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77.Детские болезни сердца и сосудов №2 2014

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Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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ЦЙ ? 03847 сз 25.01.2001 ?.
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т?б????кзбн╦лс?с ткр╦обллс?с ??а?б╞блк? ка??збн?.
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клыс?о??кк, рс?б?й??бхр?
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ГЯККО ко. д.Г. е?мшнб?? ЙдЕГ,
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??
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Изтб??з?лс ? ГЯККО
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Мбн. (499) 236-92-87
ябзрмкб ╥снбалк рб???? к рсрш?с?
2014. ? 2. 1?64
ISSN 1810-0686
Мк??й 500 ?ма.
Хс?ткрлсх кл?бмр 84550
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CHILDREN?S HEART
AND VASCULAR DISEASES
????????????? ??????-???????????? ??????
??????? 1 ??? ? ??? ??????
??????? ? 2004 ?.
.
2 2014
??????? ???????? ?.?. ???????
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?.?. ????????, ?.?. ???????,
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?.?. ??????????, ?.?. ???????
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Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
Nauchnyy tsentr serdechno-sosudistoy
khirurgii imeni A.N. Bakuleva Rossiyskoy
Akademii Meditsinskikh Nauk
DETSKIE BOLEZNI
SERDTSA I SOSUDOV
CHILDREN?S HEART
AND VASCULAR DISEASES
Peer-reviewed scientific-practical journal
Published once in three months
.
Founded in 2004
2 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?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
??????????
CONTENTS
???????? ?.?., ???????? ?.?. ????????? ????????????? ?? ?????????? ??????? ????? ?????
??????????? ??????????? ????????? ?????????
???????????????????? ??????
5
Tursunov Sh.L., Samsonov V.B. Repeated interventions on the mitral valve after previously performed a radical correction of the atrioventricular
septal defect
14
Bockeria L.A., Makhachev O.A., Gordeeva M.V.,
Panova M.S., Philippkina T.Yu., Khiriev T.Kh.
Quantitative heart anatomy of congenital heart diseases: Taussig?Bing anomaly
22
Podzolkov V.P., Kokshenev I.V., Yurlov I.A.,
Samsonov V.B., Kovalev D.V., Danilov T.Yu.,
Zemlyanskaya I.V., Mamadshoev B.D. Experience
reoperations after implantation of artificial pulmonary artery trunk with radical correction of congenital heart defects
30
Kirillov K.O., Nachinkin V.V., Kim A.I., Yurlov I.A.
Epidemiology of congenital heart disease and ways
of optimization of cardiac surgical care in the
Volgograd region
33
Gorbachevskiy S.V., Mukimov F.H., Shmal?ts A.A.,
Grenaderov M.A., Kol?tsov Yu.A., Khal?vani M.Yu.
Effectiveness of a two-stage surgical correction of
ventricular septal defect complicated by
Eisenmenger syndrome
??????? ?.?., ??????? ?.?., ???????? ?.?., ?????? ?.?., ?????????? ?.?., ?????? ?.?. ?????????????? ???????? ?????????? ???????
??????: ???????? ?????????????
????????? ?.?., ???????? ?.?., ????? ?.?.,
???????? ?.?., ??????? ?.?., ??????? ?.?.,
?????????? ?.?., ????????? ?.?. ???? ????????? ???????? ????? ??????????? ?????????????? ?????? ???????? ??????? ??? ??????????? ????????? ?????????? ??????? ??????
???????? ?.?., ???????? ?.?., ??? ?.?., ????? ?.?. ????????????? ?????????? ???????
?????? ? ???? ??????????? ???????????????????
?????? ?? ?????????? ????????????? ???????
???????????? ?.?., ??????? ?.?., ?????? ?.?.,
?????????? ?.?., ??????? ?.?., ???????? ?.?.
????????????? ??????????? ????????????? ????????? ??????? ??????????????? ???????????,
???????????? ????????? ????????????
???????? ?.?., ??????? ?.?., ???????? ?.?.,
????????? ?.?. ?????? ???????? ?????????
?????????????? ??????? ????? ? ??????? ???????? ????? ?????? ?????????? ? ???????? ???????? ? ??????? ????? ????? ??????????? ???????? ???????? ??? ???????????? ?????????????
???????
???????? ?.?., ???????? ?.?., ??????? ?.?.,
???????????? ?.?., ?????????? ?.?. ???????????????? ???????????????? ??????? ????? ???????????????????? ????????? ? ???????? ????
??? ???????? ????????
Chiaureli M.R., Kovalev D.V., Nezhlukto A.A.,
Mamadshoev B.D. Successful correction of subvalvular aortic stenosis and conduit stenosis
between the right ventricle and the pulmonary artery
in female patient after previous Rastelli procedure in
great vessels transposition
39
44
Kokshenev I.V., Samsonov V.B., Sabirov B.N.,
Astrakhantseva T.O., Zemlyanskaya I.V. Re-prosthesis tricuspid valve after one and a half ventricular
repair and operation by Sealy with Ebstein?s anomaly
3
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
??????? ?.?., ??????????? ?.?., ???????? ?.?., ?????????? ?.?. ??????????????? ?
??????????? ?????? ?????????? ???????? ???????? ???????. ????????? ???????????? ? ??????
??? ??????????? ???????
48
Plakhova V.V., Baryshnikova I.Yu., Pursanov M.G., Yurpol?skaya L.A. Echocardiography in
the diagnosis of rare congenital anomalies of the pulmonary arteries. Imaging difficulties ? is it error or
limitation of the method?
?????? ?.?., ?????????? ?.?., ??????? ?.?., ???????? ?.?. ?????? ???????? ????????? ???????? ????????????? ? ????? ? ???????? ???? ????? ? ??????????????
53
Shamrin Yu.N., Gorbatikov K.V., Bondar? V.Yu.,
Kurbanov S.A. Successful correction of
Taussig?Bing anomaly with type B interrupted aortic
arch in newborn
??????? ??? ???????
58
Rules for authors
4
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
╘ ?.?. ????????, ?.?. ????????, 2014
??? 616.126.42-007-053.1-089.193.4
????????? ????????????? ?? ?????????? ???????
????? ????? ??????????? ??????????? ?????????
????????? ???????????????????? ??????
?.?. ????????, ?.?. ????????
???? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ?
???????? ??? ? ???? ?.?. ???????) ????; ?????????? ?????, 135, ??????, 121552,
?????????? ?????????
???????? ??????????????? ???????????, ????????;
???????? ?????? ?????????, ?????? ???. ????, ???. ?????. ????., e-mail: samsonof@yandex.ru
?????? ????????? ?????????? ???????? ?????????? ?????????????? ??????? ????????? ??????????? ??????? (??) ?
?????????, ?????????? ??????????? ????????? ????????? ???????????????????? ?????? (????). ????? ??????
?????????? ??????????????? ?? ??????????? ?????????? ??????? ??????????? ? ???????????? ???????????????? ?? ?????
????????? ???? ? ?????????? ????? ????? ????????. ??????????? ?????? ??????, ??????????? ???????? ???????????????
?? ????? ????? ??????????? ??????????? ????????? ??????, ??? ??? ?????????, ??? ? ??? ?????? ??? ?????. ???????? ??
????????? ??????????? ????????? ????????? ?????? ? ?????? ? ?????????? ????????????????? ??????? ???????????
??????????, ???????? ?? ??????? ???????? ????????????? ??? ???????????????? ??????????????? ??. ? ???????????
???????? ????? ??????????? ?? ??, ??? ????????? ?????? ???????? ???? ???????????? ?????????? ???????? ? ???????? ???
??????? ???????? ?????????? ??? ?????? ?????? ?????????????? ?????????????. ???????? ?? ??? ? ??????????? ??????????
??????????? ?????? ?????? ???????????? ?????????????? ?? ??? ??? ???????????????, ???????? ??? ???????????
?????????. ??? ??????? ? ??????????? ?????? ????????? ??????? ?????? ? ?????? ???????, ? ????? ? ????????? ??????????
???????????? ?????????. ???????? ?? ?? ??? ?????????? ???????????? ???????????? ?? ?? ???????? ??????? ??????, ???
??????? ??? ????????? ??????????????? ?? ?????? ?????????? ????????????? ???????? ?????????? ? ??????????????, ???
?????????????? ???????????? ???????.
???????? ?????: ???????? ??????????????????? ?????; ????????? ????????; ?????????? ??????; ?????????????? ???????; ???????? ???????.
REPEATED INTERVENTIONS ON THE MITRAL VALVE AFTER PREVIOUSLY
PERFORMED A RADICAL CORRECTION OF THE ATRIOVENTRICULAR SEPTAL
DEFECT
Sh.L. Tursunov, V.B. Samsonov
A.N. Bakoulev Scientific Center for Cardiovascular Surgery of Russian Academy of Medical
Sciences; Rublevskoe shosse, 135, Moscow, 121552, Russian Federation
Tursunov Shermuhammadhozha Lutfullovich, Postgraduate;
Samsonov Victor Borisovich, MD, DM, Leading Research Associate, e-mail: samsonof@yandex.ru
Article is devoted to the problem of re- surgical treatment of mitral valve (MV) disease in patients undergoing radical correction of atrioventricular septal defect (AVSD). Review of literature data indicates intensive development problems of diagnosis and prevention of
incompetence after correction MV of AVSD late after surgery. Shows the spectrum of the reasons for the lack of development of MV after
previously performed a radical correction of the defect, as the partial and at its full form. Despite the improvement in the results of primary
correction of the defect in the early and late postoperative complications observed basic of which is the occurrence or progression of disease MV. In most publications indicate that a detailed assessment of all components of the anatomy of the valve apparatus and the study
of its functions are the basis for the choice of surgical intervention. Despite this, the current literature there is no consensus on the bill when
it prosthetics MV failure, especially in borderline situations. This is due to their experience to correct this defect in each clinic, as well as different age cohorts of patients. Despite the fact that the implementation of plastic interventions at MV is the method of choice, if his total
failure at the time of re-intervention is an indication for prosthesis that is supported by most authors.
Key words: atrioventricular septal defect; reoperation; mitral valve; valve prosthesis; plastic valve.
г?б?блкб
???????? ??????????????????? ????? (????)
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? ???) [1, 2]. ???????????? ????????????? ????
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?????? ????????? [3].
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Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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???? ????????? ?????????? ??????????????? ??,
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?? ?? ????????? ???????????? ?? ?????????? ???????? ????????? ???????????? ????????? ??. ????? ???????, ???????? ????????? ??????????????? ?? ??????? ????????? ????????? ?????????
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???????????? ?????????? ? ?????????? ???????,
?? ????????? ???????? ??????????? ???????? ?????????? ??? ????????????? ?? ? ????? ?????????
??????? [34]. ? ????? ??????? ?????????? ???????????????? ???????????? ?? ?? ?? ?????????????? ?????????, ????? ???? ???????????? ??? ?????????????? [12, 35, 36].
Х?сзбак?с??лкб окз??н╦лс?с мн?т?л?
т?к тс?зс?лсх мс??бм?кк ИдгД
??? ??????? ?????? ?????????? ????????? ???
???????? ?? ???? ???????? ??? ????, ??? ?? ???
??? ??????? ?????? ? ???????????? ???????? ????? ??????????????? ?? ? ????????? ???????
? ???? [30, 35, 36]. ???????? ???????? ??????????? ? ??? ????????? ??????????????, ???? ???????
?????????????? ?? ? ????? ??????? ???????????
???? [4, 30]. ??? ??????????? ??? ??????????
??????????? ???????? ??????? ? ??? ????????????????? ???????? ?? ???? ?????????????????? ????????????? ???????????, ??? ? ? ?????????? ???????????????? ?????????????? ?????????. ?? ????? ?????? ?????????? ??????????????? ?? ??????
? ???? ??????????????????? ???????, ???????
???????????? ??????? [4, 35, 37].
???????? ?? ??????????????? ??????????????
???? ???????????????? ???????????? ?? ????????
?????? ? ??????? ????????, ?????? ????? ????????
??????? ??????????? ?????????, ??? ??????? ???????? ?????? ?? ??????????????. ??? ???????????
??? ????????????????, ??? ? ???????????? ????????? ???????? [38, 39].
?? ?????????????? ? ?????????? ?????????
????? ???????? ????????? ????? ?????????
? ?????????????? ?? ? ?????????, ?????????? ??????????? ????????? ???? ? ????????? ??:
? ?????? ?????????? ??????? ??????? (??????????, ??????, ???????????? ??????????);
? ?????????? ?????????? ??????? ??? ???????
??;
7
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
? ?????????? ????????? ?????????????????
???????? ?? ??????? ?????????? ???????????
???? ??? ?? ????????? ????????????;
? ??????????????? ??? ?????? ?? ????? ?????
??????????? ????????, ??????? ??????? ????????????? ????? (???????????????? ?? ??? ??? ????????).
??? ?????? ???????????? ?? ????????? ???????? ??????????? ????????????, ??????? ?????????? [11, 35, 40]. ????? ???????, ???????, ? ??????? ??????? ??????????/?????????? ??????? ? ?????????? ?????????? ????????????? ???????? ??,
? ????? ????????????????? ????????? ???????????? ????????? ?????? ??????????????? ? ????????
?????????? ?? ?????????????? ???????. ??? ????
????? ??????? ??????????? ????? ????????? ????????, ??? ??? ??? ?????????? ????????? ??????????????? ? ??????????? ???????? ??????? ????????
???????????? ?????????????? [35, 41].
???????? ?????? ?????????? ??????????????
?? ??? ????????? ?????????????? ?? ??????
???? ????????? ???????? ? 30% ??????? [28, 31].
??? ???? ????????? ?????????????, ?? ??????
?????? ???????, ?? ?????? ??????????????? ?? ????? ????????? ????????? ????? ???? ??????????
3?18%, ??? ?????? ????? ? 6?14%, ??? ? ????? ??????????? [7, 8]. ????????? ?????? ????????? ??
???????? ??????????????? ?? ? ??????????? ?? ??
???????? ??????? ?? ????????? ?????????, ? ????? ?? ???????????? ????????????? ??? [40]. ? ?????????? ??????? ????????? ??????, ??????????
????? ?????????? ??????????????? ?? ? ????????? ??? ???????? ????? [8], ??? ??????????? ?????
?????? ???????? ????????? ??????? ?? (???????
??????? ????? ???????? ???????) ? ??? ????????????????? ????????.
????????? ????????????? ???????? ? ???? ????????????? ??????????? ? ???????? ??????????????? ?? ? ????????????????? ??????? [4, 7, 28,
35]. ??? ???? ?????????? ?????????? ????????????? ???????? ? ????????? ? ? ???????????? ???????? ? ????????????? ????, ?????????? ? ????????????????? ???????????? ????????????. ?????
????????, ??? ???????, ? ?????????? ?????????
? ?????????????? ???????.
?????? ? ?????????????? ?????????????, ??????????????? ???????????? ????????? ?? ???
?????? ?????????, ????? ?????????????? ?? ?? ????????, ??????????? ?????????????? ??????? ?????? ???????? ? ╚???????????╩ ?? ??? ??????????
???????????????? ?????????? [12, 42, 43]. ????????, ??? ?????????????? ????????????? ????????? ?????????????? ??????????? ??????? ???????????????, ??? ? ???? ??????? ????? ? ????????
????? ??????????, ??? ????????????, ???, ????????, ????????????? ? ???????????? ????????
?????? ??????? [43, 44]. ??? ????? ?????????
?????????????? ???????, ???????? ? ?????? ??????? ????????, ???????? ??? ?????????? ???????
8
╚?????????╩ ??????? (? ???????????? ?????????? ?
╚prosthesis-patient mismatch╩). ???? ???? ? ?????????????? ??????????? ??????? ????????? ????????????? ??????? ??????? ??????? ??????????? ????
???????? [6, 45]. ? ????? ???????? ?????????? ????????? ?????????????? ???????????? ? ????? ???????? ? ???????????????? ?????????? ?, ??? ?????????, ? ????????? ??????????? ???????????, ?????
??? ?????????? ????????? ??, ?????????? ?????
?????? ? ?.?. ????? ???????, ???????? ?? ???????
?????????? ??????? ??????????? ????????????
???????? ?????? ? ?? ???????????? ? ????????, ? ?????????? ????????? ??? ???????? ???????????? ???????????????? ??????????????, ? ??? ??????????
???????? ????????????? ???????? ??? ????????????? ??????????? ?????????????? [46].
Йбт?сзбак?с??лкб окз??н╦лс?с мн?т?л?
т?к тс?зс?лсх мс??бм?кк ИдгД
??????? ??????? ?????? ????????????? ????????? ??????? ??????? ????????????? ??????????
???????? [33, 41, 42]. ??? ?????????? ????????
?????????????? ??????????? ??????? ? ???????
???????? ? ??????????? ????????? ??? ????? ???????, ??? ╚????????╩ ??????? ??? ?????????????
??? ?????????? ? ?????????? ????? ????? ????????. ????? ???????, ?? ???????? ????????? ??????
? ????????? ?????????????, ?? ???? ????????????????. ? ?????????? ?????????? ????????? 10 ???
?????? ??????????? ????????? ? ????????? ??????????????? ?? ??? ?????????? ????????? ????????-?????????? ??????? [42, 47]. ?????? ? ???????????? ????????????, ??????? ????????????
????????? ??????????????, ?????????? ????????????? ??????????????? ??????? ??????, ?????????????? ??????????? ?? ??????????????????? ? ??????????????, ? ???????? ?????????? ???
????????? ???????????? ????????? ???????????????? ????????? (???????, ??????? ?????????, ???????? ?????????????? ?????? ?????, ??????????
??????????? ??????? ????????? ??????? ? ??? ???????????????? ?????????? ? ?.?.), ????????????
??? ???????????????????? ????????????. ???????
????????, ??? ? ????????? ??????????? ??????????? ?? ??, ??? ???????????? ????????? ?????????
??????????????? ?? ?????? ??????????? ? ???????
?????????? ??????? ??????? [48].
????????? ? ?????????????? ????????????? ???
?????????? ????????????? ???????, ???????????????? ???????? ??? ????????????????, ???????
??????? ??? ??????? ??? ??????????????? ????????? ??????? [42, 49].
?????????? ??????? ???????????? ?????????
?????????????? ??????? ?? 1,16 ??2/?2 ????????,
?? ?????? ??????????, ??????????????? ????????, ?? ???? ? ????? ??????? ???????????????
╚????????╩ ???????. ??? ????????? ??????? ????????????????? ???????????????? ?????? ? ????????? ? ???? ??????????? ????????? ??????? ????-
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
?????? ? ???????? ??????? ???????????? ?????????, ??????? 1,5 ??2/?2 [37, 47].
?? ?????? ?????????? [33, 35, 37, 40, 46, 48],
? ???????? ?????????? ???????? ?????????: ??????, ??????? ╚?????????╩ ??????? (??????????????
??????/???????), ????????????? ?????????????
??????, ???????????? ?????????? ??????? ??????? ? ???????? ????????? ?/??? ???????, ???????
???????.
??? ???? ???? ????????? ?????????? ?????????
??????? ?????????????? ??????? ??????, ???????
??????????????? ? ???????? ??? ?????-???????????? ? ??????????? ? ??????????? ??????????? ?????????????? ???????? ??? ?????????, ? ?????????
????????????? ??????, ??????? ??? ?????????,
? ????? ?????????? ?????????? ?? ??????? ? ???????? ???? ??? ?????????????????? ????? ????????? ????????.
??????? ????????, ??? ?????? ????????? ? ?????
?? ?????? ?????? ???????? ?????????? ???????
???????, ???????? ? ?????, ? ????? ?????????????
??????????? ???????? [42, 43]. ???????? ?? ????????? ? ???????????????? ??????? ? ????????,
?? ?????? ??????????, ????? ???????? ????? ??
?????? ?????? ? ???????? ???????? [42, 43].
????? ?? ??????? ?????????? ??????????????
?? ???????? ?????????? ?????????? ??????, ??????? ??????? ? ???????????? ??????? ???????
????? [44, 46]. ? ???? ??????? ??????????? ?? ?????????????? ?????????? ????? ???????????????
??????? ??? ?????????? ??? ?????????? ????? ??????????? ??????. ?? ??? ?????????? ??????? ?????? ?????????? ??????? ???????, ??? ??? ????????
???? ??????? ? ??????????????? ╚??????╩ ?? ??
??? ????????? ????????, ? ????? ? ??????? ?????????????? ????? ???????? ????????????. ?????
?????? ??? ?????????? ??? ?????? ?????????? ???????? ???????????????? ???????? ?????? ? ?????.
? ??????? ?????????? ??????????? ??? ?????????
?????????????? ? ??????????? ??????? ???????
?????????????? ?????? ???????? ???????? [13, 25,
28, 40?42, 46, 48].
??????? ?????????????? ?????? ╚?????????╩
??????? ????????? ???????? ???????? ? ??????????
?? ??????? ? ?????????? ???????????????? ??????????????. ? ?????? L.A. Durham ? ?????. [30], ???
??????????? ?????? 164 ????????? ? ??????????????? ??, ? 75% ??????? ???????????????? ????
?? ??, ??? ????????? ??????? ?????????? ??????
?????? 21 ???????. ? 44% ??????? ???? ????????,
????????????? ?? ?????? ????. ??????? ????????, ??? ??? ?????? ????? ????????? ?? ????
?? ?? ?? ?????? ????????????????. ????? ????
????????? 24 ????????? ?????????????, ?????
14 ??? ????? ?????????? ?????????????, ??????
?????????? ? ?????????? ????????????? ??????
??????? ╚?????????╩ ??????? ? 20 ??????? (83,3%)
? ? 4 (16,7%) ??????? ??? ??? ??????. ????? ???????, ?????? ???????????? ????? ????? ??????
? ???, ??? ?????????????? ?? ? ??????? ????????,
??????????, ?????? ?? ????? ????????? ????????????? [8, 11, 40, 41, 48]. ????? ?????? ? ??????????????/???????????????? ??? ??????????? ????????????? ???????? ?????? ? ???????????????
??????? ?? ?????? ????????. ????????? ??????,
????????, ??????????, ??? ?????????? ????????
?????? ???????? ?????????? ??? ??????????? ???????????????? ???????????? ???????? ????? ???????????, ? ???? ?????????? ????????????? ? ?????? ????? ??????? [6].
?? ????????? ???????? ?????????? Z-score, ??????????? ????????? ???????? ?????????? ????????? ??????? ? ???????? ?? ? ?????, ?????
??????? ???????????? ??????? ????????????????
?????? ????????. ? ????????? ??????? ??????
????????? ?? ????????????? ??????????? ???????
? Z-score=+3 ??? ?????????????? ???????? ???????? ╚?????????╩, ??? ????, ??? ???????, ???????????
??????????????? ?????????????? ?? [30].
?????? ???????? ? ?????????? ????????? ?????? ?????? ????????????? ???????. ? ?????????
????? ???????????? ???????? ???????????????
?????????????? ????????, ??? ??? ??? ????????
???????? ????????????????? ????????????????
[30, 35]. ????????? ?????????? ???????? ???????? ??????? ?????????? ???????????? ?????? ???????????? ??????????? ? ??????? ? ??????????????? ??, ? ??? ????? ? ? ??? [30, 33].
??????? ????, ??????? ???????, ??? ????? ??????
????????? ??????????????? ?? ????? ????? ???????????? ???????????? ????????????? ??? ???
?????? ????????????. ??? ?????? ?????????????
?????????? ????????? ????? ????????? ????????,
????????????? ??????????? ?????? ? ???????????? ?????????? ??, ? ????? ??? ? ??????????????????? ???????.
Йбашн╦з?з? тс?зс?л?? ?об╞?збн╦рз?
т?к ИдгД
?????????? ??????? ????????? ???????? ? ???????????? ?????????, ???????????????? ? ??????????? ???????? ?????????????? ?????????????
????????? ??????? ????? ???????????. ?????????
????? 1990 ?. ????????? ?? 3?5% [20, 30, 41].
??? ??????? ?????? ?????????? ???? ????????,
??? ??????? ??????? ?? ?????? ?????????????, ??????? ?????????, ?????????????? ????? ?? NYHA,
??????? ????????????? ??????????? ? ?????????? ????????????? ??????????? ?????? ?? ?????????? [16, 50]. ?? ?????????? ?????????? ?????
? ???? ?????????? ?????????????: ????????? ?????????? ???????? ? ?????? ?? ?????? ???? ?????
?????????? ????????????? [35], ??? ????????????????? ???????? ??????? ???????????? ??????????? ? ????? 20%.
???????????? ??????????? ??? ????????? ?????????????? ?? ?????? ??????????????? ?? ?????
9
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
??????????? ????????? ????, ?? ?????? ????????? ??????????, ?????????? 11?36% [10, 44, 45].
????????? ????????? ???????????????????? ??????????? ???????? ???????????? ?????? ????????? ????? ????? ?????????? ???????, ?????????
?????? ?? ??????? ?? (????????????? ??????????), ????????? ?????? ?? ??????? ??????? ?????????? ?????????? ??????????? ??????? ╚?????????╩ ??????? (???? ??? ????????? ?????? ?????
????), ? ????? ????????? ????? ?????? [24, 30,
35, 44]. Z-score ??????????????? ??????? ????????? ???????????? ????????, ???????? ?? ???????????? ??????????? [10], ?? ??? ???? ??? ????????????? ??????? ????? ???????? ?? ????????????
? ????? ?????????? ????????? ????????. ? ?????????????? ???????? ????? ????????? ???????????? ????????? ?????? ????? ????, ???????
Shone, ????????????? ???????? ? ????????????
??????? ?????????????? ?????????????? [44].
??? ??????????????? ??????? ???? ???????????,
??? ?????????? ?????????? ????????, ?????????
?? ? ???????? ??????????? ???????? ??????? ??
???? ???????????? ????????? ????? ?????????
????????. ??????? ??? ???????? ???????????? ??????????? ????????? ???????? ??????????? ???????? ??????? ?? [14, 22].
???????????????? ?????????? ? ??????????
????????????????? ??????? ??? ??? ?????????
??????????????, ??? ? ??? ????????? ???????????
????????? ???????, ????????? ????????????? ??????, ? ????? ??????????????. ??????? ?? ????????
?????????? ? ??????? 10-??????? ??????? ?????????? ?? 90% [6]. ??? ???? ?? ??????? ????????
? ????? ??????? ??????????, ??? ????????????
??????????, ??????? ?????????????? ??????? ???????????? ? 25?60% [28]. ?????????????, ???????????? ????? ?????????? ????? ?????. ??? ??????????? ? ?????????? ???????????? ???????? ??????? ???????? ????? ????????? ??? ???????????
?????? ?? ?????? ??????? ???????, ? ????? ????????????? ????????????? ???????? ?????? ? ????????? ???????????? ????????? (???????????, ????????? ???????).
???????? ???? ? ??????????? ??????? ?????????? ????????????? ?? ?? ????? ?????????
???? ?????? ?????-????????????, ???????????
????? ????????????? ??????????????? ? ????????????, ???????? ???? ??????????? ???????? ???????. ?????????? ?????????? ? ?????????? ???????? ?????????????? ??????????????????? ??
??????????? ??????????????? ?????? ???????????? ???????? ???????????? ?????? ??????????????? ?????????? ???????? [30]. ??? ???????????????? ??????????????? ?? ?????????? ???????
?????? ? ????????? ?????????????, ?? ?????? ????????? ? ????????? ?? ? ???????? ???????? ???????????, ??????? ????????? ??????? ??????
? ???????????? ????????? ??????????? ????????? [20, 35, 50].
10
? ?????????? ??????? ???????, ??? ?? ?????????
?????? ? ?????????? ??? ??????? ?????? ? ???????
????????? ????????? ?? ??? ????????? ?????????????, ??? ??????????? ???????? ???????????
?????????????? ???????. ?? ??? ?? ???????????
???????? ?????????????? ??????? ?????????? ????????????? ????????????? ??? ??????? ╚???????????? ??????????╩ ??????? ? ??? ????????????
????????, ???????? ? ??????? ????????. ??? ????????????? ??????????? ??, ? ????? ??? ??????????
??????? ???????????? ????????? ?????????
?????? ?????? ??????????????, ??? ??? ? ??????
???????? ????????? ???????????? ????????? ???????????????. ???????? ????????????? ????? ???????? ???????, ??????? ?????????????? ? ??????????? ?? ?????????-??????????? ???????? ??,
????? ?????? ?? ????? ??????? ???????? ??????????????? ??????? ? ????????????????? ???????
? ????????? ? ???? ????????? ???????????????
????????? ?????????. ????? ?????????? ???????
????????? ????????, ??? ??? ??? ?????????? ????????? ??????????????? ? ??????????? ????????
??????? ???????? ???????????? ??????????????
??. ??? ??? ????????? ?? ???????? ??? ????????
????????????? ????????? ?????????????? ? ????????? ???????? ??????????????? ??, ? ????? ?????????? ?????? ?? ?????????????, ??? ???????
?????????? ?????????? ???????????? ?? ?????????? ??????????? ???????? ????????? ???????
?????????? ? ?????? ?????????? ?????????????
????????.
??????????
1.
2.
3.
4.
5.
6.
7.
8.
9.
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Wetter J., Sinzobahamvya N., Blaschczok C., Brecher A.M.,
Gravinghoff L.M., Schmaltz A.A. et al. Closure of the zone of
apposition at correction of complete atrioventricular septal
defect improves outcome. Eur. J. Cardiothorac. Surg. 2000;
17 (2): 146?53.
Prifti E., Bonacchi M., Bernabei M., Crucean A., Murzi B.,
Bartolozzi F. et al. Repair of complete atrioventricular septal
defects in patients weighing less than 5 kg. Ann. Thorac. Surg.
2004; 77 (5): 1717?26.
Wood A.E., Healy D.G., Nolke L., Duff D., Oslizlok P., Walsh K.
Mitral valve reconstruction in pediatric population: Late clinical
results and predictors of long outcome. J. Thorac. Cardiovasc.
Surg. 2005; 130 (1): 66?73.
Hetzer R., Walter E.B., HЭbler M., Alexi-Meskeshvili V.,
Weng Y., Nagdyman N. et al. Modified surgical techniques and
long-term outcome of mitral valve reconstruction in 111 children. ?nn. Thorac. Surg. 2008; 86 (2): 604?13.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
Komoda T., HЭbler M., Siniawski H., Hetzer R. Annular stabilization in mitral repair without a prosthetic ring. J. Heart Valve.
Dis. 2000; 9: 776?82.
Ohno H., Imai Y., Terada M., Hiramatsu T. The long term
results of commissure plication annuloplasty for congenital
mitral insufficiency. ?nn. Thorac. Surg. 1999; 68: 537?41.
Malhotra S.P., Lacour-Gayet F., Mitchell M.B., Clarke D.R.,
Dines M.L., Campbell D.N. Reoperation for left atrioventricular
valve regurgitation after atrioventricular septal defect repair.
?nn. Thorac. Surg. 2008; 86 (1): 147?52.
??????? ?.?., ??????? ?.?., ??????????? ?.?. ? ??. ?????????? ?????????????? ??????????? ??????? ? ?????
??????? ????????. ??????? ??????? ?????? ? ???????.
2008; 2: 60?6.
Durham L.A., Burkhart H.M., Dearani J.A., Puga F.J.,
O'Leary P.W., Schaff H.V. Mitral annular growth in children following early mechanical mitral valve replacement. World J.
Pediatr. Congenital Heart Surg. 2010; 1 (2): 177?81.
Barber J.E., Kaspera F.K., Ratliff N.B., Cosgrove D.M.,
Griffin B.P., Vesely I. Mechanical properties of myxomatous
mitral valves. J. Thorac. Cardiovasc. Surg. 2001; 122 (5):
955?62.
Adams D.H., Anyanwu A.C. Seeking a Higher Standart for
Degenerative Mitral Valve Repair: Begin with Etiology.
J. Thorac. Cardiovasc. Surg. 2008; 136 (3): 551?6.
????????? ?.?., ??????? ?.?., ????????? ?.?., ??????? ?.?., ??????? ?.?. ??????? ?????????? ????? ??????????? ????????? ????????? ????? ????????????????????
??????. ??????? ??????? ?????? ? ???????. 2007; 2: 33?7.
Cohn L.H., Soltesz E.G. The evolution of mitral valve surgery:
1902?2002. Am. Heart Hosp. J. 2003; 1 (1): 40?6.
????????? ?.?. ??????????? ????????? ?????????????
????????? ????????? ????? ???????????????????? ?????? ? ????? ???????? ???????????????? ? ?????????? ???????????: ???. ? ?-?? ???. ????. ?.; 2009: 364.
Kaza A.K., Colan S.D., Jaggers J., Lu M., Atz A.M.,
Sleeper L.A. et al. Surgical Interventions for Atrioventricular
Septal Defect Subtypes: The Pediatric Heart Network
Experience. Ann. Thorac. Surg. 2011; 92 (4): 1468?75.
Magne J., Mathieu P., Dumensnil J.G., Tanne D., Dagenais F.,
Doyle D. et al. Impact of prosthesis-patient mismatch on survival after mitral valve replacement. Circulation. 2007;
115 (11): 1417?25.
Paul W.M., Fedak M.D., Carthy Patrick M.Mc., Robert O.
Evolving concepts and technologies in mitral valve repair.
Circulation. 2008; 117: 963?74.
Suri R.M., Schaff H.V., Dearani J.A., Sundt T.M., Daly R.C.,
Mullany C.J. et al. Recurrent mitral regurgitation after repair:
should the mitral valve be re-repaired? J. Thorac. Cardiovasc.
Surg. 2006; 132 (6): 1390?7.
Stulak J.M., Burkhart H.M., Dearani J.A., Cetta F.,
Barnes R.D., Connolly H.M. et al. Reoperations after repair of
partial atrioventricular septal defect: a 45-year single-center
experience. Ann. Thorac. Surg. 2010; 89 (5): 1352?9.
????????? ?.?., ???????? ?.?., ???????? ?.?., ???????? ?.?., ??????? ?.?., ???????? ?.?. ? ??. ????????? ?
?????????? ?????????????? ??????????? ??????? ? ?????????? ????? ????? ??????????? ????????? ???????????????????? ??????. ??????? ??????? ?????? ? ???????.
2011; 1: 54?7.
Pibarot P., Dumesnil J.G. Prosthesis-patient mismatch: definition, clinical impact, and prevention. Heart. 2006; 92: 1022?9.
Rizzoli G., Guglielmi C., Toscano G., Pistorio V., Vendramin I.,
Bottio T. et al. Reoperations for acute prosthetic thrombosis
and pannus: an assessment of rates, relationship and risk. Eur.
J. Cardiothorac. Surg. 1999; 16 (1): 74?80.
Erez E., Kanter K., Isom E., Williams W., Tam V. Mitral valve
replacement in children. J. Heart. Valve Dis. 2003; 1 (12):
25?30.
Shi W., Yap C., Hayward P., Dinh D., Reid C., Shardey G. et al.
Impact of prosthesis-patient mismatch after mitral valve
11
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
46.
47.
48.
49.
50.
replacement: a multicentre analysis of early outcomes and
mid-term survival. Heart. 2011; 97 (13): 1074?81.
