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79.Детские болезни сердца и сосудов №4 2014

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http: //www.bakulev.ru
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Мбн. (499) 236-92-87
ябзрмкб ╥снбалк рб???? к рсрш?с?
2014. ? 4. 1?60
ISSN 1810-0686
Мк??й 500 ?ма.
Хс?ткрлсх кл?бмр 84550
??????? ???????
?????? ? ???????
CHILDREN?S HEART
AND VASCULAR DISEASES
????????????? ??????-???????????? ??????
??????? 1 ??? ? ??? ??????
??????? ? 2004 ?.
.
4 2014
??????? ???????? ?.?. ???????
???????????? ????????
?.?. ?????????, ?.?. ???????,
?.?. ?????????, ?.?. ?????????, ?.?. ???,
?.?. ????????, ?.?. ???????,
?.?. ??????? (???. ???????? ?????????)
???????????? ?????
?.?. ???????, ?.?. ???????, ?.?. ??????,
?.?. ??????????, ?.?. ???????
?????? ?????? ? ???????? ????????????? ????????????? ??????? ???????,
??????????? ? ?????????? ?????????, ? ??????? ????????????? ??????????
???????? ??????????? ??????????? ?? ????????? ?????? ??????? ??????? ?
????????? ???? ?? ????????
?????? ??????? ? ?????????? ?????? ???????? ???????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
Nauchnyy tsentr serdechno-sosudistoy
khirurgii imeni A.N. Bakuleva
DETSKIE BOLEZNI
SERDTSA I SOSUDOV
CHILDREN?S HEART
AND VASCULAR DISEASES
Peer-reviewed scientific-practical journal
Published once in three months
.
Founded in 2004
4 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?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
??????????
? 75-????? ???????? ????????? ?????????
??? ? ???? ??? ?????????? ???????
??????? ?.?., ?????????? ?.?., ???????? ?.?.,
??????? ?.?., ??????? ?.?. ??????????? ???????????????? ? ???????????????? ?????? ????? ?
??????????? ???????? ?????? ? ?????????? ???????
???????? ?.?., ?????????? ?.?., ????????? ?.?. ?????????? ????? ? ??????????? ?????????? ?????????????? ???????????? ??????????????? ??????? ? ????? ? ?????????? ???????
????? ?.?., ?????? ?.?., ??????? ?.?., ?????? ?.?., ??????? ?.?., ????????? ?.?., ????? ?.?., ?????? ?.?. ????? ?????????????
?????????? ??????? ??? ????????? ????????????? ????????????
??????????? ?.?., ???????? ?.?., ??????? ?.?.,
??? ?.?., ????? ?.?. ????????????? ????????
??????????? ??????? ??? ??? ???????????????,
??????????? ????? ??????????? ????????? ?????? ????????? ???????????????????? ?????? ?
????? ??????? ????????
???????? ?.?., ??????? ?.?., ???????? ?.?.,
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??????????? ?.?., ????????? ?.?., ????????? ?.?., ???????? ?.?. ??????? ????????????????? ??????? ? ??????? ?????
CONTENTS
5
On the 75th anniversary of Editor-in-Chief
Academician of RAS and RAMS Leo A. Bockeria
Bockeria L.A., Milievskaya E.B., Krupyanko S.M.,
Tamazyan G.V., Osipova G.R. Access to the cardiological and rehabilitation care for children with congenital heart disease in the Moscow region
7
15
Abramova M.F., Novoselova S.N., Stepanova I.A.
Indicators of norm and features of carrying out of
brachiocephalic vessels researches at children in
age aspect
Il?in A.S., Teplov P.V., Sakovich V.A., Yu.Yu.
Spichak, Il?inykh K.A, Afanas?ev I.S., Titov A.M.,
Lytkin V.A. Arterial switch operations: the method
of coronary arteries reimplantation
24
Abduvokhidov B.U., Sukhacheva T.V., Bockeria L.A., Kim A.I., Serov R.A. The Surgical morphology of mitral valve of it_s insufficiency after radical correction of the complete atrioventricular canal
defect in infants
29
Chiaureli M.R., Kovalev D.V., Nezhlukto A.A.,
Minaev A.V. Case of successful removal of subaortic stenosis in patient after repair of common atrioventricular septal defect
38
42
Baryshnikova I.Yu., Berishvili D.O., Makarenko V.N., Nefedova I.E. Major congenital coronary
cardiac fistulas in infancy
3
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
???????? ?.?., ????????? ?.?., ????? ?.?.,
???????? ?.?. ?????? ??????????? ??????????
???????? ???????? ??? ? ??????? ? ????????
2,5 ???????
???????????? ?.?., ?????? ?.?., ?????????? ?.?., ??????? ?.?. ?????? ?????????????
????????? ??????????? ??????? ??????????? ??????
4
Nefedova I.E., Netalieva G.S., Serov R.A.,
Ivaschenko D.K. A case of diagnostics of congenital
pulmonary vein stenosis in a 2,5-month-old child
46
Gorbachevskiy S.V., Shmal?ts A.A., Grenaderov M.A., Mazhidov U.A. Case of surgical correction
congenital stenosis of the coronary sinus
50
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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e-mail: elena_miliev2004@mail.ru;
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?????? ?????, ??????????? 311 ???????: 288 ??????????, 23 ????????????. ????? ? ?????? ??????? ??????? ????? ?? 89 ??????????, ????????????? ? 31 ???????????????-??????????????? ??????? (???) ?????????? ???????. ??????????? ???????????????? ?????? (??) ????? ? ??? ???? ??????? ?? ???? ???????????: 1) ??????? ???????? ?????? ??????????? ??,
??????????? ?????????????; 2) ??????? ???????? ?????????? (??), ???????? ???????????? ????? ? ???????-???????????????? ?????????? (???); 3) ??????????? ??? ?? ??????, ??? ?????????? ??????????????????? ?????????, ? ??????? ?????
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???????? ?????: ?????????? ?????? ??????; ??????????? ??????????? ??????; ????????????.
ACCESS TO THE CARDIOLOGICAL AND REHABILITATION CARE FOR CHILDREN
WITH CONGENITAL HEART DISEASE IN THE MOSCOW REGION
L.A. Bockeria1, E.B. Milievskaya1, S.M. Krupyanko1, G.V. Tamazyan2, G.R. Osipova2
1 A.N.
Bakoulev Scientific Center for Cardiovascular Surgery; Rublevskoe shosse, 135, Moscow,
121552, Russian Federation;
7
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
2 The
Ministry of Health of the Moscow Region; Bul?var Stroiteley, 1, Krasnogorsk, Moscow
Region, 143407, Russian Federation
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;
Milievskaya Elena Borisovna, MD, PhD, Deputy Head Physician of the Institute of Coronary
and Vascular Surgery of A.N. Bakoulev Scientific Center for Cardiovascular Surgery,
e-mail: elena_miliev2004@mail.ru;
Krupyanko Sof'ya Mikhaylovna, MD, DM, Head Physician of Rehabilitation Center for Children
with Heart Defects of A.N. Bakoulev Scientific Center for Cardiovascular Surgery;
Tamazyan Gayane Vartanovna, MD, DM, Professor, Deputy Minister of Health of the Moscow
Region;
Osipova Galina Romanovna, MD, PhD, Chief Pediatric Rehabilitation of the Moscow Region
Introduction. In recent decades the results of surgical treatment and those of the survival children with congenital heart disease
(CHD) requiring treatment have improved and got up. At the same time, despite its relevance, many problems of the organization of
skilled cardiac care and rehabilitation of children after surgical treatment of CHD ? are still remain very actual.
Material and methods. In the article we analyzed the factors that influence the results of availability of the qualified cardiac care and
the rehabilitation of the children after surgical treatment of CHD living in Moscow region. The study included questionnaires was completed by 311 physicians: 288 pediatricians, 23 cardiologists. Who participated in the survey of physicians of 89 institutions located
in 31 administrative territorial units (ATU), including Moscow region. Availability of cardiac care (CC) children with CHD has been
evaluated in the three areas: 1) the means of availability CC made by respondents; 2) the availability of pediatric cardiologist (PC), a
leading outpatient care in the health facilities; 3) the distance from Moscow ATU where the Cardiac hospitals are situated and in which
children with CHD underwent operations.
Results. In most of the ATU of the Moscow region clearly evident that there are the correlation links between the use of indicators of
availability of cardiac care for children with CHD. For medical rehabilitation of children after surgical treatment CHD guide 70 (24.3%)
of 288 pediatricians. Most respondents (n = 218; 75.7%) said that they had not engaged in the direction of children with CHD to medical rehabilitation. About one-third of respondents believe that the organization of rehabilitative care to children with congenital heart
is unsatisfactory (n = 91; 31.6%), while 7.3% of pediatricians marked it as an extremely unsatisfactory. Most respondents cardiologists (n = 13; 56.5%) indicated that the records for children with CHD to them were done at the reception and there was no advice
available at the same day. Two cardiologist noted that they needed quite a long time to wait for the record ? from 2 weeks to 1 month.
About one-third of respondents (n = 7; 30.4%) reported a shorter waiting time for consultation of record ? less than 1 week. Waiting
times for children in the queue to receive pediatric cardiology?s help directly depended on the schedule reception doctors: the 5-day
work schedules appointments were missing.
Conclusion. The proposed scheme of study and using of the indicators can be recommended to use them in the larger-scale studies, such as A total survey of physicians of all ATU Moscow region or any other region of the Russian Federation. The important purpose of the work done was to compile a manual for pediatricians Moscow region by category CHD and to improve the process of
organization for their additional training of pediatric cardiology in a whole.
Key words: congenital heart disease; access to health care; rehabilitation.
г?б?блкб
???????????????? ? ???????????????? ??????
????????? ? ??????????? ???????? ?????? (???)
?????????? ?? ????????? ?????? ?? ?????. ?????
??? ??????? ???????????? ? ????? ?????? ???????? ????????????????? ?????? ??????????? ???,
???????????? ?????????? ?????? ??????? ? ?????? ?????????? [1?5]. ? ????????? ???????????
?????????? ???????????? ?????? ? ???????????
???, ?????????? ?????????? ?????????????? ??????? ?????????, ? ??? ????? ?????????????, ?????????? ???????????? ????? ? ???, ???????????
? ??????????? ???????????? ?????????? [6]. ? ??
?? ?????, ???????? ?? ???? ????????????, ??????
??????? ????????????????? ??????????? ????????? ????????????????? ???????????????? ? ???????????????? ?????? ????? ????? ?????????????? ??????? ??? ???????? ???????????.
???? ??????? ???????????? ? ?? ????????? ??????????? ????????????? ?????? ??????? ???????,
??????? ?????? ?? ??????????? ????????????????
8
?????? ????? ????? ?????????????? ??????? ???,
??????????? ? ?????????? ???????.
Е?зб?к?н к обзс??
????????? ???????????? ????????, ????????
?? ??????????? ???????????????? ? ???????????????? ?????? ????? ????? ?????????????? ???????
???, ??????????? ? ?????? ???????? ?????????. ? ???????????? ? ?. 1 ??. 6 ?????? ??????????
??????? ?? 31 ?????? 2013 ?. ?11/2013-?? ╚?? ???????????????-??????????????? ?????????? ?????????? ???????╩ ??????? ???????????????-??????????????? ?????? (???) ?????????? ??????? ?????????? ??????, ?????? ?????????? ??????????
? ???????? ???????????????-??????????????? ??????????? (????? 73 ???) [7]. ??????????? ????????? ?????????? ??????? ? 7 048 000 ??????? ?? ????????? ?? 1 ?????? 2013 ?.
? ??????????? 2014 ?. ???????? ????? ????????? ? ??????? ??????????? ???????????? ?????????????? ????? ?????????? ???????.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
??????????? ??? ???? ?????: 1) ?????? ????????;
2) ?????? ???????? ??????????. ? ?????? ??? ??????
???????? ??????? ? ??????????????? ???????????? ?????????? ???????? ??????????, ????????
???????????? ?????, ? ??????? ?????? ?? ???????????? ? ??????????, ??????? ???????? ? ???????
?? ??????, ? ??????? ? ???????????-??????????????? ?????????? ??????????????? ????????, ??????????? ??? ?????? ????????? ????? ? ???, ???
?????? ????????. ?????? ????????? ????????? ??
??????????? ????? ? ?? ????? ??.
? ???????????? ???????? ?????? ?????, ??????????? 311 ???????: 288 ??????????, 23 ????????????. ????? ? ?????? ??????? ??????? ????? ??
89 ??????????, ????????????? ? 31 ??? ?????????? ???????.
??????????? ???????????????? ?????? (??)
????? ? ??? ???? ??????? ?? ???? ???????????:
1) ??????? ???????? ?????? ??????????? ??, ??????????? ?????????????; 2) ??????? ????????
??????????, ???????? ???????????? ????? ? ???????-???????????????? ?????????? (???);
3) ??????????? ??? ?? ??????, ??? ??????????
??????????????????? ?????????, ? ??????? ?????
? ??? ????????? ????????.
