects; report of first ten cases. Ann. Surg. 1955; 142
(3): 418?42.
????????? ?.?., ???????? ?.?. ??????? ?????. ?.: ?????
??. ?.?. ???????? ????; 2008.
??????? ?.?. ????????? ???????? ? ?????????? ?????
????? ??????????? ????????? ??????? ?????: ???????.
???. ? ?-?? ???. ????. ?.; 2011.
Kobayashi J., Kawashima Y., Matsuda H., Nakano S.,
Miura T., Tokuan Y. et al. Prevalence and risk factors of tricuspid regurgitation after correction of tetralogy of Fallot. J.
Thorac. Cardiovasc. Surg. 1991; 102 (4): 611?6.
????????? ?.?., ???????? ?.?., ??????? ?.?., ????? ?.?., ??????? ?.?., ?????????? ?.?. ? ??. ?????????????? ???????? ?????? ? ?????????? ????? ????? ??????????? ????????? ??????? ?????. ??????? ? ????????-?????????? ????????. 2010; 5: 18?26.
Rocchini A.P., Rosenthal A., Freed M., Castaneda A.R.,
Nadas A.S. Chronic congestive heart failure after repair of
tetralogy of Fallot. Circulation. 1977; 56 (2): 305?10.
Coles J.G., Freedom R.M., Olley P.M., Coceani F.,
Williams W.G., Trusler G.A. Surgical management of critical
pulmonary stenosis in the neonate. Ann. Thorac. Surg. 1984;
38 (5): 458?65.
Hachiro Y., Takagi N., Koyanagi ?., Abe T. Reoperation for tricuspid regurgitation after total correction of tetralogy of Fallot.
Ann. Thorac. Cardiovasc. Surg. 2002; 8 (4): 199?203.
Kanter K.R., Doelling N.R., Fyfe D.A., Sharma S., Tam V.K. De
Vega tricuspid annuloplasty for tricuspid regurgitation in children. Ann. Thorac. Surg. 2001; 72 (4): 1344?8.
????????? ?.?., ??????? ?.?., ????????? ?.?., ????? ?.?., ??????? ?.?. ???????? ??? ????????? ???????????? ??????????? ? ??????? ? ??????????? ????????
??????. ??????? ? ????????-?????????? ????????. 2008;
2: 4?8.
Li W., Somerville J. Infective endocarditis in the grown-up
congenital heart (GUCH) population. Eur. Heart J. 1998; 19
(1): 166?73.
Gersony W.M., Hayes C.J., Driscoll D.J., Keane J.F., Kidd L.,
O?Fallon W.M. et al. Second natural history study of congenital heart defects. Quality of life of patients with aortic stenosis,
pulmonary stenosis, or ventricular septal defect. Circulation.
1993; 87 (2 suppl.): 152?65.
Dearani J.A., Danielson G.K. Congenital heart surgery nomenclature and database project: Ebstein?s anomaly and tricuspid
valve disease. Ann. Thorac. Surg. 2000; 69 (3): 106?17.
D?Udekem Y., Sluysmans T., Rubay J.E. Tricuspid valve repair
for tricuspid valve endocarditis after Fallot repair. Ann. Thorac.
Surg. 1997; 63 (3): 830?2.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Lillihei C.W., Cohen M., Warden H.E., Read R.C., Aust J.B.,
Dewall R.A. et al. Direct vision intracardiac surgical correction
of the tetralogy of Fallot, pentalogy of Fallot, and pulmonary
atresia defects; report of first ten cases. Ann. Surg. 1955; 142
(3): 418?42.
Podzolkov V.P., Kokshenev I.V. Tetralogy of Fallot. Moscow:
Bakoulev Scientific Center for Cardiovascular Surgery of the
Russian Academy of Medical Sciences; 2008 (in Russian).
Danilov T.Yu. Repeated operations late after radical correction
of tetralogy of Fallot: diss. Moscow; 2011 (in Russian).
Kobayashi J., Kawashima Y., Matsuda H., Nakano S.,
Miura T., Tokuan Y. et al. Prevalence and risk factors of tricuspid regurgitation after correction of tetralogy of Fallot. J.
Thorac. Cardiovasc. Surg. 1991; 102 (4): 611?6.
Podzolkov V.P., Chiaureli M.R., Danilov T.Yu., Yurlov I.A.,
Sabirov B.N., Kagramanov I.I. et al. Heart valve replacement late
after radical correction of tetralogy of Fallot. Grudnaya i serdechno-sosudistaya khirurgiya. 2010; 5: 18?26 (in Russian).
Rocchini A.P., Rosenthal A., Freed M., Castaneda A.R.,
Nadas A.S. Chronic congestive heart failure after repair of
tetralogy of Fallot. Circulation. 1977; 56 (2): 305?10.
Coles J.G., Freedom R.M., Olley P.M., Coceani F., Williams W.G.,
Trusler G.A. Surgical management of critical pulmonary stenosis
in the neonate. Ann. Thorac. Surg. 1984; 38 (5): 458?65.
Hachiro Y., Takagi N., Koyanagi ?., Abe T. Reoperation for tricuspid regurgitation after total correction of tetralogy of Fallot.
Ann. Thorac. Cardiovasc. Surg. 2002; 8 (4): 199?203.
Kanter K.R., Doelling N.R., Fyfe D.A., Sharma S., Tam V.K.
De Vega tricuspid annuloplasty for tricuspid regurgitation in children. Ann. Thorac. Surg. 2001; 72 (4):
1344?8.
Podzolkov V.P., Gadzhiev A.A., Rozneritsa Yu.V., Popov D.A.,
Solyanik I.S. Surgery for valve infective endocarditis in
patients with congenital heart disease. Grudnaya i serdechnososudistaya khirurgiya. 2008; 2: 4?8 (in Russian).
Li W., Somerville J. Infective endocarditis in the grown-up
congenital heart (GUCH) population. Eur. Heart J. 1998; 19
(1): 166?73.
Gersony W.M., Hayes C.J., Driscoll D.J., Keane J.F., Kidd L.,
O?Fallon W.M. et al. Second natural history study of congenital heart defects. Quality of life of patients with aortic stenosis,
pulmonary stenosis, or ventricular septal defect. Circulation.
1993; 87 (2 suppl.): 152?65.
Dearani J.A., Danielson G.K. Congenital heart surgery nomenclature and database project: Ebstein?s anomaly and tricuspid
valve disease. Ann. Thorac. Surg. 2000; 69 (3): 106?17.
D?Udekem Y., Sluysmans T., Rubay J.E. Tricuspid valve repair
for tricuspid valve endocarditis after Fallot repair. Ann. Thorac.
Surg. 1997; 63 (3): 830?2.
????????? 26.11.2014
60
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?????? ?????? ????????? ????????? ???????.
1. ???????????? ?????. ?????? ?????? ????? ???? ???????????? ? ?????????????? ??????????? ???????????? ?? ??????????, ?? ???????? ??????? ?????? (? ??????? ???????), ? ??????????? ??????? ? ?????????? ???????????. ? ??????????? ??????? ???????, ???????? ?? ?????? ???????????????.
? ??????????? ??????????????, ??? ?????? ?????? ?? ???????? ????????, ? ????????? ???????
??????????? ?????? ????? ???????????? ?????, ? ????? ??????????? ? ?????????????-??????????????? ???????, ? ????????? ??????? ????????, ?? ?? ?????? ????????? ??????????????? ??????????? ??? ???????? ?????????? ?????.
?????? ?????? ???? ????????? ????? ????????.
?????? ?????????? ? ???????? ??????, ???????????? ? ???? ???????? ??? ???????????? ? ????
???????.
???????? ????????? ?? ????? ????? ????????? ? ????????????? ???????? ??????. ????? ??????????? ?????? ????????? ????? ??????????? ?????????????? (???????????????) ???????? ??????.
2. ?????? ??????????? ? ???????? ? ?????????? ? ???????????? ??????????? ??????????? ??????. ?? ??????????? ????? ?????? ?? ???????????.
3. ?????? ?????? ???? ?????????? ??????? Times New Roman ??? Arial, ?????? ?????? 12,
? ??????? ?????????? ????? ????????, ???? ??????? 3 ??.
4. ????? ?????????, ???????? ? ????????????? ?????? ?? ?????? ????????? 15 ? (???????
???????????, ??????? ? ?????? ??????????), ???????????? ???????????? ? 12 ?, ???????? ? 3 ?.
5. ????????? ???? ?????? ?????????:
1) ??????? ? ???????? ??????; 2) ???????? ??????; 3) ?????? ???????????? ??????????, ? ??????? ???????? ?????, ? ???????????? ?????? ? ???????????? ????????? ????????????? ??????????????; 4) ???????? ?????? ??????????, ?????, ??????; 5) ?????????????? ???????? ? ??????
??????, ??????????? ??? ????????? ??????? ? ?????????? ??????? ???????? ???????????: ?.?.?.
????????? ?? ??????? ????? ? ? ??????????????, ?????? ? ?????????, ?-mail, ???????? ????? ??????????? ??? ????????? ? ???????? ?????? (????? ???? ?? ???? ???????).