Kanter K., Forbess J., Kirshbom P. Redo mitral valve replacement in children. Ann. Thorac. Surg. 2005; 80: 642?6.
Tanne D., Kadem L., Rieu R., Pibarot P. Hemodynamic impact
of mitral prosthesis-patient mismatch on pulmonary hypertension: an in silico study. J. Appl. Physiol. 2008; 295: 1916?26.
Masuda M., Kado H., Tatewaki H., Shiokawa Y., Yasui H. Late
results after mitral valve replacement with bileaflet mechanical
prosthesis in children: evaluation of prosthesis-patient mismatch. Ann. Thorac. Surg. 2004; 77 (3): 913?7.
Bonow R.O., Carabello B.A., Kanu C., de Leon A.C.,
Faxon D.P., Freed M.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: e84?231.
Abdulhameed A., Lawton J.S., Maniar H.S., Pasgue M.K.,
Damiano R.J., Moon M.R. Factors affecting survival after
mitral valve replacement in patients with prosthesis-patient
mismatch. Ann. Thorac. Surg. 2010; 90 (4): 1202?11.
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Mitral valve reconstruction in pediatric population: Late clinical
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Hetzer R., Walter E.B., HЭbler M., Alexi-Meskeshvili V.,
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Dis. 2000; 9: 776?82.
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results of commissure plication annuloplasty for congenital
mitral insufficiency. ?nn. Thorac. Surg. 1999; 68: 537?41.
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955?62.
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Magne J., Mathieu P., Dumensnil J.G., Tanne D., Dagenais F.,
Doyle D. et al. Impact of prosthesis-patient mismatch on survival after mitral valve replacement. Circulation. 2007;
115 (11): 1417?25.
Paul W.M., Fedak M.D., Carthy Patrick M.Mc., Robert O.
Evolving concepts and technologies in mitral valve repair.
Circulation. 2008; 117: 963?74.
Suri R.M., Schaff H.V., Dearani J.A., Sundt T.M., Daly R.C.,
Mullany C.J. et al. Recurrent mitral regurgitation after repair:
should the mitral valve be re-repaired? J. Thorac. Cardiovasc.
Surg. 2006; 132 (6): 1390?7.
Stulak J.M., Burkhart H.M., Dearani J.A., Cetta F.,
Barnes R.D., Connolly H.M. et al. Reoperations after repair of
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Bottio T. et al. Reoperations for acute prosthetic thrombosis
and pannus: an assessment of rates, relationship and risk. Eur.
J. Cardiothorac. Surg. 1999; 16 (1): 74?80.
Erez E., Kanter K., Isom E., Williams W., Tam V. Mitral valve
replacement in children. J. Heart. Valve Dis. 2003; 1 (12):
25?30.
Shi W., Yap C., Hayward P., Dinh D., Reid C., Shardey G. et al.
Impact of prosthesis-patient mismatch after mitral valve
replacement: a multicentre analysis of early outcomes and
mid-term survival. Heart. 2011; 97 (13): 1074?81.
Kanter K., Forbess J., Kirshbom P. Redo mitral valve replacement in children. Ann. Thorac. Surg. 2005; 80: 642?6.
Tanne D., Kadem L., Rieu R., Pibarot P. Hemodynamic impact
of mitral prosthesis-patient mismatch on pulmonary hypertension: an in silico study. J. Appl. Physiol. 2008; 295: 1916?26.
Masuda M., Kado H., Tatewaki H., Shiokawa Y., Yasui H. Late
results after mitral valve replacement with bileaflet mechanical
prosthesis in children: evaluation of prosthesis-patient mismatch. Ann. Thorac. Surg. 2004; 77 (3): 913?7.
Bonow R.O., Carabello B.A., Kanu C., de Leon A.C.,
Faxon D.P., Freed M.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: e84?231.
Abdulhameed A., Lawton J.S., Maniar H.S., Pasgue M.K.,
Damiano R.J., Moon M.R. Factors affecting survival after
mitral valve replacement in patients with prosthesis-patient
mismatch. Ann. Thorac. Surg. 2010; 90 (4): 1202?11.
????????? 18.02.2014
13
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????????????? ?????? ??????????? ? ????????-?????????? ????????, e-mail: oamakhachev@mail.ru;
???????? ????????? ????????????, ????. ???. ????, ???. ?????. ????.;
?????? ?????? ?????????????, ????. ????. ????, ???. ?????. ????.;
?????????? ??????? ???????, ????. ???.-???. ????, ??. ?????. ????.;
?????? ??????? ????????????, ????. ???. ????, ??. ?????. ????.
????. ???????? ?????? ? ????? ??????, ????????? ???????? ? ??????? ???????? ?????????? ?????? ??? ????????
????????????? (???) ??? ?????? ??????????????? ????????? ??????.
???????? ? ??????. ????????? ??????????? 30 ?????????? ??????. ?????????? ??????????? ????????, ??????? ??????
??????? (??) ? ?????? ?????????? (??) ?????????? ? ???????????? ??????? D.M. Schultz, D.A. Giordano (1962 ?.)
? ????????? ?????????? Z-score. ???????, ?????? ?? ?? ??????? ???????? ???, ?????????? ?????, ??????? ?????????????????
??????????????? ????????????? ??????? (??), ?????? ???????? ??????????? (??) ?? Heath?Edwards ? ??????????????
??????? ??????????????? ??????????? (????). ?????????????? ????????? ???????? ?????????????, ???????????,
????????????? ? ?????????????? ??????? ? ?????????????? ????????? SPSS 15.0.
??????????. ??????????? ??????????? ?????????? ??????? ??????? ????????? ?????? ?? ????????? ? ??? ??????????????
??????????? ????????? (p=0,02). ??? ??????? ?????????? ????? ??????? ??????????????? ??????? ???????? (p=0,049),
? ??? ?????????????? ??????? ????? ???????? ??????? ??????? ????? (p<0,028). ???, ??????????????? ??
? ?????????????? ???? ?? ?????? ?? ??????? ???????? ??????. ??????? ????????? ????????????? ??????????? ?????
?????????? ???????? ?????? ? ??????????????????? ???????. ??????? ???????? ?? ?????? ? 84% ??????? ??????????
(p<0,001) ????????? ?????????????? ??????????? ???????? (Z-score > +2), ??????? ???????? ?? ? 90% ??????????
??????????????? ?????????? ?????. ??????????? ??????? ?????????????? ????? (r=0,85) ????? ?????????? ???????
???????? ?? ? ??. ?? ?????? ??????????????? ??????? ???, ????????????? ??????????? ????????? ? ?????????????
???????? ?? ?????? ?? ???????? ??????? ???????? ?????????? ??????.
??????????. ?????????????? ?????? ?????? ? ??? ???????? ??? ??? ????????? ?????????? ??? ??????????? ????????
?????????: ?????????? ?? ????????? ? ????? ????? ?????? (? 87% ???????), ??????? ???????? ?? (? 84% ??????????)
? ???????? ????????? ??????? (? 52% ???????). ??????? ???????? ??, ???????? ??????????????????? ? ???????????
???????? ? ??????????? ??????? ??????????????? ?????. ???????????? ????????? ?????????? ????? ?????? ??? ??? ????:
??????? ??????????????? ????????? ??????? ?????? (III?IV ?????? ?? Heath?Edwards) ? ??????? ??????? [ME, 95% ??=5,9 ????
(1,87; 9,42)]. ????????? ?????????????? ????????? ? ????????????? ??????????????? ???????? ????? ?????? ????????
?????????? ???????????? ???????? ????? ????????? ??? ??? ? ?????????????? ???? ????????????????? ? ?????????????
??????????. ????????????? ? ??????????? ??????????? ????? ?????? ??? ???????????? ??????? ??? ????????? ??
????????????? ????????????? ????????????? ????????? ????? ??????.
???????? ?????: ???????? ?????????????; ???????? ??????; ???????????????? ???????????? ??????; ???????? ?????????? ?????? ? ?????; ????? ??????; ??????? ???????? ??????; ??????? ???????? ?????????? ??????.
QUANTITATIVE HEART ANATOMY OF CONGENITAL HEART DISEASES:
TAUSSIG?BING ANOMALY
L.A. Bockeria1, O.A. Makhachev1,2, M.V. Gordeeva1, M.S. Panova1, T.Yu. Philippkina1,
T.Kh. Khiriev1
1
A.N. Bakoulev Scientific Center for Cardiovascular Surgery of Russian Academy of Medical
Sciences; Rublevskoe shosse, 135, Moscow, 121552, Russian Federation;
2 Dagestan Center for Cardiology and Cardiovascular Surgery, ?Chernye Kamni? suburban Beach,
Makhachkala, Republic of Dagestan, 367009, Russian Federation
14
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
Bockeria Leo Antonovich, Academician of Russian Academy of Sciences and Russian Academy of
Medical Sciences, Director of A.N. Bakoulev Scientific Center for Cardiovascular Surgery of
Russian Academy of Medical Sciences;
Makhachev Osman Abdulmalikovich, MD, DM, Professor, Chief Research Associate, Director of
Dagestan Center for Cardiology and Cardiovascular Surgery, e-mail: oamakhachev@mail.ru;
Gordeeva Margarita Vladimirovna, MD, PhD, Leading Research Associate;
Panova Marina Stanislavovna, Candidate of Biological Sciences, Leading Research Associate;
Philippkina Tat?ana Yur?evna, Candidate of Physical and Mathematical Sciences, Senior Research
Associate;
Khiriev Titalav Khayrullaevich, MD, PhD, Senior Research Associate
Objective. To obtain data on the mass of the heart, diameters of valves and thickness of the ventricular myocardium in patients with
Taussig?Bing anomaly (TBA) with different morphological variants of defects.
Material and methods. During the study morphometry of 30 heart specimens was performed. Results of morphometry of valves, wall
thickness of the right (RV) and left (LV) ventricles were compared with reference data published by D.M. Schultz, D.A Giordano
(1962) and the index Z-score were calculated. The following issues were studied: whether the valve size depends on gender, aortic
obstruction, type of transposition of the great arteries (GA), stage of pulmonary hypertension (PH) according to Heath?Edwards
classification and additional ventricular septal defects (AVSD). Statistical processing included dispersion, multivariate, regression
and correlation analyses using the SPSS 15.0 software.
Results. Significant size increase of the valve of pulmonary trunk compared with its individual normal value (p=0.02) was detected.
In presence of the aortic obstruction the diameter of the tricuspid valve was reduced (p=0.049) and in presence of multilevel aortic
stenosis the diameter of the aortic valve was reduced (p<0.028). Gender, transposition of the great arteries and additional ventricular septal defects do not affect the size of the heart valves. Regression equations of the relationship between the diameters of the heart
valves and anthropometric data were created. RV myocardial thickness in 84% cases significantly (p<0.001) exceeded the individual normal value (Z-score > 2), LV myocardial thickness in 90% cases corresponded to the age norm. High correlation (r=0.85)
between the values of the RV and LV myocardial thickness was shown. According to the statistical analysis the gender, anatomic
peculiarities of pathology and associated defects do not affect the ventricular myocardial thickness.
Conclusion. Quantitative assessment of the heart and its structures in TBA patients allowed to determine three distinctive signs of
pathology: increase of the mass of the heat (87% cases), RV myocardial thickness (84% cases) and the diameter of the pulmonary
valve (52% cases) relative to the normal values. LV myocardial thickness, diameters of the atrioventricular and aortic valves in most
cases corresponded to normal values. Independent factors for the heart mass increase in TBA patients were: the degree of morphological changes of the pulmonary vessels (III?IV grade according to Heath?Edwards classification) and older age [ME, 95% CI = 5.9 years
(1.87; 9.42)]. Created mathematical equation and established indexed values of the mass of the heart allow to calculate predictive
value of this parameter in TBA patients and optimize dose of cardioprotectors and cardiotropic drugs. Progressive and significant
increase of the mass of the heart during natural course of the disease in TBA patients indicates the need for early surgical correction
of this defect.
Key words: Taussig?Bing anomaly; anatomy of the heart; morphometric study of the heart; normal values of heart parameters; mass
of the heart; diameter of the heart valves; thickness of the ventricular myocardium.
г?б?блкб
???????? ????????????? (???) ????????????
????? ???? ?? ????????? ???????? ?????????? ????????????? ??????? (??) ?? ??????? ?????????
(??). ??????? ??? ???????? ???? ???????
H.B. Taussig, R.J. Bing ? 1949 ?. ??? ?????? ???????????? ????? ? ??????????? ???????? ??????? [1].
? 1950 ?. M. Lev, B.M. Volk ??????? ???????????
?????? ? ??????? ??? ╚?????? ?????????????╩ (╚the
Taussig?Bing heart╩). ???????? ????????????? ?????????? ?? ???? ?????????? ??????? ?????????
???????????? ???????? ???????????? ???????
??????????????? ??????????? (????). R. Van Praagh ??? ????????? ??????????? ???? ????????????: ???????? ??????? ????? ?? ??, ??????????
??????? ??? ? ??? ? ?????????????? ?? ????? ??????, ????????????? ????? ? ?????????????? ????????? ?????? ???????? ????????????? ? ??????????? ??????? ? ??????? ??????????? ???? [2].
?????? ╚??????? ????? ?? ??╩ (╚double-outlet right
ventricle╩ (DORV)), ??????????? K. Braun ? ?????.
? 1952 ?. ? ?????????? ? ??????????? ????? ????
A.C. Witham ? 1957 ?., ???? ?????????????? ??????
??????? ╚????????? ????????????╩. ???????? ???-
????????????? ?????????????? ???????? ??????
?? ?? ??????? ???????? ????????????? M. Lev
? ?????. (1972 ?.), ? ?????? ??????? ????? ????????????? ???????????? ???? ? ?? [3]. ????????
???? ????????????, ??? ? ??? ??????? ????? ??
?? ? ??????????? ????. ??????????????? ?????????????? ????? ?????? ??????????? ??????????????????? ?? [4, 5]. ????? ????, ??? ????? ?????????????? ??????- ? ???????????? ???????????, ????????? ?? ???????????? ??????? ??????
? ????????? ????????? ?????? [6]. ? ????? ?????????? ?????????: ????????????? ????????? ?????
?? ?????? ??????? (??????? ? ???????? ??????
??, ?????????? ???? ?????, ?????????? ?????), ?????????????? ???? ? ?????? ???????? [7?9].
???????????????? ???????????? ?????? ? ???
???????????? ? ?????????? ?????????? ????????
? ?? ???????? ?????????????? ?????? ?? ?????????? ??????????????? ???????? ??? ???? ??????
[2, 10?12].
???? ?????????????? ?????? ? ???????? ???????? ?????????????? ?????? ????????????? ???????????? ?????? ? ??????? ??????? ? ???? ??????? ??????. ? ?????? ???????????? ??????? ????????? ????? ??????, ????????? ????????, ???????
15
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
???????? ?????????? ??? ???, ??????? ??????? ??
?????????? ?? ?????????????? ????? ? ????????
Z-score, ??????? ??????? ?? ?????????????? ????????? ?????? ????? ????????, ??? ?????????????
???????? ??????, ?????????????????? ?????? ?????????, ???????? ???????????.
?????????????? ? ?????????????? ?????????
?????? ??????????? ? ?????????????? ?????????
SPSS 15.0 ? ???????? ??????????????, ?????????????, ????????????? ? ??????????? ???????.
Е?зб?к?н к обзс??
????????????? ???????? ??? ? ????????????
? ???????????????? ?????????? ???????? ????
??????????: [(S) C (DRH, L, SPC-SAC) DORV (?,
?, ?)], ??? S ? situs solitus, ?????????? ??? ???????????? ??????????, ? ? ????????????? ??????????-???????????? ??????????, DRH ? ???????????? ?????????????? ??????? ?????????, ???????????????? ???? ?????? ????, ?????? ??
????????? ? ?????????????? ?????? ?????????,
L ? ??????????, SPC-SAC ? ??????? ????????????
? ?????????????? ???????, DORV ? ??????????
????? ? ???????? ??????? ?? ??. ???????? ?????????????????? ?? ???? ??????????: ??????
????? ?????? ? ??????? (D-A, n=12), ?????? ?????
?????? ? ??? ? ??? (D-SbS, n=5), ?????? ?????
?????? ? ?????, ?? ???? ?????????? ????????????
????????????? ??????? (D-P, n=13). ?????? ??????????????? ??????????? ?? ???? ??????? ???
???????????, ??? ???? ? 8 ?????????? ?????? ??????? ?????????????? ????. ?????????? ??????????? (??) ????????? ???? ???????? ? 17 ?????????? (????. 1). ?? ??????? 1 ?????????????????
???????? ?????? ??? ???.
? ?????????? ?????? ?????????? ?????? ??????????? ??? ??????????? ?????????????? ???????? ???????? ?????????????: ??????????? ?????????? ?? ????????? ? ?????? ????? ??????, ???????
???????? ?? ? ???????? ?? (???. 2). ??????????
????????? ?????? ??? ??? ????????? ? ??????? 2.
??????? ????? ?????? ????????? ? ??????
???????????? 66 ? (95% ?? 27,5; 230,8 ?),
Z-score = +3,8 (+0,2; +10,4). ????? ?????? ????????? ????? ? 87% ???????, ?????? ????? ??????
(??? ? ???????? ????? ?????? ?????? ??? ???
? ?? ?????????????? ??????????? ?????????) ??-
????????? ??????????? 30 ?????????? ??????
? ??? ?????, ??????????? ? ????? ??. ?.?. ???????? ???? ?? ?????? 1998?2012 ??. ??????? ?? ?????? ?????? ???????? (??, 95% ??): 0,4 ???? (0,04;
9,1). ??????????? ???????? ? ???????? ???? ????
2:1. ???????? ?????? ????????? ?? ????????, ????????????? ? ????? ??. ?.?. ???????? ????, ??????? ????????? ????????? ??????????? ??????????? ?????????? ???????? ?????? [13].
???????????????? ?????????? ???????? ???
????: 1) ?????? ?????????? ????? ? ?????? ???
???????????????? ?????????? ?? ?? ??; 2) ??????????? ????; 3) ????????????? ???????? ????? ? ??; 4) ??????? ???????????? ?????? ??? ????? ????? ???????????????????? ??????? (??????
??? ???????? ???????????????), ?? ???? ?????????? ?????????? ?????????-??????????? ??????????? ??. ???? ???????? ????????? ?????????:
????? ?????? (??), ???????? ????????? ?????
???????? ?????? ? ??????????? (??), ??????????????? (??), ????????? (??) ? ??????????? (??), ??????? ???????? ??????? ? ?????? ??????????
(????, ????). ?????????? ??????????? ???????? ?????????? ? ??????????????? ??????? ? ????? [14] ? ??????????? ?????????? Z-score. ?? ??????????? ??????????????? ??????? ??????????
????????? ????????? ??? ??????????? ??????????
?????? ??? ???. ???? ??????? ??????? ?? ????????? ?????? ??? ??? ????? ??????????? ????????, ??? ???, ?????? ???????? ??????????? ??
Heath?Edwards, ??????????????? ??, ??????? ?????????? ?????, ??????? ?????????????? ????.
Йбашн╦з?з?
М?╥нк?? 1
Мкт? с╥рз?шм?кх ?с?з?н╦лсош м?с?сзсмш ? рб????? р ?лсо?нкбх М?шррк??екл?? (n=17)
????????????? ?????????? (n=9)
1. ?????????? ????? (n=3)
2. ???????????? ?????? ????? (n=1)
3. ?????????? ???? ????? (n=2)
4. ?????????? ????? ? ???????????
???? ????? (n=2)
5. ????????? ?????? ????? (n=1)*
?????????????? ?????????? (n=8)
2-????????? (n=3)
1. ???????????? ??????+???????
1. ?????????+????????????
???? ????? (n=2)
??????+?????????? ????? (n=2)
2. ????????? ??????+?????????? ???? 2. ?????????+????????????
????? (n=1)
??????+??????? ???? ????? (n=1)
3. ?????????+????????????
??????+?????????? ???? ?????
(n=1)
4. ????????? ??????+?????????? ????
?????+?????????? ????? (n=1)
* C????? ?????????? ?????????? ???????????? ??????? ??????????? ???????.
16
3-????????? (n=5)
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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??
???? ??
??
???
??
????
???
??
??
??
???
???
??
?
??
????
??
??
??
???
???
?
?
???. 1. ???????? ?????? ? ????????? ?????????????, ?????????? ???????: [(S) C (DRH, L, SPC-SAC) DORV (D-P)]:
? ? ????? ??? ??????; ? ? ?????? ?????????; ? ? ????? ?????????.
?? ? ?????; ?? ? ???????? ???????; ??, ?? ? ?????? ? ????? ?????????; ??? ? ???????? ???????????? ??????; ???, ??? ? ?????? ? ????? ???????? ???????; ??? ? ??????????????? ???????????; ?? ? ???????? ???????????; ???? ? ??????????? ?????? ??????????????? ???????????;
?? ? ?????????????? ??????; ?? ? ?????????? ??????.
????? ??????
?=0,004
66,0
???
13,3
?=0,002
35,5
????
6,2 ?=0,001
9,9
2,6
????
???
???
???
???????? ?????????????
??????????? ????????? ??????
???. 2. ????????? ???????????????? ?????????? ??????
??? ??? ? ? ?????, ?? ?????? D.M. Schulz, D.A. Giordano
(1962 ?.). ???????? ??????????, ?????????? ???????????? ??
?????, ???????? ??????????? ???????.
????, ???? ? ??????? ???????? ??????? ? ?????? ??????????
(? ???????????); ???, ???, ???, ??? ? ???????? ????????????????,
???????????, ??????????? ? ????????? ???????? (? ???????????); ????? ?????? (? ???????)
??????? ? ??????? 31,5 ? (95% ?? 12,1; 124,3),
Z-score = +4,3 (+2,3; +10,9), ?<0,001. ? ?????????
13% ??????? ??? ???? ? ???????? ?????????? ???????? ? ??????? ???????? ????????? 8,5 ? (95%
?? 0; 12,0), Z-score = +1,1 (?0,1; +1,7). ????????
????? ??????, ??????????????? ? ????? (?/??)
? ????? ???? (%), ? ?????? ??? ????? ??????????
(?<0,0001) ????????? ??????????????? ?????????? ? ????? (???. 3). ?? ??????????? ????????????????? ??????? ???????????, ??? ????????????
????????? ?????????? ?? ??? ??? ????????: ??????? ?? (F=3,64; ?=0,048) ? ??????? ???????
(F=28,2; ?=0,0001). ??? III?IV ?????? ?? ????????
Z-score ????????? +7,3 (+0,4; +11,9) ?? ?????????
?? ????????? Z-score ??? ?? I?III ??????, ??????
+3,8 (+0,26; +8,9). ?? ???? ???????? ??????? ???
??? ??? ??????????? ?????????????: ?? ???
? ???????? 5 ??? ?????????? 71 ?, ????? ??? ? ???????? 0,17 ??? ?? ???????? ????? 23 ?. ??????????? ??????? ?????????????? ??????????? ????? ??, ???
? ???????? ??????????? ???? (???) ??????? ???
???. ??????? ????????? ?????????, ???????????
??? ?????????: ?? (?) = ?7,18961 + 252,55239 в
в ??? (?2); SD = 20,94509, r = 0,94, p < 0,001
? ??? (?) = ?0,2151 + 104,48897 в ???, r = 0,758,
SD = 20,8971. ?? ??????????? ???????????? ???????
17
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
М?╥нк?? 2
Юаоб?блл?б т???обз?? рб???? т?к ?лсо?нкк М?шррк??екл?? к ? лс?об
???????? ??????????, ?╠SD ??? ?? (95% ??)
????????
????, ??
????, ??
???, ??
???, ??
???, ??
???, ??
??, ?
???
?????*
6,2╠2,4
7,6╠2,4
16,1╠4,5
10,4╠4,1
15,9╠4,2
13,3╠4,8
66 (27,5; 230,8)
2,6╠0,2
7,0╠1,4
16,6╠4,5
9,4╠2,8
13,7╠4,1
9,9╠2,8
35,5 (21,0; 130,35)
Z-score ?? (95% ??)
?
+4,45 (+0,5; 18,3)
+0,35 (-1,8; +2,9)
+0,03 (-3,8; +2,6)
+0,6 (-1,8; +4,5)
+1,4 (-1,5; +4,5)
+2,0 (-1,6; +5,8)
+3,8 (+0,2; +10,4)
0,001
0,24
0,70
0,28
0,05
0,02
0,004
* ?? ??????????? ???? ?????? D.M. Schulz, D.A. Giordano (1962 ?.).
? ? ? ? ? ? ? ? ? ?. M ? ??????? ?????????????? ????????; SD ? ??????????? ??????????; ME ? ???????; ?? ? ?????????????
????????.
????? ??????/????, ? в ??-1
2,0
1,8
1,6
p<0,001
??/??, %
???
1,1╠0,3
1,5
1,3╠0,3
1,4
1,2
p<0,001
1,0
?????*
0,6╠0,1
0,8
1,0
0,6╠0,1
0,6
0,4
0,2
0,5
0,0
0,0
?
0,2
0,4
0,6
???????, ???
0,8
?????**
1,0
???
?
???. 3. ??????????????? ???????? ????? ?????? ??? ???????? ????????????? (???) ? ? ?????:
? ? ?????????? ? ????? ????; ? ? ?????????? ? ????? ????.
* D.M. Schulz, D.A. Giordano (1962 ?.); ** ?.?. ????? (1901 ?.)
???????????, ??? ????? ??????????? ???????, ???
???, ??????????????? ??, ??????? ??????????
????? ? ?????????????? ???? ?? ????????? ??????? ?? ???????? ??.
?????????? ????? ?????? ??? ??? ??????????
? ???????? ?? ???? ?????????? ????? ??: ? 84%
??????? ? ?????? ???????????? ??????? ????????
?? ????????? ????? ? ????????? ? ???????
6,2╠2,3 ?? (M╠SD) ?? ????????? ?? ?????????
2,6╠0,2 ?? ? ?????, Z-score = +4,7 (+0,52; +17,7).
??????? ???????? ?? ?????? ??? ??? ? 90% ??????? ??????????????? ????? ? ???? ????? ? ??????? 7,1╠1,8 ?? (Z-score = +0,3); ? 10% ???????,
? ??????? ???????? ?????????? ???????? ??????? ???????? ?? ?? ????????? ? ??????
(12,0╠3,0 ??), ???????? Z-score ?????????? ?? +2,0
?? +4,1. ? ?????? ????????????, ?? ???????????
???????????? ???????, ?? ???????? ?????? ? ??????? ?? ??????? ???????? ?????????? ?????? ???
??? ????? ????????, ??? ??? ????????, ??????? ?????????? ?????, ??????????????? ??, ?????? ??
? ??????? ?????????????? ????.
18
??? ?????? ??????????? ????????? ?????????
???????? ??? ??? ???? ???????? ????????? ??????: ? ??????????? ??????? (? 81% ? ??? ??,
? 68% ? ??? ?? ? ? 55% ? ??? ??) ???????? ???????? ??????????????? ????? ????????? ? ????? (???????? Z-score ?? +0,05 ?? +1,3). ?????????? ???????? ???????? ??????, ??????? ???????? ? 52%
??????? ???????? ?????????????? ???????????
???????? (ME ? 95% ?? Z-score ??????????????
+3,4 ? +2,1; +6,5), ?=0,002.
? ??????? 3 ???????????? ?????????? ???????
??????? ??????? ?? ?? ?????? ???????? ?????? ???
???: ?????????? ????????? ???????? ??????? ? ????? ??????? ????????? ? ?????? ? III?IV ??????? ??
(??=5,1 ???? ?? ????????? ? ??=2,1 ??? ? ??????
? I?III ??????? ??), ?? ?????? Z-score, ????????
? ????????? ???????? ? ??????????? ?? ??????? ??
?? ????????.
? ??????? 4 ???????????? ?????????? ???????????? ??????? ?????????? ????? ?? ???????? ???????? ?????? ??? ???, ?? ??????? ???????: 1) ???
?????????? ?????????? ????? ???????? ???? ???-
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
М?╥нк?? 3
гнк?лкб рзбтблк нб?с?лсх ?ктб?зблакк л? ??аоб?? мн?т?лс? рб???? т?к ?лсо?нкк М?шррк??екл??
?????? ? ???????????? ?? ??????? ???????? ??????????? ?? Heath?Edwards
I?III ?????? (n=24)
??????? ???????, ??
Z-score (?)
M╠SD
??
??
??
??
III?IV ?????? (n=6)
14,7╠3,5
14,7╠3,3
9,1╠2,8
12,0╠3,8
M╠SD
+0,3
+1,4
+0,8
+2,0
Z-score (?)
21,7╠6,1
20,7╠4,3
15,2╠4,8
18,5╠5,0
0
+0,6
+0,9
+0,9
? ? ? ? ? ? ? ? ? ?. ??????? ???????? ????? ? ?????? ? I?III ??????? ???????? ??????????? ????????? 2,1 ??? (95% ?? 1,2; 5,1), ?
?????? ? III?IV ??????? ?? ? 61 ??? (95% ?? 18,0; 98,8).
М?╥нк?? 4
як?обз?? мн?т?лс? рб???? т?к ?лсо?нкк М?шррк??екл?? т?к л?нк?кк кнк сзршзрз?кк с╥рз?шм?кк ?с?з?
??????
??????? ???????,
??
??? ?????????? ????? (n=13)
M╠SD
??
??
??
??
18,6╠5,3
16,8╠4,7
12,2╠4,5
15,3╠5,6
? ??????????? ????? (n=17)
Z-score (?)
M╠SD
Z-score (?)
+3,3
+4,1
+4,4
+7,4
14,0╠3,2
15,7╠4,2
8,3╠1,7
11,9╠2,7
+0,8
+3,1
+1,4
+4,1
????? ?? ???????? Z-score ????????? ??????????????? ???????? ? ?????; 2) ??????? ??????????
?? ??????????? ?? ??????? ?? ? ?? (Z-score ?????????????? +0,8 ? +1,4); 3) ???????? ?? ? ?? ???
??????? ?????????? ????? ????????? ??????????????? ?????????? ? ?????; ?????????? ????????
???? ???????? ?? ?????????? ?? ??????? ? ???????
? ??? ??? ?????????? ????? (Z-score ?????????????? +3,1 ? +4,1 ??? ??, +4,1 ? +7,4 ??? ??, ???????? ????????????? ????????????). ??????? ? ???????? ????? ????? ???????? ????????? 1,1 ??? (??
3,3 ? 2,2 ???).
??????????? ??????????? ????? ??????????
???????? ?????? ??? ??? ? ???????? ???????????
???? ? ??????? ????????????? ??????????, ?????????? ????????? ????????? ??? ??????? ?? ????????: ??? = 9,43846 + 17,75915 в ??? (?2),
r = 0,83; SD = 2,8; ?<0,001; ??? = 9,96959 +
+ 15,85081 в ??? (?2), r=0,87; SD=2,8; ?<0,001;
??? = 1,64704 + 28,73639 в ??? (?2) ? 15,79502 в
в ??? (?2), r=0,98; SD=0,55; ?<0,001; ??? =
= 6,6513 + 17,75063 в ??? (?2), r=0,85; SD=2,5;
?<0,001.
И╥ршй?блкб
? ??????????, ??????????? ???????? ?????????????, ???????????????? ????????????
???????????? ? ????????? ???????. M. Lev ? ?????. (1966 ?.) ????????? ???????????? ? ?????????????? ?????? ?????????? ?????? ??? ???????
??????????????? ????? ???. ?????? ????????
p
<0,05
??
<0,05
??
????? ??????, ??????? ?????? ? ?????? ????? ??????????, ?????????? ??????????????????? ? ?????????? ????????. ??????????, ? ?????????,
?? ???????????? ? ???? ???????? ????????, ? ????
??? ????????? ? ?????????? ????? ??????, ??????????? ?????????? ?? ? ??, ??? ???????? ?????????? ??? ?????????? ??, ?????????? ??? ???????????? ????? ??????? ?? [12]. R. Van Praagh
(1968 ?.) ??????? ????????? ?????? ?????????????? ?????? (?????? ???????????? ?????? ????? ??
? ??, ????? ?? ? ??; ????? ?????????? ????????
??????????? (crista supraventricularis), ?????????? ?????????? ??????? ????? ?????????? ???????? ?? ??), ?????????????? ?????? ????????? ? ?????? ????? ?? ??????????? [2]. H. Kurosawa ? ?????. (1986 ?.) ???????? ????? ????????
???????????, ?????????? ????? ???????????
? ???????????????????? ?????????, ??????????????? ????????????? ??????? ? ???????? ??? ??????????? ???????????? ???????? ???????? ??????? ??? ????????? ?????? ???????????? ????????????? ??????? (???) ? ??? [10]. ?? ??????
?????? ?????????????? [11, 15?18], ?????? ????????? ???????? ??????????? ??? ??? ?? ??????
?????????? ??? ????, ???????????? ? ? ????????
????? ??????? ?????????????? ??????? ??????. ???
??????????????? ??? ??????, ???????? ????????
???????? ??????????? ? ???????????? ????????
? ???????????? ?????????????? ???????, ??????????? ???????? (╚?verriding╩) ????????? ??????? ? ???????????? ???? ???? ╚??????????????╩
(╚malalignment╩). ????????????? ??????, ?? ??
19
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
??????, ???????? ???????? ? ?????????? ??? ???????? ???? ?????.
?????????????? ? ?????? ?????? ????????????,
???????, ??????? ???? ?????? ?????????????? ?????????????? ???. ????????? ?? ?????? ????????? ???????? ???????? ? ?????????? ?????? ? ????????? ????????, ??????? ?????? ????? ??????????, ????? ??????, ?? ????????? ?????????
?????? ??? ??? ? ???????????? ????????? ??????????? ?????????? ? ????? ? ??????????? ?????????? Z-score, ???????????? ??????? ??????? ?????????? ??????? ?? ?????????? ?? ??????????????
?????.
?? ??????????? ???????????? ??????? ????????
??????????? ?????? ?? ?????????? ????? ??????
??? ??? ?? ????????? ? ?????????? ?????, ?????????? ??????? ???????? ?? ? ???????? ?????????
???????.
??????? ???????????? ???? ??? ??? ? ???????????????? ???????????? ????????? ??????? ???????????? ???????? ? ????????? ??????? ????????
??????????? [18]. ???? ???????????? ???????????,
??? ??????? ???????? ???????????, ?????? ?? ??????? ?????????, ???????? ??????????? ????????
?????????? ?? ????????? ? ?????? ????? ??????
??? ???, ? ?? ????? ??? ???, ??????????????????
??, ??????? ?????????? ??????????? ?????????
? ??????? ?????????????? ???? ?? ???????????
?? ???????? ????? ??????.
??? ????????????????? ??????????? ??????? (??????? ??????? ???????? ???????????) ??
?????? ?? ??????? ?????????? ??????? ?????? ??????????.
???????????? ??????? ?????? ? ??????? ?????????? ??????????? ????????? ?? ???????? ???????? ?????? ??? ???: ???????? ?? ? ?? ??? ??????? ?????????? ????????????? ????? ??????????