?????-???????? ????????? ??????????? ???????????????? ?????? ????? ? ??? ?? ???????????? ???????????? ?????, ??? 5 ?????? ? ????????
???????????, 4 ? ???????, 3 ? ??????????????????,
2 ? ??????, 1 ? ????? ??????. ??? ?????? ??????????? ???????? ?????????? ?? ????? ?????????? ???????? ?????????, ?????????????? ? ?????????????? ????????, ???????????? ??? ????? ??????: ╚???
????? ????? ????????? ??????? ?????????, ? ???????? ???? ????? ?????????????? ??????? ???, ??????????? ??? ????? ???????????, ????? ????
???????????╩, ?? ??????? ?????????? ?????????
????????? ???????: ? ? ? ?????? ??????????; ? ?
? ??????????, ????????????? ? ???? ?? ?????????? ??????; ? ? ? ??????????, ?????????????
? ?????? ?????????? ?????? ??????? ?????????????? ??????????? ??????? ??????; ? ? ? ??????????, ????????????? ? ?????? ????????????? ??????????? ??????? ?????? ?????????? ???????;
? ? ? ?????? ?????? ???????; ? ? ? ??????.
??? ????????????? ??????, ?????????? ???
???????? ?????? ??????????? ????????????????
??????, ??????????? ??????????, ????????? ????????? (???????????????? ???????????? ????????
?????????? ???????????? ????? ?????????? ?????
? ???) ????????? ????????? ???????? ????
(?????): ? ? ? ? 5 ?????? (?????? ???????????????
???????????? ???????? ??????????), ? ? 4 (??????? ??????????????? ???????????? ???????? ??????????), ? ? 3 (?????????????????? ??????????????? ???????????? ???????? ??????????), ? ? 2
(????????? ??????????????? ???????????? ???????? ??????????), ? ? 1 (???????? ????????? ??????????????? ???????????? ???????? ????????-
?? ? ? ?????? ???????? ?????????, ? ?????? ?????? ? ? ??????). ??????????? ??? ?? ?????? ?????????? ??? ?????? ??? ? ???????????? ? ??????????? ?? ????????? ?????? ?? ?????????? ????????? ????????????? ?????? (????) ? ??????????.
?????????? ?? ???? ?? ???????????????????? ?????????? ? ?????, ??????????? ? ????, ?? ???????????. ?????????? ?? ???? ? ?????? ???????????? ????????? ???????: ?? 10 ?? ? 5 ??????,
10?30 ?? ? 4 ?????, 30?60 ?? ? 3 ?????, 60?90 ?? ?
2 ?????, ????? 90 ?? ? 1 ????.
?????-???????? ??????? ??????????? ? ?????
??????? ???????????????? ?????? ????? ?????
?????????????? ??????? ??? ?? ????????????
?????, ??? 5 ?????? ? ???????? ???????????, 4 ????? ? ???????, 3 ????? ? ??????????????????, 2 ????? ? ??????, 1 ???? ? ????? ??????.
???????????? ??????? ????????, ????????????, ???????????????. ?????????????? ????????????, ??????????? ??????????. ??? ???????? ???????????? ?????? ??????????? ?????????? ???????? ? ????.
Йбашн╦з?з?
дл?нка ??лл?? ?лмбз,
а?тснлблл?? ш??рзмс??ок тб?к?з??ок
????????????? ???????????? ? ?????? ??????????????? ?? ???????? ???????????? ?? ??????? 1.
??????????? ??????-????????? (285; 99,0%) ????
?????????. ? ???????? ?? 39 ??? ???? ????? 47
(16,3%) ??????-?????????, ???, ????????, ?????
?????????, ??? ????????? ??????? ????????????
???????? ? ??????????????? ??????????? ?? ?????? ?????????????. ?????????????? ?????????
? ?????????? ????? ????????? ? ?????????? ?????? 35?39 ??? ? ????????? ? ?????????? ?????????? ??????? 30?34 ????. ? ???????? 55 ???
? ?????? ???? 132 ???????????, ??? ?????????
45,8% ?????????? ??????-?????????, ?? ???? ????? ???????? ???? ?????? ?????????? ? ????????
?????? ???????????????.
????? ???????? ????????? ???? ????? 1 ????
????? 3 (1,1%) ????????, 1?3 ???? ? 13 (4,5%), 3?
5 ??? ? 7 (2,4%), 5?10 ??? ? 22 (7,6%), ????? 10 ??? ?
243 (84,4%). ???????? ???? ? ????????? ????????????? ????? 1 ???? ????? 8 (2,8%) ????????????, 1?3 ???? ? 30 (10,4%), 3?5 ??? ? 20 (7,0%),
5?10 ??? ? 20 (7,0%), ????? 10 ??? ? 210 (72,8 %).
????????????? ??????? ??????-????????? ?? ?????? ? ??????? ? ??? ????????? ????????? ???????????? ?? ??????? 2. ?????? ??????? ? ??????
?????? ?? ???? ?? ???? ?????????? ?? ????? ??????-?????????.
?????????????? ???????? ?? ???????? ???????
??????????? ? ???? ??????, ?????????, ??????????? ?????? 74 ?? 288 ?????????, ??? ????????? 25,7%. ?? ??? 64 ????? ????????, ??? ? ??????
???????? ????? ???????, ????????? ? ???. ???
9
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
55
77
43
66
15
23
9
0
10
20
30
40
50
60
70
80
90
100
???? ????????????, %
?? 29 ???
30?34 ????
35?39 ???
40?49 ???
50?54 ????
55?59 ???
60 ??? ? ??????
???. 1. ????????????? ???????????? ??????-????????? ?? ????????, n = 288
9
50
158
64
7
?? ??????? ??
?????? ??
?????? ??
?? ????? ??
?????? ??
???. 2. ????????????? ??????-????????? ?? ????????? ??????????, n = 288
????????? ???????? ????? ??????? ??????????
?????????? ???????? ??? ????? ?????? ? ?????
?????????? ?????? ???????? ???????? ? ???????.
? ?? ?? ????? ?? 214 ????????????, ?? ????????????? ? ??????????????? ???????????? ?? ???????
???????????, ??????????? ? 193 (90,2%) ????? ????? ?????? ?????????????? ???????? ?? ????????
???. ??????????? ???????????? (11 ?? 21 ?
52,4%), ?????????? ?? ?????? ?????? ????????????, ???????? ? ???????????, ??? ????? ????? ??????? ????????? (??), ???, ????????, ????????? ??
???????. ? ????????? 10 ??????? ??????? ????????? ????? ????? ? ??? ?? ???, ??? ???????????
10
???????????-??????????????? ??????????????
??????, ? ??????? ???????? ???????????.
????? ??????? ???? ????????? ?????? ?? ??????? ??????????? ????????????? ??????? ?????????: ???????? ?????, ????????????? ?????, ??????, ? ??? ????? ?? ??????? ?????, ????????, ???????????, ????????????? ????????, ????? ?????,
????????? ????????????, ???????????? ??????????????????. ??????? ??????? ?? ??????? ???????????, ???????????? ?????????? ?????????
?????????? ???????: ??????? ????? ? ??? ?? ???????, ? ??? ????? ??? ????????????? ?????????,
???????????? ????? ? ???, ???????????, ? ??? ????? ? ?????, ??????? ? ???? ???, ????????? ? ???????????? ?????????????, ???????????????????
(???), ????????? ??????? ????? ??????????????
??????? ????? ? ???, ????????? ?????, ???????????????? ????????.
? ??????? 1 ???????????? ?????????? ??????????? ???????????????? ?????? ??? ????????? ? ???
? 31 ??? ?????????? ??????? ?? ??????????? ??????? ??????-?????????.
? ???? ????????? ?? ?????? ??? ??????????
??????? ?????????????? ??????????? ????? ?????
???????????? ??????????? ???????????????? ?????? ????? ? ???. ???, ? ??? 1, ??? 9, ??? 16,
??? 18, ??? 26 ??? ???????????? ???????????
??? ?? ?????? ? ?????????? ? ??? ??? ? ????????? ??? ???????? ?????????? ???????? ?????? ????????? ? ?????? ??????? ??????? ???????????
???????????????? ?????? ????????? ? ?????? ?????????? (???. 3).
????????, ??? ??????? ? ??? ???????? ?????????? ????????? ????? ??????????? ???????????????? ?????? ???? ???? ? ??????????? ??????? ??
??? ? ???? ??????? ????????? ???????? ?? ?????
(??? 3, ??? 5, ??? 6, ??? 7, ??? 8, ??? 10,
??? 13, ??? 15, ??? 23).
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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М?╥нк?? 1
Хсм?а?збнк ?срзштлсрзк м???кснс?к?брмсх тсос?к ?н? т??кблзс? р гХК ? 31 дМж Есрмс?рмсх с╥н?рзк
? ???
??????? ???? ???????????
???????????????? ??????
??????? ????
???????????? ??
??????????
?? ????, ??
??????????
?? ????, ?????
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1
3
4,6
2
4,7
4,5
5
4,3
2
3,9
3
2,9
4,2
3,3
4
1,7
3,7
1,6
2,8
3
3
2,9
3,9
3,8
3,5
2,5
3
4,8
5
4
4
1
2
5
1
5
5
5
5
1
4,7
3
2
5
4,9
5
1
5
1
2,5
1
4
4,9
5
4
4,5
2
4,1
5
5
3
4
>90
10?30
30?60
10?30
>90
10?30
10?30
<10
>90
<10
>90
60?90
10?30
10?30
<10
>90
30?60
>90
30?60
10?30
<10
<10
>90
10?30
<10
>90
10?30
30?60
30?60
60?90
60?90
1
4
3
4
1
4
4
5
1
5
1
2
4
4
5
1
3
1
3
4
5
5
1
4
5
1
4
3
3
2
2
6
5
????
4
3
2
1
0
1 2
3
4 5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
ATE
??????????? ??
??????? ??????????
??????????? ?? ??????
???. 3. ??????????? ??????????? ??????????? ???????????????? ?????? ????? ? ???, ??????????? ? ?????????? ???????
(?? ?????? ?????? ?????????)
11
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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М?╥нк?? 2
120
Й?рт?б?бнблкб тс ??рзсзб ?салкмлс?блк?
срлс?л?? ?ст?срс? рбобх т?к с╥???блкк
р ?б╥блмсо р гХК м ш??рзмс?сош тб?к?з?ш
?????
?????????, n (%)
???????????? ?????????? ???????
?????????? ?????????? ????????
??????????? ? ??????????
??????????? ?? ?????, ???
????????????, ?????????-?????????
???????
????
??????? ????????????? ??????????
???????????? (????????????,
?????????)
??????? ???????????
42 (25,6)
38 (23,1)
25 (15,2)
24 (14,6)
23 (14,0)
17 (10,4)
14 (8,5)
80
75
70
60
40
21
20
11
0
?????
13 (7,9)
4 (2,4)
? ? ? ? ? ? ? ? ? ? . ????? ? ???????????????; ???? ? ??????
????????????? ???????? ????????.
????? ???????? ?????? ? 164 (56,9%) ????????, ? ?????? ????????? ?????????? ? ??? ?????
????????? ????? ?????????????? ??????? ???
(????. 2). ???? ????? ????? ?????????? ? ?????????? ????????? ? ????? ????????????? ?????????? ? 42 (25,6%).
?????????? ?????????? ???????? ??? ?????
? ??? ?????????? 23,1% ?????????. ?? ???????????? ? ?????????? ? ?? ???????????????? ???????????? ? ????????? ?????????? 15,2% ????? ?????
? ???. ? ???????????? ???????????? ? ?????????-?????????? ??????? ?????????? 14,0% ?????????. ??????? ????????? ????????? ?? ?????? ??????? ????????????, ????????????, ????????? ????????????, ???????? ??????????? ????????? 8,5,
7,9 ? 2,4% ??????????????.
?? ??????????? ???????????? ????? ????? ?????????????? ??????? ??? ?????????? 70 (24,3%)
?? 288 ??????-?????????. ??????????? ???????????? ? 218 (75,7%) ????????, ??? ?? ?????????? ???????????? ????? ? ??? ?? ??????????? ????????????. ??? ???? ? ??????????? ??????? (239, ???
83,0%) ??????????? ???????, ??? ?????????? ??????? ? ??? ?? ??????????? ???????????? ??????
??????? ?????????, ? 22 (7,6%) ??????? ? ?????????
? ???????, ? 11 (3,8%) ? ???????????? ? ?????????,
? 9 (3,2%) ? ????????????, ? 7 (2,4%) ? ???????.
?? ??????? 4 ???????????? ?????????? ???????? ??????, ??????????? ???????-??????????, ??????????? ? ??????? ?????????? ??????? ???????????????? ?????? ????? ????? ?????????????? ??????? ???.
????? ????? ???????????? ??????? ??????????? ???????????????? ?????? ????? ? ??? ???????????????????? ? 91 (31,6%), ??? ???? 7,3%
????????? ??????? ?? ??? ?????? ????????????????????.
12
100
????? ????????????
?????????? ???????