???? ??????? ?????????, ? ?????? ??????? ? ???????????????? ?????????? ????????????? ???????? ??????. ???? ??? ?????? ?????? ???????? ? ????? ??????????, ????????? ????? ?????? ??????? ?????? ???????? ?? ?????.
?????? ???? ?????????? ?????? ???? ??????????? ??? ?? ???????, ??? ? ?? ??????????
?????. ??????? ??????? ????????????? ????????????????? ??? ??, ??? ? ?????????? ???????????, ??? ?? ??????? BGN (Board of Geographic Names), ??. ???? http://www.translit.ru. ? ????61
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
????? ???????????(??) ?????, ????? ??? ?????? ?????????? ???????? ?????????? ???????
????????????.
??????? ?????????? ?????:
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? ???? ??????????? ??????????????????? ??????
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?.?. ????????1, ?.?. ????????1, ?.?. ???2, ?.?. ?????2
1
???? ╚????????????? ????????? ??????????? ???????????????? ?????╩, ???????????????
????????, 106, ?????????, 400008, ?????????? ?????????;
2 ????? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ?
???????? ??? ? ???? ?.?. ???????); ?????????? ?????, 135, ??????, 121552, ??????????
?????????
???????? ?????? ????????, ????????, e-mail: k.o.kirillov@mail.ru;
???????? ??????? ??????????, ???. ???????? ?????;
??? ??????? ????????, ?????? ???. ????, ?????????, ?????????? ??????????;
????? ???? ?????????????, ????. ???. ????, ???. ?????. ????., ????????????
EPIDEMIOLOGY OF CONGENITAL HEART DISEASE
AND WAYS OF OPTIMIZATION OF CARDIAC SURGICAL CARE
IN THE VOLGOGRAD REGION
K.O. Kirillov1, V.V. Nachinkin1, A.I. Kim2, I.A. Yurlov2
1 Volgograd regional clinical cardiological centre, Universitetskiy prospekt, 106, Volgograd, 400008,
Russian Federation;
2 A.N. Bakoulev Scientific Center for Cardiovascular Surgery; Rublevskoe shosse, 135, Moscow, 121552,
Russian Federation
Kirillov Kirill Olegovich, Postgraduate, e-mail: k.o.kirillov@mail.ru;
Nachinkin Valeriy Viktorovich, Deputy Chief Physician;
Kim Aleksey Ivanovich, MD, DM, Professor, Chief of Department;
Yurlov Ivan Aleksandrovich, MD, PhD, Leading Research Associate, Cardiac Surgeon
6. ?????????? ???? ?????????? ???????????? ?????? ?????? ???? ?????????: ??????,
???????? ?????, ??????? ????????, ?????????? ????????? ??????? ? ??????? ????????? ??????,
? ?????? ?????????? ????????????, ???????? ? ??????, ?????????? ? ??????????, ?????? ?? ??????? ??? ??????????, ?????? ???????????? ??????????.
?????? (???????, ?????????) ? ???????? ? ???????? ???????? ????? ??????. ? ????????????
??????? ??? ????? ???????? ?????? ????????? ????????? ?????? ? ???????? ?????? ???????: ╚????╩
(????????????? ???????? ? ??????????? ????????); ╚???????? ? ??????╩ (?????? ????????????,
????????? ????????, ???????????, ????????????????, ?????????????????, ?????????????? ? ?????? ????????; ╚??????????╩ (???????? ?????????? ?????????? ? ?? ?????????????? ??????????);
╚??????????╩ (???????? ????? ????????????).
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???????? ?? ????????? ???????????? ?? ????? ????? ??. ?.?. ???????? ??? ????????? ?????????
? ???? ???????? ? ????????????? ???????? ?????????? ?????????. ????????? ?????? ?????? ????
???????????? ?? ??????? ? ?????????? ??????.
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??????.
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?? ??????? ????????? ?/??? ???????????? ?????????), ?? ?????? ?????????? 100?350 ????.
???????? ????? ?????? ????? ????? ? ??????? ? ?? ?????? ??????????? ????? ??????, ??????? ?????????????? ???????????? ??? ?????? ?????? ? ????; ?????????? ??????????? 3?6 ???????? ????.
?????. ?? ╚????????╩ ?? ????????? ??????? ???????????? ??????? ???????????? ????????????
???????????? ? ????????????? ??? ???????? (???? ????????????).
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???????????? ???????? ??????????? ??? ????????????? ??????? ?? ????????????.
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?????????????? ? ?? ??. ??.), ? ???????? ????? ????????????? ????????????, ????????: ???,
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?????? ╚??????????╩ ???????? ???????? ?????? ????????. ?????????? ????? ???? ????????????
? ???????? ? ???????????? ? ?????? ????????????????? ? ?????? ??? ??????? ?????? ? ??????.
?? ??????????? ???????????? ???????????.
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7. ?????????. ??? ??????? ? ??????????? ?????? ???? ?????? ??????????, ?? ?????????
(??? ???????, ??? ? ?????????) ?????? ??????????????? ╚?????????????????? ??????? ??????????? ????????╩ (? 3 ?., ??? ???. ????. ?.?. ???????????).
????????????? ????????? ?????? ???? ????????? ?????? ? ????????????? ??????????????? ?????????, ??????? ????????????? ???????, ????? ? ?????? ????????????? ??????????
????????? ???????? ???????? ??????????, ?????????????????? ? ?????? (? ???????????? ? ?????????????-????????? ???????? ╚??????-?????????╩ ? ??????????????? ?????? ????????????? ???????).
??????????, ????? ????????? ????????? ??????????????? ????????? Enzyme Classification.
??????????, ????? ??????????? ??? ???????? ??????????? ??????????????? ?????????????
????????????? ??????????? ????????? ? ???????? (Mendelian Inheritance in Men, ??.
http://ncbi.nlm.nih.gov/Omim).
???????? ??????????????? ?????? ???? ???????? ? ???????????? ? ╚????????????????? ???????? ??????????? ????????╩ (? 3 ?., ??? ???. ????. ?.?. ???????????) ??? ?? ??????? ╚??????????? ?????????????╩ (??? ???. ?.?. ???????????).
????????? ?.?.?., ??????????? ? ??????, ?????? ??????????????? ?????? ??????????.
???????, ????????? ??????? ? ???????? ??????????? ??? ?????????, ?????? ???? ????????.
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???????????? ? ?????? ??? ?? ?????? ??????????. ?? ??????????? ?????????? ??????? ????,
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??????, ? ??????? ??? ??????????? ???????. ??? ????? ? ???????? ?????? ??????????????? ?????? ? ?????? ? ??????????? ???? ????????????? ?????????????. ?????? ? ???????? ?????? ????
????????????, ? ?? ???????????? ?????. ??? ???????????? ???????????? ?????? ???? ????????. ??????? ????????? ?????????? ????????? ????? ??????? ? ?????? ??? ? ??????? ??????? ????? ?? ??????????. ???? ??? ?????????? ? ??????? ???????? ? ????? ????????, ?? ?? ??????? ???????? ????? ??????? ????? ????????? ???????.
9. ?????????? ? ????????. ? ?????? ??? ??????????? (??????????, ?????, ?????????,
??????? ? ?.?.) ????????? ?????????. ?? ??? ??????? ? ?????? ?????? ???? ???? ??????. ??????? ?????? ????????????? ??????????????? ????? ??????, ? ??????? ??? ??????????? ???????.
????????? ??????????? ??????????? ? ?????? ? ???? ????????? ?????? ? ??????? tif ??? jpg,
?? ??????????? ????, ???????? ??? ????????, ????? ?????????? ??????????? ???????? ? ??? ?????????.
???? ?? ????????? (???????) ???????????? ?? ????? 5 ??????????, ?? ??? ??????? ?? ????????
(?????) ?????????? ???????????? ?? ??????? ???????, ? ?????-????? ? ?????????? ??????
????????? ??? ??????, ???? ????? 5 ? ???????. ????????????? ???????????? ??????????
?????????.
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??????????? ????????? ?????? ???? ????? ???????? ????????. ??????? ?????? ???? ???????
?? ????? ???????????. ??????? ?? ???????????? ?????? ???? ???????, ??????????? ?? ???????
?????.
???????, ?? ??????????????? ???????????, ????? ????????? ?? ??????, ????????? ?? ?????????
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??????????? ?? ???? ??????? ? ??????? ? ??????? ?????????, ?????????? ????????? ?? ??????
??????.
??? ????????????? ??????? ??? ??????? ?? ??????-???? ????????? ??????????? ?????? ?? ???????? ? ???????????? ? ???????????? ? ?????????? ??????.
10. ????????????????? ?????? ???????????? ? ?????? ╚?????? ?????????? ? ?????????, ?????????????? ? ?????????????? ???????╩ ?????????????? ???????? ??????????
??????????? ???????? (Uniform Requirements for Manuscripts Submitted to Biomedical Journals).
?????????? ???????? ???????????? ?????????? ? ??????? ?????????? ???????? ??????? ????, ???
?????????? ?????????? ????? ?????? ??? ?????? ??????? ???????????? ?? ??????? ? ???????????,
? ??????? ??? ????????.