??????, ? ???????? ?? ? ?? ? ????????? ?? ????????? ? ??????. ? ??????? ??? ??? ??????????
????? ??????? ???? ???????? (???????? ?????????,
Z-score +7,4) ????????? ???????? ?????????????? ?????.
?????????? ? ?????? ???????????? ????????
? ?????????????? ???????? ?????? ? ??? ????????
??? ??? ?? ????????? ???????? ? ???????? ? ??????????????? ???????? ???????????????? ???????????? ??? ??????????? ? ??????????? ?????????????? ???????? ?????? ? ????????? ? ?????????? ??????????? ???????? ??????.
г??с??
1. ?????????????? ?????? ?????? ? ??? ???????? ??? ???????? ????????????? ????????? ?????????? ??? ??????????? ?????????????? ????????:
?????????? ?? ????????? ? ????? ????? ??????
(? 87% ???????), ??????? ???????? ?? (? 84% ??????????) ? ???????? ????????? ??????? (? 52%
???????).
20
2. ? ??????????? ?????? ? ????????? ????????????? ??????? ???????? ?? (90%), ????????
??????????????????? (?? ? 81%, ?? ? 55%) ? ??????????? ???????? (68%) ??????????????? ???????
??????????? ?????????.
3. ???????????? ????????? ?????????? ?????
?????? ??? ???????? ????????????? ????????: ??????? ??????????????? ????????? ???????? ???????????? ??????? (III?IV ?????? ?? Heath?Edwards;
F=3,64; p=0,048) ? ??????? ??????? [ME, 95%
??=5,9 ??? (1,87; 9,42); F=28,2; p=0,0001].
4. ??????? ?????????????? ????????? ? ??????????? ??????????????? ???????? ????? ??????,
??? ????????? ?????????? ???????????? ????????
????? ?????? ??? ???????? ????????????? ? ?????????????? ???? ????????????????? ? ????????????? ??????????.
5. ???????????? ??????? ???????? ????????????? ?????????????? ????????????? ? ??????????? ??????????? ????? ?????? ?? ????????? ? ???????? ???????????? ??????????, ???
????????? ?? ????????????? ?????? ????????????? ????????? ????? ??????.
??????????
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Taussig H.B., Bing R.J. Complete transposition of aorta and
levoposition of pulmonary artery. Am. Heart J. 1949; 37: 551.
Van Praagh R. What is the Taussig?Bing malformation?
Circulation. 1968; 38: 445?9.
Walters H.L., Mavroudis C., Tchervenkov C.I., Jacobs J.P.,
Lacour-Gayet F., Jacobs M.L. Congenital heart surgery
nomenclature and database project: double outlet right ventricle. Ann. Thorac. Surg. 2000; 69: S249?63.
Mavroudis C., Backer C.L., Muster A.J., Rocchini A.P.,
Rees A.H., Gevitz M. Taussig?Bing anomaly: arterial switch
versus Kawashima interventricular repair. Ann. Thorac. Surg.
1996; 61: 1330?38.
Wilcox B.R., Cook A.C., Anderson R.H. Surgical anatomy of
the heart. 3th ed. UK: Cambridge University Press; 2006.
Alsoufi B., Cai S., Williams W.G., Coles J.G., Caldarone C.A.,
Redington A.M. et al. Improved results with single-stage total
correction of Taussig?Bing anomaly. Eur. J. Cardiothorac.
Surg. 2008; 33: 244?50.
Griselli M., McGuirk S.P., Ko C.S., Clarke A.J.B., Barron D.J.,
Brown W.J. Arterial switch operation in patients with
Taussig?Bing anomaly ? influence of staged repair and coronary anatomy on outcome. Eur. J. Cardiothorac. Surg. 2007;
31: 229?35.
Sinzobahamvya N., Blaschczok H.C., Asfour B., Arenz C.,
Jussli M.J., Schindler E. et al. Right ventricular outflow tract
obstruction after arterial switch operation for the Taussig?Bing
heart. Cardiothorac. Surg. 2007; 31: 873?78.
Rodefeld M.D., Ruzmetov M., Vijay P., Fiore A.C.,
Turrentine M.W., Brown J.W. Surgical results of arterial switch
operation for Taussig-Bing anomaly: is position of the great
arteries a risk factor? Ann. Thorac. Surg. 2007; 83: 1451?57.
Kurosawa H., Van Mierop H.S. Surgical anatomy of the
infundibular septum in transposition of the great arteries with
ventricular septal defect. J. Thorac. Cardiovasc. Surg. 1986;
91: 123?32.
Stellin G., Zuberbuhler J.R., Anderson R.H., Path M.R.,
Siewers R.D. The surgical anatomy of the Taussig?Bing malformation. J. Thorac. Cardiovasc. Surg. 1987; 93: 560?9.
Lev M., Rimoldi H.J.A., Eckner F.A.O., Melhuish B.P.,
Meng L., Paul M.H. The Taussig?Bing heart. Pathology. 1966;
81 (1): 24?35.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
13.
14.
15.
16.
17.
18.
19.
????? ?.?. ?????? ??????????? ???????? ? ????????????
?????? ????????. ? ??.: ?.?. ???????, ?.?. ???????? (???.).
?????? ?? ???????????. ?.: ????? ??. ?.?. ????????
????; 2001; 2: 171?85.
Schulz D.M., Giordano D.A. Hearts in infants and children.
Arch. Pathol. 1962; 74: 464?71.
Ueda M., Becker A.E. Classification of hearts with overriding
aortic and pulmonary valves. Int. J. Cardiol. 1985; 9: 357?70.
Anderson R.H., Lenox C., Zuberbuhler J.R. Morphology of
ventricular septal defect associated with coarctation of aorta.
Br. Heart J. 1983; 50: 176?81.
Waldman J.D., Schneeweis A., Edwards W.E., Lamberti J.J.,
Shem-Tov A., Neufeld H.N. The obstructive subaortic conus.
Circulation. 1984; 70: 339?44.
???? ?., ?????????? ?., ????????? ?. ???????????????
??????????? ??? ??????? ?????????? ??????? ?? ???????
?????????. ? ??.: ????????? I ??????????? ?????????? ?
???????? ??????????? ???????????? ╚?????????? ? ??????????? ?????? ? ????? ? ??? ?????????? ???????╩.
?.; 1990: 112?8.
????? ?.?. ???? ?????? ? ????? ?? ?????????: ???. ? ?-??
???. ????. ???.; 1901: 110.
References
1.
2.
3.
4.
5.
6.
7.
Taussig H.B., Bing R.J. Complete transposition of aorta and
levoposition of pulmonary artery. Am. Heart J. 1949; 37: 551.
Van Praagh R. What is the Taussig?Bing malformation?
Circulation. 1968; 38: 445?9.
Walters H.L., Mavroudis C., Tchervenkov C.I., Jacobs J.P.,
Lacour-Gayet F., Jacobs M.L. Congenital heart surgery
nomenclature and database project: double outlet right ventricle. Ann. Thorac. Surg. 2000; 69: S249?63.
Mavroudis C., Backer C.L., Muster A.J., Rocchini A.P.,
Rees A.H., Gevitz M. Taussig?Bing anomaly: arterial switch
versus Kawashima interventricular repair. Ann. Thorac. Surg.
1996; 61: 1330?38.
Wilcox B.R., Cook A.C., Anderson R.H. Surgical anatomy of
the heart. 3th ed. UK: Cambridge University Press; 2006.
Alsoufi B., Cai S., Williams W.G., Coles J.G., Caldarone C.A.,
Redington A.M. et al. Improved results with single-stage total
correction of Taussig?Bing anomaly. Eur. J. Cardiothorac.
Surg. 2008; 33: 244?50.
Griselli M., McGuirk S.P., Ko C.S., Clarke A.J.B., Barron D.J.,
Brown W.J. Arterial switch operation in patients with
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
Taussig?Bing anomaly ? influence of staged repair and coronary anatomy on outcome. Eur. J. Cardiothorac. Surg. 2007;
31: 229?35.
Sinzobahamvya N., Blaschczok H.C., Asfour B., Arenz C.,
Jussli M.J., Schindler E. et al. Right ventricular outflow tract
obstruction after arterial switch operation for the Taussig?Bing
heart. Cardiothorac. Surg. 2007; 31: 873?78.
Rodefeld M.D., Ruzmetov M., Vijay P., Fiore A.C.,
Turrentine M.W., Brown J.W. Surgical results of arterial
switch operation for Taussig-Bing anomaly: is position of the
great arteries a risk factor? Ann. Thorac. Surg. 2007; 83:
1451?57.
Kurosawa H., Van Mierop H.S. Surgical anatomy of the
infundibular septum in transposition of the great arteries with
ventricular septal defect. J. Thorac. Cardiovasc. Surg. 1986;
91: 123?32.
Stellin G., Zuberbuhler J.R., Anderson R.H., Path M.R.,
Siewers R.D. The surgical anatomy of the Taussig?Bing malformation. J. Thorac. Cardiovasc. Surg. 1987; 93: 560?9.
Lev M., Rimoldi H.J.A., Eckner F.A.O., Melhuish B.P.,
Meng L., Paul M.H. The Taussig?Bing heart. Pathology. 1966;
81 (1): 24?35.
Sinev A.F. Bases of clinical anatomy and embryogeny of the
human heart. In: L.A. Bockeria, E.Z. Golukhova (eds).
Lectures on Cardiology. Moscow: A.N. Bakoulev Scientific
Center for Cardiovascular Surgery of Russian Academy of
Medical Sciences; 2001; 2: 171?85 (in Russian).
Schulz D.M., Giordano D.A. Hearts in infants and children.
Arch. Pathol. 1962; 74: 464?71.
Ueda M., Becker A.E. Classification of hearts with overriding
aortic and pulmonary valves. Int. J. Cardiol. 1985; 9: 357?70.
Anderson R.H., Lenox C., Zuberbuhler J.R. Morphology of
ventricular septal defect associated with coarctation of aorta.
Br. Heart J. 1983; 50: 176?81.
Waldman J.D., Schneeweis A., Edwards W.E., Lamberti J.J.,
Shem-Tov A., Neufeld H.N. The obstructive subaortic conus.
Circulation. 1984; 70: 339?44.
Tuma S., Povishiliva V., Shkovranyak Y. Infundibulum in double outlet right ventricle. In.: Heart morphology and morphometry in norm and in congenital heart diseases. Proc.1st AllUnion Symp. with Aid of Foreign Specialists. Moscow, 1990:
112?8 (in Russian).
Falk A.A. Cardiac growth in children of different age. Dr. med.
sci. Diss. Saint Petersburg; 1901 (in Russian).
????????? 07.04.2014
21
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
╘ ????????? ???????, 2014
??? 616.12-007.21-053.1-08:616.126.56-089.843
???? ????????? ???????? ????? ???????????
?????????????? ?????? ???????? ???????
??? ??????????? ????????? ??????????
??????? ??????
?.?. ?????????, ?.?. ????????, ?.?. ?????, ?.?. ????????, ?.?. ???????,
?.?. ???????, ?.?. ??????????, ?.?. ?????????
???? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ?
???????? ??? ? ???? ?.?. ???????) ????; ?????????? ?????, 135, ??????, 121552,
?????????? ?????????
????????? ???????? ????????, ?????? ???. ????, ?????????, ???????? ???, ??????????
??????????;
???????? ????? ??????????, ?????? ???. ????, ?????????;
????? ???? ?????????????, ????. ???. ????, ???. ?????. ????., ????????????;
???????? ?????? ?????????, ?????? ???. ????, ???. ?????. ????., e-mail: samsonof@yandex.ru;
??????? ??????? ??????????, ?????? ???. ????, ???. ?????. ????.;
??????? ????? ???????, ?????? ???. ????, ???. ?????. ????.;
?????????? ???? ????????????, ?????? ???. ????, ???. ?????. ????.;
????????? ??????? ????????????, ????????
????????. ? ????????? ???? ?? ?????? ??????????????????? ???????? ???? ???????? ???????????? ???? ?? ??????????
?????????????? ?????? ???????? ??????? (??) ??? ????????? ?????????? ??????? ?????? (???). ?????? ? ??? ??????????
?? ????? ?????????? ? ?????????? ????? ???????????????, ??? ? ???? ??????? ?????????? ?????????? ????????, ??????? ????
????? ??????????? ? ??? ?????????? ? ??????? ?????????????? ??? ???????????????? ?????????????.
???????? ? ??????. ? 1964 ?? 2013 ?. ? 244 ??????? ????????? ??????????? ????????? ??????? ??? ? ??????????????
????????? ????? ?????????. ? ?????????? ????? ????? ???????? ? 125 (51,8%) ??????? ????????? ????????? ????????
(14 ??????? ????????????? ??????): ???????? ????????????? ????????????? ????????? 84 (67,2%) ???????, ?????????
??????????????? ????????? ? 41 ????????. ??????? ????????? ?? ?????? ?????????? ????????????? ????????? ?? 3 ?? 37 ???,
? ??????? ? 14,6 ????, ???????? ????? ??????????? ?????????? ? ????????? ????????? ? 9,8╠7,6 ???? (?? 1 ???? ?? 16 ???).
??????????. ? ?????? ????????????????? ??????? ?????? 9 (7,2%) ?????????. ? ?????????? ??????? ????? ?????????
???????? ??????????? 60 ?????????. ???? ?????????? ???????? ? ??????? 6,3╠1,8 ????, ??????? ??????? ?? ??????
???????????? ? 14,4╠3,5 ????. ? I ??????????????? ?????? (??) ???????? 36 (60%) ?????????, ?? II ? 18 (30%), ? III?IV ?
6 (10%). ????? ????????? ???????? ???????? ? ????? ?? 2 ??? ?? 4 ??? ??????? 3 ????????. ???????????? (23,3%) ?????????
????? 2?4 ???? ????? ????????? ???????? ???? ????????? ????????? ??????????.
??????????. ??????? ?????????? ??????? ???????????, ??????? ???????????? ? ???????????? ?? ????????? ? ??????????
??????? ??????????? ???? ????????? ???????? ????? ??????????? ?????????.
???????? ?????: ?????????? ?????? ??????; ????????? ????????; ??????????; ????????????? ????? ???????? ???????;
??????????????? ????????.
EXPERIENCE REOPERATIONS AFTER IMPLANTATION OF ARTIFICIAL
PULMONARY ARTERY TRUNK WITH RADICAL CORRECTION
OF CONGENITAL HEART DEFECTS
V.P. Podzolkov, I.V. Kokshenev, I.A. Yurlov, V.B. Samsonov, D.V. Kovalev,
T.Yu. Danilov, I.V. Zemlyanskaya, B.D. Mamadshoev
A.N. Bakoulev Scientific Center for Cardiovascular Surgery of Russian Academy of Medical
Sciences; Rublevskoe shosse, 135, Moscow, 121552, Russian Federation
Podzolkov Vladimir Petrovich, MD, DM, Professor, Academician of Russian Academy of Sciences,
Chief of Department;
Kokshenev Igor? Valer?evich, MD, DM, Professor;
Yurlov Ivan Aleksandrovich, MD, PhD, Leading Research Associate, Cardiac Surgeon;
Samsonov Victor Borisovich, MD, DM, Leading Research Associate, e-mail: samsonof@yandex.ru;
Kovalev Dmitriy Viktorovich, MD, DM, Leading Research Associate;
Danilov Timur Yur?evich, MD, DM, Leading Research Associated;
Zemlyanskaya Inga Vladimirovna, MD, DM, Leading Research Associate;
Mamadshoev Broimsho Davletshoevich, Postgraduate
22
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
Introduction. In recent years, many cardiac clinics around the world have accumulated considerable experience in the use of artificial pulmonary artery trunk in the correction of congenital heart disease. However, observation of these patients in the long-term period indicate that in some cases there prosthetic dysfunction, which often lies in its obstruction and require surgical or endovascular
intervention.
Material and methods. From 1964 to 2013 in 244 patients underwent radical correction of complex CHD using different types of
conduits. In the long-term period after surgery in 125 (51.8%) patients fulfilled reoperations (14 patients operated on again twice):
open surgery performed 84 patients (67.2%), various endovascular procedures ? 41 patients. The age of patients at the time of reintervention was from 3 to 37 years, mean 14.6 years, the interval between radical correction and re-operation ? 9,8╠7,6 years (from
1 to 16 years).
Results. In the early postoperative period 9 patients died (7.2%). In the late period after reoperation examined 60 patients. Followup was average ? 6,3╠1,8 years, the age of patients at the time of the survey was on average ? 14,4╠3,5 years. By functional class I
related 36 (60%) patients to II ? 18 (30%) to the III?IV ? 6 patients (10%). After re-open operations in the period from 2 months to 4
years, 3 patients died; 14 (23,3%) patients in 2?4 years after the reoperation was performed re-reoperation.
Conclusion. A large number of good results, high survival and stability of their condition in the long term to justify the risk of reoperation after implantation conduits.
Key words: congenital heart disease; reoperation; complications; artificial pulmonary artery; endovascular surgery.
г?б?блкб
? ????????? ??????????? ?? ?????? ??????????????????? ???????? ???????? ????????????
???? ?? ?????????? ?????????????? ?????? ???????? ??????? (???????) ??? ????????? ??????????
??????? ?????? (???). ?????? ? ??? ?????????? ??
????? ?????????? ? ?????????? ????? ???????????????, ??? ? ???? ??????? ?????????? ??????????
????????, ??????? ???? ????? ??????????? ? ??? ?????????? [1?3].
? ??????? ?????????? ??????? ????????? ??????????, ?????????? ? ????????? ????????? ????? ??????????? ????????? [4, 5].
I. ??????????, ????????? ? ??????????? ????????. 1. ?????? ???????? ? ???????: ?) ?????????????? ??????????; ?) ??????? ????????; ?) ?????? ????????; ?) ??????????? ??????????. 2. ??????????????? ??????? ????????. 3. ???????? ???
?????? ????????? ????????? ? ??????? ?????????? ???????. 4. ????????.
II. ??????????, ?? ????????? ? ???????????
????????. 1. ??????????????? ????????????? ???????????????????? ???????. 2. ??????????????? ??????? ????????. 3. ?????????????? ???? ????????
???????? ??????? ??????????????? ???????????
(????). 4. ?????????? ?????? ???? ???????? ????????? ?????? ?????? ?????????. 5. ??????????
??????? ?????? ???????? ???????. 6. ?????????????? ???? ???????????? ??????? ?????????????
?????????????? ??????? ???? ????????? ????????????? ???????. 7. ????????.
????????? ? ??????????? ???????? ???????????????? ????????? ????????????? (?????) ? ????????????? ???????? ??????? (??) ???????????
??????? ??????? ???????? ??????? ??????????
?????????. ????????? ???? ???????, ????????? ??????????? ????????? ???????? ??????? ????????,
?????? ???????? ??????? ??? ? ?????????, ???
? ? ?????????? ????????????????? ???????, ???
????????? ???????? ????????????? ?????????????? ??????? ???? ????????? ?????????. ? ???????
????????? ????????? ??? ????????????? ?????????? ????????? ????? ??????? ????????????? ???-
????? ??????????, ?? ???????? ??? ???? ? ????????? ???????? [6?9].
???? ?????? ? ??????????? ???? ??????????
????????? ???????? ????? ??????????? ?????????????? ????????? ?????? ??? ?????????? ??????????? ????????? ??????? ???.
Е?зб?к?н к обзс??
C 1964 ?? 2013 ?. ? 244 ??????? ???? ????????? ??????????? ????????? ??????? ??? ? ?????????????? ????????? ????? ?????????. ? ?????????? ????? ????? ???????? ? 125 (51,8%) ???????
????????? ????????? ???????? (14 ??????? ????????????? ??????).
??????????? ?????????, ? ? ??????????? ????????? ????????, ??????????? ??? ?????????
???: ???????????? ????????????? ???????
? ???? ? ???????? ?? ? ? 37 (29,6%) ?????????,
????? ???????????? ????? (???) ? ? 21 (16,8%),
??????? ???????? ??????? ? ???? ? ? 21 (16,8%),
??????? ????? ? ? 14 (11,2%), ?????????? ?????
? ???????? ??????? ?? ??????? ????????? (??) ??
???????? ?? ? ? 14 (11,2%), ?????????? ?????
? ???????? ??????? ?? ?????? ????????? (??) ??
???????? ?? ? ? 4 (3,2%), ??????????????? ???????????? ????????????? ??????? (???) ?? ????????
?? ? ? 13 (10,4%), ????? ???????? ????? ?
1 (0,8%).
??????? ????????? ?? ?????? ?????????? ????????????? ??? ?? 3 ?? 37 ???, ? ??????? ????????
14,6 ????, ???????? ????? ??????????? ?????????? ? ????????? ????????? ? 9,8╠7,6 ???? (?? 1 ??
16 ???).
????? ?????????? ????????? ???????? ????
125: ???????? ????????????? ????????????? ????????? 84 ??????? (67,2%), ????????? ??????????????? ????????? ? 41 ???????? (????. 1).
????????? 72 (57,6%) ????????? ??????????????? II ??????????????? ?????? (??), 50 (40,0%) ????????? ???? ???????? ? III ??, ? 3 (2,4%) ? ? IV ??
?? ????????????? NYHA.
? 53 (42,4%) ??????? ?????????? ???????? ??????????????? ?????????????? 2??2? ??. ? 8 ???23
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
М?╥нк?? 1
Мкт? тс?зс?л?? стб???кх ? сз??нблл?б р?смк тсрнб котн?лз??кк мсл?шкзс?, n (%)
??? ????????
??????????????
????????????
???????????????????
???????????????????? ????????????
???????????????????? ?????????????????
?????? ?? ??????????????
?????? ?? ???
????????
????????????? ?????????????????
???
????????? Hancock
?????? Bjork?Shiley
?????? ???-????
??????
????????
????????
??????
?????
1
?
3
4
8
6
2
2
5
3
2
?
?
3
4
2
3
6
3
3
?
?
?
?
3
6
13
21
16
5
2
24
14
8
2
3
?
12 (9,6)
10 (8,0)
12 (9,6)
20 (16,0)
35 (28,0)
25
10
4 (3,2)
29 (23,2)
17
10
2
3 (2,4)
12 (9,6)
72 (57,6)
23 (18,4)
18 (14,4)
125 (100)
?????????????
????????
8
3
1
?
?
?
?????????????
??????
? ? ? ? ? ? ? ? ? ?. ??? ? ?????????? ??????? ?????? ???????? ???????? ?????; ??? ? c???????????? ??????? ? ?????????????
????????? ???????? (?????? ?????????? ??????).
???? ??? ???????? ????????? ????? ????? ??????
????????, ? 19 ??????? ????????? ??????? ?????????? ????? 2?6 ??? ????? ????????? ??-?? ????????????????? ????????????? ???????????.
? 26 ??????? ?????? ????????? ????? 3?6 ??? ????? ????????.
??????? ??????????? ? ??????? ????????
142,2╠10,2 ?/?, ????????? ????? ?????????? ? ?????????? ? ??????? ? 96,6╠5,7%.
???????????? ???????????????. ?????????????? ????????? ????????? ??????????? ??? ??????
????????? SPSS 11 ??? Windows. ?????? ???????????? ??? ??????? ???????? ????-????? ??????????? ??????????.
Йбашн╦з?з?
?? ?????? ?????????????? ??????? ?????? ??
????????? ???????? ? ???? ????????? ??????????? ?????????? ???? ?????? ?? ???? ??????????
??? ?????? ???????. ????????????????? ??????
????????? ? ???????? 53?62%, ? ???????
58,1╠2,3%. ? 85 (68%) ??????? ?? ???????????????
????????????????? ????????? ????????????? ????
????????????????? ????????. ? 51 (60%) ??????
????????? ??? ???????????? ?? ????????????
??????? ?????????????? ?????? ??, ?? ??????????????? ?? ?????? ????????, ?? ????? ?? ??? ???????.
????????? ????????? ??????? ??????? ? 34 (40%)
???????, ??? ???? ??????? ??????????? ????? ????????????? ???????? ??????, ?? ????????????
??? ??????????????. ? 6 ??????? ?? ??? ???????
????????? ??????? ????????. ???????? ???????24
??? ????????? ???????? ??? ????????????? ?????????????? ?????????, ????? ?????????? ? ???
????????????? ???????????? ???????? ? ???????????????????? ???????????? ?????????. ? ????????? ????? ??????????? ??????????????? ???????? ??????? ?????????? (?<0,01) ????? ?????? ????
????????? ?????? ????????? ??????????? (? ??????? 2,5 ????) ?? ????????? ? ??????? ?????? ????????? (? ??????? 5?6 ???).
?? ?????? ????? ? ???? 125 ????????? ??????????????? ???????? ?????????????? ???????? (???)
????? ?? ? ??, ??????? ????????? 45?108 ?? ??. ??.
(? ??????? ? 78,4╠17,6 ?? ??. ??.). ????????? ???????? ? ?? ??????????? ? ???????? 77?128 ?? ??. ??.
(? ??????? ? 96,4╠16,6).
???????, ?????? ? ?????????????? ??????????? ?? ?? ?????? ????? ??????????? ? ???????? ?????????? ????????. ???????? ?????????????? ????? (???) ?? ? ??????? ????????
82,4╠12,2 (64?96 ??/?2). ??????? ??????? ??
? ??????? ?? ?????? ????????? 58,1╠2,6%
(56?60%). ? 20 ??????? ?????????? ????????? ????????? ??????? ??, ????????????? ???????? ????????????? ? ?????????? ????????? ? ??
? ? ?????? ??. ?????? ??? ?? ? ??????? ?? ?????? ???????? 96,6╠12,6 ??/?2 (74?108 ??/?2). ?????????????? ??????????? ???????? ?? ? ???? ????????? ???? ??????????????????, ??????? ??????? ?? ? ??????? ????????? 56,2╠2,4%
(54?57%).
? 13 (7,6%) ????????? ?? ?????? ????? ????
???????? ????????????? ????, ??????? ? 12 ????????? ????? ????????????? ???????????, ?
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
? 1 ???????? ? ?? ???? ???????????????-????????????????? ?????????. ?????? ???????????????? ????????? ? 8 ????????? ????????? 4?7 ??,
? ? 5 ? 8?12 ??.
? 6 ????????? ???????? ????????????? ????????? ????????????? ???????, ? 1 ? ?????????????
?????? ?? ????? ????????? ?????? ???, ? 2 ? ?????? ??????????? ???????, ? 2 ? ???????????? ?????? ?????, ? 3 ? ??????????????? ??????????? ??????? II?III ???????, ? 18 ? ??????????????? ???????????????? ???????.
? 21 (16,8%) ???????? ?????????? ?????????
???????? ????????????, ? 31 (24,8%) ? ??????????,
??????? ???? ??????????? ??????????? ???????
?????? ????????. ???????-?????????????? ?????????? ?? ? ???? ????????? ????????????? ???????
?????????? ?? ??????????? ?? ????????? ??? ???????? ???????????? (?<0,05).
???? 125 ????????? ????? ????????? ?????????
???? ????????? ????????????? ???????? ??????
? ????????????????? (???). ???????? ?????????
?????????? ??????????????? ????????????: ??????????? ????????????? ???????? ????? ?? ? ??
? ??????? ???? 0,91╠0,19 ? ??????????? ?? 0,88 ??
1,34, ????????????? ???????? ? ?? ??????????
? ???????? 80?135 ?? ??. ??. (? ??????? 93,4╠
╠21,4 ?? ??. ??.). ? 5 ??????? (4,0%) ???????? ? ??
???? ?????? ??? ???? ?????????? ????????. ????????????? ???????? ? ?? ?????????? ? ????????
15?36 ?? ??. ??. (? ??????? 22,6╠7,6 ?? ??. ??.), ???
????? ?? ? ?? ???????? 56?106 ?? ??. ??. (? ??????? 72,2╠22,8 ?? ??. ??.), ????????????? ????????
? ????? ? 85?130 ?? ??. ??. (? ??????? ? 117,3╠18,4).
?? ?????? ??? ? 22 (17,6%) ????????? ???????? ?????????? ?????????? ????????? ?????????
??????? ??????????, ????????? ????????.
? 9 (7,2%) ????????? ??? ?????????? ?????? ???????????????? ????????????? ??????????? ?????????? ??????????????? ??????.
???????? ?????? ???????? ?????????? ????????? ??????? ?? ?????????????? ? ?????????????
??? ?????????? ??????? ? 36 ????????? (28,8%).
? 19 (15,2%) ????????? ???????? ?????????? ??????? ????????? ?????? ????????. ???????????
????????? ????????? ???????? ??????? ????????
? 10 (8,0%) ?????????. ??????? ????????? ???????
?? ? ???? ????????? ? ??????? ???????? 7,2╠2,2
(5?12) ??. ??????????? ??????? ???????? ?? ????
?????????? ? ??? ?????????????? ???????? ? ????
???????? (???????? ???????) ??????? ? 5 (4,0%)
???????, ??????????????? ???????? ???????
? ??????? ????? ???????? ? ? 2 (1,6%) ???????, ???????????? ???????????? ?????????? ? ??????????? ????????????????????? ???????? ? ???????????? ? ??? ???????? ????????? ?????????, ?????????? ??????? ???????? ?? 78?90% ? ? 2 (1,6%)
???????. ? 2 (1,6%) ??????? ???????? ????????????????? ?????????? ?????????????? ?????? ???????? ?? 50?60% ?? ?????????.
?? ???? ??????? ??????????? ? ????????? ???????? ???????? ??????? ?????????? ????????,
?????????? ? ????????????? ????????? ????????
? ??, ???????? ??? ????? ?? ? ??, ??????????????? ??????? ???????, ? ????? ??????? ??????????? ????????? ???????, ??????????????? ?????????????? 2?, 2? ???????, ?????????? ??????, ?????????????? ?????. ? 2 ??????? ???????? ??????
?????????? ????????.
? 49 ??????? ????????? ???????? ????????
? ??????? ??????????? ? ???????? ??????????????? ???????? ? ???????????????? ????????????
(╚?????????╩): ???????????? ??????? ?????????????? ?????????????? ?????????? ? ????????
60?244 ???, ? ??????? ? 135╠7,5 ???, ????? ????????? ????? ? 16?98 ???, ? ??????? ?
59,6╠7,3 ???, ??? ?????????? ???????????
17?30 ╟?, ? ??????? ? 23,3╠1,7 ╟?. ? ????????? ???? ???????? ?? ????????? ???????? ?????????
?????????? ? ???????? ?? ?????????? ?????? ? ???????? ??????????? ??? ?????????? ????????????
(35 ???????).
????????????? ????????, ?? ???? ?????? ??????
??????? ??????, ???? ????????? 12 (14,3%) ?????????. ?????? ?????????? ??????????? ???????????
? 8 ???????, ???????? ??????????? ? ? 3, ?????????????????? ???????????????????? ???????? ? ? 1.
?????? ????????????????? ??????? ????????????? ? 3 ??????? ?? ???????????? ?????????????
?????? (???-????, ????????) ? ? ????????? ??????? ? ?? ???????????????????? ????????????????? ??????? ?? ????????? ?? ??????????? ???????
??????.
? 72 (85,7%) ????????? ???? ???????????? ???????? G.K. Danielson [10]. ? 47 (65,3%) ???????
??? ?????????? ???????? ??? ???????? ????????
?????? ???????? ???????????? ???????????????????? ??????? ? ???????????? ??? ??????????
??????? ???????? ???????????? ? ????????????????? ???????. ? 25 ??????? ? ???????? ?????
5?6 ??? ? ????? ???? ????? 25?30 ?? ??? ????????
?????????????? ??????? ??? ??????????????? ??????? ?? ????????? ?????????? ?????????????? ?????????? ???????? ?????????? ??????????????
???????? ? ?????????? ????? ????? ?????????
????????.
? ?????? ????????????????? ??????? ??????? 9 ?????????, ??? ????????? 7,2% ?? ????
125 ?????????, ??????? ??????????? ?????????
????????.
???????????? ???????? ????????? ?????? ? ???????? ????????? ??????????? ?? ????????????
?????. ????????????? ???????? ? ?? ????? ??????????? ????????? ????????? 32?79 ?? ??. ??.,
? ??????? ? 48,3╠1,8 ?? ??. ??. ????????????? ???????? ? ?? ????????? 20?60 ?? ??. ??., ? ??????? ?
29,2╠1,1 ?? ??. ??. ??????? ???????? ? ?? ? ??
? ??????????? ??????? ???? ??????????? ???????
????????? ???????? ????????????. ???????? ???25
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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??????????? ???????? ????? ?? ? ?? ????????
0?50 ?? ??. ??., ? ??????? ? 18,4╠0,7 ?? ??. ??. ??????????? ????????????? ???????? ?? ? ??, ????? ??????????????? ???????????? ????????????
?????????????, ????????? 0,25?0,86, ? ???????
0,46╠0,01.
?? ?????? ????? ??????????? ?????? ???????
????????. ???????? ????????? ?? ???? ??????? (?????????????, ?? ?????? ??????? ? ??????????). ???????? ?????????????? ???????? ?? ?????????????
?????????? ???????? ? ??????? ? 7,2╠0,3 ?? ??. ??.
(2?18 ?? ??. ??.), ?? ?????? ??????? ?
9,7╠0,4 ?? ??. ??. (0?17 ?? ??. ??.), ?? ??????????
?????????? ? 17,1╠0,7 ?? ??. ??. (7?24 ?? ??. ??.).
????????? ??? ????? ?? ? ?? ????????
22,1╠4,3 ?? ??. ??., ????????? ???????? ? ?? ?
46,0╠3,1 ?? ??. ??.
? 8 (9,5%) ??????? ???????????? ?? ??????? ???????? ??? ?? ????????????? ??? ???? ?? I ???????,
? 71 (84,6%) ?????? ???? I?II ???????, ? 5 (5,9%)
??????? ? ?? ????? II ???????.
? 41 (32,8%) ???????? ? ?????????? ????? ?????
??????????? ????????? ??????? ??? ?????????
????????? ??????????????? ?????????. ?????????? ????????? ??????? ?????????????? ??????
??: ?????????? ????? ???????? ? ? 17 (41,5%)
???????, ????????????? ????? ? ? 8 (19,5%), ?????? ??????????? ? ?????????????? ??????? ?
? 14 (34,1%), ?????? ?? ?????? ??????? ???????? ?
? 2 (4,9%).
??? ???????????? ???????????? ?????? ?????
?????????????? ?? ??????????????? ???????? ??
???? ??????? ?????????? ????????? ??????????:
??????????? ????????????? ???????? ?? ? ??
? ??????? ????????? 0,86╠0,20, ????????????? ???????? ? ?? ? ??????? ? 97,9╠22,1 ?? ??. ??., ????????????? ???????? ? ?? ? 33,3╠20,4 ?? ??. ??., ???
????? ?? ? ?? ? 64,7╠18,2 ?? ??. ??.
? 23 ??????? ????????? ?????, ? 18 ? ??????????? ??????? (????. 2). ????? ????????????? ???????? ?? ??????????? ????? ?????????? ??????????? ??????? ?????.
????? ?????????? ??????????????? ????????