111
1 ????
2 ?????
3 ?????
4 ?????
5 ??????
???. 4. ?????????? ???????? ?????? ?????? ??????????? ???????????????? ?????? ? ??? ?????????? ??????? ????? ????? ?????????????? ??????? ???
? ?? ?? ????? ????? ????? ?????? ? 86 (29,9%)
??????? ??????????? ???????????????? ??????
??????? ? ????????. ????? ??? ????? ???????????? ??????? ??????????? ???????????? ??? ?????????????????? ? 111 (38,5%).
????? ? ???????? ??????? ? 135 (46,9%) ???????
????? ??????-????????? ?? ???? ???????? ????????????? ????????????. ?????? 63 (21,9%) ??????????? ? ???? ?????? ??????? ?? ??????? ?????????? ? ???????? ? ???? ???????? ?? ????? ???????
????? (???. 5). ????? ???????, ??????? ???????????? ????????????? ???????????? (??) ?????????
?????????? ??????? ???????? 469 ?? 1000 ??????.
63
135
90
??? ??
???? ?? c ???????? ? ???? ????????
???? ?? ??? ??????? ? ???? ????????
???. 5. ????????? ??????? ???? ???????????? ?? ? ????????
? ????????, n = 288
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
дл?нка ??лл?? ?лмбз,
а?тснлблл?? ?бзрмкок м???кснс??ок
?????? ??????? ??????????? ???????? ?? 17
??? ?????????? ???????. ??? ???? ??? 23 ?????????? ???????? ? ????????? ??? ? ????? ??????????? ???????????. ??????????? ?? ???????? ????????????? ? ????????? ?????: ????? 1 ???? ????? ? 1 ???????, 1?3 ???? ? 7, 3?5 ??? ? 7, ?????
5 ??? ????? ? 8 ????????????. ??? ??????? ?????????? ????????? ???????? ??????? ?????? ??????????? ?? ????????????? ?? ???????, ??????????,
?????????, ?????????. ??? ??????????? ???????. ????? ????? ????? ?????????????? ???????
???, ??????????? ??? ??????????? ? ??, ????????? ?????????: ?? 4 ?? 150 ?????????.
??????? ?????? ?? ????? ??????????. ???? ???
? ?????? ??? ????? ? ?????? ??? 1 ??, 2 ???? ?
6 ??, 3 ???? ? 4 ??, 4 ???? ? 3 ??, ????????? ??
?????? ????????? ????????? 9 ??. ??? 10 (43,5 %)
?? ?????? ??? ?? ???????? ???????? ?????? ??????. ??????????? ???????????? ? 13 (56,5%) ????????, ??? ?????? ??? ????? ? ??? ? ??? ?? ????? ?? ?????????? ? ???????????? ???????? ? ???? ?????????. ??? ????? ???????? ?????????? ??????????
????? ???????? ?????? ?? ?????? ? ?? 2 ??? ??
1 ???. ????? ????? ???????????? ? 7 (30,4%) ??????? ????? ???????? ????? ???????? ???????????? ??
?????? ? ????? 1 ???. ????? ???????? ?????? ?????
??????? ?? ????? ? ??????? ??????????? ????????
???????? ?? ??????? ?????? ??????: ??? ?????????? ??????? ?????? ?????? ?? ????? ?????????????.
???????, ?????????? ??????? ? ??????? ???????????, ???? ??????? ? ????????? ?????????,
?????????? ??????????? ??????????.
??????????? ???????? ????????? ???????????????? ?????? ??????????? ??? ????????? ? ???
? ???. ? ??????????? ???, ??? ???????? ?????????? ? 18 (78,3%), ?????????? ??????????? ????????? ???????????????????? ???????????? ?????.
???????????????????????? ???????????? ???????? ?? ???? 23 ???????????. ???????????? ??????????????? ???????? ????????? ????? ? ??? ? 11
(47,8%) ?? 23 ???, ??? ????? ????? ??????? ??????????, ? ??????????????? ? ? 8 (34,8%). ???????????? ?????????????? ???????????????? ?????????
(???) ? ??????????????? ??????? (???) ???????? ?????? ? 7 (30,4%) ???. ??????????????, ???????????? ?????????? ? ????????-??????????? ?????????? ?? ???????? ??? ????? ? ??? ?? ? ?????
?? 23 ???????????-??????????????? ??????????,
? ??????? ????? ????? ??????? ??????????. ??????? ???????????? ??????? ???? ??????????? ??
???????? 17,4%.
И╥ршй?блкб
??????????, ??????????? ?????? ????? ? ???
?????????? ????????? ?? ?????? ??????????????
?????? ? ??????? ???????????, ????????-?????????? ????????, ?????????? ??????-?????????, ?????? ????? ???????? (???????? ??????) [8].
?????? ?????? ???????? ??????? ????????
??????????? ???????????????? ?????? ??? ????????? ? ???, ??????????? ? ????????, ?????
? ?????? ?????????? ??????? ? ?????? ???????????? ???????????? ? ???????? ???????.
? ?????? ???????????? ?? ?? ?????????????
??????? ????????????? ????????? ? ??????????
?????? ????? ????????? ? ??? ?? ?????????????
???????, ????????? ? ???????????? ???????????????? ??????, ??? ??? ??? ?????????????? ??? ?????
??? ????????? ??????????. ??????????????, ???,
? ???????, ? ???????? ????? ??????? ??????? ??
???? ?????? ????????????? ????????, ????????????? ??????? ????? ? ??? ?? ??????????? ??????????? ?????? ???? ?????????, ???????? ??????? ??
????????? [9]. ?????? ????????????: ╚??? ?????? ??????????? ??????????? ?????? ?? ?????? ?????????-????????????? ?????, ????? ?????????????? ????????????????? ????????????? ?????
? ?????? ??? ????? ?????╩ [9]. ? ?????? ?????????????? ???????????? ????? ?????? ??? ????? ???? ??? ????? ????????? ??????? ? ?????????????
???????? ??????????? ?? ?????? ??? ??????????
???????, ?? ? ??? ?????, ??????????? ? ?????????? ??????? ??.
А?мн??блкб
??????????, ?????? ????? ?? ?????????? ????
??????-????????? ???????????-???????????????
????? 31 ??? ?????????? ??????? ? ?? ????? ????????? ???????? ?? ?????? ?? ?????? ???????????
???????????????? ?????? ????? ????? ?????????????? ??????? ??? ? ?????? ???. ? ?? ?? ?????
???????????? ????? ???????????? ? ?????????????? ? ??? ?????????? ????????? ?????????? ?????? ???????, ?????????? ? ????????????????? ?????? ?????? ??????. ????? ???????????? ?????
???? ????????????? ??? ?????????? ? ????? ?????????? ?????????????, ???????? ??? ?????????
?????? ?????? ???? ??? ?????????? ??????? ???
?????? ??????? ???????? ??. ?????? ???????????
??????????? ???????????????? ?????? ????? ????? ?????????????? ??????? ??? ???????? ??? ???????? ????????? ??????? (? ??? ????? ? ??????????? ???????????? ??????????? ???????) ?????????? ????? ????????????? ? ??? ? ??????? ??
???????????????????? ?????????? ??? ?????????? ?????? ?? ????? ?????????? ? ? ?????????? ???????????????? ???????????. ???????? ??????????? ????????? ?????? ??????? ?? ?????? ? ??????
????????? ??????, ??? ?????????? ????? ????????
???????????? ? ??????????? ???????????. ??????? ????????, ?? ??? ??????, ???????? ??????????
????????????? ??????? ??? ?????????? ?????????
?????????? ??????? ?? ???????? ??? ? ?????????
13
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
??????????? ??? ??? ??????????????? ???????? ??
??????? ???????????. ?????????? ????????? ??????? ???? ?????? ???????????-???????????????
????? ????????????? ???????????? ? ???????????? ??????? ? ???? ????????.
9.
Gerber A.U., Torre A.H., BЭscher G., Stock S.A.K., Graf C.,
Schickendantz S., Brockmeier K., LЭngen M. Direct non-medical and indirect costs for families with children with congenital
cardiac defects in Germany: a survey from a university centre.
Cardiol. Young. 2010; 20: 178?85.
References
??????????
1.
2.
3.
4.
5.
6.
7.
8.
??????? ?.?., ????????? ?.?. ??????????? ?????? ╚??????? ???????????╩. ??????? ??????? ?????? ? ???????.
2007; 3: 4?8.
??????? ?.?., ????????? ?.?., ?????????? ?.?. ???????
???????????? ??????????? ?????????? ??????? ?????? ??
?????????? ??????? ? ????????????? ???????. ???????
???????????? ????????. 2008; 3 (5): 71?7.
??????? ?.?., ??????? ?.?., ????????? ?.?. ??????? ????????????? ?????? ????????????? ? ???????????? ??????????? ???????? ??????: ????????? ???????? ? ???????
???????? ? ????????? ??????? ? ??????, ? ????????? ? ??????????? ??????????? ??????. ??????? ??????? ?????? ?
???????. 2009; 3: 3?11.
??????? ?.?. ????????????????? ??????????? ? ??????????? ??????????? ?????? ????? ??? ??????????
??????? ???????? ????????-?????????? ??????? ? ?????????? ???????. ??????? ??????? ?????? ? ???????.
2010; 1: 4?7.
??????? ?.?., ????????? ?.?., ??????? ?.?. ?????????? ??????? ???????????? ??????????? ? ??????????? ? ??????????????? ?????. ??????????? ???????. 2004; 2:
24?31.
??????? ?.?., ??????? ?.?., ?????????? ?.?. ? ??. ?????????????? ?????????????. ????? ??????? ? ???????
??????????? ? ???????? ????? (??????????? ?????????
????????). ????????? ????? ??. ?.?. ???????? ????.
2010; 11 (6): 4?17.
????? ?????????? ??????? ?? 31 ?????? 2013 ????
?11/2013-?? ╚?? ???????????????-???????????????
?????????? ?????????? ???????╩. ?????????? ??????.
2013; 2 ???????.
?????? ???????????? ??????????????? ?? ? 440? ??
25.10.2012 ???? ╚?? ??????????? ??????? ???????? ??????????? ?????? ?? ??????? ???????? ????????????╩. ?????????? ??????. 2012; 21 ???????.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Bockeria L.A., Bespalova E.D. Service Organization ?Pediatric
Cardiology?. Detskie Bolezni Serdtsa i Sosudov. 2007; 3: 4?8
(in Russian).
Bockeria L.A., Bespalova E.D., Pitirimova O.A. Impact of prenatal diagnosis of congenital heart disease in the obstetric tactics and postnatal prognosis. Voprosy Prakticheskoy
Meditsiny. 2008; 3 (5): 71?7 (in Russian).
Bockeria L.A, Tumanyan M.R., Bespalova E.D. The system of
perinatal care for neonates with critical congenital heart disease: the trend of development in the world and the state of the
question in Russia, in particular in the Central Federal District.
Detskie Bolezni Serdtsa i Sosudov. 2009; 3: 3?11 (in Russian).
Tamazyan G.V. Improving the Diagnostics and the Organization of Medical Care for Children with Congenital Malformations of the Cardiovascular System in the Moscow Region.
Detskie Bolezni Serdtsa i Sosudov. 2010; 1: 4?7 (in Russian).
Tumanyan M.R., Bespalova E.D., Gudkova R.G. Actual
aspects of neonatal cardiology ? organization and continuity of
service. Meditsinskaya Kafedra. 2004; 2: 24?31 (in Russian).
Bockeria L.A., Tumanyan M.R., Filaretova O.V. et al. Newborn
Heart Surgery. New Approaches to the Analysis of Results and
Risk Factors (State of the Art). Bulleten? Nauchnogo Tsentra
Serdechno-Sosudistoy Khirurgii imeni A.N. Bakuleva Rossiyskoy
Akademii Meditsinskikh Nauk. 2010; 11 (6): 4?17 (in Russian).
Law of the Moscow region on January 31, 2013 ?11 / 2013
?On administrative-territorial structure of the Moscow
Region?. Rossiyskaya Gazeta. 2013; 2 February (in Russian).
Ministry of Health of the Russian Federation ? 440n of
25.10.2012 ?On approval of the order of Health Care in the
Profile ?Pediatric Cardiology?. Rossiyskaya Gazeta. 2012; December 21 (in Russian).
Gerber A.U., Torre A.H., BЭscher G., Stock S.A.K., Graf C.,
Schickendantz S., Brockmeier K., LЭngen M. Direct non-medical and indirect costs for families with children with congenital
cardiac defects in Germany: a survey from a university centre.
Cardiol. Young. 2010; 20: 178?85.
????????? 19.09.2014 ?.
14
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
╘ ????????? ???????, 2014
??? 616.132.5-053.2-073.431.1
?????????? ????? ? ??????????? ??????????
?????????????? ???????????? ???????????????
??????? ? ????? ? ?????????? ???????
?.?. ????????, ?.?. ??????????, ?.?. ?????????
??? ??? ╚?????????? ???????????? ????????????????? ??????????? ???????????