? ???????????? ??????? ??????????? ??????????? ?? ????? 25 ??????????, ? ??????? ?????????? ? ?? ????? 50, ? ?????? ?????????? ? ?? 15. ???????????? ?????? ????????? ?????? ???????????????? ????? ?????????? ?? ????????? 5 ???.
? ?????? ?????????? ??? ?????? ????????????? ? ??????? ???????????. ?????????????????
?????? ? ?????? ?????? ?????? ? ?????????? ??????? ????????. ?????? ?? ???????????????? ?????? ?? ???????????.
????????????????? ???????? ?????: ?????(?), ????????, ????? (??? ??????), ????? ????????? ?
???????? ????????????; ????? ????? ? ??????? ? ??? ???????. ???? ?????? ?????? ?? ????? ?? ?????:
??????, ???????? ?????, ????? ????? ???????? ╚? ??.:╩ ??? ╚In:╩ ? ???????(?) ??????(??) ??? ?????????(??), ????? ???????? ????? ? ???????? ??????.
????????????????? ???????? ?????? ?? ???????: ?????(?), ???????? ??????, ???????? ???????, ???, ???, ? ??????? ????? ???????, ????? ????????? ????? ?????? ? ????????? ??????? ???????????.
??? ????????? ?????????? ?? 6 ??????? ???????????? ??????????? ???, ??? ??????? ?????????
??????????? ? 6 ?????? ??????? ╚? ??.╩, ? ??????????? ╚et al.╩; ???? ? ???????? ??????? ???? ????????? ?????????, ????? ??????? ??????? ??????? ╚???.╩, ? ??????????? ╚ed.╩.
?? ????? ????????, ??????????? ?????????? ????? ????????????? ?????? ???????????,
??? Web of Science ? Scopus, ????????????????? ?????? (References) ?????? ? ????????????
???? ?????? ? ?????????????? ?????? ???????? ?? ?????? ?? ????? ?????????, ?? ? ?????????
(????????? ?????????). ??????? ?????? ?????? ?????? ?????? ?????? ?????????? ? ???? ?????????: ???? ?? ????? ????????? (????????????? ????????? ? ??????????, ???????????? ? ?????????), ??? ???? ??????? ?????, ? ????????? ?????? ??? ?? ?????? ?????????? (References)
? ????????? ???????? ??? Scopus ? ?????? ?????????? ??? ??????, ???????? ? ??? ??? ????????? ??????????, ?????????? ?? ????, ??????? ?? ????? ??? ???????????. ???? ? ?????? ????
?????? ?? ??????????? ??????????, ??? ????????? ??????????? ? ??????, ??????????? ? ????????? ????????.
65
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
? ????????? ???????? ??? ????????????? ?????????? ????????? ????????? ????????? ????????????????? ??????: ?????(?) (??????????????), ??????? ???????? ????? ??? ?????? ?? ?????????? ????, ???????? ????????? (??????????????), ???????? ?????? ? ???????? ???????, ???????? ?? ???? ?????? ? ??????? (in Russian).
?????????? ?????????? ?????? ? ?????????????? ???????
?????????????? ?????????????? ? ???????????
?? ????? http://www.translit.ru ????? ????????? ??????????????? ?????????? ??????????????
???????? ?????? ? ????????. ????????? ????? ???????.
1. ?????? ? ????????? Translit.ru. ???????? ??????? ?????????????? BGN (Board of Geographic
Names). ????????? ? ??????????? ???? ???? ????? ????????????, ????? ???????? ????? ??? ??????,
?? ??????? ????? ? ???????? ?????? ╚? ????????╩.
2. ???????? ??????????????????? ????? ? ??????????? ?????? References.
3. ????????? ? ??????? ??????????? Google ??? ???????? ?????????, ????? ??????? (????????
?????, ??????, ????????????? ? ?. ?.) ?? ?????????? ????, ????????? ??? ? ??????????? ??????.
???????, ??????????, ??????? ??????????????, ??????? ?????? ????? ?????????? ???????? ????????, ??????????? ?????????? ????.
4. ?????????? ???????? ? ????????? ? ??????????, ???????? ? ???????????? ? ????????? ?????????. ??? ???? ?????????? ???????? ????? ??????? (Moscow), ???????? ????????
(Molekulyarnaya meditsina) ?, ????????, ?????? ????????? ??????????? ????????.
5. ? ????? ?????? ? ??????? ??????? ??????????? (in Russian). ?????? ??????.
??????? ?????????????? ????????????? ?????????? ??????????
??? ????????????? ????? ??????
?????? ?? ???????:
Belushkina N.N., Khomyakova T.N., Khomyakov Yu.N. Diseases associated with dysregulation of programmed cell death. Molekulyarnaya meditsina. 2012; 2: 3?10 (in Russian).
Zagurenko A.G., Korotovskikh V.A., Kolesnikov A.A., Timonov A.V., Kardymon D.V. Technical and economic optimization of hydrofracturing design. Neftyanoe khozyaistvo. 2008; 11: 54?7 (in Russian).
?????? ?? ???????????? ???????:
Swaminathan V., Lepkoswka-White E., Rao B.P. Browsers or buyers in cyberspace? An investigation of
electronic factors influencing electronic exchange. Journal of Computer-Mediated Communication. 1999;
5 (2). Available at: http://www.ascusc.org/jcmc/vol5/issue2/ (Accessed 28 April 2011).
????? (??????????, ???????):
Kanevskaya R.D. Mathematical modeling of hydrodynamic processes of hydrocarbon deposit development. Izhevsk; 2002 (in Russian).
From disaster to rebirth: the causes and consequences of the destruction of the Soviet Union. Moscow:
HSE Publ.; 1999 (in Russian).
Latyshev V.N. Tribology of cutting, vol. 1: Frictional processes in metal cutting. Ivanovo: Ivanovskii Gos.
Univ.; 2009 (in Russian).
????????? ???????????:
Usmanov T.S., Gusmanov A.A., Mullagalin I.Z., Muhametshina R.Ju., Chervyakova A.N., Sveshnikov A.V.
Features of the design of field development with the use of hydraulic fracturing. In: New energy saving subsoil technologies and the increasing of the oil and gas impact. Proc. 6th Int. Symp. Moscow, 2007; 267?72
(in Russian).
66
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
????????-??????:
??? Style (2011). Available at: http://www.apastyle.org/apa-style-help.aspx (accessed 5 February 2011).
??????????? ???????????:
Semenov V.I. Mathematical modeling of the plasma in the compact torus. Dr. phys. and math. sci. Diss.
Moscow; 2003 (in Russian).
Grigor'ev Yu.A. Development of scientific bases of architectural design of distributed data processing systems. Dr. tech. sci. Diss. Moscow: Bauman MSTU Publ.; 1996 (in Russian).
????:
State Standard 8.586.5-2005. Method of measurement. Measurement of flow rate and volume of liquids
and gases by means of orifice devices. Moscow: Standartinform Publ.; 2007.
??????:
Palkin M.V. et al. The way to orient on the roll of aircraft with optical homing he; d. Patent RF,
?2280590; 2006 (in Russian).
??????? ?????????? ?????? ?? ??????????
??? ????????????? ????? ??????
?????? ?? ???????:
??????? ?.?., ?????????? ?.?., ????? ?.?., ??????? ?.?., ????? ?.?., ??????? ?.?. ? ??. ??????????????? ??????????? ????????? ??? ?????????????? ??????????? ???????? ?. ??????? ???????????. 2012; 1: 45?8.
??????? ?.?. ?????: ????? ???????? (??????????? ???????). ?????????????. 2010; ????. 1: 3?8.
Aiuti A., Cattaneo F., Galimberti S., Benninghoff U., Cassani ?., Callegaro L. et al. Gene therapy for
immunodeficiency due to adenosine deaminas deficiency. N. Engl. J. Med. 2009; 360 (5): 447?58.
Glauser T.A. Integrating clinical trial data into clinical practice. Neurology. 2002; 58 (12, Suppl. 7):
S 6?12.
?????:
????? ?.?. ?????????????? ?????????: ???????, ??????????? ????????? ? ??????????? ????????.
?.: ????????; 2003.
???????? ?.?. (???.) ??????????? ?? ???????????. 3-? ???. ?. 3. ?.: ?????????; 2005.
?????????? ?.?. (???.) ?????????????: ??????? ???????. ?.: ????; 2008.
Beck S., Klobes F., Scherrer C. Surviving globalization? Perspective for the German economic model.
Berlin: Springer; 2005.
Michelson A.D. (ed.) Platelets. 2nd ed. San Diego: Elsevier Academic Press; 2007.
Mestecky J., Lamm M.E., Strober W. (eds) Mucosal immunology. 3rd ed. New York: Academic Press;
2005.
????? ?? ?????:
??????? ?.?. ????????? ? ??????? ?????? ????????? ??????. ? ??.: ?????? ?.?., ???????????
?.?. (???.) ??????????????? ???????? ?????? ? XXI ????. ?.: ????-??????; 2009: 110?31.
Silver R.M., Peltier M.R., Branch D.W. The immunology of pregnancy. In: Creasey R.K., Resnik R. (eds).