?????????? ???????????? ?????? ????? ?????????М?╥нк?? 2
Ыл?с??рмшн??л?б ?об╞?збн╦рз?? т?к рзблса??
мсл?шкз?
?????????? ????????????, n (%)
??????? ???????
?????
?????????????
?????
?????????? ?????
????????????? ?????
?????????????
? ?????????? ??????
?????? ????????
6
6
11
2
17 (41,5)
8 (19,5)
10
1
4
1
14 (34,1)
2 (4,9)
??????
23
18
41 (100)
26
????? ??????????? ??????????. ??????????? ??
? ?? ? ??????? ????????? 0,60╠0,15, ????????
? ?? ? ??????? ? 62,5╠8,5 ?? ??. ??., ????????????? ???????? ? ?? ? 47,2╠10,1 ?? ??. ??., ??? ????? ?? ? ?? ? 16,8╠4,0 ?? ??. c?., ??? ??????????????? ?? ????????????? ???????????????? ???????.
?? ?????? ????? ??? ??????? ?? ???? ???????
????????? ??????? ???????????????? ?????? ?????????????, ?????????? ?????????? ?????? ????????? ???????? ?? ????????? ???????? ???????. ??????????? ????????? ???????? ????????? ?????????????? ???????? ????? ?? ? ??, ???????????
??? ?????? ????????? ?? ???????????? ?????
? ??????? ????? ??? ???????.
? ?????????? ??????? ????? ????????? ???????? ??????????? 60 ?????????. ???? ??????????
???????? ? ??????? ? 6,3╠1,8 ????, ??????? ???????
?? ?????? ???????????? ???????? ? ???????
14,4╠3,5 ???? (8?48 ???).
? I ?? ???????? 36 (60%) ?????????, ?? II ?
18 (30%), ? III?IV ? 6 (10%) ?????????.
????? ????????? ???????? ???????? ? ????? ??
2 ??? ?? 4 ??? ??????? 3 ????????. ? ?????? ??????
?????? ????????? ????? ????????? ??????? ???????? ??? ??????????????? ???????????? ????????????? ??????? (????) ????????? ????? 2 ??? ??
?????????. ?? ?????? ?????? ?????? ????????? ????? ???????? ???????? ??? ??????? ???????? ??????? ? ???? ????????? ????? 5 ??? ?? ???? ????????????? ?????????, ????????? ? ?????????? ????????? ?????? (???????????????? ?????
???????? ? ??????????? ?????? ???? ???????????
????????????). ?????? ????????? ? ????????? ╚???????? ????????? ??????, ????╩ ??????? ?????
2 ???? ????? ????????? ????????. ????????? ??
????????? ???? ??????? ?? ? ??????????? ????????, ? ? ???????? ???????? ??????, ????????????????? ??????????????? ??????????????????? ???????? ? ????????? ??????? ???????? ???????????.
????????? ???????????? ????????? ????? ????????? ???????? ???????????? ?? ??????? 1.
? ?????????? 3 ?????????, ??????????? ? III
??, ????????? ??????? ?????????? ??? ????? ??
? ??, ?? ????????? ????????? ???????? ? ?????????? ???????? ?????? ???????? ????????.
? ?????????? ????? ????? ????????? ????????
?? ?????? ????? ? ???? ??????? ?????????? ????????? ????????? ?????????????? ???????? ?????
?? ? ?? ? ?????????????? ???????? ? ??: ????????????? ???????? ? ?? ? ??????? ?????????
66,9╠8,1 ?? ??. ??., ??? ????? ?? ? ?? ?
32,8╠9,8 ?? ??. ??., ????????????? ???????? ? ?? ?
34,2╠2,1 ?? ??. ??., ?????????????? ????????
? ?? ? 13,3╠2,2 ?? ??. ??.
??? ?????? ?????????????? ? ???????? ??????? ??, ???????? ??????????? ?? ? ?? ????????
?????????? ????????? ?????????????? ??????
(???) ? ??? ?? ?? ????????? ? ?????????????????? ???????: ??? ?? ?????????? ? ???????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
C?????? ?? ????????? ??????????, %
??????? ??????? ?????? ? ???????, ? 2, 2014
1,0
????????????, %
0,8
0,6
0,4
0,2
100
80
60
40
20
0
1
2
3
4
5
6
7
8
9
10
???? ??????????, ????
???. 2. ????????? ??????? ?? ????????? ??????????
0,0
0,0
2,0
4,0
6,0
8,0
10,0
???? ??????????, ????
12,0
??????? ???????
???????????????
???. 1. ????????? ???????????? ? ?????????? ????? ?????
????????? ??????????
? 36,2╠1,9 ?? 59,8╠2,3 ??/?2, ??? ?? ?
? 78,2╠4,3 ??/?2 ?? 92,2╠4,5 ??/?2. ???????????
??????? ??????? ?? ? 58,5╠2,5% ?? 63,6╠3,9%.
??????? ??????? ?? ????????????? ? 54,2╠2,1 ??
61,7╠3,6%.
?? ?????????? ??????? ???? ????? ?????????
???????? ?? ???? ??????? ???????? ??????????
????????? ??????? ????????? ???????? (?? ????????????? ?????????? ? 7,5╠2,7 ?? ??. ??.,
?? ?????? ??????? ? 8,5╠3,7 ?? ??. ??. ? ?? ?????????? ?????????? ? 19,3╠6,4 ?? ??. ??.). ???????
??? ?? ??????? ??????? ?????????? ??????.
??? ???????????? ??????? ?? ???? ??????? ???????
???? ??????????, ???????????? ?? ??????? ????????????? ? 6 ??????? ? ???? ????????? (?? I ???????) ? 50 ???????, ?????????? (II?III ???????) ? ? 4
???????. ???????? ?????????? ???????????????
???????? ????? ????????? ???????? ? ????? ????????? ? ???? ???? ??????????????? ??????? ???????? ???????????, ? 2 ??????? ? ???????????
???????????? ????????? ?????????, ? 1 ? ?????????? ???????? ???????? ?????? ???????? ???????
???????? ??? ???????????.
??? ??????? ??????? ???????? ? ????? ?????????? ????? (? ??????? 6,3 ????) ?????????? ????????? ? ??????????? ?????????? ?????????? ?? ????
??????? ???????. ?? ????????????? ??????????
??? ?????????? ?? ?????? ?????????? ?????,
? 7,5╠2,7 ?? ??. ??. (????? 1 ??? ????? ????????) ??
14,5╠5,2 ?? ??. ??. (????? 6 ??? ????? ????????).
??
??????
???????
???
????????????
? 8,5╠3,7 ?? ??. ??. ?? 17,6╠5,2 ?? ??. ??. ? ???????
???? ?? ???????. ???????? ??????????? ?????????
??? ?? ?????????? ?????? ????????. ?? ?????????? (?<0,05) ?????????? ? 19,3╠6,4 ??
40,6╠5,0 ?? ??. ??.
???????????? (23,3%) ????????? ????? 2?4 ????
????? ????????? ???????? ???? ????????? ????????? ?????????????: ????????? ?????????? ???????? ?????? ???????? ???????? ?? ????????? ??????? ? ? 5 ???????, ????????? ????????
G.K. Danielson [10] ? ????????? ?????????? ?????
????????????????? ?????? ? ? 1, ????? ???????
???????? ? ? 2 ???????, ????????????? ???????????
?????? ???????? ? ? 5 (? 3 ? ??????????? ??????, ? 2 ?
??????????????), ??????????? ????????? ?????-??????? ? ? 1. ????????? ?????? ??????? ?? ?????????
?????????? ???????????? ?? ??????? 2.
?????????? ???????? ?????? ???????? ???????? ????????? ?? ??????? ??????????? ??????????? ??????? (? 4 ??????? ??????? ?????????? ??????
??????????? ?????? ????????, ? 2 ? ??????????????), ?????????? ?????? ????????, ?????? ??????????????? ???????? ???????? ????????????????,
??????? ????????? ????????? ???????? ?????????????. ???????? ?????????????? ???????? ??
???????? ???????? 70?95 ?? ??. ??.
????? ????????? ?????????? ???????????????
???????????? ??????????? ????????????? ???????? ? ?? ? ?? ????????? ? 0,75╠0,15 ??
0,44╠17,10 (p<0,05), ????????????? ????????
? ?? ????????? ? 95,2╠12,4 ?? 48,6╠15,9 ?? ??. ??.
(p<0,05), ??? ????? ?? ? ?? ? ? 66,1╠17,7 ??
26,4╠12,2 ?? ??. ??. (p<0,05).
И╥ршй?блкб
????????? ???????? ? ????????? ?? ????????
???, ??????? ????? ???? ?????????????? ????????? ???? ?????????????? ?????? ??, ?? ?????????? ??????? ???????????? ?????????? ?????????
???????? ??? ?????? ??????????????????? ??????
???? [5, 8].
? ?????????? ????? ????? ??????????? ????????? ???? ?????????? ?????? ?????????? ?? ??????
27
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
??????????? ???????? ? ?? ? ??. ???, ?? ??????
???? ???????, ?????? ??????????? ?????? ????????
??????????? ? 20?95% ???????, ? ?????????????? ?
? 12% [1, 2, 12]. ?? ????? ????????? ?????? ?????????????? ??? ??????????? ??????????? ?????????? ? 50,4%. ?????????? ????????? ???????? ??
???????? ???? ??????????? ??????????? ????????
?????????, ???????????, ??????????? ???????.
??????? ??????????????, ??? ?????????? ????????
??? ?????????????? ?????? ?? ??? ????????? ???
? ???????????? ??? ??????????? ?????????????
????? ????? ?? ? ??, ?? ??????????. ????? ???????????????? ??????? ? ??????? ???????? ?????
????????? ? ?????? ? ?????? ????????.
?? ?????? B. Askovich ? ?????. [11], ????????
???????? ???????? ????? ??????????? ??? ? ????????????? ? ????? ??????? ???? ?????, ? ????????? ??????? ?????????? ???????? ?????? ??????????? ??????? ????????? ? ??????????? ????????, ??????????????? ??????????? ???????,
?????? ???????. ?? ?????? ???????, ????? 10 ???
????? ??????????? ???????????? ? ?????????????? ????????? ? 71% ??????? ????????????? ?? ??????, ????? 15 ??? ????? ???????? ? ? 99%. ?? ???
?????????? ???? ?????????? ????????? ???????????? ?????????????? ???????. ?? ??????
R.C. Elkins ? ?????. [12], ????? 10 ??? ????? ??????????? ??????? ?????? 80% ?????????????? ????????? ? 40% ???????????? ????????. ????? ?? ??????????? ??????????? ??? ??????????? ?????????
????????? ????? 15 ?? ? ????? 15 ??.
A.A. Holmes ? ?????. [13] ??????????, ??? ?????
5 ??? ????? ??????????? ????????? ?? ?????????
???? ???? (Contegra) ??????? ?? ?????????? ?????????? 60%. ?????? ????????????, ??? ???? ????????????? ???? ??? ??????? ??? ? ? ??? ??????, ???? ??????? ???????? ?? ?????? ???????????
????? 3 ??? ? ??????? ???????? ????? 14 ??.
?? ?????? D. Boethig ? ?????. [14], ??????? ?? ?????? ????? 5 ??? ????? ??????????? Contegra ?????????? 90%, ????? 10 ??? ????? ??????????? ??????????? ? 20%, ????? 15 ??? ????? ???????????
???????????? ? 20%. ???????? ?????? ????????
A. Rastan ? ?????. [15], E. Belli ? ?????. [16].
A. Schlichter ? ?????. [17] ????????, ??? ??????? ?? ????????? ???????? ????? ??????????? ??????????????????? ????????????????? ?????????
????? 5 ??? ?????????? 92%, ????? 10 ??? ? 76%.
?? ?????? ?.?. ??????? ? ??. [18], ????? ??????????? ???????????????????? ????????????????? ????????? ??????? ?? ????????? ????????
????????? ????? 5 ??? ? 95%, ????? 10 ??? ? 48%.
????????? ? ??????????? ????? ?????????? ?????????? ????????????? ?? ?????? ?????????? ???????? ??????? ?? ??????? ? ???????? ????????? ????????? ???????????????, ????????? ????? ??????,
?? ???????????? ????????? ?????????????? ???????? ????? ?? ? ??. J. Kirklin, B.G. Barratt-Boyes [9]
??????????? ????????? ?????????? ??? ???????
28
?????????? ???????? ? ??????? ??? ?????
70 ?? ??. ??. ? ????????? ??? ????????? ??????????????? ??????????????, ? ????? ? ????????? ? ????? ?????????? ??????????? (????? 50 ?? ??. ??.)
??? ????????? ????????? ????????? ????????? ???????????????.
?? ?????? T. Sugita ? ?????. [19], ???????? ??????????? ????????? ?????? ?? ????? ??????? ???
????? ?? ? ?? ????? 50 ?? ??. ??. ?????? ???????
???????????? ?????????? ??????????? ????????????? ???????? ?? ? ?? ? 79,5% ?????????
(? 0,75╠0,13 ?? 0,51╠0,12) ????? ????????? ????????. ?????? ? ?????????, ???????????? ??????????
?? ?????? ????????? ?????????? ????????, ????????? ????????????? ???????? ?? ? ?? ??????? ??
???????????. ???? ????????? ????????? ??????????? ????????? ?????????? ?????? ????????? ???????? ????????? ??. ???????? ??????? ???? ??????????, ??????????? ??? ?????????? ???????????? ????????? ???????????, ?????????????
??????????? ????????? ?????? ? ??????????? ?????????? ??? ????? ??????? ????????? ????????
??? ??? ????? ??????? ??????????? ?????????????
???????? ?? ? ?? ???? ?????, ????? ??????????
????????? ???????????? ?????????????.
?? ?????? J. Stark [20], ??? ??????????????
?????? ?? ?????????????? ?????????, ? ?????
????- ? ???????????????????? ??????????, ? ???????? ?????????? ???????? ?????????? ????????
G.K. Danielson [10], ??????? ??????????? ? ?????????? ??????? ?? ???? ?????????? ???????? ??????
????????. ?????? ????????????? ????????? ????????? ????????? ? ?????????? ????????????? ╚??????? ?????????╩ [2]. ??? ?????????????? ?? ???????????? ???????? ?????? ???????? ????????? ???? ?????????? ???????????? ?????? ?????? (????),
???????????? ??????? ?????????? ??? ?????????
????????????? ????????. ??????????????? ?????????? ?????????? ???????? ???????? ??????????
?? ????????? ?????? ?? ????????.
??????????
1.
2.
3.
4.
5.
6.
7.
8.
9.
????????? ?.?., ????????? ?.?., ??????? ?.?. ????????????????? ???????? ? ????????????? ??????? ???????
?????????? ??????? ??????. ?.: ????? ??. ?.?. ???????? ????; 2000.
????????? ?.?., ?????? ?.?., ???????? ?.?., ????? ?.?.
????????? ???????? ????? ????????? ?????????? ??????? ??????. ?.: ????? ??. ?.?. ???????? ????; 2013.
Ziemmer G. Herzchirurgie. Berlin: Springer; 2010.
Stark J., Pacifico A.D. Reoperations in cardiac surgery. SpringVerlag; 1989.
Stark J., deLeval M., Tsang V.T. Surgery for congenital heart
defects. John Wiley, Sons, Ltd; 2006.
??????????? ?.?. ?????????? ?????? ??????. ????:
?????-????; 2010.
??????? ?.?., ?????? ?.?. ??????????? ?? ??????????????? ????????. ?.: ????? ??. ?.?. ???????? ????; 2008.
????????? ?.?., ???????? ?.?. ??????? ?????. ?.: ?????
??. ?.?. ???????? ????; 2008.
Kirklin J.K., Barratt-Boyes B.G. Cardiac surgery. New York:
John Willey; 2003.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Danielson G.K., Downing T.P., Schaff H.V., Puga F.J.,
DiDonato R.M., Ritter D.G. Replacement of obstructed extracardiac conduits with autogenous tissue reconstructions.
J. Thorac. Cardiovasc. Surg. 1987; 93: 555?9.
Askovich B., Hawkins J.A., Sower C.T., Minich L.L., Tani L.Y.,
Stoddard G., Puchalski M.D. Right ventricle-to-pulmonary
artery conduit longevity: is it related to allograft size? Ann.
Thorac. Surg. 2007; 84: 907?12.
Elkins R.C., Lane M.M., McCue C., Ward K.E. Pulmonary autograft root replacement: mid-term results. J. Heart Valve Dis.
1999; 8: 499?503.
Holmes A.A., Co S., Human D.G., Leblanc J.G., Campbell A.I.
The Contegra conduit: Late outcomes in right ventricular outflow tract reconstruction. Ann. Pediatr. Cardiol. 2012; 5:
27?33.
Boethig D., Thies W.R., Hecker H., Breymann T. Mid term
course after pediatric right ventricular outflow tract reconstruction: a comparison of homografts, porcine xenografts and
Contegras. Eur. J. Cardiothorac. Surg. 2005; 27: 58?66.
Rastan A.J., Walther T., Daehnert I. Bovine jugular vein conduit for right ventricular outflow tract reconstruction: evaluation of risk factors for mid-term outcome. Ann. Thorac. Surg.
2006; 82: 1308?15.
Belli E., Salihog?lu E., Leobon B. The performance of Hancock
porcine-valved Dacron conduit for right ventricular outflow
tract reconstruction. Ann. Thorac. Surg. 2010; 89: 152?7.
Schlichter A.J., Kreutzer C., Mayorquim R.C., Simon J.L.,
RomАn M.I., Vazquez H. et al. Five- to fifteen-year follow-up of
fresh autologous pericardial valved conduits. Thorac.
Cardiovasc. Surg. 2000; 119: 869?79.
??????? ?.?., ?????????? ?.?., ???????? ?.?., ???????? ?.?. ???????????? ? ????????-?????????? ????????.
?.: ????? ??. ?.?. ???????? ????; 2009.
Sugita T., Ueda Y., Matsumoto M., Ogino H., Sakakibara Y.,
Matsuyama K. Repeated procedure after radical surgery for
tetralogy of Fallot. Ann. Thorac. Surg. 2000; 70: 1507?10.
Stark J. The Use of Valved Conduits in Pediatric Cardiac
Surgery. Pediatr. Cardiol. 1998; 19: 282?8.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
References
1.
2.
3.
4.
Podzolkov V.P., Zelenikin M.A., Shatalov K.V. Extracardiac
conduits in the surgical treatment of complex congenital heart
defects. Moscow: Nauchnyy Tsentr Serdechno-Sosudistoy
Khirurgii imeni A.N. Bakuleva Rossiyskoy Akademii
Meditsinskikh Nauk; 2000 (in Russian).
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
imeni A.N. Bakuleva Rossiyskoy Akademii Meditsinskikh
Nauk; 2013 (in Russian).
Ziemmer G. Herzchirurgie. Berlin: Springer; 2010.
Stark J., Pacifico A.D. Reoperations in cardiac surgery. SpringVerlag; 1989.
17.
18.
19.
20.
Stark J., deLeval M., Tsang V.T. Surgery for congenital heart
defects. John Wiley, Sons, Ltd; 2006.
Zin?kovskiy M.F. Congenital heart defects. Kiev: Kniga-Plyus;
2010 .
Bockeria L.A., Alekyan B.G. Guidelines for endovascular surgery. Moscow: Nauchnyy Tsentr Serdechno-Sosudistoy
Khirurgii imeni A.N. Bakuleva Rossiyskoy Akademii
Meditsinskikh Nauk; 2008 (in Russian).
Podzolkov V.P., Kokshenev I.V. Tetralogy of Fallot. Moscow:
Nauchnyy Tsentr Serdechno-Sosudistoy Khirurgii imeni
A.N. Bakuleva Rossiyskoy Akademii Meditsinskikh Nauk;
2008 (in Russian).
Kirklin J.K., Barratt-Boyes B.G. Cardiac surgery. New York:
John Willey; 2003.
Danielson G.K., Downing T.P., Schaff H.V., Puga F.J.,
DiDonato R.M., Ritter D.G. Replacement of obstructed extracardiac conduits with autogenous tissue reconstructions.
J. Thorac. Cardiovasc. Surg. 1987; 93: 555?9.
Askovich B., Hawkins J.A., Sower C.T., Minich L.L., Tani L.Y.,
Stoddard G., Puchalski M.D. Right ventricle-to-pulmonary
artery conduit longevity: is it related to allograft size? Ann.
Thorac. Surg. 2007; 84: 907?12.
Elkins R.C., Lane M.M., McCue C., Ward K.E. Pulmonary autograft root replacement: mid-term results. J. Heart Valve Dis.
1999; 8: 499?503.
Holmes A.A., Co S., Human D.G., Leblanc J.G., Campbell A.I.
The Contegra conduit: Late outcomes in right ventricular outflow tract reconstruction. Ann. Pediatr. Cardiol. 2012; 5:
27?33.
Boethig D., Thies W.R., Hecker H., Breymann T. Mid term
course after pediatric right ventricular outflow tract reconstruction: a comparison of homografts, porcine xenografts and
Contegras. Eur. J. Cardiothorac. Surg. 2005; 27: 58?66.
Rastan A.J., Walther T., Daehnert I. Bovine jugular vein conduit for right ventricular outflow tract reconstruction: evaluation of risk factors for mid-term outcome. Ann. Thorac. Surg.
2006; 82: 1308?15.
Belli E., Salihog?lu E., Leobon B. The performance of Hancock
porcine-valved Dacron conduit for right ventricular outflow
tract reconstruction. Ann. Thorac. Surg. 2010; 89: 152?7.
Schlichter A.J., Kreutzer C., Mayorquim R.C., Simon J.L.,
RomАn M.I., Vazquez H. et al. Five- to fifteen-year follow-up of
fresh autologous pericardial valved conduits. Thorac.
Cardiovasc. Surg. 2000; 119: 869?79.
Bockeria L.A., Kagramanov I.I., Kokshenev I.V., Britikov D.V.
Biomaterials in cardiovascular surgery. Moscow: Nauchnyy
Tsentr Serdechno-Sosudistoy Khirurgii imeni A.N. Bakuleva
Rossiyskoy Akademii Meditsinskikh Nauk; 2009 (in Russian).
Sugita T., Ueda Y., Matsumoto M., Ogino H., Sakakibara Y.,
Matsuyama K. Repeated procedure after radical surgery for
tetralogy of Fallot. Ann. Thorac. Surg. 2000; 70: 1507?10.
Stark J. The Use of Valved Conduits in Pediatric Cardiac
Surgery. Pediatr. Cardiol. 1998; 19: 282?8.
????????? 18.02.2014
29
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
╘ ????????? ???????, 2014
??? 616.12-007-053.1:614.2
????????????? ?????????? ??????? ??????
? ???? ??????????? ??????????????????? ??????
?? ?????????? ????????????? ???????
?.?. ????????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 of Russian Academy of Medical
Sciences; Rublevskoe shosse, 135, Moscow, 121552, Russian Federatio
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
Introduce. Examination of incidence and structure of congenital heart disease (CHD) is an actual problem of modern medicine.
Material and methods. To solve the problem of studying the prevalence and structure of CHD in the Volgograd region, were analyzed
literary sources and official statistics.
Results. The dynamics of indicators of general and primary CHD morbidity in children and adults in the Russian Federation and the
Volgograd region. Analysis of the structure of CHD in the Volgograd region.
Conclusion. On the basis of the received results, in order to optimize cardiac surgical care in the Volgograd region, it is necessary to
introduce a regional register of CHD, followed by monitoring of this disease.
Key words: incidence; structure; congenital heart defects; registry.
г?б?блкб
??????? ????????? ??????????????????? ?????? ????????? ? ??????????? ???????? ??????
(???) ???????? ???????? ??????????????????
? ????????? ?????? ?????????. ? ???????? ???????
??????????? ????????? ? ??????????? ???????
? ???????????? ??? [1, 2]. ??????? ????????? ???
30
????????? ? ??????? ???????? ? 2,4?14,15 ??
1000 ????????????? [3]. ??? ???? ??????? ?????
90 ????????????? ????????? ??? ? ????? 200 ????????? ?? ????????? [3?6].
?? ?????? ????????? EUROCAT, ??????? ????????????? ?????????????????? ??? ? ??????? ???????? ?????? ?????????? ? ??????? 8,0 ??
1000 ???????? ????????? [7]. ???????? ???????-
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
??????????????????? ???????????? ????????? ???????, ????????????? ?????????????????? ???
? ??????? (??????) ????????? 11,89 ?? 1000 ???????? ????????? [8]. ?? ??????????? ???? ????????????, ??????? ????????????? ?????????????????? ??? ????? ???????? ?????????? 3,0?4,09 ??
1000 ???????? [8, 9].
?? ??????????? ?????? ??????????? ??????
?????????? ?? ? ???? ?????????????? ? ??????????? ??????????????? ?? ??, ????? ?????????????? ??? ? ????? ? ?????????? ????????? ?????
????????? ?????? [1]. ???, ? 1992 ?. ???? ??????????
???????? 3,8 ?? 1000 ???????? ?????????,
? ? 2011 ?. ? ??? 13,65. ????? ??????????????
??? ????? ????????? ????????? ? ?? ? 1992 ?. ????????? 0,55 ?? 1000 ????????? ?????????,
? 2011 ?. ? 0,71.
???? ?????????? ???????????? ? ??????? ?????, ????????? ?????????????? ? ????????? ???
? ????? ? ????????, ??????????? ?? ??????????
????????????? ???????.
Е?зб?к?н к обзс??
???????? ?????? ???????????? ?????????? ??????????, ??????????? ?????????? ???????????
?????? ?????????? ?? (???????), ???? ?????????????? ? ??????????? ??????????????? ?? ??,
???????????????? ?????? ??????????? ?????? ??????????????? ?????????? ?? ????????????? ??????? (?????????????) ? ???????????????? ?????????
?????????? ??????????????? ╚????????????? ????????? ??????????? ?????????????-????????????? ?????╩ (???? ╚??????╩).
Йбашн╦з?з?
???????????????????? ?????????? ????? ?????????????? ??? ???????? ????????? ? ????????????? ??????? ?? ?????? 2008?2011 ??. ?????????? ???? ??????????????: 1413,83╠254,6
? 1280,25╠87,4 ?? 100 000 ???????? ????????? ??????????????.
???????????????????? ?????????? ?????????
?????????????? ??? ???????? ????????? ??
2008?2011 ??. ? ????????????? ??????? ?????????
?????????? ????, ??? ? ??: 466,1╠93,5
? 346,6,87╠24,2 ?? 100 000 ???????? ????????? ??????????????.
? ????????? ????????? ?? ?? ??????????? ?????? ???????????????????? ?????????? ????? ?????????????? ?????????? ????, ??? ? ?????????????
???????: 71,45╠0,5 ? 58,45╠1,35 ?? 100 000 ????????? ?????????.
? ????????? ????????? ?????????? ?????????
?????????????? ? ?? ? ? ????????????? ??????? ??
100 000 ????????? ??????????? ?? ???????????.
?????????? ???????? ????????? ??????????????
????????? ????????? ?? ???????????????? ? 2010
? 2011 ??. (4,4 ?? 100 000 ????????? ?????????),
???????????? ? ? 2008 ?. (4,7 ?? 100 000 ????????? ?????????), ? ????????????? ??????? ? ?????????????? ? 2009 ?. (3,3 ?? 100 000 ????????? ?????????) ? ? 2011 ?. (4,3 ?? 100 000 ????????? ?????????).
???????? ???????????? ?????? [3, 5, 6],
? ????????? ???????? ???????????????? ??? ? ????? ??????????? ????? ?????? ??????, ??? ??????
??????????????? ??????????? (????) ?
15?23%, ???????????? ????????????? ???????
(???) ? 9?20%, ?????? ?????????????? ??????????? (????) ? 2,5?16%, ???????? ????????????
?????? (???) ? 6?18%, ??????? ????? (??) ?
8?14%, ?????????? ????? (???) ? 6?15%, ??????
???????? ??????? (???) ? 6,8?9%.
????????? ??? ? ????????, ?? ????????????
?????? [10, 11], ???????? ????????? ???????:
???? ? 22%, ?? ? 20%, ???? ? 15%, ??? ? 13%,
??? ? 9%, ?????? ????????????? ?????? ?????? ?
9%.
????? ?????????? ?? ?????????? ?? ??????? ???????? ??? ??????? ??????????? ?????? ? ????????? ??? ????? ???????? ? ????????? ?????????
?? ?????????????? ?????????. ? ???????? ????????? ? ???, ??? ???????, ? ???????? ???????????
????????????? ????????-?????????? ?????????.
??? ???? ??? ???????? ? ?????? ?????????????
????????? ? ? ??????????? ?????????? ?? ??????????????.
???????? ? ????????? ??? ? ???????? ? ????????? ????????? ?? ????? ?????? ?? ????????? ???
?????????, ???????????? ???????????? ???????.
???, ? 2010 ?. ???????? ???????????????? ???
??????????????? ? ????????? ???????????: ????
? ??? ???? ?????????????? ? 92,3% ???????,
???????? ? ?????? ??? ? ? 7,7% ???????, ??? ?
? 88,5 ? 11,5%, ???? ? ? 72,1 ? 27,9%, ???? ?
? 95,5 ? 4,5%, ?????????? ?????? ???????? ???
(????) ? ? 71,1 ? 28,9%, ???????? ??????????????????? ????? (????) ? ? 82,7 ? 17,3%, ???????
????? (??) ? ? 61,4 ? 38,6%, ?? ? ? 93,6 ? 6,4%,
??? ? ? 99,8 ? 0,2%, ?????? ??????? ??? ? ? 90,1
? 9,9% [12].
?? ??????????? ?????? ???????????????? ?????? ??????????? ?????? ??????????????? ?????????? ?? ????????????? ??????? (?????????????)
? ??????, ?? ?????????? ????????????? ???????
?? ?????? ? 2008 ?? 2012 ??. ????????? ??
458,2 ???. ????? (2008 ?.) ?? 462,3 ???. (2012 ?.).
? 2008 ?? 2012 ??. ? ????????????? ?????????
??????????? ???????????????? ?????? (?????)
??????????? 21 576 ????? ? ??? (?? ????????????). ????????? ???????? ???????????????? ???
? ????? ????????????? ???????, ?? ?????? ?????,
?? ?????? 2008?2012 ??. ?????????????? ????????? ???????: ???? ? 27,3%, ???? ? 21,1%,
??? ? 10,4%, ?? ? 8,1%, ??? ? 8%, ??? ? 2,8%,
???? ? 2,6%, ?? ? 2%,??? ? 1,1%.
31
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
???????? ????????????? ?????? ?????????
??? ? ????? ????????????? ??????? ? ???????????? ????????????? ??????? [3, 5, 6]. ??????? ????????????? ????????? ??? (????, ???, ???, ??,
????) ? ???? ? ? ????????????? ??????? ??????????? ?? ???????????. ? ?? ?? ????? ????? ???,
??? ??, ???, ???, ?? ?????????? ?????????????
??????? ?????????? ??????????? ???? [3, 5, 6].
? ????????? ??? ????????????? ??????? ?? ?????????? 2%, ??? ? 2,8%, ??? ? 1,1%, ? ?? ????? ???
? ???? ???????????? ?????? ?????? ? ?????????
??? ?????????? 8?14, 6?15 ? 9?20% ??????????????.
? ????????? ??? ????????????? ??????? ????
?????????? 27,3%, ??? ??????????? ????????? ??????????, ?????? ?? ???????????? ??????????, ?
2,5?16% [3, 5, 6].
И╥ршй?блкб
???????????? ???? ?????????????? ??? ?????
????? ?? ? ????????????? ??????? ????????? ??
?????????? ??????????? ? ???????????????????
?????? ????? ? ???, ??? ? ???? ??????? ???????
????????? ?????????????? ?????????? ????????
?? ??????????? ????????????????????? ??????????????????? ??????????? ??????.
?????????? ?????????? ????? ? ??? ??????????? ? ??? ????? ? ???????????? ?????????? ??????????? ??????????????? ??? ?????????? ????????
? ?????????? ???????????? ?????, ??? ????? ????????? ? ?????????? ????????? ????????? ???????? ?????????? ?????????? ????????? ? ????????????? ??????? ??????????????? ????????????? ?????????????.
?????? ??????? ?????????????? ????????? ????????? ? ??? ????? ????????? ??????????? ?????????? ????????? ??? ?? ???????????: ??????
????????????? ????? ? ??? ????? ??????????????
???????, ?? ???? ?? ??????????; ?????? ???????????? ????? ?? ???????? ???, ???????????????
??????????? ? ?????????????? ??????? ????????????? ????????????? ??? ?????? ????????? ? ??.
???????? ?? ?????????????? ? ????????? ???
? ????????????? ??????? ????? ????? ?????????
? ??????? ?????????? ??????????????? ????? ???
? ???????????? ???????? ??????? ? ??. ????????,
??? ?????? ?????????????? ? ???????????? ???????? ??????? ???????? ?? ?????????? ?????????
????????? ?????????, ? ?? ????? ??? ? ?? ? ?? ????? ??????? ????????? ????????? ? ??????????????? ???????? ??????????.
???????? ????????????? ? ?????????? ?? ?????????? ????????????? ??????? ?????????????????? ???????????? ??? ????????? ?????????????????? ? ????????? ??? ? ???????? ? ????????? ?????????. ??? ???? ???? ?????????? ????????
???????????? ??????? ????????? ? ??? ? ?? ??????????? ????????????.
32
г??с??
1. ?? ?????? 2008?2011 ??. ????? ? ?????????
?????????????? ??? ????? ???????? ?????????
??????????? ??? ? ?? (? 1,14 ????), ??? ? ?? ?????????? ????????????? ??????? (? 1,41 ? 1,43 ????
??????????????).
2. ?? ?????? 2008?2011 ??. ????? ? ?????????
?????????????? ??? ????? ????????? ?????????
??????????? ?? ??????????.
3. ????? ?????????????? ??? ? ????? ??
? ????????????? ??????? ????????? ??????? ??????? ?????? ? 1,3?1,5 ????.
4. ????? ?????????????? ??? ? ????????? ????????? ? ?? ? ????????????? ??????? ???? ??????? ??????? ?????? ? 4,8?5,9 ????.
5. ???????? ?? ?????????????? ? ?????????
??? ? ????????? ????????????? ??????? ? ???????
??????????? ?????????? ? ????????????? ??????? ????? ????????? ??????? ?????????? ??????????????? ????? ??? ? ???????????? ????????
??????? ? ??.
6. ? ????? ??????????? ?????????????? ????????? ??? ? ????? ? ???????? ??????????? ?????????????????? ? ????????? ???, ?????????????
?????????? ? ??????? ????????? ? ??? ?? ?????????? ????????????? ??????? ?????????? ????????? ????????????? ???????? ???.
??????????
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
??????? ?.?., ???????? ?.?., ??????????? ?.?., ???????? ?.?., ?????? ?.?. ????? ????????? ??????????? ?????????????? ??????????? ???????? ?????? ?????????
?????????? ?????????. ????????? ????? ??. ?.?. ???????? ????. ?.; 2007; 8 (5): 28?34.