??. ?.?. ????????╩ ????????? ??; ??. ?????????????, 1, ??????, 117997,
?????????? ?????????
???????? ?????? ?????????, ????. ???. ????, ?????????? ????????????,
e-mail: de_mar@bk.ru;
?????????? ???????? ??????????, ??. ?????. ????.;
????????? ????? ??????????, ??. ?????. ????.
????. ??????????? ??????????? ??????????????? ????? ????????????? ????????? ? ???????? ????? ??????? ????????.
???????? ? ??????. ???? ??????????? ?????- ? ????????????????? ?????? ????? ??? ? 6000 ????? ?? 1 ???? ?? 18 ??? ???????? ???????????????? ?????????????? (????), ????????????????? ??????????? ???????????? (????) ? ??????????????? ??????????? ???????????? (????). ???????????? ??????????? ? ???????? ????? ? ??? ?????????????? ??????, ???????????????? ??? ????????? ???????? ????????.
??????????. ?????????? ? ????????? ?????? ???????????? ? ???????? ???????????? ??????????? ? ????????????-??????????? ?????????, ???????? ??? ????? (??????? ???????, ???????? ?????????, ??????? ???????, ??????? ????????).
??????????. ????????? ???????? ???????? ????????????? ???????? ???????????? ? ???? ? ???????? ?????? ????????????? ???????? ??? ?????. ??? ????????? ??????? ???????? ??????????????? ?????????? ?????????? ???????????????? ????? ??????????, ? ????? ?????? 7 ??? ???????? ?????????? ? ???????????????? ??????????????? ????.
???????? ?????: ???????????? ? ?????????????????? ????????????; ???????????????? ?????????????? ??????????????;
?????????? ????????????; ??????????????? ??????; ?????????????? ?????.
INDICATORS OF NORM AND FEATURES OF CARRYING OUT
OF BRACHIOCEPHALIC VESSELS RESEARCHES AT CHILDREN IN AGE ASPECT
M.F. Abramova, S.N. Novoselova, I.A. Stepanova
N.I. Pirogov Russian National Research Medical University of Ministry of Health of the Russian
Federation; ulitsa Ostrovityanova, 1, Moscow, 117997, Russian Federation
Abramova Marina Fedorovna, MD, PhD, Chief of Laboratory, e-mail: de_mar@bk.ru;
Novoselova Svetlana Nikolaevna, Senior Research Associate;
Stepanova Irina Alekseevna, Senior Research Associate
Objective. Definition of indicators of physiological norm of a cerebral blood flow at healthy children of different age.
Material and methods. Intra- and extracranial vessels of more than at 6000 children from 1 to 18 years were examined by methods
of transcranial doppler sonography (TCD) and transcranial duplex scanning (TC?D) and ultrasonic duplex scanning. Examination
was carried out in the condition of rest and at the functional tests modified for patients of children?s age.
Results. Data of arterial and venous hemodynamics of carotid and vertebral vessels, deep brain veins (depth of location, blood velocity, Purcelo index, Gosling index) were defined and added.
Conclusion. Patients of children?s age are recommended to begin examination with TCD with the fullest investigation of deep brain
veins. Detection of hidden venous insufficiency requires carrying out of modified Valsalva?s test. Carrying out of modified orthostatic
tests is possible for patients of more than 7 years.
Key words: cerebral and extracerebral hemodynamics; ultrasonic examination; ultrasonography; transcranial Doppler; color-coded
duplex; brachiocephalic vessels; functional tests.
?? ??????? ??????? ?????????? ????????????
????????? (????? 6000 ?????) ?? ???? ???????????
??????? ????????? ??????????? ???????? (???????
???? ? ?????? ??????????? ????, ?????????
?.?. ????????) ? ?????? ? ?????? ? ?????????????
????????????? ???????? ?????????? ? ???????????? ?????? ?? ????????? ???????????? ?????????? ??????????? ????????????? ? ??????????????????? ?????????, ??? ??? ???? ?? ?????????
????????? ????? ????????? ?? ????????? ??????????????? ?????????, ?????????? ? ??????? ? ????????? ??????????? ???????????. ? 2004?2008 ??.
???? ?????????? [1, 2], ? ? ????????? ????? ????????? ?????? ??????????? ???????????? ????????
???????? ????????? ?? ???????????? ????????
? ???????? ????? ?????: ??????? ????????? ??????,
??????????? ???????, ???? ??????, ??????? ?????
? ????? ????????? ?????????? ????? ? ????????
15
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
?????. ????? ?????????? ???????????????? ???
????? ?????????????? ?????.
????????? ???????????? ???????????? ? ???????? ???????????? ?????? ???????? ???? ???
???????? ???????. ?????? ???????????? ???????????? ? ?????????? ??????????? ????????????????? ???????????? ?????? ? ???????????? ???????????? ?????????????? ??????? ???????????? ??????? ????????? ????? ???????? ? ????, ??? ???
???????????? ????? ??????????? ??????????? ?????????????????, ?????????????????????, ?????????????????, ?? ??? ????????? ???????????
? ?????????????? ?????????? ?????????? ??? ?????? ?? ???????? ????????????? ? ?????????? ????????. ?????????? ????????????? ???????????
???????? ? ?????????? ??????????? ??????? ? ????????????? ?????????? ??????????????? ???????????? ??????????????? ???????.
????????? ????????? ????????????? ? ??????????????????? ????????? ? ????? ????????????
??? ????????? ?????????????? ?????????? (???????? ????, ??????????????, ??????? ????????
???????? ? ???????????????) [3?9]. ??????? ????????, ??? ??????????? ??? ????????????? ?????????? ? (?????) ??????? ???????? ???????? ??? ?????????? ????? ? ???????? ?????, ???? ?????? ?????
??? ????????????? ?????? ???????????? ????????
?????????. ?? ?????????? ???????????????? ?????? ??????????? ????? ?? ????? ???? ????????????????? ??-?? ??????????????? ???? ????? (??????
20?30 ?????) ? ?? ????? ???????? ???????? ╚?????╩ ? ?????????? ??????? ??-?? ??????? (?????????)
? ? ??????? ????????? ?????????? ???????? ?????: 5?14 ???, 7?16 ??? ? ?. ?. ????????? ? ???????????? ╚?????╩ ???????? ????????? ????? ?? ???????? ??????????, ????????? ?? ????????? ????????? ?? ????? ???? ?????? ??, ??? ? ?????,
? ? ?????????????????? ??????? ? ?????? ??, ???
? 18 ???. ? ?????????? ?? ??????????? ? ??????
╚?????╩ ??? ??????????? ????????? ????????? ???????????? ???????? ???????????? ? ??????? ??????????? ????????? ???????? ????????? ????????? ?????????: ? ????? ?????? ???????????????
???? ? ?????????? ????? ?????????? ??????????
?? ??????????? ???????? ?????????.
????? ?????????? ????????? ? ??????????? ???????, ???????? ??????? ??????? ????????????
???????, ??????? (????????????? ???????? ??????? ? ????? ?? ???????????? ╚????╩). ?? ??? ???
? ?????????? ? ????? ?????????? ?? ?? ??????? ??????? (??????????) ???????, ??? ? ? ????????,
?? ???????????? R. Aaslid ? ?????. [10] ??????? ???
??????? ???????????? ??????? ??? ????????? ???????? ???????? ?? ?????? ????????? (???????? ?????????? ????????????? ???????????) ? ????????.
? ????? ? ???? ????? ????? ?????? ???? ??????????? ??????????? ??????????????? ????? ????????????? ????????? ??? ???????????? ???????? ????? ??????? ????????.
16
Е?зб?к?н к обзс??
?? ??????? ???????????? ????? 6000 ?????
? ???????? ?? 1 ???? ?? 18 ???. ???? ???? ????????? ?? 8 ?????: 1?3 ????, 3?5 ???, 5?7 ???, 7?9 ???,
9?11 ???, 11?13 ???, 13?15 ???, 15?18 ???, ? ???????????? ? ???????????????? ??????????????
?.?. ?????????, ?.?. ????????? [11, 12].
???????????????? ?????????????? (????) ?
?????????????? ???????????? ??????? ?????????
?????, ??????? ??????????? ?????????????? ????????????? ╚????????╩ (╚?????╩, ??????) ? ╚???????-400╩ (╚??????????╩, ??????) ?? ??????????? ???????? ? ?????????????? ??????????? ?????? ? ????????????????? ????? ? ????????
????????? 2 ???. ???????????? ???????????????? ??????: ???????, ????????, ?????? ????????
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???????????? ???????????? ???? ????????? ? ???????? ??????????????? ????? ? ??? ??????. ????? ??????????, ??????????????? (????- ? ???????????????????) ????????? ? ???????????? ????
? ?????????????? ? ?????? ???????????? ???????? ???????? ?????????. ?????????????? ??????????? ???????????? (???? ? ????) ??????? ??????????? ? ????????????-??????????? ?????????
????????? ?? ??????????? ?????????????? ??????? ╚Aplio MX╩ (╚Toshiba╩, ??????) ? ??????????????
????????: 2,5 ??? ? ???????????? ????????
(????), ????????? 6?12 ??? (????). ??????????
???????????? ??????????? ? ??????? ?????????
??????????????? ??????? Microsoft Excel XP
? Statistica 7.0. ?????????????? ?????? ???????????? ? ???? M ╠ ? (M (mean) ? ??????? ????????
? ??????, ? ? ??????????? ?????????? ?????? ? ???????).
Йбашн╦з?з?
М??лрм??лк?н╦л?? ?сттнб?с???ык? ш ?бзбх
?????????????? ???????????? ????????? ? ?????? ?????????? ???????????? ????? (????????????? ??????????????, ?????, ?????????? ???????, ????????????? ?????????? ??????????? ???????????? ? ?. ?.).
??? ?????????? ???? ? ????? ?? ??????? ??????????? ???????????? ????? ? ????????: ???? ????????????? ?? ??????? ???????, ????? ??????? ???
?????? ????? ?????????, ????????? ??? ?????????
?? ???? ????????????. ??? ????????????? ??????? ????? ?????? ?? ????? ? ?????? ? ????????????? ????? ?? ?????? ???????. ???????????? ???????? ?????????? ? ?????????????? ????????? ??
?????, ????? ?? ?????? (??? ???????????? ???????? ??? ?????), ? ????????? ???????? ??? ???????
(??. ???????).
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?
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?????????? ???????????????? ?????????????? ? ?????:
? ? ???????????? ??????? ?????????? ????? ????? ???????? ╚????╩; ? ? ???????????? ???????? ??? ????? ?? R.W. Baumgartner ? ?????., 1997
??? ???????????? ????? ? ???????????? ???????? ???? ? ???? ???????? ??????? ???????? ??????? (???) ?????????????? ? ??????????? ?????????, ???????? ???????? ??????? (???), ??????
???????? ??????? (???), ???????? ??????? (??),
???????????????? ??????? ??????????? ???????
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???????? ??? ?????: ??????? ????????? ??????
(???), ???? ?????? (??), ??????????? ???????
(??), ??? ????????? (??), ?????????? ??????? ???
(???) ? ??.
?????????????? ????? ???????????? ??????????? ??????????????? ??????? ??? ?????? ?????????????? ??????????????? ?????????????? ??????? ?????????? ????? ? ????????? ??????????
?????????????? ??????????? ??? ???????????????
???????? ????????? ?????????????????? ??????
??????????????? ???????. ?????????? ?????????????? ??????????? ???? (??????????, ????? ??????????????????? ????) ?????????? ??? ????????? ? ??????????? ??????? ???????????? ???????? ?????????.
???????????? ???????????????? ??????? (???????, ???) ????????? ????? ?????????????? ╚????╩: ???????? (????? ???????? ?????) ? ???????
???????? ??????? ???????, ??????????? ???????????? ???? ???????? ?????; ??????????? (??????,
?????????? ?????? ??????) ? ??????? ?????? ?????????? ?????? ??????? (???), ??????? ???????
? ????, ??????????? ??????; ????????????? (???????????????? ??????? ? ??????? ?????????? ?????????) ? ???????? ??????? ???????? ???????
? ???????????????? ???????? (V4) ?? ? ??????? ?1
??? ?? ???????? R. Aaslid ? ?????. [10]. ???????????? ???????? ??? ?????: ???? ?????? ? ???????
?????? ????????? ?? ???????? R.W. Baumgartner
? ?????. [13]. ?????? ????? ?????? ? ????? ???????????? ??????? ?????? ???????? ??? ??????????? ??????????????? ???? ? ??????? ????????????
???????? ??? ????? ??? ???? ??????? ????????????
? 100%.
Мб?лкм? шн╦з??а?шмс?с?с ?штнбмрлс?с рм?лк?с??лк?
клз??м??лк?н╦л?? рсрш?с?
??????? ???? ???????? ?? ??? ?? ?????????,
??? ? ?????????????? ????. ??? ???????? ???????????? ?????? ???? ????????? ????? ??????
(????????????) ??? ?????????? ????????????????? ??????????? ????????????. ???????????? ?????????? ????????? ??????????????? ????????