Maternal-fetal medicine: Principles and practices. 5th ed. Philadelphia: W.B. Saunders; 2004: 89?109.
????????? ??????? ???????????, ???????????:
?????????? ??????? ??????????? ? ???????????????: ????????? ??????-???????????? ???????????. 8 ???? 2009 ?. ?????-?????????. ???.; 2009.
????? ?.?., ?????????? ?.?. ?????????? ??????? ??? ?????????????? ?????? ?????. ? ??.: ????????? IV ??????????? ?????? ╚???? ? ????╩. ?.; 2000; ?. 1: 516?9.
67
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
European meeting on hypertension. Milan, Jine 15?19, 2007. Milan; 2007.
Harnden P., Joffe J.K., Jones W.G. (eds) Germ cell tumours V: Proceedings of the 5th Germ cell tumour
conference. 2001, sept. 13?15; Leeds; UK. New York: Springer; 2001.
?????????? ?.?. ???????-????????????? ? ??????????????? ????????? ?????? ? ??????? ?
??????????? ?????????????: ???????. ???. ... ?-?? ???. ????. ?.; 2008.
Borkowski M.M. Infant sleep and feeding: a telephone survey of Hispanic Americans: diss. Mount
Pleasant (MI): Central Michigan University; 2002.
??????????? ????????:
??????????????? ?????? ╚? ????????? ???????? ????????? ?????????? ???? ? 2009 ????╩.
Available at: http://www.minzdrav.rkomi.ru/left/doc/docminzdr
Abood S. Quality improvement initiative in nursing homes: the ANA acts in an advisory role. Am. J. Nurs.
2002; 102 (6). Available at: http://www.nursingworld.org/AJN/2002/june/Wawatch.htm
????? ????? ??????????????? ?? ???????????? ????????????????? ??????.
??? ????????? ?????????? ???????????? ?????? ????????? ??????????? ???????? ??????????
?????????? ?? ??????: 121552, ??????, ?????????? ?., 135, ????? ??. ?.?. ????????,
????????? ??????? ???????????? (e-mail: kupriashov2007@rambler.ru).
??? ????????? ????????? ?????? ?????? ??????????????? ?? ?????.
????? ?? ?????????? ????????? ?? ?????????.
68
? ? , 25 ???, ????????? ? ????????? ? ???????? ?? ?????? ? ??????? ???????????? ???
?????????? ????????, ????? ?????? ???????????.
?? ???????? ????????, ??? ?????????? ?????
?????? ? ?? ? ????????? ????? ???????? ??????? ?
?????????? ? ????????. ? 10-?????? ???????? ? ????? ? ?????????? ???????????? ??????????? (????????? ???????????? ????? ?????????? ? 80%) ? ????????????? ????????? ???????????? ?????? ???????? ??????? ??????? ???? ????????? ????????????
(??? ???????? ??????? ??????????????? ???????????) ????????????? ????????? ?????? ??????? ????????? (??) ???????????????????? ????????. ????? 13 ??? ??????? ????????? ??????????? ????????? ?? ? ????????? ????????? ?????? ?? ? ??????
???????? ??????? (??) ???????????????????? ???????? ? ??????? ???????????????? ????????
(??? ? 40 ?? ??. ??., ?? ? 100 ?? ??. ??.). ?????? 4 ?????? ????? ??????? ? ????????? ???????? ????????? ??????????? (?? 38?39 ╟?) ? ??????? ? ???????? ?????????? ? ???????, ?? ?????? ???? ???
???? ????????????????? ? ????????? ?? ????? ??????????, ??? ?? ????????? ??????????? ?????????
? ?????? ???????????? ???????????? ??? ????????? ??????????? ??????? ????????????? ???????????. ????? ???????????? ???????, ???????????
????????? ??????????????????, ? ????????????
????????? ????????? ???????? ??? ??????????
?????????? ?? ????? ??????????.
??? ??????????? ? ??????? ??? ?????????? ???????????? ? ?????????????? ???????? ????? ?????????? ? ???????? ??????????? ????????, ?? ?
110/60 ?? ??. ??. ??? ???????????? ?????? ???????????? ????????????? ??? ??? ?????????? ?????????. ?????? ?????????????? ?? 2 ?? ???? ????
???????? ????. ?????? ???: ????????? ???? ?
??? 78 ? ?????? ? ?????????? ?????????????
???????????????, ????????????? ??? ?????? ????????? ??????, ???????? ??????????? ??, ????????????????? ????????? QRS ? 120 ??.
?????????????? ??????? ??????? ??????: ???????????? ?????????? ???? ?????? ? ???????????
?? ???? ??????? ?????????? ? ?? (??? ? 65%).
?????? ?????: ????????? ??????????????? ??,
????????????? ?????????? ?????????? ??????
58
(44 ??), ??????? ???? ? ????????? ???????? ??????? ? ????? ???????? ????????????; ??????????????
???-?????? ? ???????? ???????? ???????, ????????????? ? ?????? ?????????? (?????????); ??????
???????????? (65 в 70 ??); ?????? ????? ?? ??????
??????????????? ??????????? ???; ???????? ?????????????? ???????? ????? ? 24 ?? ??. ??.; ???????? ??????? ?????? ????????? (??): ??? ?
5,4 ??, ??? ? 3,0 ??, ???? ? 63%, ???? ? 55%.
??????? ????????? ?????????????? ??????????????? ???????. ?????? ? ?????? ????????????? ??????????? ????????? ????????????? (2-? ?? ?????
? ???? ?????????). ?????? ?????? ?????? ?????????, ???????? ?????? ??????????. ???????? ??????????? ? ???????? ?? (107 ???), ?????????? (trec ?
28 ╟C) ? ???????????????? ???????????? (╚Custodiol╩). ????? ????????? ?????????? ????? ?
58 ???. ????? ???????? ??????? ?????????? ? ????????? ?????????????????? ???????? ?????????
??????? ??. ?????????? ????????? ??????????
?????? ??????? ?? 50 ??, ????????? ???????? ?
?????????? ??????? ???????, ?????????? (??????)
6?7 ?? ? ???????? ? ╚???????????╩ ?????? ? ????
???????? ???????, ????????? ????? ???? ????????
???????, ? ????? ????????? ? ???? ????????????
?????? ????????? ?? ???????? ??????? ?? (??.
???????). ???????????????? ????????????? ??
??????????????? ??????? ???? ???????? ???????????. ??????? ??????? ????????, ????? ???? ?
??????????????? ??????? ??????????? ???? ????????????? ????????????? ?????? ?? ?????????
?? ??????????? ??????? ?????? ???????? ????????
????? (╚??????╩ ? 31).
? ?????? ????????????????? ??????? ???????
??????? ????????? ????????? ???????????????. ????????? ???????????? ?????????????? ???????????
(0,05 ???/??/???) ? ??????????? (0,8 ???/??/???).
??? ???? ?? ?????????? 115/70 ?? ??. ??., ??????????? ???????? ???????? ? 9 ?? ??. ??. ?? ??????
?????, ??????? ??????? ???????????????? ??????? ???? ??????????????????: ???????? ????????????? ????????? ? ?????? ??????, ??????? ?????????????? ???????? ? 5,0 ?? ??. ??., ??????? ?
3 ?? ??. ??., ??????? ??????? ?????? ? ??????? ?????????? ?????? ? 55 ? 50% ??????????????. ??
??? ??????????????? ????????? ???? ? ???
80?90 ? ???. ?? 2-? ??? ????? ???????? ???????
???? ????????????? ? ?????????? ? ?????????. ????? ???????????? ??????????????? ???????, ??????????? ????????????, ????????? ??????????????????, ????? ?????????? ????? ? ??????????, ?
????? ???????????????? ???????, ????????? ???????? ?? ?????????? ? ?????????????????? ?????????. ??????????????????? ???????????? ?????
???????? ?? ??????? ???????? ?????????? ????
?????? (??? ? 58%).
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???? ????????? ?????????. J. Kobayashi ? ?????.,
?????? ? ?????????? ????? ????? ??????????? ????????? ?? ?????? ????? 133 ?????????, ?????????? ??????????????? ???????????? ? 48% ???????, ??? ???? 19% ????????????? ????????? ?????
????????? ? ?????????? ???????????? [4]. ??
?????? A. Rocchini ? ?????., ??????? ?????????????
????????? ??? ?????????? ??????????????? ???????????? ? 102 ?????????, ???????????? ????????????? ? ??? ???????? ?????? ? ?????????? ??????? ????? ????????? ??, ????????? 11% [6].
J. Coles ? ?????., ?????????? ? ?????????? ???????
????? ?????????? ???????????? ??????? ?? ?????,
???????????????? ? ????????????? ????????, ???????, ??? ??????????????? ???????????? ??????????? ? 19% ??????? [7].
????? ?? ???????? ?????? ?????? ????????????? ??????????????? ?? ? ?????????? ??????? ????? ????????? ??????? ???????????? ???????? ?????????? ??????????? ??????? ?? ? ??? ????????????? ????????. ???? ????? ??? ???????????