Knowles R., Griebsch I., Dezateux C., Brown J., Bull C.,
Wren C. Newborn screening for congenital heart defects: a
systematic review and cost-effectiveness analysis. Health
Technol. Assess. 2005; 9 (44): 1?176.
??????? ?.?. ?????????? ?????? ??????. ?.: ?????;
2009.
???????? ?.?., ??????? ?.?., ??????? ?.?., ???????? ?.?. ?????????????????? ?????????????? ?????????? ??????? ?????? ? ??????? ??????? ? ????? ??????
?????. ????????? ??????????? ??????. 2011; 26 (1):
154?9.
??????????? ?.?., ??????? ?.?. (???.) ????????-?????????? ????????: ???????????. ?.: ????????; 1996.
???????? O.A. ?????? ? ????? ???????? ? ????? ? ??????????. ???.: ???????; 2005.
Dolk H., Loane M., Garne E. Prevalence and Perinatal
Mortality, 2000 to 2005. Circulation. 2011; 123: 841?9.
Marelli A.J., Mackie A.S., Ionescu-Ittu R., Rahme E., Pilote L.
Congenital heart disease in the general population. Changing
prevalence and age distribution. Circulation. 2007; 115:
163?72.
Mulder B.J. Epidemiology of adult congenital heart disease:
demographic variations worldwide. Neth. Heart J. 2012;
20 (12): 505?8.
???????????? ???????????? ?? ??????? ???????? ????????? ? ??????????? ???????? ??????. ?.: ?????
??. ?.?. ???????? ????; 2010.
Cardiovascular Diseases in Europe: European Registries of
Cardiovascular Diseases and Patient Management. Sophia
Antipolis, France: European Society of Cardiology. 2004: 56.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
12.
??????? ?.?., ??????? ?.?. ????????-?????????? ???????? ? 2010. ??????? ? ?????????? ???????? ??????? ??????????????. ?.: ????? ??. ?.?. ???????? ????; 2011:
80?124.
1.
Bockeria L.A., Stupakov I.N., Samorodskaya I.V.,
Bolotova E.V., Ocheret T.S. General tendencies of indicators of
incidence of congenital heart diseases of the population of the
Russian Federation. Bulleten' Nauchnogo Tsentra SerdechnoSosudistoy Khirurgii imeni A.N. Bakuleva Rossiyskoy
Akademii Meditsinskikh Nauk. 2007; 8 (5): 28?34 (in
Russian).
Knowles R., Griebsch I., Dezateux C., Brown J., Bull C.,
Wren C. Newborn screening for congenital heart defects: a
systematic review and cost-effectiveness analysis. Health
Technol. Assess. 2005; 9 (44): 1?176.
Sharykin A.S. Congenital heart diseases. ?.: Binom; 2009 (in
Russian).
Bogacheva E.V., Antonov O.V., Artyukov S.I., Filippov G.P.
The epidemiological characteristic of congenital heart diseases
and large vessels at children of the city of Omsk. Sibirskiy
Meditsinskiy Zhurnal. 2011; 26 (1): 154?9 (in Russian).
Burakovskiy V.I., Bockeria L.A. (eds) Cardiovascular surgery:
A Guide. Moscow: Meditsina; 1996 (in Russian).
References
2.
3.
4.
5.
6.
Mutaf?yan O.A. Defects and small anomalies at children and
teenagers. SPb.: SPbMAPO; 2005 (in Russian).
7.
Dolk H., Loane M., Garne E. Prevalence and Perinatal
Mortality, 2000 to 2005. Circulation. 2011; 123: 841?9.
8.
Marelli A.J., Mackie A.S., Ionescu-Ittu R., Rahme E., Pilote L.
Congenital heart disease in the general population. Changing
prevalence and age distribution. Circulation. 2007; 115:
163?72.
9.
Mulder B.J. Epidemiology of adult congenital heart disease:
demographic variations worldwide. Neth. Heart J. 2012;
20 (12): 505?8.
10. National recommendations about maintaining adult patients
with congenital heart diseases. Moscow: Nauchnyy Tsentr
Serdechno-Sosudistoy Khirurgii imeni A.N. Bakuleva
Rossiyskoy Akademii Meditsinskikh Nauk; 2010 (in
Russian).
11. Cardiovascular Diseases in Europe: European Registries of
Cardiovascular Diseases and Patient Management. Sophia
Antipolis, France: European Society of Cardiology. 2004:
56.
12. Bockeria L.A., Gudkova R.G. Cardiovascular surgery ? 2010.
Diseases and congenital anomalies of system of blood circulation. Moscow: Nauchnyy Tsentr Serdechno-Sosudistoy
Khirurgii imeni A.N. Bakuleva Rossiyskoy Akademii
Meditsinskikh Nauk; 2011: 80?124 (in Russian).
????????? 18.02.2014
╘ ????????? ???????, 2014
??? [616.124.6-007.253:616.131-008.331.1]-089
????????????? ??????????? ????????????? ?????????
??????? ??????????????? ???????????,
???????????? ????????? ????????????
?.?. ????????????, ?.?. ???????, ?.?. ??????, ?.?. ??????????, ?.?. ???????,
?.?. ????????
???? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ?
???????? ??? ? ???? ?.?. ???????) ????; ?????????? ?????, 135, ??????, 121552,
?????????? ?????????
???????????? ?????? ??????????, ?????? ???. ????, ?????????, ?????????? ??????????;
??????? ?????? ???????????, ????????, e-mail: farruh1983@mail.ru;
?????? ????? ??????????, ???. ?????. ????., ?????? ???. ????;
?????????? ?????? ?????????????, ???. ??????????? ??????????;
??????? ???? ?????????????, ????-????????????;
???????? ????? ???????, ??. ?????. ????.
????????. ?? ????????? ??????? ????????????? ??????? ??????? ??????????????? ??????????? (????) ? ?????????
???????????? ????????? ???????????. ????????? ????????? ? ??????? ??????????????, ?????????????? ? ????????????
????????? ? ?????????????? ??????? ???? ? ???????? ??????????? (??) ??? ????? ???????????. ??????? ????????? ???
?? ????????????? ??????????? ?????????, ??? ? ? ??????????? ????????? ? ???????????? ?????????? ???????? ???????
(??) ?? ?????? ?????. ??????? ???????????? ?????????????? ??????? ???? ? ????????? ???????????? ?? ??????????
??????? ?? ???????????.
???????? ? ??????. ?????? ???? ?????????????? ??????? ???? ? ????????? ???????????? (????????? ?? ? ????????
???????) ??? ???????? 44 ??????? ? ???????? 5,8╠0,6 ????, ?????? ???? (??????????? ?????????) ? 30 (68,2%) ?? ???.
33
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
? 14 (31,8%) ?????????, ?????????? ????????? ??, ?????????? ??????????? ????????? ?? ?????????????? ?????????
????? ????????????? ??????? ?? ?/??? ??????? ?????????????? ????????? ???????? ???????. ????????? ? ??????? ??
?????? ????????? ?????????? ?? ????????? ????????????? ???????? ?????? ? ??????????? ??????????? ???????? ? ??
(?????). ??????????????? ????????? ???????? ??????? ? ???????? ??????? ??????? ????????? ?? ?????????????
Heath?Edwards ? ??????? ??????? ??????? ?????????? ???????? ???????? ???????.
??????????. ? ?????? ??????? ????? ????????? ?? ?? ???? ???????????? ?? ?????? 3 (6,8%) ???????; 30 ????????? ?
?????????? ??????? ????? ????????? ?? ???? ???????????? ??????????? ????????? ?????? ??? ????????? ???????.
? 14 ??????? ?????????? ??????????? ????????? ?? ?????????????? ????????? ????? ???????????? ?? ?/???
??????????????? ????????? ???????? ???????.
??????????. ????????? ? ???????? ? ??????? ? ???? ? ????????? ???????????? ?????? ???????????? ?? ?????? ?????.
??????????? ????????? ???? ? ????????? ???????????? ????????????? ????????? ????? ???????????????? ?????????
??. ??? ??????? ? ??????? ? ???? ??????????????? ????????? IV ?????? ?? ????????????? Heath?Edwards ????????
??????? ?? ??? ? ??????, ??? ? ? ?????????? ????????????????? ????????.
???????? ?????: ?????? ??????????????? ???????????; ???????? ???????????; ?????????? ?????? ??????; ???????
????????????.
EFFECTIVENESS OF A TWO-STAGE SURGICAL CORRECTION OF VENTRICULAR
SEPTAL DEFECT COMPLICATED BY EISENMENGER SYNDROME
S.V. Gorbachevskiy, F.H. Mukimov, A.A. Shmal?ts, M.A. Grenaderov, Yu.A. Kol?tsov,
M.Yu. Khal?vani
A.N. Bakoulev Scientific Center for Cardiovascular Surgery of Russian Academy of Medical
Sciences; Rublevskoe shosse, 135, Moscow, 121552, Russian Federation
Gorbachevskiy Sergey Valer?evich, MD, DM, Professor, Chief of Department;
Mukimov Farrukh Khasanboevich, Postgraduate, e-mail: farruh1983@mail.ru;
Shmal?ts Anton Alekseevich, Leading Research Associate, MD, DM;
Grenaderov Mikhail Aleksandrovich, Deputy Chief of Department;
Kol?tsov Yuriy Aleksandrovich, Anesthesiologist;
Khal?vani Mariya Yur?evna, Junior Research Associate
Introduction. Until recently, surgical treatment of ventricular septal defects (VSD) with Eisenmenger syndrome was considered as
impossibility. Due to advancement in the cardiac surgery, anesthesiology and pharmacology, indications for surgical management
of ventricular septal defects and pulmonary hypertension (PH) are continuously expanding. There are some reports both about
simultaneous radical correction and two-stage correction with palliative pulmonary artery (PA) narrowing in the first stage. The
approach of two-stage surgical management of VSD with Eisenmenger syndrome has not been developed yet.
Material and methods. The first stage of surgical management of VSD with Eisenmenger syndrome (narrowing of PA with lung biopsy) was performed in 44 patients aged 5.8╠0.6 years, the second stage (radical correction) ? in 30 (68.2%) of them. In 14 (31.8%)
patients after PA narrowing, radical correction was impossible due to high residual PH and/or sclerotic changes in pulmonary vessels.
The indications for each correction stage were determined on the basis of the catheterization of cardiac chambers and invasive pressure monitoring in the PA (IPAPM). Morphological changes in biopsy specimens of the pulmonary vessels were evaluated by
Heath?Edwards classification and mean relative medial thickness of pulmonary vessels.
Results. In the early postoperative period after PA narrowing, 3 patients (6.8%) have died with residual PH; in the late postoperative
period after PA narrowing, 30 patients underwent radical correction without any deaths. In 14 patients, radical correction was not possible due to high residual PH and / or sclerotic changes in pulmonary vessels.
Conclusion. Indications for surgery in patients with VSD and Eisenmenger syndrome should be based on IPAPM data. Radical correction in VSD with Eisenmenger syndrome is advisable to perform after PA narrowing. If VSD patients had IV stage morphological
changes according to Heath-Edwards classification, PH regression is possible both in early and late postoperative periods.
Key words: ventricular septal defect; pulmonary hypertension; congenital heart disease; Eisenmenger syndrome.
г?б?блкб
?? ????????? ??????? ????????????? ???????
??????? ??????????????? ??????????? (????)
? ??????? ???????? ???????????? (??) ? ????????? ???????????? ????????? ??????????? [1?3].
? ??????? ? ??????????????? ???? ? ????????
????? ????? ????? 100% ??, ? ??????????? ?????????????? ????????? ???????? ??????? ????? ??????????? ??? ? ????? ??????? ???? ????? [4?11].
??? ???????????? ??????? ???? ? ??????? ??
????????? ??????????? ????? ????????? 9?10%,
? ?? ??? ?????????? ?? ?????? 5 ??? ?????. ???????
???????? ?????? ?????? ??????????????? ??????????????, ??????? ? ????????? ? ???????????
34
????? ?????? ? ???????? ?????????? ???????????
[2, 4?6, 12?14].
? ?????????? ? ??????? ??????????????, ?????????????? ? ???????????? ????????? ? ?????????????? ??????? ?????????? ??????? ?????? (???),
? ??? ????? ? ??????????? ??????? ??, ??? ?????
???????????. ???? ????????, ??? ???????? ??????????? ???????? ???? ???????? ? ? ????? ? ????????? ????????????. ??? ???? ??????? ????????? ??? ?? ????????????? ??????????? ?????????,
??? ? ? ??????????? ????????? ? ???????????? ?????????? ???????? ??????? (??) ?? ?????? ?????
[14?16]. ?????? ??????? ???????????? ?????????????? ??????? ???? ? ????????? ???????????? ??
?????????? ??????? ??????????? ?? ???????????.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
???? ???????????? ? ???????? ???????????
? ??????? ?????????? ??????????? ?????????????
????????? ???? ? ????? ? ????????? ????????????.
Е?зб?к?н к обзс??
??????? ?????????? ?????????????? ???????
44 ????????? ? ???????????????? ???? ? ????????? ????????????, ????????????? ? 1984 ??
2012 ?.
?? ?????? ?????????? ??????????? ? ???????
??????? ????? ????????? 0,5?16,5 ???? (? ???????
5,8╠0,6), ????? ???? ? 4,2?54 ?? (21,4╠1,7). ??????????? ????????? ? ??????? ???? ??????. ????????????? ???? ?????????? ? 29 (65,9%) ???????.
? 9 (20,5%) ??????? ?????? ????????????? ??????
?????????????? ??????????? (????), ? 3 (6,8%) ?
???????? ???????????? ?????? (???), ? 3 (6,8%) ?
??? ? ????.
????????? ??????? ? ????? ???????? ???????????? ?? ??????? ????????? ???????????? ????? ?????????? ? ???????? ????? ????? 94% ? ????????? ? ???????????????? ??? ????????????
??????? ????? ?? ?????? ??????????????? ???????????.
? ???????? ??????? ????? ?????????????? ??????? ?? ???? 44 ??????? ???? ????????? ?????????
?? ? ???????? ???????. ?????? ???? ??????????????
??????? ? ??????????? ????????? ? ?????????
???? ? ??????? ??????? ? ?? ??? ?? ????????? ?
??? ??????????? ? ?????????? ??????? ????? ????????? ?? 30 (68,2%) ??????? (1-? ??????).
? 14 (31,8%) ?????????, ?????????? ????????? ??,
??????????? ????????? ?? ???? ???????? ????? ????????????? ??????? ?? ?/??? ??????? ??????????????? ????????? ???????? ??????? (2-? ??????).
?????? ???????????? ????????????, ?????????????????????????, ?????????????????????
(?????) ? ??????????????????? ????????????,
???? ??????? ????????? ????????????? ????????
?????? ? ?????????????????? ? ??????????? ?????????? ???????????? ???????? ? ???????? ??????? (?????). ?????????? ???????????? ??????
????? ?????????????? (???) ????????????? ????? ? ?????? ? ?????????? ???????? ????? ???????????? ???????.
??????????????? ????????? ???????? ???????
? ???????? ??????? ??????? ????????? ?? ????????????? Heath?Edwards [17]. ?????? ???????
??????? ???????? ???????? (?????) ???????????? ? ??????? ????????? Image-Pro Plus [18?20].
?????????????? ?????? ????????? ? ???????
????????? Excel 2007 ?????? ??????????????
???????? Statistica 6.0 ????? ╚St?t Soft╩. ?????????????? ?????????? ????????? ??????????????? ????????? ?????????????? ?????? ? ????????????? ???????????: ????????? (?), ???????
??????? (?) ? ??????? ?????? ???????? ??????-
?????????. ? ???? ??????? ??? ?????? ??????????
????????: ?<0,05; ?<0,01; ????????????? ???????? 95, 99%.
Йбашн╦з?з?
????? 44 ????????????? ??????? ???????? ????????? ???????????? ????? ?????????? ?????????? ? ???????? 74?94% (? ??????? 87,9╠0,6%),
??????? ???????? ??????????? ? 94,3?131%
(? ??????? 98,1╠3,1%), ??????? ???????? ? ?? ?
52?90 ?? ??. ??. (? ??????? 72,5╠3,4 ?? ??. ??.).
????? ???????? ????????????? (???) ? ???? ??????? ???? ????????? ? ????????? 7,6?33,6 ??. ????
(? ??????? 16,6╠0,6 ??. ????). ????????? ??????
????????? ? ?????? ??????????????? ????????????? (???/???) ?????????? ? ???????? 0,95?1,21,
????????? ? ??????? 0,97╠0,02. ??? ???? ???? ???????? ? 3??4 ??????? ???????????????? ????????? [4] (????. 1).
????? ???????, ??????? ? ?????????? ???????
????? ????????? ?? ???? ???????????? ??????????? ?????????, ?? 3? ?????? ??????? ?????
????? ? 24 (80%) ???????, ?? 4-? ?????? ?
? 6 (20%). ????? ????????? ? ??????????????????
? ??????????? ????????? ? 3? ?????? ??????? ?????????? 9 (64,3%) ?????????, ? 4-? ? 5 (35,7%)
?????????. ???????, ????????????? ? ??????? ???????? ? ?? ? ??? ???? ?????????? ???? ? ??????? 2-? ??????. ?????????? ?????????? ?????
? ???????????????? ??????? ? ???? 44 ???????
??????????????? ???????? ? ????? ??????? ?????????? ? ????????????? ????????? ?? (???????
??? ????????? ????? ??? ?? 10 ?? ??. ??. ??? ????????? ??).
????????? ?? ????????? ?? ??????? ??????????? ??? ????????? ???????? ? ????????? ??????????? ????? ??????????. ????????? ??????? ????????????? ????????? ???????? ?? ??????? ??? ?????????? ????????? ????? ?? ???? 85% ???
?????????. ??????????????? ????? ????????? ??
????????????? ? ??????? ???????? ? ??, ??? ? ??????????? ???/??? ? ??????? 1-? ?????? ????
?????????? ???? (??. ????. 1). ?? ???? ??????? ????????? ?? ????????? ???????? ???????.
??? ??????? 1-? ?????? ???????????? ????????? ????????? ??, ????? ????????? 2-? ??????
?????? 3 (21,4%). ??????? ?????? ?? ???? ???????
???? ??????? ? ???????? ???????????? ??????.
??????????????? ?????? ???????? ???????
??????? ????????? I?V ?????? ?? ????????????? Heath?Edwards (???. 1). ???????????????
????????? ???????? ??????? I?III ?????? ??
Heath?Edwards ??????? ? 24 (80%) ???????
1-? ?????? ? ? 3 (21,4%) ??????? 2-? ??????
(?<0,05); ????? ??????? ?????? ?????????????
???????? ? 1-? ?????? ? ??????? ????????
17,5╠0,7% (12,5?29,1%), ?? 2-? ? 16,8╠1,1%
(11,1?24,4%) (?>0,05).
35
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
М?╥нк?? 1
Днклкмс-?бос?кл?ок?брмкб тсм?а?збнк ╥сн╦л?? ?с к тсрнб ршйк??лк? нб?с?лсх ??зб?кк
????? ????????? ??
?? ????????? ??
??????????
1-? ?????? 2-? ??????
???????, ???
??????????3?
??????
?????? ??, n (%) 4
Sat O2, %
??, %
??? (????.),
?? ??. ??.
??? (??.),
?? ??. ??.
???, ??/?2
???/???
5?199
(58,3╠7,5)
24 (80)
6 (20)
p
1-? ??????
21?150
<0,01
(93,6╠11,1)
9 (64,3)
5 (35,7)
? ?????????? ???????
? ?????? ???????
2-? ??????
?
p
?
1-? ??????
?
2-? ??????
p
?
?
?
<0,05
74?93
83?94
>0,05
(88,1╠0,9) (86,2╠1,2)
88,3?110
91,3?131 >0,05
(97,1╠0,8) (99,1╠1,6)
80?120
78?130
<0,05
(105,2╠2,1) (114,7╠4,0)
52?86,7
55,3?93
<0,01
(71,2╠1,5) (80,1╠2,8)
8,1?33,6
12,7?25,9 <0,01
(16,5╠0,7) (20,4╠0,6)
0,94?1,25
0,95?1,18 >0,05
(0,96╠0,02) (0,98╠0,02)
84?95
76?95
>0,1
89?95
85?93
>0,05
(89,7╠0,96) (87,4╠1,34)
(92,3╠0,9) (87,4╠2,3)
38?87,8
50,8?111,1 <0,01 31?76,8
50,8?95,6 <0,01
(62,7╠2,4) (89,2╠3,6)
(45,3╠2,1) (77,5╠3,59)
40?86
55?110
<0,01
35?89
61?95,0 <0,01
(60,8╠2,5) (92,1╠4,7)
(52╠2,47) (82,5╠2,84)
25,3?62
42,7?89,3 <0,01
23?63
43,3?75 <0,01
(42,9╠2,2) (66,5╠3,6)
(34,1╠2,0) (58,8╠2,7)
4,0?27,2
9,0?23,7
<0,01 4,0?20,1
9,2?21
<0,01
(9,1╠0,7)
(15,3╠0,8)
(7,4╠0,72) (14,1╠0,94)
0,3?1,4
0,4?1,0
<0,01
89?95
85?93
>0,05
(0,63╠0,04) (0,84╠0,04)
(92,3╠0,9) (87,4╠2,3)
????? ??????? ?? ?????????? ??? ??????? ????????? ???????? ?????????????? ??????? ??????????.
? ?????????? ??????? ????? ????????? ?? ???????????? ?????????? ?????? ?? 41 ?????????.
??????????? ??? ?????????? ???????????? ???
? 1-? ?????? ???? ?????????? ????, ??? ???? ??
? ?????? ???????? 1-? ?????? ?? ??????????? ???????????????? ?? (??. ????. 1).
?? 2-? ?????? ? ?????????? ??????? ????? ????????? ?? ???????? ? ?? ????????? ???????????? ?????????, ?? ??? ?? ?????????? ?? ?????????? ??????? ??????. ? 3 (21,4%) ?????????,
???????? ?? ??????? ? ??? ??????????????? ????????? ???????? ??????? I?III ?????? ??
Heath?Edwards, ????????? ????? ??? ?????????????, ??? ????????? ???????? ?????? ? ??????????? ?????????.
??????????? ????????? ????? ????????? ??
???? ????????? 30 ???????. ??????? ??????? ??
?????? ??????????? ????????? ?????????? ??
5 ??? ?? 18,8 ???? ? ? ??????? ???????? 6,1╠2,5 ????. ?????????? ? ???????? ?? ???? ??????? ??????? ????????????? ?????????? ????? ? ???????????????? ???????. ??? ???? ???????? ????
???????????? 24 ???????? ? I?III ??????? ?????-
1 (7,1%)
6 (20%)
1 (7,1%)
3 (10%)
1 (7,1%)
8 (26,7%)
6 (42,9%)
13 (43,3%)
5 (35,8%)
?
I ??.
II ??.
III ??.
IV ??.
?
I ??.
II ??.
III ??.
IV ??.
V ??.
???. 1. ??????????????? ????????? ???????? ??????? ?? Heath?Edwards ? ??????? ? ???? ? ????????? ????????????:
? ? 1-? ?????? (n=30); ? ? 2-? ?????? (n=14)
36
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М?╥нк?? 2
Хсм?а?збнк ?бос?кл?окмк ЕДД ш ╥сн╦л?? 1-х ??штт? ?с к тсрнб ???км?н╦лсх мс??бм?кк
??????????
????? ???????????
?????????
?? ??????????? ?????????
Sat ?2, %
??, %
??? (????.), ?? ??. ??.
??? (??.), ?? ??. ??.
???, ??/?2
???/???
89?95 (92,3╠0,9)
31?76,8 (45,3╠2,1)
35?89 (52╠2,5)
23?63 (34,1╠2,0)
4,0?20,1 (7,4╠0,7)
0,21?0,7 (0,40╠0,02)
?????????? ????????? ???????? ??????? ??
Heath?Edwards ? 6 ????????? ? IV ???????.
?? ????? ??????????? ????????? ?????? ???????? ???? ? 23 (76,7%) ??????? ????????? ??????
??????? ? ??, ? 7 (23,7%) ? ?????? ??????? ? ????????? ? ????????? ?? ???????????????????? ????????. ???????????????? ??????????, ??????????
????? ??????????? ?????????, ????????? ? ??????? 2. ????????? ??????? ????? ??????? ????? ??????? ?? ????. ??????????? ?? ???? ??????? ?????????? ?????????? ??????????? ??????? ????????
???????????.
И╥ршй?блкб
?? ????? ??????, ????? ????????? ? ????,
??????? ?? ? ??????? ????????????, ???????????
? 3? ? 4-? ???????????????? ??????? ?? ????????????? ?.?. ???????????? ? ?????. ?/??? ???????
??????????????? ????????? ???????? ???????
IV ?????? ?? ????????????? Heath?Edwards, ????
??????? ? ???????????????? ? ????????????????? ??????? ??. ????????, ??? ???? ???????????
???????? ? ??? ????????? ???????????? ????????
???????.
???????? ??????? ?????? ??? ???? ? ???????
?? ???????? ?? ??? ??? ????????????, ?? ??????
?? ?????????? ??????? ???????? ????????? ???????? ?????. ??????? ? ???????? ????????????? ????????, ??????? ????? ??????????????? ???? ????????????????? ??????????. ????? ????, ??????????????? ??????? ?????? ???? ??? ???????
????????? ?? ????? ???? ?????????, ? ? ????????
????? ??????????? ?????????, ?????????? ????? ??????? ???????-??????????? ????? [21].
? ????? ? ???? ????? ? ???????????????? ??????? ????????, ?? ?????? ??????, ???????? ??????????? ??????? ???????????? ??????? ? ???
? ??????? ?? ??? ??????? ??????? ?? ??????????? ???????.
??????? ????????, ??? ?????????? ??? ???????
? ????????????? ????????? ???? ? ?????????
????????????. ????????? ??????????? ?????????,
??????? ?????????? ??? ??????? [22, 23], ????????,
?? ?????? ??????, ????????????, ?????? ??? ????????????? ?????????? ?? ???????? ? ?????????????????? ????????????? ? ?????????? ???????-
94?98 (96,7╠0,6)
23?48 (34,8╠1,6)
26?45 (33,1╠1,6)
18?31 (24,1╠1,0)
3,2?13,7 (5,8╠0,4)
0,2?0,6 (0,34╠0,01)
?
<0,05
<0,01
<0,01
<0,01
>0,05
<0,01
????, ??????????? ?????????? ??????? ?? ? ????????????????? ???????, ?????????? ???? ???????? ????????????? ???????????, ????? ????????????? ? ?????? ???????? ??????????????? ? ????????? ? ???? ?????.
??????????? ????????? (????????? ?? ? ??????????? ??????????? ??????????), ???????? ? ?????? [24?26], ??? ?????????? ??????? ????? ?? ??????? ?????????? ???????????? ??????????????.
????? ?????????? ??????? ????? ?????? ???????????? ????????? ????????????? ???????? ??? ?????????, ??? ??????? ???? ????????????? ????????????????? ???????????????. ????? ????, ?? ?????? ???? ????????? ???????? ???? ??? ??
????????? ???????????? ????????? ???????? ?????????? ??????????????.
г??с??
1. ????????? ? ???????? ? ??????? ? ????
? ????????? ???????????? ?????? ????????????
?? ?????? ?????.
2. ??????????? ????????? ???? ? ?????????
???????????? ????????????? ????????? ?????
???????????????? ????????? ??.
3. ??? ??????? ? ??????? ? ???? ??????????????? ????????? IV ?????? ?? Heath?Edwards ???????? ??????? ?? ??? ? ??????, ??? ? ? ??????????
????????????????? ????????.
??????????
1.
2.
3.
4.
5.
6.
??????? ?.?., ???????????? ?.?., ??????????? ?.?. ??????????? ?? ???????? ??????????? ? ?????. ?.: ?????
??. ?.?. ???????? ????; 2013.
Freeman S.B., Taft L.F., Dooley K.J., Allan K., Sherman S.L.,
Hassold T.J. et al. Population-based study of congenital heart
defects in Down syndrome. Am. J. Med. Genet. 1998; 80:
213?7.
Benza R.L., Park M.H., Keogh A., Girqis R.E. Management of
pulmonary arterial hypertension with a focus on combination
therapies. J. Heart Lung Transplant. 2007; 26: 437?46.
??????????? ?.?., ??????? ?.?. (???.) ????????-?????????? ????????: ???????????. ?.: ????????; 1996.
??????? ?.?., ???????????? ?.?. ???????????????????
?????. ???????? ? ??????????? ????????????? ?????????.
?.: ????? ??. ?.?. ???????? ????; 2005.
??????? ?.?. ?????????? ?????? ??????. ???????????
??? ?????????, ???????????, ????????????. ?.: ???????;
2005.
37
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
7.
??????? ?.?. (???.) ?????? ?? ????????-?????????? ????????. ?. 1. ?.: ????? ??. ?.?. ???????? ????, 2001:
414?24.
8.
???????????? ?.?., ??????? ?.?., ????????? ?.?., ?????????? ?.?., ??????? ?.?., ??????? ?.?. ? ??. ??????? ???????? ??????????? ?? ?????????? ????????????? ????????? ???????????? ????????????? ??????? ? ???????? ????????????? ??????? ???????????? ???????????? ?
????????? ??????? ??????????????? ???????????. ??????? ??????? ?????? ? ???????. 2005; 1: 67?70.
9.
Humbert M., Sitbon O., Chaouat A., Bertocchi M., Habib G.,
Gressin V. et al. Pulmonary arterial hypertension in France:
Results from a National registry. Crit. Car. Med. 2006; 173:
1023?30.
10. Peacock A.J., Murphy N.F., McMurray J.J., Cabellero L.,
Stewart S. An epidemiological study of pulmonary arterial
hypertension. Eur. Respir. J. 2007; 30: 104?9.
11. Anderson B.R., Stevens K.N., Nicolson S.C., Gruber S.B.,
Spray T.L., Wernovsky P.J. et al. Contemporary outcomes of
surgical ventricular septal defect closure. J. Thorac.
Cardiovasc. Surg. 2013; 145: 641?7.
12. ???????????? ?.?. ???????? ???????? ??????????? ? ???????? ?????????? ??????? ?????? ? ?????? ????????:
???. ? ?-?? ???. ????. ?.; 1995.
13. ???????????? ?.?., ????????? ?.?., ????????? ?.?.,
??????? ?.?., ????????? ?.?., ????????? ?.?. ????????
???????? ??????????? ? ?????????? ??????? ????? ????????? ??????? ??????????????? ??????????? ? ??????? ?
?????????? ???????? ????????????. ??????? ???????
?????? ? ???????. 2004; 5: 29?32.
14. Barst R.J., McGoon M., Torbicki A., Robyn J., Sitbon O.,
Krowka, M.J. et al. Diagnosis and differential assessment of
pulmonary arterial hypertension. J. Am. Coll. Cardiol. 2004;
43: 43?7.
15. Cynthia D., Morris D., Magilke, Reller M. Down's syndrome
affects resalts of surgical correction of complete atrioventricular canal. Pediatr. Cardiol. 1992; 13: 80?4.
16. Novick W.M., Sandoval N., Lazorhysynets V.V., Castillo V.,
Baskevitch A., Reid R.W. et al. Flap valve patch closure of ventricular septal defects in children with increased pulmonary
vascular resistance. Ann. Thorac. Surg. 2005; 79: 21?8.
17. Heart D., Edwards J.E. The pathology of hypertensive pulmonary vascular: A description of six grades of structural
changes in the pulmonary arteries with special reference to
congenital cardiac septal defects. Circulation. 1958; 18:
533.
18. Rabinovitch M., Castaneda A.R., Reid L. Lung biopsy with
frozen section as a diagnostic aid in patients with congenital
heart defects. Am. J. Cardiol. 1967; 19: 854.
19. Hislop A., Reid L. Intrapulmonary arterial development during
fetal life ? branching pattern and structure. J. Anat. 1972; 113:
35.
20. Rabinovitch M., Haworth S.G, Vance Z., Vawter G.,
Casteneda A.R., Nadas A.S. et al. Early pulmonary vascular
changes in congenital heart disease studied in biopsy tissue.
Human Pathol. (suppl.). 1980; 11: 499?509.
21. ????????? ?.?., ????????? ?.?., ?????? ?.?., ???????????? ?.?. ??????????? ????????? ??????? ?????? ? ?????????? ??????????????? ??? ???????? ??????????? ? ??????? ? ??????????? ???????? ??????. ??????? ? ?????????????????? ????????. 1996; 5: 29?35.
22. Robicsek F. Flap-valve closure of ventricular septal defects.
Ann. Thorac. Surg. 2006; 81: 788.
23. Zhang B., Wu S., Liang J., Zhang G., Jiang G., Zhou M. et al.
Unidirectional monovalve homologous aortic patch for repair
of ventricular septal defect with pulmonary hypertension. Ann.
Thorac. Surg. 2007; 83: 2176?81.
24. Batista R.J., Santos J.L., Takeshita N., Eocchino L., Lima P.N.,
Goehr M. et al. Successful reversal of pulmonary hypertension
in Eisenmenger complex. Arq. Bras. Cardiol. 1997; 68:
279?80.
38
25.
26.
Ohashi N., Matsushima M., Maeda M., Yamaki S. Two-stage
procedure for pulmonary vascular obstructive disease in down
syndrome with congenital heart disease. Circ. J. 2006; 70:
1446?50.
??????? ?.?., ???????????? ?.?. ????????????? ???????
??????? ??? ? ????????? ????????????. ????????? XVI
?????????????? ?????? ????????-?????????? ????????.
??????; 2010; 12 (3): 13.
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213?7.
Benza R.L., Park M.H., Keogh A., Girqis R.E. Management of
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transposition of the great vessels and Taussig?Bing anomaly
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Russian).
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Gressin V. et al. Pulmonary arterial hypertension in France:
Results from a National registry. Crit. Car. Med. 2006; 173:
1023?30.
Peacock A.J., Murphy N.F., McMurray J.J., Cabellero L.,
Stewart S. An epidemiological study of pulmonary arterial
hypertension. Eur. Respir. J. 2007; 30: 104?9.
Anderson B.R., Stevens K.N., Nicolson S.C., Gruber S.B.,
Spray T.L., Wernovsky P.J. et al. Contemporary outcomes of
surgical ventricular septal defect closure. J. Thorac.
Cardiovasc. Surg. 2013; 145: 641?7.
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2004; 5: 29?32 (in Russian).
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Krowka, M.J. et al. Diagnosis and differential of pulmonary
arterial hypertension. J. Am. Coll. Cardiol. 2004; 43: 43?7.
Cynthia D., Morris assessment D., Magilke, Reller M. Down's
syndrome affects resalts of surgical correction of complete
atrioventricular canal. Pediatr. Cardiol. 1992; 13: 80?4.
Novick W.M., Sandoval N., Lazorhysynets V.V., Castillo V.,
Baskevitch A., Reid R.W. et al. Flap valve patch closure of ven-
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
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18.
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tricular septal defects in children with increased pulmonary
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changes in the pulmonary arteries with special reference to
congenital cardiac septal defects. Circulation. 1958; 18: 533.