2,5?5 ??? ? ????????????? ??????? ????? ??????????? ?????, ??? ????? ?????????, ?????? ???????? ????. ?????????? ????? ??????? ???? ??????????? ????????? ??????? ? ??????????? ?????????? ?????????? ????????? ?? ????????????
??????, ?????? ?????????? ?????? ??????? (???????????????? ????????), ??????? ????????,
??????? ????? [14].
??? ????? ??????? ???????? ???? ??????????
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??????? 58?65 ??, ????????? ????????????? ????? ??? (?2??3) ? ?? ??????? 45?50 ??. ????????
???????? ??????? ?????????? ?? ??????? 60?70 ??;
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??????? ??????? ? 35?55 ??, ??????????? ??????? ? 40?70 ??, ???????? ??????? ? 60?80 ??.
??????? ??????? ???????? ??? ?????: ???? ????????? ? 55?70 ??, ?????? ???????? ????? ? 54?56 ??,
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(V?s) ????? ?????? ???????????? ????????, ? ????????? ???????? ???????? ?????? V?s ?????????
???????? ?????????? ? ?????????????? ????????.
?????????????? ???????? (Vd) ? ??????? ????????
(Vm) ???????????? ??? ??????? ???????? (??????????? ?????? ??????? (RI), ???????????? ?????? ???????? (PI), ???????? ???????? ?????????).
? ??????????? ???? ???????? ???????????? ?????? V?s ???????????????? ???????: ?????? ???????, ???????? ╚?????????? ?????╩, ??????????
?????????? ???????? ????????? (????. 1). ?????17
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М?╥нк?? 1
М??лрм??лк?н╦л?? ?сттнб?с???ык?, з??лрм??лк?н╦лсб ?штнбмрлсб рм?лк?с??лкб.
Хсм?а?збнк м?с?сзсм? (V?s, RI) тс клз??м??лк?н╦л?о ??зб?к?о ? а??кркосрзк сз ?са??рз? ? лс?об (M ╠ ?)
???????,
???
???
???
Vps, ??/?
RI
1?3
107,3 ╠ 11,8
3?5
110,5 ╠ 11,8
5?7
???
??
Vps, ??/?
RI
Vps, ??/?
RI
Vps, ??/?
RI
0,52 ╠ 0,04
90,4 ╠ 5,8
0,52 ╠ 0,02
73,3 ╠ 6,2
0,52 ╠ 0,02
72,4 ╠ 3,7
0,54 ╠ 0,03
0,53 ╠ 0,02
88,7 ╠ 10,8
0,53 ╠ 0,02
70,3 ╠ 9,7
0,54 ╠ 0,03
73,4 ╠ 8,9
0,56 ╠ 0,03
127,5 ╠ 15,9
0,55 ╠ 0,03 104,8 ╠ 12,6
0,55 ╠ 0,03
78,4 ╠ 7,8
0,55 ╠ 0,02
81,5 ╠ 8,1
0,57 ╠ 0,03
7?10
124,7 ╠ 22,4
0,53 ╠ 0,05
94,4 ╠ 7,9
0,54 ╠ 0,03
68,3 ╠ 9,6
0,53 ╠ 0,03
80,1 ╠ 6,2
0,54 ╠ 0.04
9?11
115,3 ╠ 14,5
0,53 ╠ 0,05
77,9 ╠ 13,8
0,53 ╠ 0,04
68,5 ╠ 7,7
0,54 ╠ 0,05
78,3 ╠ 7,2
0,53 ╠ 0,04
11?13
100,9 ╠ 17,8
0,53 ╠ 0,03
77,2 ╠ 8,7
0,54 ╠ 0,02
62,4 ╠ 4,2
0,53 ╠ 0,04
74,7 ╠ 6,5
0,52 ╠ 0,05
13?15
96,5 ╠ 8,3
0,55 ╠ 0,04
66,4 ╠ 6,6
0,56 ╠ 0,02
57,6 ╠ 8,8
0,52 ╠ 0,05
71,5 ╠ 9,3
0,53 ╠ 0,03
15?18
92,5 ╠ 10,7
0,53 ╠ 0,02
70,7 ╠ 8,3
0,55 ╠ 0,03
53,2 ╠ 10,8
0,51 ╠ 0,04
68,3 ╠ 10,7
0,52 ╠ 0,04
??? ??????? ?????????????? RI ? ????? ?????????
? ???????? 0,52?0,57. ????????? ??????? RI ? ????? ?????????? ??? ?????????: ??????????????? ?
?????????? RI ????? 30%, ?????????????? ? ???????? RI ???? 30% ? ????????????? ? ???????????
???????? RI ????? ??? 20% [15].
????????????????????? ??????????? (S/D),
?????? ??????? ??p????? ??p???????????????
???????? ?p??p??, ???????? ????????????? ?????????????? ?????????????, ?? ?????????? ? ?????????, ??????? ? ?????????????? ???????? ?????????? ????? ???????????. ??? ?????? ? ?????????
??????????? ????????? ? ???? ?????? ????? ???????? ???????? ?? ?????????????? ?????? ???????????? ? ???? ??????? ??????? ? ??? ??????. ?????????? ????????? ?? ???????????????? ?????? ? ????????? ?????? ??????? ???????????. ?????
??????? ???????? ???????? ????????? (???) ?????????????? ? ???????? ???. ? ???????? ??? ???
???? ?? 10?15%, ? ???????? ??? ? ?? 20?25% (???????????? ??? ?? ???). ???? ???????????? ?????? ?? ????????? ??????????? (?????????? ?????????) ??? ? ?????? ??????? ? ?????, ??????? ????? ????? ??????? ???????? (???????? ??? ???????
?????????) ? ??????????? ?????????? ?? ???????
? ????????? ???????? ????????. ????? ???????,
?????????? ????????? ?? ??? ?? ?????? ????????? 10%, ?? ??? ? ??? ? 15%, ?? ? 20%, ? ???????? ???????? ??????????????? ????????????? ??
?????? 10% (??. ????. 1).
???????????? ????????????? ????????? ??????
??????????????? ???????? ????, ???? ???????????? ???????????? ???????? ??? ?????, ??????????
???????? ????? ? ??????? ??? ???????????? ???????? ???????????? ??????? ????????. ? ??????? ???????????? ? ?????? ??????? ????????? ???????? ????? ???????????? ???????? ?????. ????? ????? ?? ???????? ????????????? ??????
?????????????? ??????????????? ? ?????? ?????????? ?????, ? ?? ??????? ?????? ? ?????. ???????????? ???????????? ?????? ???????? ???,
18
?? ??????? ? ?????????? ???????? ???????? ?????
?? ??????? ??????. ???????? ? ???????? ???????
? ???????????? ??????, ??? ??????? ????? ? ????????????? ????, ? ????? ? ??????? ????? ????.
????? ?????? ???????? ??? ???????????? ???????? ???????????? ????? ??????????? ?????
(sinus cavernosus, ?????????? ??????, ??????), ????????? ? ??????? ????????? ????????: ??????? ???????????? (????? ???????) ? ?????????? (?????
?????) ????????, ? ????? ? ???????? ? ???????????? ????????? ???????????, ? ???????? ??????.
?? ??????? 2 ?????, ??? ?????????? (???????)
???????? ????????? ?????? ???????? ? ???????????? ????? ? ???????? (14?28 ??/?) ?????? ? ???????? 3?5 ??? [16]. ????? ? ??????????? ????????
??????? ?????????? ???????? ??? ??? ?? ??????? ????????? ??????, ??? ? ?? ???????? ???? ?????? (???????? ??? ?? ???? ??????? ???????????
?????).
??????? ???? ???????? ??? ????? ???? ????????? ??????????? ?????????????? ???????? ???????????? ???????? ????????????: ???????? ?????????, ??????? ??????????? ????????? ? ???????????? ?????????? ????????????? ?? ???????? ?????
????? ??? ??????????? ?????? (?????? ?????????????? ??????????? ????????????????? ?????????
М?╥нк?? 2
Хсм?а?збнк ?блсалс?с м?с?сзсм? тс т??осош
?блсалсош рклшрш к ?блб и?нбл?
M╠?
???????, ???
???, ??/?
??, ??/?
3?5
25,4 ╠ 3,2
25,6 ╠ 4,2
5?7
18,8 ╠ 5,0
19,0 ╠ 5,2
7?10
20,1 ╠ 6,5
21,0 ╠ 4,4
10?14
18,0 ╠ 3,6
19,0 ╠ 3,0
14?18
17,6 ╠ 2,1
16,9 ╠ 2,4
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
??????): ????? ??????????, ????- ? ??????????????????? ????? [17, 18]. ????????, ??? ??????????????? ????? ?????????? ?? ??????????? ??????????
?????, ? ?????????? ???????????????? ????? ? ????????? ?????????? (???????? ??????? ? ????????
? ?????????????? ????????? ???????? ??????????
???????, ???????? ? ??????? ????????, ??? ???????? ? ????????? ??????????? ????????????), ????
?????????? ??????????? ?????????????? ????
??? ????? ? ?????? ???????? (????. 3).
Лн╦з??а?шмс?сб ?штнбмрлсб рм?лк?с??лкб
╥???кс?бы?н╦л?? рсрш?с? ш ?бзбх
???????? ????????????? ??????? ???????????? ?????????????????? ?????? ???????????????
??????? (???) ???????? ?????????????? ?????????? (???????????? ???????? ? ?- ? D-??????)
? ??????????? ???????????? (? ??????? ?, D ? CD
??? +?W). ??????????? ?????????????? ???????
????? ?????????????? ?????? ????????????, ??????????? ??????????? ??????????????? ???????????. ? ??? ??????? ????? b-flow ? ???????
???????? ???????????? ?????? ???????, ?????????
????? ??????? ?????????? (????? ?????? ??????
?????????? ? ?????? ??????????) ? ??. ?????????????? ????? ???????????? ????????? ?????????
????? ??? ?????????????, ??? ???????? ????? ? ????? (??? ????? ????????????? ???????-?????????? ????????; ????????? ????????? ╚???????? ???
?????╩ ????????? ?????? ? ????????? ?????????).
?????????? ?????????? ????? ??????????????????
?????? ??????????????? ??????? ????????????
? ???????? 4, 5.
??? ?????????? ???????????? ???????????? ???????????? ???????? ??? (v. jugularis interna), ??????? ???????? ???????????? ???????????? ??????. ?????? ??? ??????, ??? ???????????? ????????
?????????. ??? ?-?????? ?????? ??????? ??
?????????, ??????? ?????????? ?? ?????????????
????? ??????? ? ?????????? ??????????? ?????????? ????????? ???????? (??? ?????????? ?????????
?????? ?? ??????? ?????? ? ????????? ???????? ??????????? ?????????????? ???????? ?????????).
? ????? ??????? ???? ??????????? ? ??????????.
??? ?????????? ???????? ????????? ?/??? ???
?????????? ????????????? ??????? ????? ?????
М?╥нк?? 3
Хсм?а?збнк о?мрко?н╦лсх нклбхлсх рмс?срзк м?с?сзсм? тс т??осош ?блсалсош рклшрш
к ?блб и?нбл? ш ?бзбх 3?18 нбз т?к ышлм?ксл?н╦л?? т?с╥??, ро/р
?min??max
M╠?
???????,
???
???
??
???-?
??-?
3?5
25,4 ╠ 3,2
25,6 ╠ 4,2
29?31
5?7
18,8 ╠ 5,0
19,0 ╠ 5,2
7?10
20,1 ╠ 6,5
10?14
14?18
???-??
??-??
27?34
29?36
31?37
23?33
21?30
20?35
20?33
21,0 ╠ 4,4
20?32
22?33
18?33
23?33
18,0 ╠ 3,6
19,0 ╠ 3,0
19?29
20?29
17?27
18?27
17,6 ╠ 2,1
16,9 ╠ 2,4
19?22
19?23
18?21
20?22
? ? ? ? ? ? ? ? ? ? . M ╠ ? (M (mean) ? ??????? ???????? ? ??????, ? ? ??????????? ?????????? ?????? ? ???????); Xmin, Xmax ? ??????????? ? ???????????? ???????? ?????????? ? ???????; ???-? ? ???????????? ???????? ???????? ????????? ? ??????
???????? ?????? ??? ????? ??????????; ??-? ? ???????????? ???????? ???????? ????????? ? ???? ?????? ??? ????? ??????????; ???-?? ? ???????????? ???????? ???????? ????????? ? ?????? ???????? ?????? ??? ??????????????????? ?????;
??-?? ? ???????????? ???????? ???????? ????????? ? ???? ?????? ??? ??????????????????? ?????.
М?╥нк?? 4
Хсм?а?збнк м?с?сзсм? тс ?мрз??м??лк?н╦л?о ??зб?к?о ? а??кркосрзк сз ?са??рз? ? лс?об (M ╠ ?)
???????,
???
???
Vps, ??/?
???
RI
Vps, ??/?
???
??
RI
Vps, ??/?
RI
Vps, ??/?