???????????? ????????? ??????? ?? ??????? ??????????????? ??????????? (????), ??????????
? ?????????? ??????? ??????? ? ??????????? ??
??????????? ? ??????? ??????? ?????????? ??????
??, ???????? ? ????? ???????. ????? ????, ???????? ????? ??? ?????? ?????????? ??????? ??,
??????????? ??? ????????? ????, ???????????
??????? ?? ???? ?? ?? ????????? ?????? ??, ? ??
???? ??????? ??????? [2, 3, 8]. ?????? ??????????
?????? ?????????? ????????????? ?????????? ??????????????? ??, ???????? ????????? ??? ?????
??????????? ???????? ??? ????????? ???????????????? ??????? ?? [4].
??? ????? ???????? ????????????? ??????????????? ???????????? ? ????????? ????? ?????????
??? ? ??????????? ????????? ?????? ?? ????????
??????????? ?????????? ??, ????????????? ????????? ???????? ????????????, ???????? ?????????-
????????????????? ????. ?????????????? ??????. ?????????? ? ???? ???????? ??????? ??????? ? 6?7 ?? ? ????????
(?????? ???????) ? ???????????? ?????? ????????? (?????
???????)
???? ?????? ?? ?????? ??????????????? ??????????? ? ?????????? ?????????? ????????? ??????
??. ??????????????? ??????? ?? ????? ??????????
?????????? ????????? ????????? ???????? ????????
?????? ??????????? ? ?????????? ????? ?????
????????? ??. ????????? ???????????? ????????
????????????, ???????? ? ????????? ? ??????? ????????????? ????????, ???????????? ?? ????????
?????????? ? ????????? ??. ??????????? ???
???? ?????????????? ???????? ? ????????? ????????? ?????????? ?????? ?? ???????? ? ????????
??????????????? ???????????? ???? ??? ???????????? ?????????? ? ?????????????? ?? [5, 9].
? ??????????? ????????? ?? ? ?????? ?? ??-??
?????????????? ?????????? ?? ?????? ????? ???????? ? ??????????? ??????? ????, ????????? ????????? ??????? ? ?????? ??????????????? ?????????? ?????????? ? ????????????? ???????? [8].
???????????? ?????????? ? ????????? ? ??????????? ???????? ?????? ??????????? ? 4,0?4,7%
??????? ?? ?????? ????? ????????? ???????? ???????? [10, 11]. ?????????, ??? ??????? ???????????
?????? ?????? ??????????? ???? ?????????????
????????????? ??????????? ? 35 ??? ?? ?????????
? ????? ??????????. ???????? ????? ???????????? ?????????? ????????? ???????????? ???????
??????????? ?????? (27,1 ?????? ?? 10 000 ???????????) ? ??????? ??????????????? ???????????
(14,5 ?????? ?? 10 000 ???????????) [12]. ?????
????, ? ?????? ??????????? ????? ?????????????
????????????? ??????????? ?????? ? ??????? ?
???????????? ??????????? ???????? ?????? [13].
?????? ? ?????????? ????? ????? ?????????????
????????? ?? ???????????? ?????????? ????????
?????? ??????????? ? ????????? ???????? ????????????? 7 ??????? ?? 10 000 ???????????. ??
????????????????? ????????, ??????????????
???????? ???????????, ?????????? ???????? ????? ???????????? ???????? ? ??????? ???????? ?
???????? ??????????? ??????, ? ????? ?????????
???? (???????, ?????? ????????), ??????? ?????
???????????? ?? ????? ???????? ??? ??? ??????????? ???????????. ???????????? ???? ? ?????????? ?????????????????? ??????????? ??????? ?????????? ?????? ????????? ? ????????? ?????????????? ????. ??? ??? ??????? ??????? ? ? ?????
?????????, ? ??????? ???????????? ??????????
?????? ???????? ????????? ??????????????? ??.
??? ?????????? ??????????????? ??????????????? ????????????? ?????? ??????????? ??? ???????????????? ???????? (????????????? ????????????, ???????? ????? ??????? ???????, ?????????
???????? ???????????? ? ???????????????? ??????? ? ??.), ??? ? ?????????????? ??????? [10].
Y. D?Udekem ? ?????. ??????? ????????? ???????
??????????????? ???????????????, ????????????? ???????????? ????????????, ??????? ?????????? ????????????? ???????, ??? ????????? ???????? ????????????? ??????????? ??????-????
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Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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?????????? ????????? [14]. ? ?? ?? ????? ??? ????????? ????????? ????????? ????????????? ?????? ?????????? ?????? ???????? ???? ?????????????? ?????? ? ????????, ? ??????????? ????????? ??????? ????????? ????? ?????????
?????????????? ???????. ? ????? ?????? ? ???????????? ??????? ???? ????????? ??? ??????? ??
(???????? ? ??????????) ? ??????????? ???????????????? ??????????? (??????? ?????????, ?????????? ? ???? ???????, ?????????? ??????????
???????, ????? ???? ?? ??????????? ????). ??????????? ????????? ??????? ????????? ??????????????? ??????????????? ??? ????? ??????? ?????????? ??????? ??????? ? ????????????????? ????????, ?? ??? ??????, ??????? ???????????
?????????????? ???????.
? ?????????? ???????? ?? ????????, ??? ??????????? ?????????????? ??????? ????? ????????? ?????????? ???????????? ??? ??????????? ??????, ???? ??????? ????? ??????? ?????????????? ??????????????? ???????????????. ?????? ?
??? ???????? ??????? ????????? (25 ???) ? ??????? ?????? ????????????????? ??????? (31 ??)
????????? ????????? ?? ?????????? ??????????????? ???? ?????? ???????.
11.
12.
13.
14.
References
1.
2.
3.
4.
??????????
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Lillihei C.W., Cohen M., Warden H.E., Read R.C., Aust J.B.,
Dewall R.A. et al. Direct vision intracardiac surgical correction
of the tetralogy of Fallot, pentalogy of Fallot, and pulmonary
atresia defects; report of first ten cases. Ann. Surg. 1955; 142
(3): 418?42.
????????? ?.?., ???????? ?.?. ??????? ?????. ?.: ?????
??. ?.?. ???????? ????; 2008.
??????? ?.?. ????????? ???????? ? ?????????? ?????
????? ??????????? ????????? ??????? ?????: ???????.
???. ? ?-?? ???. ????. ?.; 2011.
Kobayashi J., Kawashima Y., Matsuda H., Nakano S.,
Miura T., Tokuan Y. et al. Prevalence and risk factors of tricuspid regurgitation after correction of tetralogy of Fallot. J.
Thorac. Cardiovasc. Surg. 1991; 102 (4): 611?6.
????????? ?.?., ???????? ?.?., ??????? ?.?., ????? ?.?., ??????? ?.?., ?????????? ?.?. ? ??. ?????????????? ???????? ?????? ? ?????????? ????? ????? ??????????? ????????? ??????? ?????. ??????? ? ????????-?????????? ????????. 2010; 5: 18?26.
Rocchini A.P., Rosenthal A., Freed M., Castaneda A.R.,
Nadas A.S. Chronic congestive heart failure after repair of
tetralogy of Fallot. Circulation. 1977; 56 (2): 305?10.
Coles J.G., Freedom R.M., Olley P.M., Coceani F.,
Williams W.G., Trusler G.A. Surgical management of critical
pulmonary stenosis in the neonate. Ann. Thorac. Surg. 1984;
38 (5): 458?65.
Hachiro Y., Takagi N., Koyanagi ?., Abe T. Reoperation for tricuspid regurgitation after total correction of tetralogy of Fallot.
Ann. Thorac. Cardiovasc. Surg. 2002; 8 (4): 199?203.
Kanter K.R., Doelling N.R., Fyfe D.A., Sharma S., Tam V.K. De
Vega tricuspid annuloplasty for tricuspid regurgitation in children. Ann. Thorac. Surg. 2001; 72 (4): 1344?8.
????????? ?.?., ??????? ?.?., ????????? ?.?., ????? ?.?., ??????? ?.?. ???????? ??? ????????? ???????????? ??????????? ? ??????? ? ??????????? ????????
??????. ??????? ? ????????-?????????? ????????. 2008;
2: 4?8.
Li W., Somerville J. Infective endocarditis in the grown-up
congenital heart (GUCH) population. Eur. Heart J. 1998; 19
(1): 166?73.
Gersony W.M., Hayes C.J., Driscoll D.J., Keane J.F., Kidd L.,
O?Fallon W.M. et al. Second natural history study of congenital heart defects. Quality of life of patients with aortic stenosis,
pulmonary stenosis, or ventricular septal defect. Circulation.
1993; 87 (2 suppl.): 152?65.
Dearani J.A., Danielson G.K. Congenital heart surgery nomenclature and database project: Ebstein?s anomaly and tricuspid
valve disease. Ann. Thorac. Surg. 2000; 69 (3): 106?17.
D?Udekem Y., Sluysmans T., Rubay J.E. Tricuspid valve repair
for tricuspid valve endocarditis after Fallot repair. Ann. Thorac.