Rabinovitch M., Castaneda A.R., Reid L. Lung biopsy with
frozen section as a diagnostic aid in patients with congenital
heart defects. Am. J. Cardiol. 1967; 19: 854.
Hislop A., Reid L. Intrapulmonary arterial development during
fetal life ? branching pattern and structure. J. Anat. 1972; 113:
35.
Rabinovitch M., Haworth S.G, Vance Z., Vawter G.,
Casteneda A.R., Nadas A.S. et al. Early pulmonary vascular
changes in congenital heart disease studied in biopsy tissue.
Human Pathol. (suppl.). 1980; 11: 499?509.
Kuznetsova B.A., Gorchakova A.I., Fokina N.S.,
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Ann. Thorac. Surg. 2006; 81: 788.
Zhang B., Wu S., Liang J., Zhang G., Jiang G., Zhou M. et al.
Unidirectional monovalve homologous aortic patch for repair
of ventricular septal defect with pulmonary hypertension. Ann.
Thorac. Surg. 2007; 83: 2176?81.
Batista R.J., Santos J.L., Takeshita N., Eocchino L., Lima P.N.,
Goehr M. et al. Successful reversal of pulmonary hypertension
in Eisenmenger complex. Arq. Bras. Cardiol. 1997; 68:
279?80.
Ohashi N., Matsushima M., Maeda M., Yamaki S. Two-stage
procedure for pulmonary vascular obstructive disease in down
syndrome with congenital heart disease. Circ. J. 2006; 70:
1446?50.
Bo?keria L.A., Gorbachevskiy S.V. Surgical treatment patients
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????????? 07.05.2014
╘ ????????? ???????, 2014
??? 616.12-007-053.31-089.168
?????? ???????? ????????? ?????????????? ???????
????? ? ??????? ???????? ????? ?????? ??????????
? ???????? ???????? ? ??????? ????? ?????
??????????? ???????? ???????? ??? ????????????
????????????? ???????
?.?. ????????, ?.?. ???????, ?.?. ????????, ?.?. ?????????
???? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ?
???????? ??? ? ???? ?.?. ???????) ????; ?????????? ?????, 135, ??????, 121552,
?????????? ?????????
???????? ?????? ?????????, ??. ?????. ????., ?????????, ?????? ???. ????;
??????? ??????? ??????????, ??. ?????. ????., ?????? ???. ????, e-mail: kovalevdv@mail.ru;
???????? ???? ??????????, ??. ?????. ????., ????. ???. ????;
????????? ??????? ????????????, ????????
??????????? ?????? ?????????? ?????????????? ??????? ? ??????? ???????? ????? ?????? ?????????? ? ???????? ????????
? ??????? ????? 5 ??? ????? ???????? ????????. ?????????? ?????????? ????????? ?????? ?????? ????????? ?????????
????? ????????? ???????? ??????????? ? ?????????? ??????? ??????????????? ??????????? ? ??????????? ?????????
?????????????????????? ??????? ??? ?????? ??????? ?? PTFE, ????????? ???????? ?????? ???????? ? ??? ?????????
???????? ?? PTFE.
????????? ???????? ? ?????????????????? ????????? ?? 18-? ????? ????? ????????. ?? ?????? ????? ???????????????
???????? ????????? ?? ???????? ??????? ?????????? ???????????: ???????? ?????????????? ???????? ????? ?????
?????????? ? ?????? ???????? ?? 102 ?? 6 ?? ??. ??., ????? ?????? ?????????? ? ???????? ???????? ? ? 86 ?? 12 ?? ??. ??.,
??????? ??????? ?????? ????????? ????????? 65%.
???????????? ?????? ??????? ????????? ??????, ????????? ? ??????? ????????? ?????? ?????? ?????????, ? ???? ???????
?????????? ? ?? ?????? ?? ?????? ? ??????? ??????????. ??????? ???????? ???????????? ????????? ??????? ? ???????
?????????? ????????, ??? ????????? ?????????? ????????? ??????? ?? ????? ??????? ? ??????????? ??????? ?????????
?????????????? ???????? ?? ?????????? ???????????.
???????? ?????: ???????? ????????; ????????????? ??????; ?????? ? ????????? ????????.
39
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
SUCCESSFUL CORRECTION OF SUBVALVULAR AORTIC STENOSIS AND CONDUIT STENOSIS BETWEEN THE RIGHT VENTRICLE AND THE PULMONARY
ARTERY IN FEMALE PATIENT AFTER PREVIOUS RASTELLI PROCEDURE IN
GREAT VESSELS TRANSPOSITION
M.R. Chiaureli, D.V. Kovalev, A.A. Nezhlukto, B.D. Mamadshoev
A.N. Bakoulev Scientific Center for Cardiovascular Surgery of Russian Academy of Medical
Sciences; Rublevskoe shosse, 135, Moscow, 121552, Russian Federation
Chiaureli Mikhail Ramazovich, Chief Research Associate, Professor, MD, DM;
Kovalev Dmitriy Viktorovich, Senior Research Associate, MD, DM, e-mail: kovalevdv@mail.ru;
Nezhlukto Anna Arkad?evna, Senior Research Associate, MD, PhD;
Mamadshoev Broimsho Davlatshoevich, Postgraduate
There is a case of management of subvalvular stenosis stenosis and conduit stenosis between the right ventricle and pulmonary
artery in female patient, 5 years after Rastelli procedure. Obstruction of the left ventricle exit site was resolved by the excision of conical septum and expansion of ventricular septal defect with the subsequent creation of aortico-left ventricular tunnel using PTFE
patch, the front wall of the conduit was expanded, PTFE patch angioplasty was performed.
The patient was discharged in satisfactory condition on the 18th day after surgery. According to echocardiography data, there were
no hemodynamically significant gradients at the ventricular exit sites: systolic pressure gradient between the left ventricle and the
aorta decreased from 102 to 6 mm Hg, between the right ventricle and the pulmonary artery ? from 86 to 12 mm Hg, left ventricular
ejection fraction was 65%.
The case is remarkable due to the combination of reasons led to a narrowing left ventricular exit site, and two levels of obstruction ?
at the exit sites of left and right ventricles. It should be noted, that the appropriateness of the approach and techniques allowed to
eliminate the stenosis at both levels effectively, and significantly lowered systolic blood pressure gradients to the normal range.
Key words: Rastelli peocedure; subvalvular stenosis; stenosis and calcification of the conduit.
????????????? ??????? ???????????? ????????????? ??????? (???) ? ???????? ??????????????? ??????????? (????) ? ???????? ????????
??????? (??) ?? ?????????? ??????? ???????? ?????????? ?????????. ?? ???? ???????, ??????????? ??? ????????? ??????? ??????, ??????????
??????????????? ???????? ???????? ????????,
???????????? ? 1969 ?., ??????? ?? ??? ??? ?????? ??????????? ??? ?????? ????????? ? ????? ?????? 2?3 ??? [1]. ? ????? ?????? ?????? ????????
???????? ???????? ????????? ?.?. ???????????
? 1981 ?. [2]. ????????? ???????? ????? ????????
???????? ? ??????????? ???????? ?????? (?????
3 ???) ??????????? ?????? ????? 70 ???????? ???????? ? 29 ???????????? ?? ?????? ??????????????
?????? ???????? ??????? ????? ???? ????????
[3, 4]. ?? ?????? ??????????, ???????? ?? ??????? ???????????? ????? ???????? ????????, ? ?????????? ????? ? ??????????? ??????? ?????????? ?????????? ???? ?????????? (?????????? ????????, ???????? ????????????? ??????????,
????????????? ????, ???????? ???????????????
???????????????? ???????, ????????? ?????
? ???????????? ?????? ? ??????), ? ???? ???????
????????? ????????? ????????????? ???????????? [3?9].
???? ????????? ?????? ? ??????????? ??????
????????? ?????????? ?????????????? ???????
? ??????? ???????? ????? ?????? ??????????
? ???????? ???????? ? ??????? ????? ????????
????????.
? ? ? ? ? ? ? ? ???, ???? ? ???????? ?? ? ??????? ??????????????? ???? ????????? ????????
????????. ?? ????? ????? ????????????? ????????40
?????? ?????????? ?????????????? ?????????????? ????, ???????? ??????? ?? ?????? ?????????
(??) ? ????? ??? ?????? ????????????????????
???????, ??????????? ?????? ?? ? ????????? ?????????????? ????? ??. ????? ?? ??????? ????????? (??) ? ?? ??? ??????????? ??? ?????? ????????????????????? ?????????????????? ????????
? 16. ???????? ???????? ????? ???????? ?????
?? ? ?????? ???????? 12 ?? ??. ??., ????? ??
? ?? ? 18 ?? ??. ??. ? ????? ? ??????????? ? ????????????????? ??????? ?????????? ??????????????????? ???????? ??????? ????????????? ????????????
???????????????????????
(???)
╚Medtronic╩.
????? 5 ??? ???????? ????????? ??????, ???????? ????????????? ? ?????????? ????????.
??? ??????????? ? ????????? ??????? ???????????
??? ????? 126 ?/?, ????????? ???????????? ?????
?????????? ? 99%. ?? ??????????????????? ??????????????? ????????? ???? ? ???????? ?????????
?????????? (???) 80 ??/???, ?????????? ????????????? ??? ?????? ?????, ???????? ??????? ??????
????? ????? ????, ??????????? ?????? ? ????? ??????? ??????. ??? ???????????? ??? ?????? ??????????? ????????????????? ? ?????? VVI ? ??????? ???????? 60 ??/???, ????? ?????????? ?????????????? ?????????? ? 1,2 ?.
?? ?????? ??????????????? ? ????? ?????????: ???????? ????????????? ????? (???) ? 8 ??,
???????? ?????????????? ????? (???) ? 17 ??,
?? ? 74%. ?????????? ?????? ??????????????
? ??????? ??????????? ???????, ????????? ?????? ? 19 ??, ???????????? I ???????. ? ???????? ?????? ?? ??????????????? ????????-????????
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??????? ?? 7 ??. ???????? ?????????????? ????????
(???) ????? ?? ? ?? ????? 86 ?? ??. ??. ??????
?????? ?????? ?????????, ??????? ?????? ? ????????? ??????? ??????? ? ?????? ????????????????????? ???????? ? ??? ????? ?? ? ??
77 ?? ??. ??. ??????? ??????????? (??) ? ??????????????? ??????? (??) ??????, ?????????, ????????? ?????? ?? ? 24 ??, ?? ? 27 ??, ???????????? ?? ????? ???????? I ???????.
?? ?????? ????????????????? ? ?????????????? ???????? ?????? ???????? ?????????? ?????????? ????????? ?????? ?????? ????????? (????),
???????????????? ?????? ????????, ?????? ?????
?????? ???????? ??????? (???), ?????????? ????? ???????? ??????? (???). ???????? ? ?? ?
116/0-6, ?? ? 30/6 (??????? ? 18), ?? ? 204/0-9,
????? ? 102/61 ?? ??. ??. (???. 1). ?????? ???????????? ?????????? ? ????????? ????????? ??????????? ??????????: ???? ?? ?????? ???????
????? ?? 6 ?? ?? ???? ?????????????????? ???????? ??????????? ? ?????? ??????????????? ???????????. ???????? ????? ?? ? 16 ??, ??????? ????? ?? ? ?? ???????????? ??????????????? ??
?????? ??????? ? ??????????? ??????, ?????? ???????? ? ?????????????? ?????????? ???????
??????????, ????? ??????????? ??????? ????????
?? 5?6 ??.
??????? ????????? ?????????? ?????????? ????????? ?????? ?? ????? ????????? ???????? ??????????? ? ?????????? ???? ? ???????????
????????? ?????????????????????? ??????? ???
?????? ??????? ?? PTFE ? ?????????? ????????
?????? ???????? ? ??? ????????? ???????? ?? PTFE
? ???????? ?????????????? ??????????????, ????-
?????? ? ???????????????? ????????????. ??????
???????? ?????????????? ????????? ╚?????????╩
(t=4 ╟?) ? ??????? ???????.
????? ????????? ????????????? ? ????????????? ?????????? ????????? ??????? ?????????????? ??????????????. ?? ???????????? ????????
? ??????????? ???????? ?? 32 ╟? ??????? ????????
?????? ???????? ????? ?? ? ??. ? ?????????? ?????? ???????? ???????? ???????????????? ??????? ??????????????? ???????, ?????????? ???????
????????, ? ???????? ?????? ???????? ??????????
????????? ????????? ??????? (???. 2, ?). ????????? ????????? ???????? ???????????????? ???????? ?????? ????????, ??????? ??????? ???????,
????????? ????????????? ?????? ? ??????? ??????
???????. ??? ????????? ?????? ?? ? ??? ? ???
???????? ??? ? 12 ? ? 16 ??????????????, ????? ???? ????????? ???? ????????? ?? 26 ╟?. ???????? ????? ? ????????? ???????????????? ????????????. ??? ???????? ??????? ?????????? ?????????? ???????? ???????? ???? (???)
????????? 5 ??, ??????? ???? ????? ????? ?????????? ????. ????????? ?? ??????? ??? ???????
?????????? ?????. ?????????? ?????? ??????????????, ? ????????????? ???????????? ??????????????? ?????????????????? ???????? ???????????,
????????? ?????????? ???? (? ?????? ????????
??? ? 11), ????????? ????????? ????????? ???????? ??????????? ??????????????. ???????????
?????????? ?????????? ?????????? ????? ????? ??
?????????????? ?????????, ??????? ???? ??????
????????? ????????????? ?????? ???????? ?? ??
????? ???????, ??????? ??????????? ????? ?? ??
? ?????. ?? ?????? ???????????????????? ???????
(??????? ??????, ??????????, ? ?????????????????
??
???
???
??
??
??
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?
???. 1. ???????????????? ???????????? ??????? ????? 5 ??? ????? ???????? ????????:
? ? ????? ????????????????, ???????? ??????? ?????????? ??????? ?????? ?? ?? ? ????? ?? ???? ?????????????????? ???????? ???????????,
???????? ? ????? ????????? ? 204 ?? ??. ??., ? ????? 102 ?? ??. ??.; ? ? ?????? ????????????????, ????????? ??????? ??????? ??????????????
?????? ?? ?? ?????? ??????????? ?????????? ? ???????, ???????? ? ?? ? 116 ?? ??. ??., ? ?? ? 30 ?? ??. ??.
?? ? ?????; ?? ? ???????? ???????????
41
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???. 2. ????????????????? ????. ????? ????????:
? ? ??????? ???????? ?????? ???????? ????? ?? ? ??, ????????? ??????? ????? ??????????; ? ? ??????? ?????? ???????, ????????? ??????? ??
?? ? ?????, ? ???????? ???? (??????? ????????); ? ? ???????? ????? ?? ??????????? ????? ?? ?? ? ????? ??? ?????? ??????? ?? PTFE; ? ? ????????? ???????? ???????? ?????? ???????? ? ????????? ?????? ?? ?? ? ?? ? ??????? ??????? ?? PTFE
???????????? ???????) ?????? ???????? ????? ??,
???????? ???????? ???????? ?????????? ???????
???????????????????? ??????? ? ????????? ??????????, ????????? ????????? ?????????????????? ???????? ???????????, ??????????? ?????????? ???? ?? 25 ?? ? ???????? 1?2 ?, ????? ????
?????????????? ? ?? ???????? ???????? ???
? 16 (???. 2, ?). ????????? ???????? ???????????? ??????? ????????????? ???????? ?? PTFE,
????????????? ??????????? ?????????? ????,
??? ????? ??????????? ????? ?? ?? ? ?????
(???. 2, ?). ????????????? ??????????? ?????
? ? ??????????? ????????? ???????? ????????
?????? ???????? ???????? ?? PTFE ?? ???????? ??????????? (???. 2, ?). ????? ???????????? ??
42
126 ???, ???????????? ?? ? 222 ???, ??????????
?? ???????????? ????? ???????? ? ?? ????? ???????? ? 36/0-6 ?? ??. ??. ??? ?? ? 105 ?? ??. ??.
?????? ????????????????? ?????? ????????
??? ??????????. ???????????? ????????????? ?????????? ?????? ????????? 14 ?, ?????????? ? ????????? ?????????? ? ??????????? ??????? ? 40 ?.
????????? ???????? ???????????????? ?????????
? ??????????????? ?????????: ????????? ?
3 ???/??/???, ??????? ? 3 ???/??/???.
??????? ???? ???????? ? ??????????????????
????????? ?? 18-? ????? ????? ????????. ????
?????? ??? ??????? ? ????????? ? ??? 107 ??/???.
?? ?????? ????? ?????????? ?????????? ??????????????? ???????? ?????????? ?? ???????? ???????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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??????????: ??? ????? ?? ? ?????? ????????
6 ?? ??. ??., ??? ????? ?? ? ?? ? 12 ?? ??. ??.,
??????? ??????? (??) ?? ? 65%.
???????? ????????, ???????? ?? ????? ???
40-?????? ???? ?????????? ? ??????????? ?????????????? ????????, ?? ??? ??? ???????? ????? ???????????????? ????????? ?????????????? ???????
??? ? ???? ? ???????? ??. ?????? ? ??????????
????? ????? ???????? ???????? ????? 60?80% ????????? ????????? ? ????????? ?????????. ???????? ??????? ????????? ????????? ???????????? ???????? ??????? ?????????????? ??????
??, ?????????? ???? ? ????????????? ???? ?
? 68, ? 7 ? ? 8% ??????? ?????????????? [6]. ??????? ?? ?????????? ?? ?????? ???????? ? ?????
10?15 ??? ?????????? 21?49%, ? ????? ?? 20 ??? ?
????? 32% [6?9] ??? ??????????? ?? ???? ????????.
????????? ????? ?????????? ?? ???????? ????????
??????? ??????? ?????? 4 ??? ? ?????? ????????
?????? 15 ?? [6, 7].
??????? ?? ?????????? ?? ???????? ?????? ??
? 15 ????? ??????????, ?? ????????? ??????,
84?93% [6, 7, 9]. ?????? ????????? ?????? ??, ???
???????, ??????????? ?? ?????? ??????? ????? ??
? ?????? ? ?????????? ??????????????? ??? ????????????? ???????? ????????, ???????????? ???????? ???????????, ? ????? ???????????? ??????????? ????????????? ????. ? ???????? ?????????? ????? ????? ????????? ???????????
??????????????? ???????????, ??????????? ???????????? ? ???????????? ?? ??? ????????????? ??????????? ?? ?????? ?? ?? ? ?? [7, 10].
??? ?????????????? ?????????? ???? ????????? ?????? ?????????? ??????? ????????? ? ?????????? ????, ???????? ? ????????? ?????
[7, 11]. ????????, ??? ??????? ?????????? ?? ????
? ?????? ???????, ??????? ??????????? ?????????? ????, ??????, ??? ????? ?????????, ? ??????? ??? ?? ??????????????? [6]. ?? ?????? ??????????? ???????, ?????????? ???????? ????????
? ??????? ?????? 1 ????, ???????? ????????????
???????? ????? ?????? ????????????? ?? ????
[6, 7]. ????????????? ????? ? ???? ???????????
??????????: ??????? ???????? ???????? ???? ????????? ? ???????? ?? 1 ????.
???????????? ?????? ?????? ??????? ????????? ??????, ????????? ? ??????? ???? (??????????? ???????? ??????????? ? ?????? ??????????????? ???????????), ? ??????? ???? ???????
?????????? ? ?? ?????? ?? ?????? ? ??????? ??????????. ? ????????????? ?????????? ?????? ?????? ?????? ???????? ? ????????????? ??????????? ????????????? ???? ????? ????????
????????, ?? ??? ???? ????????????? ????????????? ?????????? ? ?? ??????????? ??????????
???? [12].
? ?????????? ??????? ???????? ????????????
????????? ??????? ? ??????? ?????????? ????????, ??? ????????? ?????????? ????????? ???????
?? ????? ??????? ? ??????????? ??????? ????????? ?????????????? ???????? ?? ?????????? ???????????.
??????????
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Rastelli G.C. A new approach to the ?anatomic? repair of transposition of the great arteries. Mayo Clin. Proc. 1969; 44: 1?12.
??????????? ?.?., ????????? ?.?., ????????? ?.?. ? ??.
??????????? ????????? ?????? ???????????? ????????????? ???????, ???????????? ? ???????? ???????????????
??????????? ? ???????? ???????? ???????. ??????? ? ????????-?????????? ????????. 1984; 3: 14?20.
????????? ?.?., ????????? ?.?., ??????? ?.?. ????????????????? ???????? ? ????????????? ??????? ???????
?????????? ??????? ??????. ?.: ????? ??. ?.?. ???????? ????, 2000.
????????? ?.?., ???????? ?.?., ????? ?.?. ? ??. ????????????? ??????? ??? ?????????? ?????????, ???????????????? ?? ?????? ?????????? ??????? ??????. ??????? ? ????????-?????????? ????????. 2000; 4: 4?9.
???????? ?.?., ??????????? ?.?., ????????? ?.?. ? ??.
????? ?????????, ??????????? ? ?????? ????????????????? ?????????????? ?????????: ????? ?????????????????
????????????, ????????? ? ????????? ?????????. ????????? ?????????????? ? ??????????????. 2011; 3: 13?6.
HЖrer J., Schreiber C., Dworak E. et al. Long-term results after
the Rastelli repair for transposition of the great arteries. Ann.
Thorac. Surg. 2007; 83: 2169?75.
Kreutzer C., De Vive J., Kreutzer J. et al. Twenty-five year experience with Rastelli repair for transposition of the great arteries.
J. Thorac. Cardiovasc. Surg. 2000; 120: 11?23.
Lee J.R., Lim H.G., Kim Y.J. et al. Repair of transposition of the
great arteries, ventricular septal defect and left ventricularoutflow tract obstruction. Eur. J. Cardiothorac. Surg. 2004; 25:
735?41.
Brown J.W., Ruzmetov M., Huynh D. et al. Rastelli operation
for transposition of the great arteries with ventricular septal
defect and pulmonary stenosis. Ann. Thorac. Surg. 2011; 91:
188?94.
????????? ?.?., ?????? ?.?., ????? ?.?. ? ??. ?????????
???????? ? ????????????? ??????? ?????????????? ???????, ???????????? ????? ????? ??????????? ???????????
????????? ????????? ?????????? ??????? ??????. ??????? ? ????????-?????????? ????????. 2001; 4: 71?3.
Alsoufi B., Awan A., Al-Omrani A. et al. The Rastelli procedure for transposition of the great arteries: resection of the
infundibular septum diminishes recurrent left ventricular outflow tract obstruction risk. Ann. Thorac. Surg. 2009; 88:
137?43.
??????? ?.?., ????????? ?.?., ??????? ?.?. ? ??. ?????? ???????? ?????? ???????? ? ?????????? ????????????? ??????? ??????????????? ??????????? ? ????????
3 ??? 7 ??????? ????? ???????? ????????, ??????????? ?
?????? ??????? ????????. ??????? ??????? ?????? ? ???????. 2010; 4: 59?62.
References
1.
2.
3.
Rastelli G.C. A new approach to the ?anatomic? repair of transposition of the great arteries. Mayo Clin. Proc. 1969; 44: 1?12.
Burakovskiy V.I., Podzolkov V.P., Zelenikin M.A. et al. Radical
correction of complete transposition of the great arteries with
concomitant ventricular septal defect and pulmonary artery
stenosis. Grudnaya i Serdechno-Sosudistaya Khirurgiya.
1984; 3: 14?20 (in Russian).
Podzolkov V.P., Zelenikin M.A., Shatalov K.V. Extracardiac
conduits in surgical treatment of complex congenital heart
defects. Moscow: Nauchnyy Tsentr Serdechno-Sosudistoy
Khirurgii imeni A.N. Bakuleva Rossiyskoy Akademii
Meditsinskikh Nauk; 2000 (in Russian).
43
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
4.
5.
6.
7.
8.
Podzolkov V.P., Barchukov A.Yu., Cheban V.N. et al. Surgical
approach for obstructed conduits implanted for congenital
heart disease. Grudnaya i Serdechno-Sosudistaya
Khirurgiya. 2000; 4: 4?9 (in Russian).
Gorbatykh Yu.N., Sinel'nikov Yu.S., Naberukhin Yu.L. et al.
The selection of patients who require the replacement of rightsided extracardiac conduits: the extent of post-operative
observation, indications for reoperations. Patologiya
Krovoobrashcheniya i Kardiokhirurgiya. 2011; 3: 13?6 (in
Russian).
HЖrer J., Schreiber C., Dworak E. et al. Long-term results after
the Rastelli repair for transposition of the great arteries. Ann.
Thorac. Surg. 2007; 83: 2169?75.
Kreutzer C., De Vive J., Kreutzer J. et al. Twenty-five year experience with Rastelli repair for transposition of the great arteries.
J. Thorac. Cardiovasc. Surg. 2000; 120: 11?23.
Lee J.R., Lim H.G., Kim Y.J. et al. Repair of transposition of the
great arteries, ventricular septal defect and left ventricularoutflow tract obstruction. Eur. J. Cardiothorac. Surg. 2004; 25:
735?41.
9.
10.
11.
12.
Brown J.W., Ruzmetov M., Huynh D. et al. Rastelli operation
for transposition of the great arteries with ventricular septal
defect and pulmonary stenosis. Ann. Thorac. Surg. 2011; 91:
188?94.
Podzolkov V.P., Drobot D.B., Cheban V.N. et al. Mechanisms
of development and surgical treatment of subaortic stenosis,
progressed after previously performed radical repair of some
congenital heart defects. Grudnaya i Serdechno-Sosudistaya
Khirurgiya. 4: 71?3 (in Russian).
Alsoufi B., Awan A., Al-Omrani A. et al. The Rastelli procedure for transposition of the great arteries: resection of the
infundibular septum diminishes recurrent left ventricular outflow tract obstruction risk. Ann. Thorac. Surg. 2009; 88:
137?43.
Shatalov K.V., Arnautova I.V., Makhalin M.V. et al. A case of
a successful conduit replacement and correction of recanalization of ventricular septal defect in a patient of 3 years and
7 months of age after the Rastelli procedure performed in
early childhood. Detskie Bolezni Serdtsa i Sosudov. 2010; 4:
59?62 (in Russian).
????????? 28.05.2013
╘ ????????? ???????, 2014
??? 616.124.6-089.844:616.12-008.313.2:616.12-089:616.12-007-053.1
???????????????? ???????????????? ??????? ?????
???????????????????? ????????? ? ???????? ????
??? ???????? ????????
?.?. ????????, ?.?. ????????, ?.?. ???????, ?.?. ????????????, ?.?. ??????????
???? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ?
???????? ??? ? ???? ?.?. ???????) ????; ?????????? ?????, 135, ??????, 121552,
?????????? ?????????
???????? ????? ??????????, ?????? ???. ????, ?????????;
???????? ?????? ?????????, ?????? ???. ????, ???. ?????. ????., e-mail: samsonof@yandex.ru;
??????? ??????? ?????????, ?????? ???. ????, ??. ?????. ????.;
???????????? ??????? ????????, ?????? ???. ????, ???. ?????. ????.;
?????????? ???? ????????????, ?????? ???. ????, ???. ?????. ????.
???? ????????? ? ??????????? ?????? ???????? ?????? ?????????????? ??????? ? ??????? ???????????????? ??????? ?????
???????????????????? ????????? ? ???????? ????, ??????????? ? ???????????? ???????? ? ??????? ? ?????????
????????.
???????? ?????: ???????????????????? ?????????; ????????????????; ?????????????????.
RE-PROSTHESIS TRICUSPID VALVE AFTER ONE AND A HALF VENTRICULAR
REPAIR AND OPERATION BY SEALY WITH EBSTEIN?S ANOMALY
I.V. Kokshenev, V.B. Samsonov, B.N. Sabirov, T.O. Astrakhantseva, I.V. Zemlyanskaya
A.N. Bakoulev Scientific Center for Cardiovascular Surgery of Russian Academy of Medical
Sciences; Rublevskoe shosse, 135, Moscow, 121552, Russian Federation
44
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
Kokshenev Igor? Valer?evich, MD, DM, Professor;
Samsonov Victor Borisovich, MD, DM, Leading Research Associate, e-mail: samsonof@yandex.ru;
Sabirov Bahadyr Nasyrovich, MD, DM, Chief Research Associate;
Astrakhantseva Tat?yana Olegovna, MD, DM, Leading Research Associate;
Zemlyanskaya Inga Vladimirovna, MD, DM, Leading Research Associate
Goal posts ? present the case of successful biological prosthesis replacement in the position of the tricuspid valve after one and
a half ventricular repair and Seeley operations performed during infancy in a patient with Ebstein?s anomaly.
Key words: one and a half ventricular repair; re-prosthesis tricuspid valve; bioprosthesis.
г?б?блкб
???????????????????? ????????? ????????
???????? ??????????? ? ????????? ? ????????????? ??????????????? ?????? ?????????? (??)
[1?5]. ??? ?????? ???????? ???????????? ? ??????????????? ?????????? ?????? ??????????? ??????????????? ????????????????? ?????????
(????), ??? ?????? ???????? ??????????? ???????????? ?? ?? [2, 5, 6]. ????????????? ????????? ????? ??????, ???????????? ??????? ??,
????? ???????? ?????????? ? ???????????????????? ????????? [4, 7]. ??? ??????? ?????? ???????? (??? ? ??? D ?? ?. Carpentier), ??? ???????, ??????????? ???????????????????? ????????? ? ????????????? ??????????????? ???????????????
??????? (??) ??????????? [1, 2, 4, 5]. ? ????????
??????? ??????????, ???????? ? ?????, ???????????? ??????????? ? ????????? ????????????? ?????????? ????????????? [2, 8, 9].
??? ???????????????????? ????????? ? ??????????????? ??, ???????? ?? ?????????? ??????? ????? ? ?? ??-?? ????????? ????, ????? ?? ??????????? ???????? ?????????? ?????????? ? ??????????
????????????????? ???????, ?? ?????? ??????? ?????????? ????????? ????????????????. ? ??????
?????? ?????????? ???????? ??????? ?????? ???????????????? ?? ? ???????, ?????????? ???????????????????? ????????? ???????? ????????.
Иткр?лкб рнш???
? ? ? ? ? ? ? 9 ??? ????????? ? ???????? ?? ????????????, ?????? ??? ????????? ?????????? ????????. ? ???????? 7 ??? ??????? ?? ?????? ???????? ???????? ????????? ???????? ?????????????? ?? ???????? ╚???????╩ ? 23 ? ????????
??????????????? ????????? ?? 4 ??, ????????
????, ????????? ???? ? ?????????? ????? ??????
???????? ??????? (??).
??? ??????? ????????? ??????? ??????? ???????, ?????? ??????? ???????. ??????? ????????????, ?????? ???. ?????????????? ???? ?????? ?????????, ??????. ????????????? ?????????????
? ?????????????? ???? ? ???????? ??. ???????????? ???????? ? 90/60 ?? ??. ??., ??????? ?????????
?????????? ? 92 ??/???. ?????? ? ? ???? ????????
????. ??????? ??????????? ???????? 151 ?/?, ????????? ????? ?????????? ? ?????????? ? 96%.
?? ??? ??????????????? ????????? ????, ?????????? ????????????? ??? ?????? ??????, ??????? ?????? ????? ????? ????, ??????????? ??????? ?????????? (??) ? ??. ?? ?????? ????????????? ??????????????? ????????? ?????????
????, ????????? ?????????? ???????????????
????????????.
?? ?????? ??????????????????? ???????????? ?
????????? ?????????? ???? ?? ? ??. ????????????????? ?????? ???????? 49%. ???????? ???????
????????????, ????????? ?????? ??????.
?????? ?????: ????????? ????????? ???????
?? ? 37в41 ??. ?? ??????? ? ??????? ?? ??????????
???????????? ??????????? ??????????? ???????,
????????? ??????????? ?????????, ????????????
?????????????? ????? ????? ??????. ??????? ?????????????? ???????? ???????? 17 ?? ??. ??., ??????? ? 9 ?? ??. ??. ??????????? ??????? ?????????
??????? ??????? ???? ????? 0,8 ??2, ????????? ???????? ? ?? ? 22 ?? ??. ??. ?????????? ? ?????????? ??????? ??? ?????????. ??????? ??????? ?? ?
55%, ?????? ????????? (??) ? 60%.
?? ?????? ?????????? ??????? ??????? ????????? ???????????????? ?? ??????????? ╚???????╩
? 26 ? ???????? ?????????????? ??????????????,
?????????? ? ???????????????? ????????????.
????? ?????????? ????????????? ? ?????????
?????? ?? ????? ?? ???????? ???????? ?????????
??????? ?????????????? ?????????????? ? ???????????? ?????????? ??????? ????? ???? ??????? ???????. ?????? ??????????????? ????????
? ??????????? ???? ???????? ?? 28 ╟? ? ??????
?????. ???????? ?????????? ?????, ??????????????? ?????? ????????????????? ??????? (╚?????????╩). ????? ???????? ?? ????????? ??????
?????????????? ??????????? (????) ?????????
5 ??, ??????? ??? ????.
??? ??????? ??????? ?? ???????? ??????????
?????????? ???????, ? ???????? ? ???????????
???????. ??????? ?????????? ??????????, ?????????, ??????????????, ??????????? ? ???????????? ????????? (??. ???????). ?????????? ?????
??????????????? ? ?? ???? ???????. ?????? ???????. ??????????? ???????? ???? ? ??????? ??
????????????? ????????? ╚???????╩ ? 26. ?????????????? ????? ???????? ??????? ?????????????
??????? ???????.
????????? ????????????????? ?????? ???????? ??? ??????????, ?? 11-? ????? ????? ????????
45
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?
?
??????? ??? ??????????? ?????????? ?? ??????? ??????? ????????? (?) ? ??????? ?????????? (?). ?????????? ??????????
????????? ??????? ? ??????
??????? ???????? ?? ???????. ??? ??????? ?????????????? ???????? ???????? ?? ??????? ????????:
??????? ? 3 ?? ??. ??., ??????? ? 1,5 ?? ??. ??.,
??????? ??????? ?? ? 64%.
И╥ршй?блкб
??????????? ? ????????? ???????? ?? ??????
?????????? ??????? ?? ???????? ??????????????? ?????????????? II??II? ???????, ?????????? ?????????????, ??????? ????????????????
??????????, ? ????? ????????????? ?????????
[4, 9, 10]. ? ?????? ??????, ???????? ?? ????????
?????????? ??????????? ????????????, ??????????? ? ????????? ???????? ??????? ?????? ???????????? ? ?????-????????????, ????????????
?????????? ??????????. ??????? ?????????????? ????????? ? ??????????? ??????????? ???????? ???????, ?????????? ? ???????, ?????????
? ???????? ?????????? ??? ?????????? ????????????? [7?9]. ????? ??????, ??????????, ???????????? ? ????? ?????????????? ???????? ?????????? ?? ? ?????????? ????? ????? ?????????????.
??????? ????????, ??? ??????? ? ?????? ???????
????, ???????????? ???????? ???????? ?? ??,
???????? ?? ?? ??????????? ????????? ? ????????