RI
1?3
94,3 ╠ 13,6
0,75 ╠ 0,06 100,6 ╠ 15,6
0,57 ╠ 0,02
78,4 ╠ 8,5
0,70 ╠ 0,02
67,5 ╠ 7,3
0,53 ╠ 0,07
3?5
90,6 ╠ 10,5
0,70 ╠ 0,05
87,8 ╠ 13,4
0,60 ╠ 0,05
70,4 ╠ 12,6
0,76 ╠ 0,05
64,4 ╠ 7,9
0,52 ╠ 0,07
5?7
86,3 ╠ 13,8
0,70 ╠ 0,03
80,8 ╠ 14,3
0,60 ╠ 0,03
62,8 ╠ 3,6
0,69 ╠ 0,03
61,3 ╠ 8,1
0,52 ╠ 0,06
7?10
80,5 ╠ 16,7
0,65 ╠ 0,03
90,5 ╠ 16,5
0,56 ╠ 0,03
67,8 ╠ 11,4
0,70 ╠ 0,05
57,6 ╠ 5,5
0,51 ╠ 0,07
9?11
72,8 ╠ 18,4
0,66 ╠ 0,04
70,4 ╠ 9,6
0,57 ╠ 0,03
58,7 ╠ 6,6
0,71 ╠ 0,03
51,6 ╠ 4,8
0,52 ╠ 0,06
11?13
72,6 ╠ 12,5
0,70 ╠ 0,06
78,5 ╠ 8,6
0,55 ╠ 0,02
58,6 ╠ 3,2
0,71 ╠ 0,03
51,5 ╠ 3,7
0,52 ╠ 0,07
13?15
75,6 ╠ 7,5
0,70 ╠ 0,04
73,7 ╠ 7,8
0,55 ╠ 0,02
59,4 ╠ 3,4
0,72 ╠ 0,02
43,6 ╠ 3,8
0,51 ╠ 0,06
14?18
73,6 ╠ 5,8
0,71 ╠ 0,04
74,6 ╠ 5,7
0,54 ╠ 0,04
61,6 ╠ 2,7
0,74 ╠ 0,05
47,8 ╠ 4,9
0,53 ╠ 0,05
19
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
Хсм?а?збнк м?с?сзсм? к ?к?обз? ?мрз??м??лк?н╦лс?с сз?бн? ╥???кс?бы?н╦л??
???????, ??
???????,
???
???
d
1?3
4,8╠0,4
???
s
??? (??????.),
???
??
???
d
s
d
s
d
s
d
???
s
d
s
4,8╠0,44
4,3╠0,4
4,3╠0,5
2,8╠0,4
2,8╠0,2
3,2╠0,4
3,2╠0,4
94╠13
94╠18
100╠15
100╠15
3?5
4,78╠0,45 4,81╠0,52
4,2╠0,6
4,2╠0,6
3,3╠0,3
3,4╠0,3
3,0╠0,7
3,0╠0,7
90╠10
91╠14
87╠13
84╠16
5?7
4,77╠0,44 4,84╠0,47 4,36╠0,38
4,5╠0,36
3,6╠0,38 3,64╠0,32
3,2╠0,4
3,7╠0,27
86,3╠13
80,5╠16
84,3╠15,4 80,8╠14,3
74,8╠6,4
7?9
4,7╠0,43 4,76╠0,37 4,23╠0,21
4,2╠0,2
3,56╠0,3
3,57╠0,25
3,6╠0,3
3,7╠0,27
81╠15,7
90╠16,5
92╠17
9?11
4,6╠0,3
4,8╠0,3
3,8╠0,4
4,2╠0,2
3,3╠0,2
3,3╠0,2
3,4╠0,3
3,3╠0,3
72╠18
70╠18
70╠9
77╠5,5
11?13
5,1╠0,5
5,2╠0,5
4,4╠0,4
4,3╠0,4
3,4╠0,3
3,4╠0,3
3,2╠0,3
3,6╠0,3
72╠12
71╠13
78╠8
74╠7
13?15
5,1╠0,6
5,2╠0,5
4,5╠0,4
4,6╠0,4
3,6╠0,2
3,6╠0,2
3,8╠0,4
3,6╠0,2
75╠7
77╠7
73╠7
73╠6
15?18
5,5╠0,4
5,5╠0,3
4,6╠0,3
4,6╠0,2
3,5╠0,2
3,7╠0,2
3,3╠0,3
3,6╠0,3
73╠5
74╠6
74╠5
73╠8
??????? ?????? ╚??????????? ????????????????╩.
??????? ????????????, ?? ????????? ?????????
???????? ??? ??? ????????????? ???????, ?????????? ????????????????? ????, ???????? ??????
(??????????? ????????? ??????), ??? ???? ? ?????
(? ?????????? ????????????) ?????? ?????, ???
?????? ?????? ???? ??? ??????????? ???????? ?????????. ? 70% ????? ???????? ??????????????
?????????? ???: ???????????? ? ??? ?????????????? ?????? (??? ????????? ??????) ? ?????????? ?
??? ???????-?????????? ????????, ????????.
???????????? ????? ???? ???????? ???????
??? ? ???? ??????, ?????????, ?????? ??????????? ???????????. ??? ?????? ????????? ????????
???????????? ?????????? ? ???? ?????????? ? ???
????? ??????????. ? ????? ??? ????? ?????? ?????????, ? ??????????? ???????????? ???????? ???
??????????? ?????????. ? ???? ????????? ???????????? ?????? ???????? ????????? ??????? ???
(????????? ???????, ?????????? ? ? 40% ?????).
??????? ???????? ????????? ?? ???? ??????????
? ????? 40?80 ??/?, ?????????? ???????? ??? ???????????????? ? 75% ?????????, ? ???????????
???????? ????????????????? ??? ? ????? 25%, ???
??????????? ? ????????????? ??????? [19, 20].
??????????? ???? ?????????? ?? ???? ??????????? ??????? ? ??????? ?????? ? ? ???????? ?? ?????
? ???????? ?????? ??????? ?????????. ???????????
???? ??????? ?? ???????? ?????? ?? ?????? ?6??7.
????? ???????????? ??????, ???????? ??????? ???????????? ??????? ? ??????? ? ????????? ?????
????????????? ????.
?????????? ? ??????????? ?????? ?????????
??????? ???????????? ???, ?? ???????, ??????????
????????? ? ???????? ?????????. ??????? ?? ? ??????? ?????? ????????? ??????????? ? ??????????
?????????. ? ????? (??? ????????? ??????? ??????
????????????) ??????? ?? ??????????? ?? ????
?????????????? ??????????? ? ??????????
1,2╠0,24 ??, ?? ??? ????????? ???????????????
20
???? ??????????? ??????? ? ??????? ?????? (???
? ????? ?????????? ???????? ?????) ??????? ????
????? ???? ????????????? (?????????? ?????
???????? ??????????? ??????). ??? ?????? ?? ???????? ?????? ??????? ?? ????????????? ?????
?????, ??? ?????????? ? ????? 2,5 ╠ 0,2 ?? (? ?????
??????? ?? ????? ??????????? ?? 3,0?3,5 ??).
? ????? ? ????? ??????? ??? ?? ?? ??????????
10,8 ╠ 1,2 ??/?. ?????????? ????????? ?? (??????
?????? ???????? ????????????? ???????), ????????? ?????????? ??????????, ???????? ????????
????????? ????????? ?????????? ??????????? ????????? ?????? ?? ??????? ??. ??? ???????? ????????????? ???????? ??????????????? ??????????? ???? ?????? ?????????????? ????. ???????
????????? ? ?? ??? ?????????????? ????????? ???????? ?????? ?????? ??????????? ??? ?????????
????????????, ?? ???? ??? ???????? ?????????????. ? ????? ???????? ? ????? ? ????? ??????? ??????? ????????? ? ?? ? ?????????????? ?????????
??????? ? ?? 85%, ??? ???????? ? ???????? ? ??
97%, ? ????? ??????? ?? ???????? ????????????.
????????? ??????? ????????????? ???????? ????????? ????????? ??? ?????????? ????????????
????? ??????????? ?????????? ?????????. ?? ?????? ??????, ?????????? ???????? ???????? ??
???? ??????? ??, ? ???????? ? ?????? ?????????.
????????????? ????????? ????????? ?????????
?? ?? ? ??????? ?????? ?? ?????? ?5??6, ??? ???
??? ?????? ?? ???????? ?????? ?? ????? ???????????? ???????????????? ??????????? ?? ?????????? ???? ??? ?? ???????????? ????????. ???????
?????? ???????? ????????? ? ????????????? ???????? ?? ? ? ?? ????? ????, ??? ? ??????. ?????????? ???????? ????????? ?? ???? ?????????? ????
?????????? ??? ?????????????? ??????? ??? ????????? ????????? ?????? ?? ??????? ?????? (? ????? ??????????? ??? ???????? ??????????????,
???????? ????????, ????- ? ???????? ????????
??????? ? ??.). ????????? ????????? ????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
М?╥нк?? 5
??зб?кх ? а??кркосрзк сз ?са??рз? ? лс?об (M ╠ ?)
??/?
RI
???
d
??
s
d
???
s
d
???
s
d
???
s
d
??
s
d
s
78╠8
77╠8
67╠7
69╠8
0,75╠0,06
0,74╠0,06
0,57╠0,02
0,56╠0,02
0,70╠0,02
0,70╠0,02
0,53╠0,07
0,53╠0,07
70╠12
74╠8
64╠7
63╠6
0,70╠0,05
0,72╠0,04
0,60╠0,05
0,61╠0,05
0,76╠0,05
0,73╠0,07
0,52╠0,07
0,52╠0,07
62╠3,6
60╠2,4
61,3╠8,1
62,6╠7,2
0,70╠0,03
0,71╠0,02
0,60╠0,03
0,58╠0,03
0,69╠0,03
0,69╠0,03
0,52╠0,06
0,52╠0,06
67╠11
67╠11
57╠5,5
58╠6,4
0,65╠0,03
0,63╠0,03
0,56╠0,03
0,56╠0,03
0,70╠0,05
0,71╠0,06
0,51╠0,07
0,51╠0,07
58╠6
58╠6
51╠4
50╠4
0,66╠0,04
0,67╠0,04
0,57╠0,03
0,56╠0,04
0,71╠0,03
0,70╠0,03
0,52╠0,06
0,52╠0,06
58╠3
58╠3
51╠3
51╠4
0,70╠0,06
0,70╠0,06
0,55╠0,02
0,54╠0,02
0,71╠0,03
0,71╠0,03
0,52╠0,07
0,52╠0,07
59╠3
60╠2
43╠3
45╠3
0,70╠0,04
0,70╠0,03
0,55╠0,02
0,55╠0,02
0,72╠0,02
0,72╠0,02
0,51╠0,06
0,51╠0,06
61╠2
62╠3
47╠4
47╠4
0,71╠0,04
0,70╠0,03
0,54╠0,04
0,57╠0,02
0,74╠0,05
0,74╠0,05
0,53╠0,05
0,53╠0,05
????????? ????? ????????????????? ?? ??????????????? ?????????? ?? (??? ???? ??????????????
???????? ????????? ????????? ??????? ??????
????????????).
И╥ршй?блкб
? ??????????? ???????????? ?? ???????? ???????????? ???????????? ?????? ??????????? ???????? ???????????? ????????? ?? ?????????????
??????? ?????????????????? ?????? [21, 22].
??? ???? ?????????? ????? ????? ???? ??????????????? ????????. ????? ???? ????????? ?????? ?????? ? ????????????? ????????????????? ????????????, ??? ????? ???? ?????????? ? ?????????
???????? ???????? ??? ????????? ? ??????????? ???????????????? ?????????? ????????????????
????????? ???????????????????? ??????. ?? ? ?????
?????? ?????????? ???????? ???????? ?????????
????????????????? ?????? (??? ????????? ? ? ???????? ? ?????). ??? ????????? ???????????????
???????? ????????????? ?????????? ??? (?????
10?20%) ? ???????? ??????????????? ????????????? (????? 10%), ??? ????????? ??? ?? ????????
????? ????? ?? ?????? ????? ????? ???? ????????????? ?????????? ???????????? ??????? ???.
? ????? ?????????? ?????????? ?????????????? ???? ? ???????????? ??????????? ???????????? ???????????? ???????? ???????????? ??? ????????????? ??????? ??? ?????????? ???????? ???????????????, ????? ?????????? ????????
????????? ?? ???????? ????? ????? ?????????????
?????????? ??????, ?? ??????? ????????? (?????????? ????????) ??? ??????????????????? ?????
? ????? ??????????; ? ????? ??? ????????? ??????? ???????????? ???????? ????????? (????? ?????????? ???????? ????????? ?? ???????? ?????
????? ????? ???????? ? ?? ????????????? ?????????? ??????, ??????? ???? ?????????? ? ??????????????????? ????? ????????).
??? ???????????? ???????? ????????? ?????
?????????? ???????? ??????????? ???????????? ?
????, ??????? ???????????? ????? ?????????? (??