Surg. 1997; 63 (3): 830?2.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Lillihei C.W., Cohen M., Warden H.E., Read R.C., Aust J.B.,
Dewall R.A. et al. Direct vision intracardiac surgical correction
of the tetralogy of Fallot, pentalogy of Fallot, and pulmonary
atresia defects; report of first ten cases. Ann. Surg. 1955; 142
(3): 418?42.
Podzolkov V.P., Kokshenev I.V. Tetralogy of Fallot. Moscow:
Bakoulev Scientific Center for Cardiovascular Surgery of the
Russian Academy of Medical Sciences; 2008 (in Russian).
Danilov T.Yu. Repeated operations late after radical correction
of tetralogy of Fallot: diss. Moscow; 2011 (in Russian).
Kobayashi J., Kawashima Y., Matsuda H., Nakano S.,
Miura T., Tokuan Y. et al. Prevalence and risk factors of tricuspid regurgitation after correction of tetralogy of Fallot. J.
Thorac. Cardiovasc. Surg. 1991; 102 (4): 611?6.
Podzolkov V.P., Chiaureli M.R., Danilov T.Yu., Yurlov I.A.,
Sabirov B.N., Kagramanov I.I. et al. Heart valve replacement late
after radical correction of tetralogy of Fallot. Grudnaya i serdechno-sosudistaya khirurgiya. 2010; 5: 18?26 (in Russian).
Rocchini A.P., Rosenthal A., Freed M., Castaneda A.R.,
Nadas A.S. Chronic congestive heart failure after repair of
tetralogy of Fallot. Circulation. 1977; 56 (2): 305?10.
Coles J.G., Freedom R.M., Olley P.M., Coceani F., Williams W.G.,
Trusler G.A. Surgical management of critical pulmonary stenosis
in the neonate. Ann. Thorac. Surg. 1984; 38 (5): 458?65.
Hachiro Y., Takagi N., Koyanagi ?., Abe T. Reoperation for tricuspid regurgitation after total correction of tetralogy of Fallot.
Ann. Thorac. Cardiovasc. Surg. 2002; 8 (4): 199?203.
Kanter K.R., Doelling N.R., Fyfe D.A., Sharma S., Tam V.K.
De Vega tricuspid annuloplasty for tricuspid regurgitation in children. Ann. Thorac. Surg. 2001; 72 (4):
1344?8.
Podzolkov V.P., Gadzhiev A.A., Rozneritsa Yu.V., Popov D.A.,
Solyanik I.S. Surgery for valve infective endocarditis in
patients with congenital heart disease. Grudnaya i serdechnososudistaya khirurgiya. 2008; 2: 4?8 (in Russian).
Li W., Somerville J. Infective endocarditis in the grown-up
congenital heart (GUCH) population. Eur. Heart J. 1998; 19
(1): 166?73.
Gersony W.M., Hayes C.J., Driscoll D.J., Keane J.F., Kidd L.,
O?Fallon W.M. et al. Second natural history study of congenital heart defects. Quality of life of patients with aortic stenosis,
pulmonary stenosis, or ventricular septal defect. Circulation.
1993; 87 (2 suppl.): 152?65.
Dearani J.A., Danielson G.K. Congenital heart surgery nomenclature and database project: Ebstein?s anomaly and tricuspid
valve disease. Ann. Thorac. Surg. 2000; 69 (3): 106?17.
D?Udekem Y., Sluysmans T., Rubay J.E. Tricuspid valve repair
for tricuspid valve endocarditis after Fallot repair. Ann. Thorac.
Surg. 1997; 63 (3): 830?2.
????????? 26.11.2014
60
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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???????? ???? ???????? ?? ??, ??? ?????? ?????? ? ??????????????? ??? ???????? ???????
????????????? ??????? ???????? ? ???????, ? ??????? ?????? ???? ???????????? ???????? ?????????? ??????????? ?? ????????? ?????? ??????? ??????? ? ????????? ????, ? ????? ? ????????????? ?????????????? ??????? ? ???? ??????, ??? ???????????? ??????????? ??????? ??????
?????? ?????? ????????? ????????? ???????.
1. ???????????? ?????. ?????? ?????? ????? ???? ???????????? ? ?????????????? ??????????? ???????????? ?? ??????????, ?? ???????? ??????? ?????? (? ??????? ???????), ? ??????????? ??????? ? ?????????? ???????????. ? ??????????? ??????? ???????, ???????? ?? ?????? ???????????????.
? ??????????? ??????????????, ??? ?????? ?????? ?? ???????? ????????, ? ????????? ???????
??????????? ?????? ????? ???????????? ?????, ? ????? ??????????? ? ?????????????-??????????????? ???????, ? ????????? ??????? ????????, ?? ?? ?????? ????????? ??????????????? ??????????? ??? ???????? ?????????? ?????.
?????? ?????? ???? ????????? ????? ????????.
?????? ?????????? ? ???????? ??????, ???????????? ? ???? ???????? ??? ???????????? ? ????
???????.
???????? ????????? ?? ????? ????? ????????? ? ????????????? ???????? ??????. ????? ??????????? ?????? ????????? ????? ??????????? ?????????????? (???????????????) ???????? ??????.
2. ?????? ??????????? ? ???????? ? ?????????? ? ???????????? ??????????? ??????????? ??????. ?? ??????????? ????? ?????? ?? ???????????.
3. ?????? ?????? ???? ?????????? ??????? Times New Roman ??? Arial, ?????? ?????? 12,
? ??????? ?????????? ????? ????????, ???? ??????? 3 ??.
4. ????? ?????????, ???????? ? ????????????? ?????? ?? ?????? ????????? 15 ? (???????
???????????, ??????? ? ?????? ??????????), ???????????? ???????????? ? 12 ?, ???????? ? 3 ?.
5. ????????? ???? ?????? ?????????:
1) ??????? ? ???????? ??????; 2) ???????? ??????; 3) ?????? ???????????? ??????????, ? ??????? ???????? ?????, ? ???????????? ?????? ? ???????????? ????????? ????????????? ??????????????; 4) ???????? ?????? ??????????, ?????, ??????; 5) ?????????????? ???????? ? ??????
??????, ??????????? ??? ????????? ??????? ? ?????????? ??????? ???????? ???????????: ?.?.?.
????????? ?? ??????? ????? ? ? ??????????????, ?????? ? ?????????, ?-mail, ???????? ????? ??????????? ??? ????????? ? ???????? ?????? (????? ???? ?? ???? ???????).
???? ??????? ?????????, ? ?????? ??????? ? ???????????????? ?????????? ????????????? ???????? ??????. ???? ??? ?????? ?????? ???????? ? ????? ??????????, ????????? ????? ?????? ??????? ?????? ???????? ?? ?????.
?????? ???? ?????????? ?????? ???? ??????????? ??? ?? ???????, ??? ? ?? ??????????
?????. ??????? ??????? ????????????? ????????????????? ??? ??, ??? ? ?????????? ???????????, ??? ?? ??????? BGN (Board of Geographic Names), ??. ???? http://www.translit.ru. ? ????61
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
????? ???????????(??) ?????, ????? ??? ?????? ?????????? ???????? ?????????? ???????
????????????.
??????? ?????????? ?????:
????????????? ?????????? ??????? ??????
? ???? ??????????? ??????????????????? ??????
?? ?????????? ????????????? ???????
?.?. ????????1, ?.?. ????????1, ?.?. ???2, ?.?. ?????2
1
???? ╚????????????? ????????? ??????????? ???????????????? ?????╩, ???????????????
????????, 106, ?????????, 400008, ?????????? ?????????;
2 ????? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ?
???????? ??? ? ???? ?.?. ???????); ?????????? ?????, 135, ??????, 121552, ??????????
?????????
???????? ?????? ????????, ????????, e-mail: k.o.kirillov@mail.ru;
???????? ??????? ??????????, ???. ???????? ?????;
??? ??????? ????????, ?????? ???. ????, ?????????, ?????????? ??????????;
????? ???? ?????????????, ????. ???. ????, ???. ?????. ????., ????????????
EPIDEMIOLOGY OF CONGENITAL HEART DISEASE
AND WAYS OF OPTIMIZATION OF CARDIAC SURGICAL CARE
IN THE VOLGOGRAD REGION
K.O. Kirillov1, V.V. Nachinkin1, A.I. Kim2, I.A. Yurlov2
1 Volgograd regional clinical cardiological centre, Universitetskiy prospekt, 106, Volgograd, 400008,
Russian Federation;
2 A.N. Bakoulev Scientific Center for Cardiovascular Surgery; Rublevskoe shosse, 135, Moscow, 121552,
Russian Federation
Kirillov Kirill Olegovich, Postgraduate, e-mail: k.o.kirillov@mail.ru;
Nachinkin Valeriy Viktorovich, Deputy Chief Physician;
Kim Aleksey Ivanovich, MD, DM, Professor, Chief of Department;
Yurlov Ivan Aleksandrovich, MD, PhD, Leading Research Associate, Cardiac Surgeon
6. ?????????? ???? ?????????? ???????????? ?????? ?????? ???? ?????????: ??????,
???????? ?????, ??????? ????????, ?????????? ????????? ??????? ? ??????? ????????? ??????,
? ?????? ?????????? ????????????, ???????? ? ??????, ?????????? ? ??????????, ?????? ?? ??????? ??? ??????????, ?????? ???????????? ??????????.