???? ???????????????? ???????. ?? ?????? ????????? ???????, ??????? ???? ?????????? ?? ?????? ?????????? ???????????????? ??????? ? ?????
?????????? ????? 5 ??? [8, 10]. ? ??????????? ?????? ???? ?????????? ???????? 8,3 ????, ??? ??????????? ????????? ??????? ???? ?????????? ?????
????????????????? ??. ????? ???????, ?????
????????????, ??? ??????? ???? ? ????????? ????? ??????????????? ?? (????????????????????
?????????) ??????????? ????? ????????????????,
???? ??? ?????????? ?????????? ??????????.
46
?? ?????? ????????? ???????, ???????? ???????? ?????????? ??????????? ? ??????????????? ???????, ???????? ? ?????, ???????? ?? ?????????
? ??????????? ??????????? [2, 8?10]. ???????????????? ? ??????????? ??????? ?????????? ???????
????????? ??????? ???????, ??? ??????????? ? ?????
??????, ??? ???? ????? ?????????? ????????? ??????? ?????????? ? ??????? ?????????? [8?10].
???????? ????, ??????????? ????????????
? ???????????????????? ?????????? ?????? ? ???????????? ????????, ???? ???????????. ?? ????
?????? ?????????? ? ??? ?????????? ?????????????? ???????????? ???????? ????????? ????? ??
????????. ????????? ????? ?????? ?? ????????
?????? ????????????? ??????????? ???????????????????? ?????????, ???, ?? ?????? ??????????
[4, 5, 7], ? ???? ??????? ????? ???????? ? ????????
??????????????? ?????? ? ?????? ?? ????????????
????????? ????????? ????? ??????????. ? ?????
?????? ?????? ?????????? ?? ????????, ????????? ????? ?????????? ? ?????????? ????????? 96%.
????????? ????? ?????? ?? ?? ?????? ?? ?????????? ????????? ????????.
? ?????????? ??????? ????????, ??? ?????????????? ?????? ??????????????? ? ??????? ?????????? ?????????? ???????????????????? ????????? ???????? ???????? ? ??????????????? ?? ????????????? ????????. ?????????? ??????????
??????????? ????????????? ??????????????? ??????????? ??????? ? ????????? ??????? ???? ??
????????? ????????????? ??????? ?? ???????????
????????? ???????.
??????????
1.
??????? ?.?., ????????? ?.?., ?????? ???, ???????? ?.?.,
??????? ?.?. ???????????????????? ????????? ????????
????????: ????? ????????? ? ??????????. ??????? ? ????????-?????????? ????????. 2004; 5: 6?9.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
2.
3.
4.
5.
6.
7.
8.
9.
10.
??????? ?.?., ????????? ?.?., ??????? ?.?. ???????? ????????. ?.: ????? ??. ?.?. ???????? ????; 2005.
????????? ?.?., ???????? ?.?., ????????? ?.?., ??????????? ?.?. ?????? ???? ╚???????????????????? ?????????╩ ??????? ?????????? ??????? ??????. ??????? ?
????????-?????????? ????????. 1999; 6: 168?9.
Chauvaud S., Berrebi A., d'Attellis N., Mousseaux E.,
Hernigou A., Carpentier A. Ebstein's anomaly: repair based
on functional analysis. Eur. J. Cardiothorac. Surg. 2003; 23:
525?31.
Stellin G., Vida V.L., Milanesi O., Rubino M., Padalino M.A.,
Secchieri S. et al. Surgical treatment of complex cardiac
anomalies: the one and one half ventricle repair. Eur. J.
Cardiothorac. Surg. 2002; 22 (6): 1043?9.
Webber S.A., Horvath ?., LeBlanc J.G., Slavik Z., Lamb R.K.,
Monro G.L. et al. Infiuence of competitive pulmonary blood
fiow on the bidirectional superior cavopulmonary shunt: a
multi-institutional study. Circulation. 1995; 92 (Suppl. 2):
279?86.
Van Arsdell G.S. One and half ventricle repair. Semin. Thorac.
Cardiovasc. Surg. 2000; 3: 173?8.
????????? ?.?., ?????? ?.?., ???????? ?.?., ????? ?.?.
????????? ???????? ????? ????????? ?????????? ??????? ??????. ?.: ????? ??. ?.?. ???????? ????; 2013.
Kiziltan H.T., Theodoro D.A., Warnes C.A., O'Leary P.W.,
Anderson B.J., Danielson G.K. Late results of bioprosthetic
tricuspid valve replacement in Ebstein's anomaly. Ann.
Thorac. Surg. 1998; 66 (5): 1539?44.
???????? ?.?., ????????? ?.?., ?????? ?.?., ?????????? ?.?., ?????? ?.?., ??????? ?.?., ??????? ?.?. ?????????? ?????????????? ???????????????? ??????? ?????????? ?????? ???????? ? ?????. ????????? ?????????????? ? ??????????????. 2012; 2: 9?14.
References
1.
Bockeria L.?., Podzolkov V.P., Hassan ?li, Samsonov V.B.,
Dontsova V.I. One and a half ventricular correction of
Ebstein's anomaly: the selection of patients and results.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2004; 5:
6?9 (in Russian).
Bockeria L.?., Podzolkov V.P., Sabirov B.N. Ebstein's anomaly. Moscow: Nauchnyy Tsentr Serdechno-Sosudistoy
Khirurgii imeni A.N. Bakuleva Rossiyskoy Akademii
Meditsinskikh Nauk; 2005 (in Russian).
Podzolkov V.P., Barchukov A.Y., Zelenikin M.M., Mchedlishvili
K.A. First experience ?One and a half ventricular correction? of
complex congenital heart defects. Grudnaya i SerdechnoSosudistaya Khirurgiya. 1999; 6: 168?9 (in Russian).
Chauvaud S., Berrebi A., d'Attellis N., Mousseaux E.,
Hernigou A., Carpentier A. Ebstein's anomaly: repair based
on functional analysis. Eur. J. Cardiothorac. Surg. 2003; 23:
525?31.
Stellin G., Vida V.L., Milanesi O., Rubino M., Padalino M.A.,
Secchieri S. et al. Surgical treatment of complex cardiac
anomalies: the one and one half ventricle repair. Eur. J.
Cardiothorac. Surg. 2002; 22 (6): 1043?9.
Webber S.A., Horvath ?., LeBlanc J.G., Slavik Z., Lamb R.K.,
Monro G.L. et al. Infiuence of competitive pulmonary blood
fiow on the bidirectional superior cavopulmonary shunt: a
multi-institutional study. Circulation. 1995; 92 (Suppl. 2):
279?86.
Van Arsdell G.S. One and half ventricle repair. Semin. Thorac.
Cardiovasc. Surg. 2000; 3: 173?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
imeni A.N. Bakuleva Rossiyskoy Akademii Meditsinskikh
Nauk; 2013 (in Russian).
Kiziltan H.T., Theodoro D.A., Warnes C.A., O'Leary P.W.,
Anderson B.J., Danielson G.K. Late results of bioprosthetic
tricuspid valve replacement in Ebstein's anomaly. Ann.
Thorac. Surg. 1998; 66 (5): 1539?44.
Gorbatykh Yu.N., Naberukhin Y.L., Lenko E.V.,
Omelchenko A.Yu., Khapaev T.S., Zhalnin E.V., Shilenko V.P.
The results of prosthetic tricuspid valve prostheses in different
kinds of children. Patologiya Krovoobrashcheniya i
Kardiokhirurgiya. 2012; 2: 9?14 (in Russian).
????????? 03.02.2014
47
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
╘ ????????? ???????, 2014
??? 616.131-007.271:616.124.6-007.253]-073.432.19
??????????????? ? ??????????? ?????? ??????????
???????? ???????? ???????. ?????????
???????????? ? ?????? ??? ??????????? ???????
?.?. ???????, ?.?. ???????????, ?.?. ????????, ?.?. ??????????
???? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ?
???????? ??? ? ???? ?.?. ???????) ????; ?????????? ?????, 135, ??????, 121552,
?????????? ?????????
??????? ???????? ??????????, ?????? ???. ????, ?????????? ??????????;
??????????? ????? ???????, ????. ???. ????, ??. ?????. ????., e-mail: jatropha@mail.ru;
???????? ??????? ??????????, ?????? ???. ????, ?????????, ??. ?????. ????.;
?????????? ??????? ???????????, ?????? ???. ????, ???. ?????. ????.
? ?????? ??????? ??????????? ? ????????? ??????????? ?????? ???????? ???????? ??????? ??? ?????? ???????????????.
???????????? ???????? ????????? ???????? ??????? (n=2), ???????? ????? ????? ???????? ??????? (n=3) ? ???????? ??????
???????? ??????? (n=1), ? ????? ??????????? ????????? ╚??????╩ ? ????????????? ??????????? ?????? (n=5). ??????????
???????????? ????? ???????????? ?????????? (??) ? ??????????????? ??????? ??????????????? ??????? ??? ???????????
????????? ???????? ???????? ???????? ???????.
???????? ?????: ???????????????; ???????? ?????? ???????? ???????; ???????? ????? ???????? ???????; ????????
╚?????╩; ???????????? ??????????.
ECHOCARDIOGRAPHY IN THE DIAGNOSIS OF RARE CONGENITAL ANOMALIES
OF THE PULMONARY ARTERIES. IMAGING DIFFICULTIES ? IS IT ERROR OR
LIMITATION OF THE METHOD?
V.V. Plakhova, I.Yu. Baryshnikova, M.G. Pursanov, L.A. Yurpol?skaya
A.N. Bakoulev Scientific Center for Cardiovascular Surgery of Russian Academy of Medical
Sciences; Rublevskoe shosse, 135, Moscow, 121552, Russian Federation
Plakhova Viktoriya Valer?evna, MD, DM, Chief of Department;
Baryshnikova Irina Yur?evna, MD, PhD, Junior Research Associate, e-mail: jatropha@mail.ru;
Pursanov Manolis Georgievich, MD, DM, Professor, Chief Research Associate;
Yurpol?skaya Ludmila Anatol?evna, MD, DM, Leading Research Associate
This article describes the facilities and pitfalls of the echocardiography in diagnosis of rare anomalies of the pulmonary arteries.
Crossing of the pulmonary arteries (n=2), unilateral pulmonary artery agenesis (left pulmonary artery agenesis (n=3); right pulmonary artery agenesis (n=1)) and pulmonary ╚sling╩ (n=5), (in one infant with the formation of the vascular ring) are described in
the article. CT was defined as the priority in the cardiac imaging methods for the determining the detailed anatomy of the pulmonary
artery.
Key words: echocardiography; criss-?ross of the pulmonary arteries; unilateral pulmonary artery agenesis; pulmonary ╚sling╩; computed tomography.
г?б?блкб
??????????????? (?????) ? ??????????? ?????
???????????? ??????????? ??????????? ?????????????????? ???????, ??????????? ????????????
??????????????? ??????????? ?????????? ? ????????????? ??????? ?????? ? ??????? ???????????????? ??????????. ?????? ????? ????? ???????????? ??????????? ??? ???????????? ????????????????? ????????, ? ????????? ??????? ????????
???????, ??? ????? ????????? ? ???????? ????????????? ????????, ? ????? ? ??? ????????? ?????????????? ? ??????? ????? ????????????? ??48
????? ??????? ??????????? ? ???????????? ?????????? (??) ? ????????????????? (???). ??? ??
????? ?????? ??????????? ???? ???????????????
??? ??????, ???????????? ??????????? ??? ???????????? ??????????????? ???????? ???????? ???????, ??? ?????? ????????? ?????? ?????????? ???????????????? ??????? ? ? ???????? ????? ?????????? ??????? ?????????????? ?????????????.
? ?????????????? ????????? ?? ????????????? ??????????? ????? ?????? ?????????? ???????? ???????? ???????, ??? ???????? ???????? ???????, ???????? ????? ???????? ??????? (?????? ???
?????), ???????? ╚?????╩.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
????? ?????????? ???????? ???????? ???????
?? ???????, ??? ??? ??? ?????????? ????? ?????
????? ????????? ?? ???????????????? ???????????, ??? ????? ???????? ? ???????? ????????????
????????. ????? ?? ??? ??????? ???????????????
???????? ??? ??? ?? ???? ?????????? ? ????????? ?????? ?????????? ?????????????? ????????????? ?????? ?????, ? ?????? ?? ???? ?????????? ?? ?? ??? ???? ???????? ??? ?????????? ???
????, ????? ╚?????? ? ???????╩, ????????????? ?????? ??? ????? ????????????? ? ???????????? ??????? ??????? ???????????, ??????????? ?????????????? ???????? ??????? ???????? ????????
?????? ?????? ????????? ???????????? ?????????? ???????????????????? ??????????? ?????????
???????? ???????? ??????? ?????????? ???????????? ???????????? ????????????.
Иткр?лк? рнш??б?
??????????????? ????????? ?? ????????????
?????????, ????????????? ??? ??????? ??????????????, ????????????????? ? ???????????????
????????? ?????? ?? ?????????????? ??????? ??????????? ?????? ????? ╚Philips╩ iE33. ???? ???????????????? ??????????????? ?????? 11 ????????? ? ??????? ??????????? ?????????? ???????? ??????? (??. ???????).
????? ???????????, ??? ? ?????? ????????????? ????????? ???????? ?????? ???????? ???????
?????????? ? ???????? ???, ?? ?????????? ? ????????? ????????????????? ???????????? ?????????? ??? ? ??. ??????? ????????? ? ???????
????? ????????????? ?????????? ???????? ???????? ??????? ????????? ????????? ?????? ??????????????? ???????? ? ? ??????????? ????????? ?????????? ????????? ???.
????????????????? ???????? ??????? ????
???????? ??? ????? ? ???? ????????? ? ????.
Днклк?брмкх т?коб? м?срркл?? ?бз?бх
нб?с?лсх ??зб?кк (о?н╦?км, 6 обр)
?? ?????? ????? ??? ?????????????? ????
(????????????????, ??????????????????), ?????????? ????? ??????? ????? ???? (???), ????????????? ? ?????????? ?????, ?????????????? ???? ?????, ??????? ???????? ???????????
(???). ? ????? ? ?????????? ???????????? ?????????? ?? ? ???????? ???????? ? ????????
?????????? ?????????????? ????????? ????????
?? ?????? ??? ???????? ?? ??????? ??? ?????????? ???????? ??. ????? ? ?????? ?????????????? ???????? ????????????? ??????? ? ???????
???? ???????? ?????????? ?? ??????? ??????????? ??????.
?? ?????? ??? ? ?? ??????? ??? ???????????.
????? ????, ??? ??-???????????? ?????????????
???????? ???????? ?????????? ???????? (?????????? ??????).
? ????? ?????? ?????????? ? ???? ?????????
? ????????? ???, ??????? ?? ???? ??????? ???? ??????????????? ??? ????????? ?????-????????????
(???. 1).
??????????? ?????? ???????? ????? ????????
??????? (???????, 7 ???)
??? ????? ??? ??????? ????????? ???? (????????????????, ??????????????????), ????????
???????? ???? (???), ?????????????? ???? ?????,
????????????? ?????????????? ??????? ?? ?????????? ?????. ? ???????? ?? ???????? ??? ??????????? ??????? ??? ???????????? ?????????? ??????
?? ????????????? ?? ????? ?????. ?????? ????????
??????? ???? ??????????? ?????????. ??? ???? ????? ???????? ???? ??????????????. ??? ?????????
??????? ╚???????? ???╩.
?? ?????? ??? ???? ???????????? ??????????
?????, ???????? ????? ??????? ??????????? ?????
???????????? ???????. ??????????? ? ?????????-
Й?рт?б?бнблкб т??кблзс? р ?б?мкок ??сй?блл?ок ?лсо?нк?ок нб?с?л?? ??зб?кх
к рстшзрз?ш??кок ??сй?блл?ок тс?см?ок рб????
?????????? ???????? ???????? ???????
???????? ??????
???????? ???????, n=2
4 ???
6 ???
???????? ?????
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3 ???
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7 ???
2 ???
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8 ???
1 ??? 1 ???
1 ??? 4 ???
???????? ?????? ???????? ???????, n=1
?????????? ??????????
????? ???????? ???????
?? ??????, n=5
????????????? ???
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?????????? ????? ???, ????????? ? ??
????
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? ? ? ? ? ? ? ? ? ?. ??? ? ?????????? ????? ??????; ??? ? ??????? ????? ????; ???? ? ?????? ??????????????? ???????????; ?? ? ?????????? ?????; ??? ? ???????? ???????????? ??????.
49
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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??????? ??????? (?????) ??????. ????????
????????? ????????????? ???????? ??? ??????
????????? ???: ??? ???????????? ??????? ???
?? ? ??????????????? ??????? ??? ???????????? ? ???????? ????? (???. 2, ?), ?? ??? ????????
????????????? ???????????? ???????????????
???????? ? ??? ?? ??????? (???. 2, ?), ??? ????????? ??????? ??? ????????????? ?? ??????? ???????. ? ?? ?? ????? ?????? ????????? ??? ????????? ???????? ??????? ? ????????? ????? ??????? ??????????????? ?????? ?????????? ???
? ???????? ?????, ??? ???????????? ?? ????????
(???. 2, ?). ???????? ????????????? ?????????
???????? ????????? ?????? ???????????? ???????? ???.
????????????? ??????? (???????? ???, ????????????? ????? ? ???) ??? ????????? ??? ?????? ???.
??
???
???. 1. ???????? ????? ???????? ??????? (???). ???????????????? ???????????????, ??????????????? ??????? ?? ???????? ??? ??????????? ???????, ??????????????? ??? ??????????? ???????????? ?????? ? ?????? ??: ????????????
????? ?? ? ???; ??? ?? ??????????????.
??? ????????????????? ????? ???????? ???? ???
?????? ?????????? ???????? ???????? ??????????????? ????????? ?????????????? ?????, ???????
????? ? ?????????? ????? ???.
Днклк?брмкх т?коб? ??блбакк т???сх
нб?с?лсх ??зб?кк (о?н╦?км, 2 обр)
??? ????? ? ???????? ???? ???????? ???
(????????? ????????????? ???????? ? ?????? ????????? ????????? 80 ?? ??. ??., ??????????????
???????? ? ???????? ??????? 45 ?? ??. ??.) ? ????????????? ??????? ????????????? ???????-
Днклк?брмкх т?коб? ?лсо?н╦лс?с сз?сй?блк? ЦЦд
сз ХЦд (?б?с?м?, 6 обр)
?? ?????? ????? ??? ????????? ???????:
???? (?????????????), ????????? ??????????
????? ? ?????? ?????????, ?????????? ?????????? ??? ?? ???, ??????? ???????? ???????????.
??? ?????? ??? ?????????? ??? ?? ??? ?? ????
????????????.
???? ????????? ???????? ????, ?????????
?????????? ????? ??????? ?????????. ????????????????? ?????? ?????????? ??????????? ???????????????? ? ?????????? ?????????? ??????.
????? ??????????? ??????? ????????? ???????
?? ????????????? ?????????? ?????? ??? ?????????? ?? ???? ???????? ?????????? ??????????
??? ?? ??? ? ?????????? ??????????? ??????
??
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??????????? ???????, ??????????????? ??? ??????????? ???????????? ?????? ? ?????? ???????? ??????? (????????? ???? ????????????):
? ? ?????????? ????? ????? ?????? ??; ? ? ? ?????? ????????? ????????????? ???????????? ??????????????? ???????? ????? ? ???; ??? ?? ????????????; ? ? ???????????? ???????? ?????, ??? ?????????? ?????? (?????????? ?? ????????), ??????????? ??????? ?????????? ? ??? ? ????????
????? (??????? ????????).
?? ? ?????; ?? ? ???????? ???????; ??? ? ?????? ???????? ???????; ??? ? ????? ???????? ???????
50
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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???
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? ? ???????????????? ?????, ??????????????? ??????? ?? ???????? ??? ??????????? ???????, ??????????????? ??? ??????????? ????????????
?????? ? ?????? ??; ? ? ?????????? ????????????? ??? ?????? ??
(? ?????????? ????? ? ????????????? ???????
??????? ???????) (???. 3).
???????? ???? ????????? ????????????? ???
? ???????? ?????, ????????????????? ?????? ???
?????????????.
И╥ршй?блкб
???????? ???????? ??????? ? ?????? ?????????? ?????????, ????????????????? ?????????? ??????????? ???????? ??????? ?? ????????? ??????
? ????????????? ?????????? ?? ???? ? ??????????? ??????. ???????? ?? ?????????? ??????????????????, ????????????? ???????? ??????? ??
???????? ?????????? ??????????? ????? ? ???????????????? ?????????, ????????? ??? ???? ???????? ????? ?? ???????? ??????? ?? ?????? ? ???????? [1]. ??????????? ???????????? ? ?????????
? ???? ??????? ???????????? ??????????????
??????????? ??????????.
? 1986 ?. W. Wolf ? ?????. [1] ??????? ????????
? ???????????? ??????????? ????????? ?? ? ??????? ??? ? ?????? ??????????????? ?????? ?????????????? ???????? ???????????????? ????????
???? ???????? ??. ??? ???????, ????? ???????? ??????? ????????? ?? ?????? ?????? ????????? ??????,
??? ???? ????? ????? ?? ????????????? ??????
? ???? ?? ????????? ? ????? ?????? ??.
?.?. ????????? ? ?????. [2] ????? ???????????
??????????????? ?????? ??????????? ????? ?????
???????????? ???????? ????????? ?? ? ???????
???, ??????? ???????????? ????????????????.
?????? ????????? ?? ?????????? ?????????? ????????? ?????? ? ???????? ?????, ? ???????? ???????????? ????????? ?? ??????????????? ????? ? ????? ??, ???????????? ???????? ?????? ??.
F.J. Zimmerman ? ?????. [3] ???????????????
???????? ?? ? ??????? ????? ? 6 ????? ? ???????? ?? 1 ??? ?? 6 ??? ? ??????????, ??? ??????????????? ????????? ??? ????????? ????? ?????? ?????
??????????, ????????? ???????????? ????? ???
??????? ??????????????? ? ???????????????? ???????? ???????. ??? ????? ?????????? ???????????????? ?????????????????? ???? ??????????
? ?????????? ?????? ??. M.R. Recto ? ?????. [4] ????? ???????, ??? ???????????????? ????????????
????? ????????? ??????????????? ?????????? ??????????????? ?????? ??. ?? ?????? ???????, ???????????? ????? ???????? ???????? ? ?????? ?????? ?? ????? ????? ??????????? ? ????? ??????????????? ????????.
??????????? ????????? ?? ? ??????? ???????????????? ???????????? ?????????? (????)
??????? ??????????? K. Sivakumar ? ?????.
? 2007 ?. [5]. ???? ??? ???????????? ????????????
?????? ???????????? ??????????? ??????? ?????????? ???????? ?????? ? ??????? ? ????????????? ? ?????????.
???? ??????????? ?????????? ?????????????, ??? ??????????? ??????????????? ?????????
??????? ?????????? ??? ?????? ???????? ???????, ?????? ???????????????? ?????? ????????
? ???????????????? ?????????? ???? ????????
??????????. ?? ???????????????? ?????? ????????? ????????? ???????? ??????? ? ??????????
??????????????? ??????? ? ?????????????????? ???????????? ??????????? ?????? ??? ????????????? ?????? ????????????? ? ???????????????? ?????????, ? ?????? ?????????? ??????????????????? ??????. ???????????????
????????? ??????????? ?????????? ?????? ??
????????? ????????? ????????? ??????????
51
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??????? ??????? ?????? ? ???????, ? 2, 2014
?????????? ????????, ? ?? ? ???????????? ?????????????? ????????????? ?????????, ??? ?????????? ????? ?????????????? ?????????????.
???????? ????? ???????? ??????? ? ??????????
????????, ????????????????? ?????? ???????????
?????????????????????? ???????? ????? ?? ??????? ?????? ???????? ???????.
????????????? ?????????? ????? ???????? ??????? ? ?????? ?????????? ????????, ??????? ?????
???? ???????????? ? ????????????? ???? ??? ? ????????? ? ??????? ??????????? ?????????? ????????-?????????? ???????, ?????? ??? ???????
?????, ?????? ?????????????? ???????????, ?????????? ?????, ?????????????? ???? ?????, ????? ???????????? ?????, ??????? ???????? ???????. ?????????? ????????? ??????????? ????????: ???????? ????????????, ??????????????
????????????? ????????. ??? ???????, ??????????? ?????????? ?????????? ??? ????????? ? ???????? ??????? ????????????? ???????????? [6, 7].
????????????? ??????????? ?????????? ?????
???????? ??????? ?????? ?????, ??? ??? ??? ??????????? ?????????????? ?????????????? ???????????? ????????? ? ??????????? ??????? ???????? ??????? ????? ???????? ??????????, ??????????? ??? ????????????? ??????? ?????? [6, 8].
??? ?????????????????? ???? ??????????,
? ??????? ??????????????? ???????? ????????????? ??????????? ???????? ????? ??, ??????
??????????? ???????????? ?????????????????
???????? ?? ????????? ???????????? ??????? ???????? ?????? ???????? ? ??????? ?????????? ?????????????? ?????????????? ???????????? ?????????. ????? ????, ?? ??????? ?????? ???????? ???
????????????????? ???????????? ?????? ? ?????????? ?????????? ????????? ?????? ????????????,
??? ?? ????????? ???????????? ???????????????
???????? ??? ? ??? ??????? ???????????????
???????.
??? ?????? ???????????? ????????????? ? ????????? ? ????????? ????? ?? ??????? ?????????
??????? ?????????? ??????? ??. ?????????????
?????? ????????? ??????????????? ??????? ?????????????? ????? ?? ???????? ? ??????? ????????????????? ? ????????????? ???????? ???
[6, 7] ? ??? ????????????? ??-??????????? ?
??? [8, 10].
?????????? ?????????? ??? ?? ??? ? ??????
?????? ?????????? ?????????? ????????, ??? ??????? ??? ??????? ?? ???, ??????? ?????????
A. Glaevecke, P. Doehle ? 1897 ?. [9]. ????????????
?????? ????? ????????? ???????, ?????? ? ??????????? ???, ? ???????????? ??????????? ??????, ??? ???????? ? ?????????? ??????, ????????
??????, ????????. ???????? ?????????? ??? ???
?????? ?????? ??? ??????? ?? ??? [9?11]. ???????
?????? ????????? ?????? ? ???????? ?????, ???????? ???????? ???????, ????? ??? ???????? ???? ???????? ??? ?????????? ??? [9, 11].
52
? ????? ?????????? ? ?????? ???????? ?? ??????????? ??? ?? ???? ??????????????? ?????????? ??? ?? ???. ? ?????????? ????????? ???? ????????? ???????? ????, ?? ? ????? ? ???????????
????????????????, ??????????? ????????????????? ??????, ????????????? ????????? ??????????? ?????????????, ??? ??? ?? ?? ???? ????????
?????????? ?????????? ??? ?? ??? ? ?????????? ??????????? ??????.
?????????????, ? ????????? ??????????? ??? ??????????? ??? ????? ??????? ????????? ??, ??? ???????? ????? ? ????????? ?????. ????????? ????????? ??????????????? ? ????????? ???????????
???????? ????????? ????????????? ? ??????????????????? ???????? ? ??????? ??, ? ??? ?????
? ????????? [9, 10, 12].
????? ???????, ??????????????? ????????
?????????? ??????? ???????????, ??????????? ?????? ??? ?????? ??????? ????????????, ??? ???????????? ?????????? ??????????? ???????? ??????.
??????????????? ? ???????????? ????? ???????????? ???????? ???????, ?????????? ????????????
?? ?????? ??????? ?? ???????????????? ?????????????. ???????? ????????????? ????? ?????????????? ??????? ?????????? ????????? ????????????, ? ?????? ? ?????????? ?????? ???????????? ????? ??? ????? ?????? ???????? ??????? ? ???????
?? ?????????? ? ???????? ????? ?? ????????? ???????? ???????? ???????. ???????????? ?????????? ? ???????? ????????????? ????? ???????????? ???????? ??????? ?? ?????????? ? ?????? ??
????????????????? ?????????????????? ?? ????????? ???? ? ????? ? ? ?????????? ????????????? ??????????. ??? ?????????? ??? ????, ??? ?????????? ?? ???????? ???????? ??????? ?? ??????
????? ? ????????? ??????????? ????????? ????????????? ?????????? ?? ? ?????????????????.
??????????
1.
2.
3.
4.
5.
6.
Wolf W.J., Casta A., Nichols M. Anomalous origin and malposition of the pulmonary arteries (crisscross pulmonary arteries) associated with complex congenital heart disease. Pediatr.
Cardiol. 1986; 6: 287?91.
????????? ?.?., ????????? ?.?., ??????? ?.?., ?????? ?.?., ?????? ?.?., ???????? ?.?. ?????????? ????? ??????, ???????????? ? criss-cross ????????? ?????????. ??????? ? ????????-?????????? ????????. 1995;
5: 74?7.
Zimmerman F.J., Berdusis K., Wright K.L., Alboliras E.T.
Echocardiographic diagnosis of anomalous origins of the pulmonary arteries from the pulmonary trunk (crossed pulmonary arteries). J. Am. Heart. 1997; 133: 257?62.
Recto M.R., Parness I.A., Gelb B.D., Lopez L., Lai W.W. Clinical
implications and possible association of malposition of the
branch pulmonary arteries with DiGeorge syndrome and
microdeletion of chromosomal region 22q11. Am. J. Cardiol.
1997; 80: 1624?7.
Sivakumar K., Prasad R., Francis E. Crossed pulmonary arteries. Cardiol. Young. 2007; 17: 572?3.
??????? ?.?., ??????? ?.?., ?????? ?.?. ?????????? ????????????? ?????????? ????? ?? ???????? ???????: ???????????, ????????????? ? ????????????? ???????. ??????? ??????? ?????? ? ???????. 2010; 4: 74?9.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
7.
8.
9.
10.
11.
12.
Kim G.B., Ban J.E., Bae E.J., Noh C.I., Kim W.H., Lee J.R.,
Kim Y.J. Rehabilitation of pulmonary artery in congenital unilateral absence of intrapericardial pulmonary artery. J. Thorac.
Cardiovasc. Surg. 2011; 141: 171?8.
Jaucot J., Bailly J.M., Darras T., Colette J.M., Molle S.P.
Absence of the left pulmonary artery. J. Belge Radiol. 1993;
76 (6): 401.
Lee K.H., Yoon C.S., Choe K.O., Kim M.J., Lee H.M., Yoon H.K.
et al. Use of imaging for assessing anatomical relationships of
tracheobronchial anomalies associated with left pulmonary
artery sling. Pediatr. Radiol. 2001; 31: 269?78.
?????????? ?.?. ????????????? ? ????????-???????????
???????????? ?????????? ? ??????????? ?????????? ??????? ??????. ??????; 2008.
Erickson L.C., Cocalis M.W., George L. Partial anomalous left
pulmonary artery: new evidence on the development of the
pulmonary artery sling. Pediatr. Cardiol. 1996; 17: 319?21.
Frischer T., Holomanova I., Frenzel K., Wollenek G.,
Wimmer M. Therapeutic strategy in a 9-month-old child with
pulmonary sling: need for bronchoscopic evaluation. Pediatr.
Cardiol. 1996; 17 (3): 201?3.
4.
5.
6.
7.
8.
9.
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3.
Wolf W.J., Casta A., Nichols M. Anomalous origin and malposition of the pulmonary arteries (crisscross pulmonary arteries) associated with complex congenital heart disease. Pediatr.
Cardiol. 1986; 6: 287?91.
Podzolkov V.P., Ivanitskiy ?.V., Makhachev O.?.,
?lekyan B.G., Mitina I.N., Safonova N.I. Congenital heart disease, combined with criss-cross the pulmonary arteries.
Grudnaya i Serdechno-Sosudistaya Khirurgiya. 1995; 5:
74?7 (in Russian).
Zimmerman F.J., Berdusis K., Wright K.L., Alboliras E.T.
Echocardiographic diagnosis of anomalous origins of the pul-
10.
11.
12.
monary arteries from the pulmonary trunk (crossed pulmonary arteries). J. Am. Heart. 1997; 133: 257?62.
Recto M.R., Parness I.A., Gelb B.D., Lopez L., Lai W.W. Clinical
implications and possible association of malposition of the
branch pulmonary arteries with DiGeorge syndrome and
microdeletion of chromosomal region 22q11. Am. J. Cardiol.
1997; 80: 1624?7.
Sivakumar K., Prasad R., Francis E. Crossed pulmonary arteries. Cardiol. Young. 2007; 17: 572?3.
Bockeria L.?., Makhachev O.?., Khiriev T.Kh. Isolated congenital absence of the one pulmonary artery: diagnosis, classification and surgical treatment. Detskie Bolezni Serdtsa i
Sosudov. 2010; 4: 74?9 (in Russian).
Kim G.B., Ban J.E., Bae E.J., Noh C.I., Kim W.H., Lee J.R.,
Kim Y.J. Rehabilitation of pulmonary artery in congenital unilateral absence of intrapericardial pulmonary artery. J. Thorac.
Cardiovasc. Surg. 2011; 141: 171?8.
Jaucot J., Bailly J.M., Darras T., Colette J.M., Molle S.P.
Absence of the left pulmonary artery. J. Belge Radiol. 1993;
76 (6): 401.
Lee K.H., Yoon C.S., Choe K.O., Kim M.J., Lee H.M., Yoon H.K.
et al. Use of imaging for assessing anatomical relationships of
tracheobronchial anomalies associated with left pulmonary
artery sling. Pediatr. Radiol. 2001; 31: 269?78.
Yurpol'skaya L.?. X-ray computed tomography and Magnetic
Resonance imaging of congenital heart disease. Moscow;
2008 (in Russian).
Erickson L.C., Cocalis M.W., George L. Partial anomalous left
pulmonary artery: new evidence on the development of the
pulmonary artery sling. Pediatr. Cardiol. 1996; 17: 319?21.
Frischer T., Holomanova I., Frenzel K., Wollenek G.,
Wimmer M. Therapeutic strategy in a 9-month-old child with
pulmonary sling: need for bronchoscopic evaluation. Pediatr.
Cardiol. 1996; 17 (3): 201?3.
????????? 14.04.2014
╘ ????????? ???????, 2014
??? 616.12-007-053.1-089.844
?????? ???????? ????????? ???????? ?????????????
? ????? ? ???????? ???? ????? ? ??????????????
?.?. ??????1, ?.?. ??????????2, ?.?. ???????1, ?.?. ???????? 3
1
???? ??? ╚??????????????? ??????????????? ??????????? ???????????╩ ????????????
??????????????? ??; ??. ?????????-?????????, 35, ?. ?????????, 680000, ??????????
?????????;
2 ???? ?? ╚????????? ??????????? ???????? ? 1╩; ??. ??????????, 55, ?. ??????, 625023,
?????????? ?????????;
3 ???? ╚??????????? ????? ????????-?????????? ????????╩, ???????????? ???????????????
??; ??. ?????????????, 2?, ?. ?????????, 680009, ?????????? ?????????