???????) ????????????, ??? ???????? ??????????
??????? ? ????? ? ?? ?????? ???????????? ??-?? ????????????? ?????????? ?????????????? ????.
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??????????? ??? ???? ???????? ??????? ????? (???????? ????? ? ???????? ????????????? ??????, ?????????? ? ???????????), ? ????? ?????????? ?????? ???????? ?????????? ?????? ?????????? ?????????? ?????? ???????? ?????, ??? ????????
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????? ?? ????????? ??? ?????? ??? ?????????? ????????, ??? ? ?? ?????????? ???????? ???????.
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[23]. ??????? ???????????? ??????? (???) ? ?????? ?? ??????? ???????? ?????? ??????????????
???? ??????? ? ???????????? ???????. ????? ???
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22
??????????? ??????? ?? ?????? I ???????? (V1).
????????????? ????????? ????????????? ????
?? ? ????? ?????????? ????????? ?????? ????????? ?? ?????? ?6??5. ?????? ???? ?? ? ????? ?
??????? ?7, ??????? ???? ? ?4 (?????? ? ???? ? ?5
????????????? ??? ╚???????╩ ?????????). ?????
????? ???????? ????????????? ?????????? ????????? ?????? ????????? ???????????? ???????? ??????? V2 ??. ? ????? ????????????? ??? ??????? ? ?????? ?? ?6 ?? ?2 ?????????????.
?? ?????? ?2 ??????? ??????? ?? ??????, ?????
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???????╩). ???????? ????? ????? ???? ?????????
?????????, ?????????????? ?????????? ????????.
????? ??????? ????? ?????? ? ????? ?? ?????? ?1
? ???????????? ? ????? (??????? V4). ????? ???????????? ? ????????? ????????? ?????????????
???????????? ???? ?? ? ?-?????? ???????? ??????? ??????? ?? ?????? V2, ? ? ?????? ?????????????? ?????????? ?????????? ??? ? ??????????????? ????????????? (?????? ?????? ?????
?6??5 ??? ?5??4). ?????????? ????????, ???
? ????? ?????????????? ????????? ??????? ??????
???????????? (??????????????, ????????? ?????????, ???????? ???????? ? ??., ??????? ??
???????? ??? ??????????? ??????? ?? ?????????????? ??????? ?????? ???????????? ? ??????????????? ???????), ??????? ????? ??????????
????????????????? ???? ??????? ? ???????? V2,
??????????????? ??????????? ??? ?? ?????????? ???? ??????? ? ????????? ??????????? ??????????????? ?????????????.
г??с??
1. ?? ??????? ???????????? ???????????? ???????????? ? ????? ? ???????? ?? ?????? ???? ?????????????? ???? ???????? ???????????? ???????
??? ??????????? ???????????? (??? ??? ?????? ?????????) ????????????? ? ????????? ????????? ????????? ? ????????? ?????????????? ??? ?????????????? ?????????. ??????????, ????????? ???
?????????? ? ???????????? ???????? ????? ????
?? ??????? ??????????? ???????, ?? ??????????
????????????? ????????? ???????. ???????????,
??????????? ? ??????? ?????? ????????????? ????????? ? ????? ? ???????????? ???????? ???????
???? ?? ???????? ??????????? ??? ??????? ?????????????? ????????????, ?????? ??????????? ?????????? ╚?????╩, ?????????????? ????????? ????????????.
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2. ??????????? ?????????????? ???????? ?????????? ??????? ???????? ??? ?????????? ????
? ???????????? ??????? (???????), ??????? ??
╚?????????╩ ?????? ????????????. ????????, ???
??????????????? ????? ?????????? ?? ??????????? ?????????? ?????, ? ?????????? ???????????????? ????? ? ????????? ?????????? (???????? ??????? ? ???????? ? ?????????????? ????????? ???????? ?????????? ???????, ???????? ? ???????
????????, ??? ???????? ? ????????? ???????????
????????????), ???? ?????????? ???????????????? ????? ??? ????? ??????? ???????? ? ????????
?? ?????????.
7.
Йбмсобл???кк
13.
1. ??????? ?????? ??????????? ????????????,
????????? ???????? ???????? ?? ??????????? ???????? ???????????? ? ????.
2. ?? ??????????? ????????? ???????????? ???????? ? ?????????????? ????????? ?? ?????, ????? ?? ?????? (??? ???????????? ???????? ??? ?????), ? ????????? ???????? ??? ???????. ???? ????????????? ?? ??????? ????????, ????? ??????? ???
?????? ????? ????????? (??? ??????????? ???).
??? ????????????? ??????? ????? ??????? ???????????? ??????? ????? ?????? ?? ????? ? ??????
? ????????????? ????? ?? ?????? ???????.
3. ??? ???????????? ????? ? ???????????? ???????? ???? ? ???? ?? ??????????? ???????? ???????? ?????? ???????????? ???????? ??? ?????:
??????? ????????? ??????, ???? ??????, ??????????? ???????, ??????????? ???.
4. ??? ????????? ??????? ???????? ??????????????? ? ????? ?????????? ?????????? ???????????????? ????? ?????????? ? ????? ?? 7 ???,
? ????? ?????? 7 ??? ???????? ?????????? ? ???????????????? ??????????????? ???? (????? ???????????? ??????????????????? ?????).
8.
9.
10.
11.
12.
14.
15.
16.
17.
18.
19.
20.
21.
??????????
1.
2.
3.
4.
5.
6.
???????? ?.?. ?????????????? ?????? ??????????? ?????????? ????????? ????????? ?????. ? ??.: ?.?. ????????
(???.) ?????????? ???????? ????????: ???????. ?.: ????????; 2004.
???????? ?.?. ?????????????? ?????? ??????????? ?????????? ????????? ????????? ?????. ? ??.: ?.?. ???????? (???.)
??????????? ??????? ??????????. ?.: ????????; 2008.
Bode H. Pediatric application of transcranial Doppler sonography. Wien; N.Y.: Springer-Verlad; 1988: 108.
???????? ?.?., ???????? ?.?., ??????? ?.?. ?????????
????????? ????????????? ????????? ? ????? ??????? ?????????????? ?????????????? ? ???????????? ????????.
?????? ?????????? ? ?????????? ??. ?.?. ?????????.
1999; 3: 29?32.
??????? ?.?. ??????????? ?? ??????????? ??????????????
?????????????? ? ??????? ??????????. ???.; 1995.
???????????? ?.?., ???????? ?.?., ???????????? ?.?.
???????????? ???????????? ? ???????????? ????? ? ????????????? ?????????? ????? ?? ?????? ?????????????
?????????. ??????? ?????? ??????????? ? ???????.
1990; 1: 11?6.
22.
23.
????? ?.?., ???????? ?.?., ?????? ?.?. ????????????
???????????? ?????????????????? ??????????? ? ?????.
???????? ??????????? ????????. 2000; 3: 179?84.
??????? ?.?. ???????????????? ?????????? ???????????? ? ????? ? ????????? ???????? ????: ???????. ???. ?
????. ???. ????. ?; 2008.
???????? ?.?. ????? ?.?. ????????? ????????? ?????????????? ??? ?????????????? ????????? ?????????? ?????? ???????. ??????????????? ??????. 2007; 2: 8?11.
Aaslid R., Markwalder T.M., Nornes H. Non-invasive transcranial Doppler ultrasound recording of flow velocity in basal
cerebral arteries. J. Neurosurg. 1982; 57: 769?74.
???????? ?.?. ??????????? ???????? ????????. ???.;
1906.
????????? ?.?., ???????? ?.?. ?????? ????????, ?????????? ? ??????? ????? ? ??????????. ?.: ????????; 2007:
384.
Baumgartner R.W., Nirkko A.C., RenИ M. MЭri, GЖnner F.
Transoccipital Power-Based Color-Coded Duplex Sonography
of Cerebral Sinuses and Veins. Stroke. 1997; 28: 1319?23.
???????? ?.?., ??????? ?.?., ????????? ?.?., ?????? ?.?. ?????? ???????????? ??????? ????????? ?????. ?????? ??, ? 2454936; 2011.
???????? ?.?., ???????????? ?.?., ?????????? ?.?.,
???????? ?.?. ??????????? ? ?????????????? ?????????????????? ????????? ? ?????. ??????????????? ???????. ??????????? ?????????? ??????????????. 2009; 3:
51?62.
Shakhnovich A.R., Shakhnovich V.A., Galushkina A.A.
Noninvasive assessment of the elastance and reserve capacity
of the craniovertebral contents via flow velocity measurements
in the straight sinus by TCD during body tilting test. Burdenko
Neurosurgery Institute, Moscow, Russia. J. Neuroimaging.
1999; 9 (3): 141?9.
??????? ?.?., ??????? ?.?., ??????? ?.?. ???????????? ???????????? ??????? ??? ?????????. ??????????????? ?
????????????? ????????. 2001; 35 (1): 41?4.
??????????? ?.?. ??????? ??????????? ? ????????????
???????????? ?? ????? ????????? ????????? ? ????????
???. ?????????? ????????. 2008; 34 (5): 117?22.
??????? ?.?., ?????????? ?.?., ???????? ?.?. ????????? ????????????? ????????? ?????????????? ? ??????? ? ????????-?????????? ??????????. ?.: ????? ??.
?.?. ???????? ????; 2003: 223.
???????? ?.?., ????????? ?.?. ??????????? ?????????????? ??????????? ????????? ????????? ??????. ??????????? ?????????? ??????????????. 2009; 3: 21?9.
????? ?.?., ????? ?.?. ?????????????? ??????????. M.: ???????? ?????; 2003: 38, 182, 237?9.
??????? ?.?., ???????? ?.?. (???.) ??????????????
????????????? ??????????? ? ???????. ???????: ???;
2004: 196?214.
???????? ?.?., ???????? ?.?. ?????????????? ?????????? ???????????? ? ??????????? ??????????? ????????????????? ???????? ?????????? ?????? ??????? ? ?????.
?????????????? ????????????. 2009; 6 (3). 80?3.
References
1.
2.
3.
4.
Abramova M.F. Ultrasonic methods of diagnostics of vascular
disorders of a brain. In: A.S. Petrukhin (ed.) Neurology of children?s age: textbook. ?.: Medicine; 2004 (in Russian).
Abramova M.F. Ultrasonic methods of diagnostics of vascular
disorders of a brain. In: A.S. Petrukhin (ed.) Clinical children?s
neurology. ?.: Medicine; 2008 (in Russian).
Bode H. Pediatric application of transcranial Doppler sonography. Wien; N.Y.: Springer-Verlad; 1988: 108.
Baturova E.A., Smirnova T.N., Polyakov V.?. Disturbances of
cerebral hemodynamics in children by Doppler ultrasound
recording in ambulance practice. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 1990; 3: 29?32 (in Russian).
23
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Andreev A.V. Instraction clinic ultrasonic Doppler in child neurology. St. Petersburg; 1995 (in Russian).
Dvoryakovskiy I.V., Sudorova O.A., Dvoryakovskaya G.M.
Cerebral hemodynamics in prematurely born children with
perinatal disturbances of brain date dopplerografy. Voprosy
Okhrany Materinstva i Detstva. 1990; 1: 11?6 (in Russian).
Lobov M.A., Checalina N.V., Gorina L.S. Screening investigation of Child cerebrovascular Disorders. Al?manakh
Klinicheskoy Meditsiny. 2000; 3: 179?84 (in Russian).
Rychkova I.V. Transcranial Duplex Sonography at children
with headaches: Thesis of Med. Sci. Diss. Moscow; 2008 (in
Russian).
Smirnova Yu.V., Shults T.E. Disturbances of cerebral hemodynamics in pathological deformation internal carotid arteries.
Nevrologicheskiy Zhurnal. 2007; 2: 8?11 (in Russian).
Aaslid R., Markwalder T.M., Nornes H. Non-invasive transcranial Doppler ultrasound recording of flow velocity in basal
cerebral arteries. J. Neurosurg. 1982; 57: 769?74.
Gundobin N.P. Features of children?s age. St. Petersburg;
1906 (in Russian).
Obreimova N.I., Petrukhin A.S. Bases of anatomy, physiology
and hygiene in children and teenagers. Moscow: Academiya;
2007: 384 (in Russian).
Baumgartner R.W., Nirkko A.C., RenИ M. MЭri, GЖnner F.
Transoccipital Power-Based Color-Coded Duplex Sonography
of Cerebral Sinuses and Veins. Stroke. 1997; 28: 1319?23.
Abramova M.F., Shayunova S.V., Stepanova I.A., Ivleva S.A.
Method of visualization of cerebral vessels. Patent RF,
? 2454936; 2011 (in Russian).
Abramova M.F., Nesterovskiy Yu.E., Novoselova S.N.,
Shurupova N.S. Structural and functional cerebrovascular
16.
17.
18.
19.
20.
21.
22.
23.
disturbances at children. Neurological aspects. Klinicheskaya
Fiziologiya Krovoobrashcheniya. 2009; 3: 51?62 (in
Russian).