?????? (???????, ?????????) ? ???????? ? ???????? ???????? ????? ??????. ? ????????????
??????? ??? ????? ???????? ?????? ????????? ????????? ?????? ? ???????? ?????? ???????: ╚????╩
(????????????? ???????? ? ??????????? ????????); ╚???????? ? ??????╩ (?????? ????????????,
????????? ????????, ???????????, ????????????????, ?????????????????, ?????????????? ? ?????? ????????; ╚??????????╩ (???????? ?????????? ?????????? ? ?? ?????????????? ??????????);
╚??????????╩ (???????? ????? ????????????).
????????? ?????? ? ?????? ???????? ???????? ?????????? ?????????? ? ????????????? ? ?????????? ?????????????? ???????? ? ????? ??????, ????????????? ??????. ????????? ??????
???????? ?? ????????? ???????????? ?? ????? ????? ??. ?.?. ???????? ??? ????????? ?????????
? ???? ???????? ? ????????????? ???????? ?????????? ?????????. ????????? ?????? ?????? ????
???????????? ?? ??????? ? ?????????? ??????.
62
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??????????, ????? ?? ?????????? ? ??????? ?????? ?????? ??? ????????? ???????????? ??? ?????
????????? ??????????. ?????????? ???????? ????????????? ? ????????????????? ??????????.
???????????? ???????? ????? ??????????? ? ?????? ????????????? ????????, ?????? ?????????,
???????, ??????? ??????????? ???????????? ??????, ? ????? ??????, ???????, ?? ??????
??????, ????? ???????????? ????????.
? ?????? ?????????? ?????? ?? ?????? ??????????? ????????, ???????????? ? ????????.
??????? ????????? ???????? ????? ?? ?????? ??????, ?????? ?????? ???? ????????? ? ?????,
???????? ?? ?????????????? ??????????, ?????? ??????? ????, ????? ? ?????????? ????????????.
? ?????? ?????????? ?????? ??????? ???????? ??????? ?????????????? ???????????, ??? ???????? ?????????? ???????????? ????????, ? ?? ????????? ?????.
?????????? ? ???????? ???????????, ????? ???????????????????, ????????? ? ?????????????? ??????? ??? ???? ?? ??????????? ? ??????????? ??? ?????? ???????????? ? ?????????
??????.
????? ?????? ?????????? ?????? ???????????? ??????????? ?????????? (??????? ????????,
?? ??????? ????????? ?/??? ???????????? ?????????), ?? ?????? ?????????? 100?350 ????.
???????? ????? ?????? ????? ????? ? ??????? ? ?? ?????? ??????????? ????? ??????, ??????? ?????????????? ???????????? ??? ?????? ?????? ? ????; ?????????? ??????????? 3?6 ???????? ????.
?????. ?? ╚????????╩ ?? ????????? ??????? ???????????? ??????? ???????????? ????????????
???????????? ? ????????????? ??? ???????? (???? ????????????).
? ??????? ╚???????? ? ??????╩ ?????????? ????????? ?????????? ? ?????????? ? ???????????? ????????? ??? ????????????????? ????????, ???????? ??????? ????????????, ?????????????? ???????????, ????????????, ????????????????, ????????????????? ? ?????? ???????. ?????????? ??????????? ????? ??????? ??????????? ?????????????? ??????????? ? ??????, ?????
???????????? ???????? ??????????? ??? ????????????? ??????? ?? ????????????.
??? ?????????? ? ?????? ????????????????? ????? ??????? ????????????????? ╚????????? ?????????? ????? ? ?????????????? ????????????????? ????????╩. ?????? ????, ???? ? ??????????
?????????????? ???????? ?????? ??????????? ?????? ????????? ??????????? ??? ??????????
??????????? ???????? ?????? ????????????? ? ?????? ??????????? ????????.
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????? ???????, ???????? ?? ?????????? ???????? ???????? ?????????? ??? ????????????,
???????? ??????? ????????, ??????????, ????????? ?????????????, ??????, ????????????, ???????? ??? ??????????? ????????, ??????????? ? ??????.
????????????? ??????????? ?????? ???? ?????????? ????????? ?????????, ??????????????????? ???????? ?? (?????????? ????? ?????????? ???????????, ??????????? ? ╟?, ? ????????,
?????????????? ? ?? ??. ??.), ? ???????? ????? ????????????? ????????????, ????????: ???,
???, ???, ?? ? ?. ?. ??????????????? ????????????? ????????????? ??????????????? ???????? ???????? ? ??????????. ? ??????? ?????????? ????? ??????????? ???????? ???????? ? ????????? (? ???????) ????? ? ?????? ?????????????.
?????? ╚??????????╩ ???????? ???????? ?????? ????????. ?????????? ????? ???? ????????????
? ???????? ? ???????????? ? ?????? ????????????????? ? ?????? ??? ??????? ?????? ? ??????.
?? ??????????? ???????????? ???????????.
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?????? ╚??????????╩ ???????? ? ???? ????????????? ??????????? ? ?? ?????????? ?? ??????? ??
??????????????? ?????? ?????? ???????, ?? ?????? ???? ?????? ? ???????. ?????? ???????????
??????????? ???????????? ? ??? ???????????? ??????????.
╚??????????╩ ?????? ????????? ???????? ????? ??????? ????????????.
7. ?????????. ??? ??????? ? ??????????? ?????? ???? ?????? ??????????, ?? ?????????
(??? ???????, ??? ? ?????????) ?????? ??????????????? ╚?????????????????? ??????? ??????????? ????????╩ (? 3 ?., ??? ???. ????. ?.?. ???????????).
????????????? ????????? ?????? ???? ????????? ?????? ? ????????????? ??????????????? ?????????, ??????? ????????????? ???????, ????? ? ?????? ????????????? ??????????
????????? ???????? ???????? ??????????, ?????????????????? ? ?????? (? ???????????? ? ?????????????-????????? ???????? ╚??????-?????????╩ ? ??????????????? ?????? ????????????? ???????).
??????????, ????? ????????? ????????? ??????????????? ????????? Enzyme Classification.
??????????, ????? ??????????? ??? ???????? ??????????? ??????????????? ?????????????
????????????? ??????????? ????????? ? ???????? (Mendelian Inheritance in Men, ??.
http://ncbi.nlm.nih.gov/Omim).
???????? ??????????????? ?????? ???? ???????? ? ???????????? ? ╚????????????????? ???????? ??????????? ????????╩ (? 3 ?., ??? ???. ????. ?.?. ???????????) ??? ?? ??????? ╚??????????? ?????????????╩ (??? ???. ?.?. ???????????).
????????? ?.?.?., ??????????? ? ??????, ?????? ??????????????? ?????? ??????????.
???????, ????????? ??????? ? ???????? ??????????? ??? ?????????, ?????? ???? ????????.
?????? ???????????? ?????????? ?????? ?????????, ??????????, ?????????? ? ?????????????? ??????? ? ???????? (???????? ???) ??????????? ???????????? ??????????????, ????? ????????????? ? ??????. ??? ???????? ??????? ????????? ??????????? ? ???????????? ?????? ????
???????????? ? ?????? ??? ?? ?????? ??????????. ?? ??????????? ?????????? ??????? ????,
???? ???? ??? ????? ???????????.
???? ????????????? ???????, ??????? ????????? ? ?????? ????????? ???????? ?????? ????
??????? ? ??????? ??.
8. ?????????? ??????. ?? ??? ??????? ? ?????? ?????? ???? ???? ??????. ??????? ????? ????????????? ? ???????? ?????????. ??????? ?????? ????????????? ??????????????? ?????
??????, ? ??????? ??? ??????????? ???????. ??? ????? ? ???????? ?????? ??????????????? ?????? ? ?????? ? ??????????? ???? ????????????? ?????????????. ?????? ? ???????? ?????? ????
????????????, ? ?? ???????????? ?????. ??? ???????????? ???????????? ?????? ???? ????????. ??????? ????????? ?????????? ????????? ????? ??????? ? ?????? ??? ? ??????? ??????? ????? ?? ??????????. ???? ??? ?????????? ? ??????? ???????? ? ????? ????????, ?? ?? ??????? ???????? ????? ??????? ????? ????????? ???????.
9. ?????????? ? ????????. ? ?????? ??? ??????????? (??????????, ?????, ?????????,
??????? ? ?.?.) ????????? ?????????. ?? ??? ??????? ? ?????? ?????? ???? ???? ??????. ??????? ?????? ????????????? ??????????????? ????? ??????, ? ??????? ??? ??????????? ???????.
????????? ??????????? ??????????? ? ?????? ? ???? ????????? ?????? ? ??????? tif ??? jpg,
?? ??????????? ????, ???????? ??? ????????, ????? ?????????? ??????????? ???????? ? ??? ?????????.
???? ?? ????????? (???????) ???????????? ?? ????? 5 ??????????, ?? ??? ??????? ?? ????????