53
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
?????? ???? ??????????, ?????? ???. ????, ??????, ????????-?????????? ??????,
e-mail: shamrinyj@yandex.ru;
?????????? ?????? ??????????, c???????-?????????? ??????, ?????????? ??????????;
??????? ???????? ???????, ?????? ???. ????, ?????????? ????????;
???????? ?????? ??????????, ????????????-????????????
???????? ????????????? ? ?????? ?????????? ????? ?????? (???), ??????????? ? ?????? ??????? ? ??????????? ????? ?
???????? ??????? ?? ??????? ????????? ? ???????? ??????????????? ??????????? (????).
????????????? ????????? ???????? ????????????? ??????????????? ??????? ??????? ????????????? ???????? ?
??????????? ?? ????????????? ????????? ??????. ? ????????? ????? ????????? ?????? ???????? ???????? ?????????????
???????????? ? ????????? ????. ????????? ???????? ????????????? ? ??????? ??? ?????????? ?????? ?????, ? ??????
??????? ???????? ????????? ????????? ?????????. ?? ???????????? ???????? ?????? ????????? ???????? ????????????? ?
????? ? ???????? ???? ?????.
???????? ?????: ???????? ?????????????; ??????? ???? ?????; ???????????? ????????????.
SUCCESSFUL CORRECTION OF TAUSSIG?BING ANOMALY WITH TYPE B
INTERRUPTED AORTIC ARCH IN NEWBORN
Yu.N. Shamrin1, K.V. Gorbatikov2, V.Yu. Bondar?1, S.A. Kurbanov 3
1
Far Eastern State Medical University, RF Ministry of Health; ulitsa Murav?eva-Amurskogo, 35,
Khabarovsk, 680000, Russian Federation;
2 Regional Clinical Hospital No.1; ulitsa Kotovskogo, 55, Tyumen?, 625023, Russian Federation;
3 Federal Center for Cardiovascular Surgery, of Ministry of Health Russian Federation; ulitsa
Krasnodarskaya, 2B, Khabarovsk, 680009, Russian Federation
Shamrin Yuriy Nikolaevich, MD, DM, Associate Professor, Cardiovascular Surgeon,
e-mail: shamrinyj@yandex.ru;
Gorbatikov Kirill Viktorovich, Cardiovascular Surgeon, Chief of Department;
Bondar? Vladimir Yur?evich, MD, DM, Chief of Chair;
Kurbanov Sergey Anagulovich, Anesthesiologist-Intensivist
Taussig?Bing anomaly is rare congenital heart malformation relating to a group characterized by the aorta and the pulmonary artery
beginning from the right ventricle with ventricular septal defect.
Anatomic correction of Taussig?Bing anomaly is characterized by a wide variety of surgical approaches, depending on the anatomical variants of the defect. Currently, the surgery of choice is arterial switch with ventricular septal defect plasty. The combination of
Taussig?Bing anomaly with other congenital heart defects is extremely rare, and each patient is the subject of a separate discussion.
We present a case of successful correction of Taussig?Bing anomaly with type B interrupted aortic arch.
Key words: Taussig?Bing anomaly; interrupted aortic arch; arterial switch.
г?б?блкб
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????? ?????? (???), ??????????? ? ?????? ??????? ? ??????????? ????? ? ???????? ??????? (??)
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????? 1% ????? ???? ???. ???????? ??????? ?????????? ?????? ???????? ?????????? ????????????? ??????? ?? ?? ? ????????????? ???? ? ???????? ?? ? ??????? ?????????? ????? ? ?? ?? ??
? ??????????? ???? ? ???????? ?????????????
[1]. ?? ?????? C. Mavroudis, ???????? ????????????? ?????????? ?? 30% ?? ???? ??????? ?????????? ????? ? ?? ?? ?? [5].
????????????? ????????? ???????? ????????????? ??????????????? ??????? ??????? ????????????? ???????? ? ??????????? ?? ????????????? ????????? ??????. ? ????????? ????? ????????? ?????? ???????? ???????? ?????????????
???????????? ? ????????? ????. ????????? ???????? ????????????? ? ??????? ??? ??????????
54
?????? ?????, ? ?????? ??????? ???????? ????????? ????????? ?????????. ?? ???????????? ??????
????????? ???????? ????????????? ? ????? ? ???????? ???? ?????.
Иткр?лкб рнш???
??????? ?????????? ????? ? ?? ?? ?? ? ??????????? ???? ??????? ?????????? ???????????????????? ??????????? ?? 21-? ?????? ????????????
? ??? ??????????? ? 30 ??? ? ????? ????????. ???????? ??????? ? ??????? ???????????????? ??????????????? ??????????????, ? ??????? ????????? ??????? ???????????? ? ???? 0,05 ???/??/???.
? ???????? 9 ???? ??????? ????????? ??? ???????????? ??????? ? ??????????????????? ?????????. ?? ?????? ??????????? ????? ?????????
???????? ??????? ??????? ???????. ??? ???????
??????? ?????? ???? 2 ?? 900 ? ????????? ? ???????? ?? ??????????????? ???????, ?? ?????? ????????? ?????????, ???? ???????. ?????? ???????
? ??????? ????????? ??????, ??????? ?????????,
?????????? ????????????? ??????? ?????? ?????-
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??????? ??????? ?????? ? ???????, ? 2, 2014
???. ??????? ???????????????, ??? ????????????
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??? ???????????? ?????? ???? ?????????, ?????,
????? ?????? ???? ??????? ????????????? ????????????????????? ???. ??????? ????????? ?????????? (???) 170 ??/???. ????????? ?????????????? ????? ?????????? 92% ? ?????, ??? ????????
?????????? ???????? ????????? ?? 80%. ?????
????????, ????????? ????????, ?????? ???????????? ?? 2 ?? ???? ???????? ????, ???? ?????? ??????.
???????????? ??????? ???????????? 2 ???/??/???.
????? ?????????? ????? ???????????? ??????? ? ??????? ????? ?????????????? ???. ?????
????????????? ?????? ?? ??, ??????? ?????????
? ?????????? ????? ?? 15 ??. ? ???????????? ????? ??????????????? ??????????? ??????? ??????
????????? ?? 9 ??, ??????????????? ??? ??. ????? ????, ????? ????? ?????? ?????????????? ??????????? (????) ????????? 10 ?? ? ???????? ???????????? ?????? (???) ? 3 ??.
???????? ?????????????? ????? (???) ??????
????????? (??) ? 18 ??, ???????? ?????????????
????? (???) ? 6 ??, ??????? ??????? ?? 63%.
??????? ?????????? ?????? ??????????? ???????
12 ??, ???????????????? ??????? ? 17 ??. ?????????? ????? ?????????? ????????, ????? ??????????
??????? ????????????? ???? ????? ?? 3 ?? ? ??????? ???? ????? ????? ????? ????? ?????? ? ?????
???????????? ?????????. ???????? ? ??????????
????? ?????????????? ????? ???????????????
??? (???. 1).
???????? ??????? ? ??????? ????????????????
?????????, ???? ?????????????? ????????? ? ??????????? ????????? ??????, ? 14.09.2012 ?. ???????? ????????? ????? ?????????? ?????? ? ????? ????? ?? ???? ????? ? ???, ?????? ?????????????????? ??????? ????? ?? ? ?? ? ???????????
???????????? ???????????? ? ?????????????? ?????? ?????????? ??????? ? ????????? ???? ? ???????? ?????????????? ?????????????? (??), ???????? ?????????? ? ?????????? ??????????????,
???????????? ????????? ╚?????????╩.
???????? ? ?????? ????????? ?????????? ????????? ???????????. ??? ??????? ??????? ??????
????? ????? ???????? ?????????? ????? ? ?? ??
??: ????? ??????????? ?????? ?? ??, ????? ??????? ??? ??????? ????????? ?? 10 ??. ??? ????????? ???? ? ?????????? ????? ? ?????????? ??
??? ???????????????? ????????? ?????????? ??????? ???? ?????, ??? ? ?? ?????????????
Celoria?Patton. ?????????? ????? ????????? 8 ??,
??????????????? ????? ? 6 ??, ????????????? ???? ????? ? 5 ??, ????? ????? ?????? ??????? ? 4 ??,
????? ?????????? ???? ???????????? ???????. ??????? ???, ??????????? ? ?????????? ?????, ??????? ??????? ?? 9 ??. ????? ???????????? ???????
??????? ?? ?????????? ?????. ??????? ?? ????????? ?? ????? ╚??????????? ????╩, ?????? ???? ??????????? ??? ?????????? ??????: ???? ? ?????????? ?????, ?????? ? ? ??????????, ????? ???
(???. 2).
?????? ?? ? ???????????? ?????????? ???????? ?? 18 ╟C. ??? ????? ?? ? ??????? ???????? ???????? ???????????. ?? ????? ?????????? ????-
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Planche. ??? ?????????????????? ??????? ????????? ???? ??????????? ???????????, ????????? 10 ??. ???????? ????? ?? ???? ?????? ???????????????????? ???????? ? ???????????? ??????? ?? ? ??. ??????? ??????????? ???????????
???????? ???? ??????????????? ????? 6.0.
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?????????? ????? ? ????? ????? ?? ???? ?????
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????? ???????????? ? ???????? ?????? Lecompte:
?? ? ??????? ?????????? ?? ??????????? ????????? ?? ????????? ? ?????????? ?????. ????????? ?????? ????????? ???????????? ?????????
???????, ?????????? ????? ????? ????????, ??????? ????????? ? ??????? ???? ?????, ????????????
?? ? ?????? ?????????? ????????. ?? ????? ?????????? ?? ??????????? ???????? ????????? ???????????? ???????????? ? ?????????????? ?????? ?????????? ???????. ????? ?????? ?????????? ??????? ?????????????? ? ???????? ????? ?? ???????
╚trap door╩, ? ????? ????????? ?????????? ???????
?????????????? ? ????? ?????? ????? (???. 3). ????????? ?????? ???? ????. ????? ????????????
??????????? ??? ???? ????? ? ?????.
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?????????? ??????? 25 ?? ??. ??. ?????????? ??????????????? I ???????.
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?????????, ????????????? ??????????? ????????
? ?????????? ??????? ??????? ?????????? ? ????????? ??????? [3, 4]. ???, ????????, ????????
?????? ??? ??????????? ? 2008 ?. ????????? ?? ??????. ??????? ? ???????? 1 ??? ? ????? 3,1 ?? ???????? ? ???????? ? ????????. ????????? ????? ?????????? ?? ??????? ? ?????? ??????????? ????????? 70 ? 90% ??????????????. ??? ????????? ???????
???????? ????????????? ? ????????? ???? ?????
(?? ????????????? Celoria?Patton ??? ?) ? ??????????? ????????? ????. ? ???????? 9 ???? ????
????????? ??????????? ???????? ? ???????? ??,
???????? ?????????? ? ????????? ??????????????.
????????????????? ??????, ??? ? ? ????? ??????,
???????? ??????, ??????? ???? ????? ?????? ??
13-? ?????, ??????? ??????? ?? ??????? ?? 54-?
????? ? ??????? ???????? ?????? ????????? ? ?????????? ????? ?????????? 86% [2].
? ????? ?????? ????? ????? ?????? ??????????
????? ?????????? ? ?????????? ??????, ??? ??????????? ???????????? ?????????? ??????. ??????????? ???????? ??????? ?????????????????
? ????????? ????????? ???????? ????????? ??????????. ????????, ???? ?? ?????????????? ??????????? ?????? ?????????? ????? ? ????????? ????????? ? ?????????????? ????????? ??????????
(???????? ???? ????? ?? ?????? ?????? ? ??????????? ????? ?????????????????? ????? ? ?????????? ??????). ?????? ???????? ???????????, ?? ??
??? ?????????? ????? ?????????? ??????? ??????????????? ????????? ??????????????.
??????????
1.
2.
3.
4.
5.
??????????? ?.?., ??????? ?.?. (???.) ????????-?????????? ????????: ???????????. ?.: ????????; 1996.
Agematsu K., Aoki M., Naito Y., Fujiwara T. Surgical palliation
for taussig-bing anomaly with multiple lesions. Asian
Cardiovasc. Thorac. Ann. 2008; 16: 412?3.
Hubera C., Mimicb B., Oswalb N. et al. Outcomes and reinterventions after one-stage repair of transposition of great
arteries and aortic arch obstruction. 23rd Annual Meeting of
the European Association for Cardio-thoracic Surgery, Vienna,
Austria, October 18?21, 2009.
Lacour-Gayet F. Arterial switch operation with ventricular sepatiental defect repair and aortic arch reconstruction. Semin.
Thorac. Cardiovasc. Surg. 2007; 19: 245?8.
Mavroudis C. Pediatric cardiac surgery. Mosby; 2003: 415.
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Burakovskiy V.I., Bockeria L.A. (eds) Cardiovascular surgery:
A Guide. Moscow: Meditsina; 1996 (in Russian).
Agematsu K., Aoki M., Naito Y., Fujiwara T. Surgical palliation
for taussig-bing anomaly with multiple lesions. Asian
Cardiovasc. Thorac. Ann. 2008; 16: 412?3.
Hubera C., Mimicb B., Oswalb N. et al. Outcomes and reinterventions after one-stage repair of transposition of great
arteries and aortic arch obstruction. 23rd Annual Meeting of
the European Association for Cardio-thoracic Surgery, Vienna,
Austria, October 18?21, 2009.
Lacour-Gayet F. Arterial switch operation with ventricular sepatiental defect repair and aortic arch reconstruction. Semin.
Thorac. Cardiovasc. Surg. 2007; 19: 245?8.
Mavroudis C. Pediatric cardiac surgery. Mosby; 2003: 415.
????????? 28.06.2013
57
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. ? ????????? ???????????(??) ?????, ????? ??? ?????? ?????????? ???????? ?????????? ???????
????????????.
??????? ?????????? ?????:
????????????? ?????????? ??????? ?????? ? ???? ???????????
??????????????????? ?????? ?? ?????????? ????????????? ???????
?.?. ????????1, ?.?. ????????1, ?.?. ???2, ?.?. ?????2
1 ???? ╚????????????? ????????? ??????????? ???????????????? ?????╩, ???????????????
????????, 106, ?????????, 400008, ?????????? ?????????;
58
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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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 of Russian Academy of Medical Sciences;
Rublevskoe shosse, 135, Moscow, 121552, Russian Federation Kirillov Kirill Olegovich, Postgraduate, email: 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 ????.
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???????? ????? ?????? ????? ????? ? ??????? ? ?? ?????? ??????????? ????? ??????, ??????? ?????????????? ???????????? ??? ?????? ?????? ? ????; ?????????? ??????????? 3?6 ???????? ????.
?????. ?? ╚????????╩ ?? ????????? ??????? ???????????? ??????? ???????????? ????????????
???????????? ? ????????????? ??? ???????? (???? ????????????).
? ??????? ╚???????? ? ??????╩ ?????????? ????????? ?????????? ? ?????????? ? ???????????? ????????? ??? ????????????????? ????????, ???????? ??????? ????????????, ?????????????? ???????????, ????????????, ????????????????, ????????????????? ? ?????? ???????. ?????????? ??????????? ????? ??????? ??????????? ?????????????? ??????????? ? ??????, ?????
???????????? ???????? ??????????? ??? ????????????? ??????? ?? ????????????.
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?????????????? ? ?? ??. ??.), ? ???????? ????? ????????????? ????????????, ????????: ???,
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(??? ???????, ??? ? ?????????) ?????? ??????????????? ╚?????????????????? ??????? ??????????? ????????╩ (? 3 ?., ??? ???. ????. ?.?. ???????????).
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??????????, ????? ??????????? ??? ???????? ??????????? ??????????????? ?????????????
????????????? ??????????? ????????? ? ???????? (Mendelian Inheritance in Men, ??.
http://ncbi.nlm.nih.gov/Omim).
???????? ??????????????? ?????? ???? ???????? ? ???????????? ? ╚????????????????? ???????? ??????????? ????????╩ (? 3 ?., ??? ???. ????. ?.?. ???????????) ??? ?? ??????? ╚??????????? ?????????????╩ (??? ???. ?.?. ???????????).
????????? ?.?.?., ??????????? ? ??????, ?????? ??????????????? ?????? ??????????.
???????, ????????? ??????? ? ???????? ??????????? ??? ?????????, ?????? ???? ????????.
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???????????? ? ?????? ??? ?? ?????? ??????????. ?? ??????????? ?????????? ??????? ????, ???? ???? ??? ????? ???????????.
???? ????????????? ???????, ??????? ????????? ? ?????? ????????? ???????? ?????? ????
??????? ? ??????? ??.
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????????????, ? ?? ???????????? ?????. ??? ???????????? ???????????? ?????? ???? ????????. ??????? ????????? ?????????? ????????? ????? ??????? ? ?????? ??? ? ??????? ??????? ????? ?? ??????????. ???? ??? ?????????? ? ??????? ???????? ? ????? ????????, ?? ?? ??????? ???????? ????? ??????? ????? ????????? ???????.
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??????? ? ?.?.) ????????? ?????????. ?? ??? ??????? ? ?????? ?????? ???? ???? ??????. ??????? ?????? ????????????? ??????????????? ????? ??????, ? ??????? ??? ??????????? ???????.
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?? ????? ???????????. ??????? ?? ???????????? ?????? ???? ???????, ??????????? ?? ???????
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? ???????????? ??????? ??????????? ??????????? ?? ????? 25 ??????????, ? ??????? ?????????? ? ?? ????? 50, ? ?????? ?????????? ? ?? 15. ???????????? ?????? ????????? ?????? ???????????????? ????? ?????????? ?? ????????? 5 ???.
? ?????? ?????????? ??? ?????? ????????????? ? ??????? ???????????. ?????????????????
?????? ? ?????? ?????? ?????? ? ?????????? ??????? ????????. ?????? ?? ???????????????? ?????? ?? ???????????.
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????????????????? ???????? ?????: ?????(?), ????????, ????? (??? ??????), ????? ????????? ?
???????? ????????????; ????? ????? ? ??????? ? ??? ???????. ???? ?????? ?????? ?? ????? ?? ?????:
??????, ???????? ?????, ????? ????? ???????? ╚? ??.:╩ ??? ╚In:╩ ? ???????(?) ??????(??) ??? ?????????(??), ????? ???????? ????? ? ???????? ??????.
????????????????? ???????? ?????? ?? ???????: ?????(?), ???????? ??????, ???????? ???????, ???, ???, ? ??????? ????? ???????, ????? ????????? ????? ?????? ? ????????? ??????? ???????????.
??? ????????? ?????????? ?? 6 ??????? ???????????? ??????????? ???, ??? ??????? ?????????
??????????? ? 6 ?????? ??????? ╚? ??.╩, ? ??????????? ╚et al.╩; ???? ? ???????? ??????? ???? ????????? ?????????, ????? ??????? ??????? ??????? ╚???.╩, ? ??????????? ╚ed.╩.
?? ????? ????????, ??????????? ?????????? ????? ????????????? ?????? ???????????,
??? Web of Science ? Scopus, ????????????????? ?????? (References) ?????? ? ????????????
???? ?????? ? ?????????????? ?????? ???????? ?? ?????? ?? ????? ?????????, ?? ? ?????????
(????????? ?????????). ??????? ?????? ?????? ?????? ?????? ?????? ?????????? ? ???? ?????????: ???? ?? ????? ????????? (????????????? ????????? ? ??????????, ???????????? ? ?????????), ??? ???? ??????? ?????, ? ????????? ?????? ??? ?? ?????? ?????????? (References)
? ????????? ???????? ??? Scopus ? ?????? ?????????? ??? ??????, ???????? ? ??? ??? ????????? ??????????, ?????????? ?? ????, ??????? ?? ????? ??? ???????????. ???? ? ?????? ????
?????? ?? ??????????? ??????????, ??? ????????? ??????????? ? ??????, ??????????? ? ????????? ????????.
? ????????? ???????? ??? ????????????? ?????????? ????????? ????????? ????????? ????????????????? ??????: ?????(?) (??????????????), ??????? ???????? ????? ??? ?????? ?? ?????????? ????, ???????? ????????? (??????????????), ???????? ?????? ? ???????? ???????, ???????? ?? ???? ?????? ? ??????? (in Russian).
?????????? ?????????? ?????? ? ?????????????? ???????
?????????????? ?????????????? ? ???????????
?? ????? http://www.translit.ru ????? ????????? ??????????????? ?????????? ??????????????
???????? ?????? ? ????????. ????????? ????? ???????.
1. ?????? ? ????????? Translit.ru. ???????? ??????? ?????????????? BGN (Board of Geographic
Names). ????????? ? ??????????? ???? ???? ????? ????????????, ????? ???????? ????? ??? ??????,
?? ??????? ????? ? ???????? ?????? ╚? ????????╩.
2. ???????? ??????????????????? ????? ? ??????????? ?????? References.
3. ????????? ? ??????? ??????????? Google ??? ???????? ?????????, ????? ??????? (????????
?????, ??????, ????????????? ? ?. ?.) ?? ?????????? ????, ????????? ??? ? ??????????? ??????.
???????, ??????????, ??????? ??????????????, ??????? ?????? ????? ?????????? ???????? ????????, ??????????? ?????????? ????.
4. ?????????? ???????? ? ????????? ? ??????????, ???????? ? ???????????? ? ????????? ?????????. ??? ???? ?????????? ???????? ????? ??????? (Moscow), ???????? ????????
(Molekulyarnaya meditsina) ?, ????????, ?????? ????????? ??????????? ????????.
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??????? ?????????????? ????????????? ?????????? ??????????
??? ????????????? ????? ??????
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??? ????????? ?????????? ???????????? ?????? ????????? ??????????? ???????? ??????????
?????????? ?? ??????: 121552, ??????, ?????????? ?., 135, ????? ??. ?.?. ???????? ????,
????????? ??????? ???????????? (e-mail: kupriashov2007@rambler.ru).
??? ????????? ????????? ?????? ?????? ??????????????? ?? ?????.
????? ?? ?????????? ????????? ?? ?????????.
64
; ??????? ???? ?????; ???????????? ????????????.
SUCCESSFUL CORRECTION OF TAUSSIG?BING ANOMALY WITH TYPE B
INTERRUPTED AORTIC ARCH IN NEWBORN
Yu.N. Shamrin1, K.V. Gorbatikov2, V.Yu. Bondar?1, S.A. Kurbanov 3
1
Far Eastern State Medical University, RF Ministry of Health; ulitsa Murav?eva-Amurskogo, 35,
Khabarovsk, 680000, Russian Federation;
2 Regional Clinical Hospital No.1; ulitsa Kotovskogo, 55, Tyumen?, 625023, Russian Federation;
3 Federal Center for Cardiovascular Surgery, of Ministry of Health Russian Federation; ulitsa
Krasnodarskaya, 2B, Khabarovsk, 680009, Russian Federation
Shamrin Yuriy Nikolaevich, MD, DM, Associate Professor, Cardiovascular Surgeon,
e-mail: shamrinyj@yandex.ru;
Gorbatikov Kirill Viktorovich, Cardiovascular Surgeon, Chief of Department;
Bondar? Vladimir Yur?evich, MD, DM, Chief of Chair;
Kurbanov Sergey Anagulovich, Anesthesiologist-Intensivist
Taussig?Bing anomaly is rare congenital heart malformation relating to a group characterized by the aorta and the pulmonary artery
beginning from the right ventricle with ventricular septal defect.
Anatomic correction of Taussig?Bing anomaly is characterized by a wide variety of surgical approaches, depending on the anatomical variants of the defect. Currently, the surgery of choice is arterial switch with ventricular septal defect plasty. The combination of
Taussig?Bing anomaly with other congenital heart defects is extremely rare, and each patient is the subject of a separate discussion.
We present a case of successful correction of Taussig?Bing anomaly with type B interrupted aortic arch.
Key words: Taussig?Bing anomaly; interrupted aortic arch; arterial switch.
г?б?блкб
???????? ????????????? ? ?????? ??????????
????? ?????? (???), ??????????? ? ?????? ??????? ? ??????????? ????? ? ???????? ??????? (??)
?? ??????? ????????? (??) ? ???????? ??????????????? ??????????? (????). ??????? ????????????? ?????????? ????? ? ?? ?? ?? ??????????
????? 1% ????? ???? ???. ???????? ??????? ?????????? ?????? ???????? ?????????? ????????????? ??????? ?? ?? ? ????????????? ???? ? ???????? ?? ? ??????? ?????????? ????? ? ?? ?? ??
? ??????????? ???? ? ???????? ?????????????
[1]. ?? ?????? C. Mavroudis, ???????? ????????????? ?????????? ?? 30% ?? ???? ??????? ?????????? ????? ? ?? ?? ?? [5].
????????????? ????????? ???????? ????????????? ??????????????? ??????? ??????? ????????????? ???????? ? ??????????? ?? ????????????? ????????? ??????. ? ????????? ????? ????????? ?????? ???????? ???????? ?????????????
???????????? ? ????????? ????. ????????? ???????? ????????????? ? ??????? ??? ??????????
54
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????????? ???????? ????????????? ? ????? ? ???????? ???? ?????.
Иткр?лкб рнш???
??????? ?????????? ????? ? ?? ?? ?? ? ??????????? ???? ??????? ?????????? ???????????????????? ??????????? ?? 21-? ?????? ????????????
? ??? ??????????? ? 30 ??? ? ????? ????????. ???????? ??????? ? ??????? ???????????????? ??????????????? ??????????????, ? ??????? ????????? ??????? ???????????? ? ???? 0,05 ???/??/???.
? ???????? 9 ???? ??????? ????????? ??? ???????????? ??????? ? ??????????????????? ?????????. ?? ?????? ??????????? ????? ?????????
???????? ??????? ??????? ???????. ??? ???????
??????? ?????? ???? 2 ?? 900 ? ????????? ? ???????? ?? ??????????????? ???????, ?? ?????? ????????? ?????????, ???? ???????. ?????? ???????
? ??????? ????????? ??????, ??????? ?????????,
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??????? ??????? ?????? ? ???????, ? 2, 2014
???. ??????? ???????????????, ??? ????????????
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??? ???????????? ?????? ???? ?????????, ?????,
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?????????? ???????? ????????? ?? 80%. ?????
????????, ????????? ????????, ?????? ???????????? ?? 2 ?? ???? ???????? ????, ???? ?????? ??????.
???????????? ??????? ???????????? 2 ???/??/???.
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? ?????????? ????? ?? 15 ??. ? ???????????? ????? ??????????????? ??????????? ??????? ??????
????????? ?? 9 ??, ??????????????? ??? ??. ????? ????, ????? ????? ?????? ?????????????? ??????????? (????) ????????? 10 ?? ? ???????? ???????????? ?????? (???) ? 3 ??.
???????? ?????????????? ????? (???) ??????
????????? (??) ? 18 ??, ???????? ?????????????
????? (???) ? 6 ??, ??????? ??????? ?? 63%.
??????? ?????????? ?????? ??????????? ???????
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??????? ????????????? ???? ????? ?? 3 ?? ? ??????? ???? ????? ????? ????? ????? ?????? ? ?????
???????????? ?????????. ???????? ? ??????????
????? ?????????????? ????? ???????????????
??? (???. 1).
???????? ??????? ? ??????? ????????????????
?????????, ???? ?????????????? ????????? ? ??????????? ????????? ??????, ? 14.09.2012 ?. ???????? ????????? ????? ?????????? ?????? ? ????? ????? ?? ???? ????? ? ???, ?????? ?????????????????? ??????? ????? ?? ? ?? ? ???????????
???????????? ???????????? ? ?????????????? ?????? ?????????? ??????? ? ????????? ???? ? ???????? ?????????????? ?????????????? (??), ???????? ?????????? ? ?????????? ??????????????,
???????????? ????????? ╚?????????╩.
???????? ? ?????? ????????? ?????????? ????????? ???????????. ??? ??????? ??????? ??????
????? ????? ???????? ?????????? ????? ? ?? ??
??: ????? ??????????? ?????? ?? ??, ????? ??????? ??? ??????? ????????? ?? 10 ??. ??? ????????? ???? ? ?????????? ????? ? ?????????? ??
??? ???????????????? ????????? ?????????? ??????? ???? ?????, ??? ? ?? ?????????????
Celoria?Patton. ?????????? ????? ????????? 8 ??,
??????????????? ????? ? 6 ??, ????????????? ???? ????? ? 5 ??, ????? ????? ?????? ??????? ? 4 ??,
????? ?????????? ???? ???????????? ???????. ??????? ???, ??????????? ? ?????????? ?????, ??????? ??????? ?? 9 ??. ????? ???????????? ???????
??????? ?? ?????????? ?????. ??????? ?? ????????? ?? ????? ╚??????????? ????╩, ?????? ???? ??????????? ??? ?????????? ??????: ???? ? ?????????? ?????, ?????? ? ? ??????????, ????? ???
(???. 2).
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Planche. ??? ?????????????????? ??????? ????????? ???? ??????????? ???????????, ????????? 10 ??. ???????? ????? ?? ???? ?????? ???????????????????? ???????? ? ???????????? ??????? ?? ? ??. ??????? ??????????? ???????????
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?????????????? ? ????? ?????? ????? (???. 3). ????????? ?????? ???? ????. ????? ????????????
??????????? ??? ???? ????? ? ?????.
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??????????? ? 20 ???/??/???, ?????????? ?
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??????? ?? 3,9 ?/?, ??? ????????????? ????????
????????? ???????? 60, ???????? 39 ?? ??. ??.
? ??????? ????? ???????? ?????????? ? ????????????? ? ???????? ????????? 0,34 ?/?. ?????????? ?????? ??????????????, ???????? ???????? ??
?????????? ??????? 25 ?? ??. ??. ?????????? ??????????????? I ???????.
И╥ршй?блкб
???????? ???????????? ??????? ?????? ???????? ????????? ???????? ????????????? ? ?????????
???? ?????. ? ?????????? ??????? ??????????? ?????
?????????, ? ?????? ???????? ????????? ?????????
?????????, ????????????? ??????????? ????????
? ?????????? ??????? ??????? ?????????? ? ????????? ??????? [3, 4]. ???, ????????, ????????
?????? ??? ??????????? ? 2008 ?. ????????? ?? ??????. ??????? ? ???????? 1 ??? ? ????? 3,1 ?? ???????? ? ???????? ? ????????. ????????? ????? ?????????? ?? ??????? ? ?????? ??????????? ????????? 70 ? 90% ??????????????. ??? ????????? ???????
???????? ????????????? ? ????????? ???? ?????
(?? ????????????? Celoria?Patton ??? ?) ? ??????????? ????????? ????. ? ???????? 9 ???? ????
????????? ??????????? ???????? ? ???????? ??,
???????? ?????????? ? ????????? ??????????????.
????????????????? ??????, ??? ? ? ????? ??????,
???????? ??????, ??????? ???? ????? ?????? ??
13-? ?????, ??????? ??????? ?? ??????? ?? 54-?
????? ? ??????? ???????? ?????? ????????? ? ?????????? ????? ?????????? 86% [2].
? ????? ?????? ????? ????? ?????? ??????????
????? ?????????? ? ?????????? ??????, ??? ??????????? ???????????? ?????????? ??????. ??????????? ???????? ??????? ?????????????????
? ????????? ????????? ???????? ????????? ??????????. ????????, ???? ?? ?????????????? ??????????? ?????? ?????????? ????? ? ????????? ????????? ? ?????????????? ????????? ??????????
(???????? ???? ????? ?? ?????? ?????? ? ??????????? ????? ?????????????????? ????? ? ?????????? ??????). ?????? ???????? ???????????, ?? ??
??? ?????????? ????? ?????????? ??????? ??????????????? ????????? ??????????????.
??????????
1.
2.
3.
4.
5.
??????????? ?.?., ??????? ?.?. (???.) ????????-?????????? ????????: ???????????. ?.: ????????; 1996.
Agematsu K., Aoki M., Naito Y., Fujiwara T. Surgical palliation
for taussig-bing anomaly with multiple lesions. Asian
Cardiovasc. Thorac. Ann. 2008; 16: 412?3.
Hubera C., Mimicb B., Oswalb N. et al. Outcomes and reinterventions after one-stage repair of transposition of great
arteries and aortic arch obstruction. 23rd Annual Meeting of
the European Association for Cardio-thoracic Surgery, Vienna,
Austria, October 18?21, 2009.
Lacour-Gayet F. Arterial switch operation with ventricular sepatiental defect repair and aortic arch reconstruction. Semin.
Thorac. Cardiovasc. Surg. 2007; 19: 245?8.
Mavroudis C. Pediatric cardiac surgery. Mosby; 2003: 415.
References
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2.
3.
4.
5.
Burakovskiy V.I., Bockeria L.A. (eds) Cardiovascular surgery:
A Guide. Moscow: Meditsina; 1996 (in Russian).
Agematsu K., Aoki M., Naito Y., Fujiwara T. Surgical palliation
for taussig-bing anomaly with multiple lesions. Asian
Cardiovasc. Thorac. Ann. 2008; 16: 412?3.
Hubera C., Mimicb B., Oswalb N. et al. Outcomes and reinterventions after one-stage repair of transposition of great
arteries and aortic arch obstruction. 23rd Annual Meeting of
the European Association for Cardio-thoracic Surgery, Vienna,
Austria, October 18?21, 2009.
Lacour-Gayet F. Arterial switch operation with ventricular sepatiental defect repair and aortic arch reconstruction. Semin.
Thorac. Cardiovasc. Surg. 2007; 19: 245?8.
Mavroudis C. Pediatric cardiac surgery. Mosby; 2003: 415.
????????? 28.06.2013
57
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 2, 2014
??????? ??? ???????
????????? ??????!
???????? ???? ???????? ?? ??, ??? ?????? ?????? ? ??????????????? ??? ???????? ???????
????????????? ??????? ???????? ? ???????, ? ??????? ?????? ???? ???????????? ???????? ?????????? ??????????? ?? ????????? ?????? ??????? ??????? ? ????????? ????, ? ????? ? ????????????? ?????????????? ??????? ? ???? ??????, ??? ???????????? ??????????? ??????? ??????
?????? ?????? ????????? ????????? ???????.
1. ???????????? ?????. ?????? ?????? ????? ???? ???????????? ? ?????????????? ??????????? ???????????? ?? ??????????, ?? ???????? ??????? ?????? (? ??????? ???????), ? ??????????? ??????? ? ?????????? ???????????. ? ??????????? ??????? ???????, ???????? ?? ?????? ???????????????.
? ??????????? ??????????????, ??? ?????? ?????? ?? ???????? ????????, ? ????????? ???????
??????????? ?????? ????? ???????????? ?????, ? ????? ??????????? ? ?????????????-??????????????? ???????, ? ????????? ??????? ????????, ?? ?? ?????? ????????? ??????????????? ??????????? ??? ???????? ?????????? ?????.
?????? ?????? ???? ????????? ????? ????????.
?????? ?????????? ? ???????? ??????, ???????????? ? ???? ???????? ??? ???????????? ? ????
???????.
???????? ????????? ?? ????? ????? ????????? ? ????????????? ???????? ??????. ????? ??????????? ?????? ????????? ????? ??????????? ?????????????? (???????????????) ???????? ??????.
2. ?????? ??????????? ? ???????? ? ?????????? ? ???????????? ?????????
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