(?????) ?????????? ???????????? ?? ??????? ???????, ? ?????-????? ? ?????????? ??????
????????? ??? ??????, ???? ????? 5 ? ???????. ????????????? ???????????? ??????????
?????????.
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??????????? ????????? ?????? ???? ????? ???????? ????????. ??????? ?????? ???? ???????
?? ????? ???????????. ??????? ?? ???????????? ?????? ???? ???????, ??????????? ?? ???????
?????.
???????, ?? ??????????????? ???????????, ????? ????????? ?? ??????, ????????? ?? ?????????
??????????????? ???????????? ???????? ??????????.
??????? ? ???????? ?????? ????????? ????????????? ??????????? ? ???????????,
? ??? ????? ???????? ?? ?????????????? ?????? ???????????? ? ?????????????? ????????
??? ???????????? ??????????? ???????????????? ??????????????? ???????, ??? ????????
??????????? ? ???????????? ????????. ? ???????? ? ???????????????? ?????????? ?????????
????? ??????? ????????? ? ?????????? ??????? ? ?????????. ? ???????? ? ???????? ???????????
??????????? ?? ???? ??????? ? ??????? ? ??????? ?????????, ?????????? ????????? ?? ??????
??????.
??? ????????????? ??????? ??? ??????? ?? ??????-???? ????????? ??????????? ?????? ?? ???????? ? ???????????? ? ???????????? ? ?????????? ??????.
10. ????????????????? ?????? ???????????? ? ?????? ╚?????? ?????????? ? ?????????, ?????????????? ? ?????????????? ???????╩ ?????????????? ???????? ??????????
??????????? ???????? (Uniform Requirements for Manuscripts Submitted to Biomedical Journals).
?????????? ???????? ???????????? ?????????? ? ??????? ?????????? ???????? ??????? ????, ???
?????????? ?????????? ????? ?????? ??? ?????? ??????? ???????????? ?? ??????? ? ???????????,
? ??????? ??? ????????.
? ???????????? ??????? ??????????? ??????????? ?? ????? 25 ??????????, ? ??????? ?????????? ? ?? ????? 50, ? ?????? ?????????? ? ?? 15. ???????????? ?????? ????????? ?????? ???????????????? ????? ?????????? ?? ????????? 5 ???.
? ?????? ?????????? ??? ?????? ????????????? ? ??????? ???????????. ?????????????????
?????? ? ?????? ?????? ?????? ? ?????????? ??????? ????????. ?????? ?? ???????????????? ?????? ?? ???????????.
????????????????? ???????? ?????: ?????(?), ????????, ????? (??? ??????), ????? ????????? ?
???????? ????????????; ????? ????? ? ??????? ? ??? ???????. ???? ?????? ?????? ?? ????? ?? ?????:
??????, ???????? ?????, ????? ????? ???????? ╚? ??.:╩ ??? ╚In:╩ ? ???????(?) ??????(??) ??? ?????????(??), ????? ???????? ????? ? ???????? ??????.
????????????????? ???????? ?????? ?? ???????: ?????(?), ???????? ??????, ???????? ???????, ???, ???, ? ??????? ????? ???????, ????? ????????? ????? ?????? ? ????????? ??????? ???????????.
??? ????????? ?????????? ?? 6 ??????? ???????????? ??????????? ???, ??? ??????? ?????????
??????????? ? 6 ?????? ??????? ╚? ??.╩, ? ??????????? ╚et al.╩; ???? ? ???????? ??????? ???? ????????? ?????????, ????? ??????? ??????? ??????? ╚???.╩, ? ??????????? ╚ed.╩.
?? ????? ????????, ??????????? ?????????? ????? ????????????? ?????? ???????????,
??? Web of Science ? Scopus, ????????????????? ?????? (References) ?????? ? ????????????
???? ?????? ? ?????????????? ?????? ???????? ?? ?????? ?? ????? ?????????, ?? ? ?????????
(????????? ?????????). ??????? ?????? ?????? ?????? ?????? ?????? ?????????? ? ???? ?????????: ???? ?? ????? ????????? (????????????? ????????? ? ??????????, ???????????? ? ?????????), ??? ???? ??????? ?????, ? ????????? ?????? ??? ?? ?????? ?????????? (References)
? ????????? ???????? ??? Scopus ? ?????? ?????????? ??? ??????, ???????? ? ??? ??? ????????? ??????????, ?????????? ?? ????, ??????? ?? ????? ??? ???????????. ???? ? ?????? ????
?????? ?? ??????????? ??????????, ??? ????????? ??????????? ? ??????, ??????????? ? ????????? ????????.
65
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
? ????????? ???????? ??? ????????????? ?????????? ????????? ????????? ????????? ????????????????? ??????: ?????(?) (??????????????), ??????? ???????? ????? ??? ?????? ?? ?????????? ????, ???????? ????????? (??????????????), ???????? ?????? ? ???????? ???????, ???????? ?? ???? ?????? ? ??????? (in Russian).
?????????? ?????????? ?????? ? ?????????????? ???????
?????????????? ?????????????? ? ???????????
?? ????? http://www.translit.ru ????? ????????? ??????????????? ?????????? ??????????????
???????? ?????? ? ????????. ????????? ????? ???????.
1. ?????? ? ????????? Translit.ru. ???????? ??????? ?????????????? BGN (Board of Geographic
Names). ????????? ? ??????????? ???? ???? ????? ????????????, ????? ???????? ????? ??? ??????,
?? ??????? ????? ? ???????? ?????? ╚? ????????╩.
2. ???????? ??????????????????? ????? ? ??????????? ?????? References.
3. ????????? ? ??????? ??????????? Google ??? ???????? ?????????, ????? ??????? (????????
?????, ??????, ????????????? ? ?. ?.) ?? ?????????? ????, ????????? ??? ? ??????????? ??????.
???????, ??????????, ??????? ??????????????, ??????? ?????? ????? ?????????? ???????? ????????, ??????????? ?????????? ????.
4. ?????????? ???????? ? ????????? ? ??????????, ???????? ? ???????????? ? ????????? ?????????. ??? ???? ?????????? ???????? ????? ??????? (Moscow), ???????? ????????
(Molekulyarnaya meditsina) ?, ????????, ?????? ????????? ??????????? ????????.
5. ? ????? ?????? ? ??????? ??????? ??????????? (in Russian). ?????? ??????.
??????? ?????????????? ????????????? ?????????? ??????????
??? ????????????? ????? ??????
?????? ?? ???????:
Belushkina N.N., Khomyakova T.N., Khomyakov Yu.N. Diseases associated with dysregulation of programmed cell death. Molekulyarnaya meditsina. 2012; 2: 3?10 (in Russian).
Zagurenko A.G., Korotovskikh V.A., Kolesnikov A.A., Timonov A.V., Kardymon D.V. Technical and economic optimization of hydrofracturing design. Neftyanoe khozyaistvo. 2008; 11: 54?7 (in Russian).
?????? ?? ???????????? ???????:
Swaminathan V., Lepkoswka-White E., Rao B.P. Browsers or buyers in cyberspace? An investigation of
electronic factors influencing electronic exchange. Journal of Computer-Mediated Communication. 1999;
5 (2). Available at: http://www.ascusc.org/jcmc/vol5/issue2/ (Accessed 28 April 2011).
????? (??????????, ???????):
Kanevskaya R.D. Mathematical modeling of hydrodynamic processes of hydrocarbon deposit development. Izhevsk; 2002 (in Russian).
From disaster to rebirth: the causes and consequences of the destruction of the Soviet Union. Moscow:
HSE Publ.; 1999 (in Russian).
Latyshev V.N. Tribology of cutting, vol. 1: Frictional processes in metal cutting. Ivanovo: Ivanovskii Gos.
Univ.; 2009 (in Russian).
????????? ???????????:
Usmanov T.S., Gusmanov A.A., Mullagalin I.Z., Muhametshina R.Ju., Chervyakova A.N., Sveshnikov A.V.
Features of the design of field development with the use of hydraulic fracturing. In: New energy saving subsoil technologies and the increasing of the oil and gas impact. Proc. 6th Int. Symp. Moscow, 2007; 267?72
(in Russian).
66
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 3, 2014
????????-??????:
??? Style (2011). Available at: http://www.apastyle.org/apa-style-help.aspx (accessed 5 February 2011).
??????????? ???????????:
Semenov V.I. Mathematical modeling of the plasma in the compact torus. Dr. phys. and math. sci. Diss.
Moscow; 2003 (in Russian).
Grigor'ev Yu.A. Development of scientific bases of architectural design of distributed data processing systems. Dr. tech. sci. Diss. Moscow: Bauman MSTU Publ.; 1996 (in Russian).
????:
State Standard 8.586.5-2005. Method of measurement. Measurement of flow rate and volume of liquids
and gases by means of orifice devices. Moscow: Standartinform Publ.; 2007.
??????:
Palkin M.V. et al. The way to orient on the roll of aircraft with optical homing he; d. Patent RF,
?2280590; 2006 (in Russian).
??????? ?????????? ?????? ?? ??????????
??? ????????????? ????? ??????
?????? ?? ???????:
??????? ?.?., ????????
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