Shakhnovich A.R., Shakhnovich V.A., Galushkina A.A.
Noninvasive assessment of the elastance and reserve capacity
of the craniovertebral contents via flow velocity measurements
in the straight sinus by TCD during body tilting test. Burdenko
Neurosurgery Institute, Moscow, Russia. J. Neuroimaging.
1999; 9 (3): 141?9.
Osadchiy L.I., Balueva T.V., Sergeev I.V. Reactivity of arterial
system at ?rthostasis. Aviakosmicheskaya i Ekologicheskaya Meditsina. 2001; 35 (1): 41?4 (in Russian).
Zabolotskikh N.V. Reactions of the central and cerebral hemodynamics during active orthostasis at healthy people.
Fiziologiya Cheloveka. 2008; 34 (5): 117?22 (in Russian).
Bockeria L.A., Buziashvili Yu.I., Shumilina M.V. Violations of
venous cerebral blood circulation at patients with cardiovascular pathology. Moscow: Nauchnyy Tsentr SerdechnoSosudistoy Khirurgii imeni A.N. Bakuleva Rossiyskoy
Akademii Meditsinskikh Nauk; 2003, 223 (in Russian).
Shumilina M.V., Gorbunova E.V. Complex ultrasonic examination of venous outflow disturbances. Klinicheskaya
Fiziologiya Krovoobrashcheniya. 2009; 3: 21?9 (in Russian).
Lelyuk V.G., Lelyuk S.E. Ultrasonic angiology. M.: Real?noe
Vremya; 2003: 38, 182, 237?9 (in Russian).
Nikitin Yu.M., Trukhanov A.I. (eds) Ultrasonic Doppler diagnostics in clinic. Ivanovo: MIK; 2004: 196?214 (in Russian).
Abramova M.F., Shurupova N.S. Duplex Sonography and
clinical peculiarities extracranial abnormalities of internal
carotid arteries at children. Pediatricheskaya Farmakologiya.
2009; 6 (3). 80?3 (in Russian).
????????? 20.06.2014 ?.
╘ ????????? ???????, 2014
??? 616.132.2-089.844
????? ????????????? ?????????? ???????
??? ????????? ????????????? ????????????
?.?. ?????, ?.?. ??????, ?.?. ???????, ?.?. ??????, ?.?. ???????,
?.?. ?????????, ?.?. ?????, ?.?. ??????
???? ╚??????????? ????? ????????-?????????? ????????╩ ????????? ??;
????? ?????????? 45, ?. ??????????, 660020, ?????????? ?????????
????? ??????? ?????????, ????. ???. ????, ?????????? ??????????;
?????? ????? ??????????, ????????-?????????? ??????, e-mail: teplovpv@gmail.com;
??????? ??????? ???????????, ?????? ???. ????, ?????????, ??????? ????;
?????? ???? ???????, ?????????;
??????? ?????????? ?????????????, ?????????? ??????????;
????????? ???? ?????????, ????????????-????????????;
????? ????????? ??????????, ????????-?????????? ??????;
?????? ???????? ?????????, ????. ???. ????, ???? ?????????????? ???????????
????????. ?? ????? ???????? ????????????? ???????????? (??) ??????? ?????????? ???????? ????????????? ??????? ?????????? ??????? (??), ??? ????? ???? ???????? ?????? ?????????? ??????????????? ?????????? ?? ????????? ? ??????????. ?????? ??????? ??????????, ??? ???????, ???????? ?????????.
???????? ? ??????. ?? ?????? 2012?2013 ??. ???? ????????? 14 ???????? ?? ? ????????????? ? ????? ??????? ???? ?????, 13 ?? ??? ? ? ?????????????? ??????? ???????? ????????????? ??. ???????? ?????????? ????????????? ??????????????? ????????? ???????? ??: ? 71,4% ? 1LCA, CxA; 2RCA; ? 21,4% ? ╚?????? ?????╩ (1LCA; 2RCA, CxA). ? ????? ??????
24
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
? ??????? ? ????????? ????????????? ???????????? ?? ???????? ?? ?????????? ??????, ??? ??????????? ????????? ???????????? ??.
??????????. ?? ?????? ????????????????? ??????????????? (?????) ???? ?????????? ???????? ? 6 (42,8%) ????????? ?
?????? ??????????????? ????????????? ??????? ?? ? ??????? 1?3 ???? ????? ????????. ??????? ??????? ?????? ????????? (??) ? ???? ????????? ????????? 59,8 ╠ 9,9%. ?? ????? ??????????? ???????? ???? ????????? ???????????? ????????????? ??????? ??????? ?? ???? 12?96 ? (? ??????? 50,4 ╠ 28,8 ?) ??? ??????????? ?? ????? ???? ? ???????????? ????????. ???????? ????? ????????? 131,2╠24,1 ???, ????? ?????????????? ?????????????? (??) ? 272,0 ╠ 26,7 ???. ????? ????????????? ?????????? ?????? (???) ???? ????? 366,8 ╠ 205,8 ?, ??????? ????? ?????????? ? ?????????? ? 10,8 ╠ 4,5 ???. ?? ????
?????? ?????????? ???? ???? ??????? ?? 34-? ????? ????? ???????? ?????????? ??????????? ??????????? ?????????? ??
???? ???????????? ???-????????. ? ??????? 2013 ?. ???????????? ??????????? ????? ???????? ?? ?????????????.
??????????. ??????? ???????? ????????????? ?? ????????? ???????? ?????????? ??????????????? ?????????? ??????? ?
????? ???????? ? ????????????????? ??????? ? ???????? ?? ??? ??????????? ?? ???????? ??.
???????? ?????: ???????????? ????????????? ???????; ???????????? ????????????; ??????????? ?????????? ???????.
ARTERIAL SWITCH OPERATIONS: THE METHOD OF CORONARY ARTERIES
REIMPLANTATION
A.S. Il?in, P.V. Teplov, V.A. Sakovich, Yu.Yu. Spichak, K.A. Il?inykh, I.S. Afanas?ev,
A.M. Titov, V.A. Lytkin
The Federal Center of Cardiovascular Surgery of the Ministry of Health of the Russian Federation;
ulitsa Karaul?naya, 45, Krasnoyarsk, 660020, Russian Federation
Il?in Alexey Sergeevich, MD, PhD, Chief of Department, e-mail: ilyinas@krascor.ru;
Teplov Pavel Viktorovich, Cardiovascular Surgeon, e-mail: teplovpv@gmail.com;
Sakovich Valeriy Anatol?evich, MD, DM, Professor, Head Physician;
Spichak Yuliya Yur?evna, Cardiologist;
Il?inykh Konstantin Aleksandrovich, Chief of Department;
Afanas?ev Ivan Sergeevich, Anesthesiologist-Intensivist;
Titov Aleksander Mikhaylovich, Cardiovascular Surgeon;
Lytkin Vladimir Andreevich, MD, PhD, Functional Diagnostics Physician
Objective. Arterial switch operations (ASO) implicates that surgeon must change the true coronary artery (CA) anatomical position
that occasionally may induce acute coronary insufficiency because of CA distortion or compression. This life-threatening complication is usually fatal.
Material and methods. 14 ASO were performed in the Krasnoyarsk Center of Cardiovascular Surgery from 2012 to 2013 where
closed CA reimplantation technique were applied in 13 newborns and neonates. According to Leiden classification CA patterns were
as follows: 71,4% (1LCA, CxA; 2RCA); in 21.4% ? ?back loop? (1LCA; 2RCA, CxA). In one case, infant with Taussig?Bing anomaly
had a single CA arising from the non-facing sinus, which has significantly complicated translocation of the CA to the neo-aortic root.
Results. Transesophageal echocardiography in operating room showed slightly hypokinetic area of the interventricular septum in
6 (42.8%) patients, with complete restoring left ventricle (LV) systolic function within 1?3 days after surgery. Left ventricle ejection
fraction was not lower than 59,8 ╠ 9,9% in all cohort of patients. At the beginning, we did not close chest for any patient for
12?96 hours (mean 50,4 ╠ 28,8 hours ) regardless both body weight and duration of the operation. Mean cross-clamping time was
131,2 ╠ 24,1 min, bypass time 272 ╠ 26,7 min. The mean time on ventilator support did not exceed 366,8 ╠ 205,8 hrs and intensive
care unit (ICU) stay was 10,8 ╠ 4,5 days. During the follow-up, only one patient with human immunodeficiency virus (HIV) died on
34th postop day due to septic complications. Otherwise there was no mortality after ASO in our Hospital.
Conclusion. The technique of closed CA reimplantation makes surgeon be able to find the most fine position in the neo-aortic root
and allows to standardize approaches for ASO despite CA patterns.
Key words: transposition of the great arteries; arterial switch; coronary artery pattern.
г?б?блкб
???????? ????????????? ?????? ??????????
??????? (??) ??? ????????? ????????????? ???????????? (??) ?? ??? ??? ???????? ??????????.
?? ????? ???????? ?? ??????? ?????????? ???????? ????????????? ??????? ??, ??? ? 0,8?14,2%
??????? [1] ????? ???????? ? ???????? ?????? ?????????? ???????????????, ????????? ? ??????????, ?????????? ??? ?????????? ?????????? ?????????? ???????. ?????? ??????????, ??? ???????,
???????? ??????????. ? ????????? ????? ???????????? ????????? ??????????? ???????? ??, ????????? ? ???????????????? ?????????????? ???????? ? ??????????? ?????????. ??????????? ??
??? ???????? ??????????? ??????? ?????????????
?????????? ???????, ???????, ?? ?????? ??????????, ????????????? ????? 16 [2?16].
???? ?????? ? ?????????????????? ???? ?????????? ???????? ????????????? ????????????
? ?????????????? ??????? ???????? ????????????? ?????????? ???????.
Е?зб?к?н к обзс??
О???мзб?крзкм? т??кблзс?
?? ?????? 2012?2013 ?. ????????? 14 ????????
????????????? ???????????? ? 6 ??????? ? 8 ?????????, ??????? ??????? ?? ?????? ???????? ???????? 2?85 ??? (17,0 ╠ 27,1), ????? ???? 2,6?4,4 ??
(3,4 ╠ 0,5). ?? ??? ??????? ???????????? ????????????? ??????? (???) ? ? 7 (50%) ?????,
25
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
О???мзб?крзкм? т??кблзс?
???????,
???
?????
????, ??
?????????????
?? R. Van Praagh
???????
?????????? ???????
??????? ???
10
7
2
6
6
7
5
2,8
3,2
3,5
3,4
3,5
3,2
2,9
SDD
SDD
SDD
SDD
SDD
SDD
SDD
1LCA; 2RCA
1LCA; 2RCA,CxCA
1LCA; 2RCA,CxCA
1LCA; 2RCA
1LCA; 2RCA
1LCA; 2RCA
1LCA; 2RCA
8
9
10
11
??? ? ????
7
11
12
4
3,4
4,4
2,6
3,2
SDD
SDD
SDD
SDD
1LCA; 2RCA
1LCA; 2RCA
1LCA; 2RCA
1LCA; 2RCA,CxCA
12
??? ? ????, ?????????? ?????
3
3,6
SDD
1LCA; 2RCA
13
???????? ?????????????,
????????????? ?????????? ?????
85
3,8
SDD
1LCA; 2RCA
14
???????? ?????????????
6
2,8
SDD
???????????? ??,
????????? ??
?????????? ??????
?
1
2
3
4
5
6
7
???????
? ? ? ? ? ? ? ? ? ? . LCA ? left coronary artery; CxA ? circumflex coronary artery; RCA ? right coronary artery; SDD ? solitus, dexter,
dexter.
??? ? ???????? ??????????????? ???????????
(????) ? ? 4 (28,6%), ??? ? ???? ? ??????????? ????? ? ? 1 (7,1%), ??????? ?????????? ????????????? ??????? (????) ?? ??????? ?????????
? ???? ? ??????????? ????? ? ????????? ???? ?
? 2 (14,3%) (??. ???????). ? 10 (71,4%) ?????????
??????? ??? ?????????? ???????????, ? ???? ? ??????? ???????? ???????? ??????? ????????????
? ???? 5?10 ??/??/??? (5,5 ╠ 2,8 ??/??/???) ? ??????? 2?12 ??? (7,7 ╠ 3,5 ???). ? 3 (21,4%) ?????????,
? ??????? ??????? ?????????? ?? ????????? ?????????????? ????????????? (? ??????? ???????
????????????, ????????????? ?????????? ??????
(???) ? ??????????? NO), ???? ????????? ????????? ????????.
? ???????????? ? ?????????? ??????????????
???? ??????????? ????????? ????????????? ???????? ?????????? ???????: 71,4% ? 1LCA, CxA;
?????
??
???. 1. ?????????? ???????????? ?????????? ??????? ?? ?????????? ?????? ?????
26
2RCA; ? 21,4% ???? ??????????????? ╚?????? ?????╩ (1LCA; 2RCA, CxA). ? ????? ?????? ? ???????
? ????????? ????????????? ???????????? ?? ???????? ?? ?????????? ?????? (???. 1), ??? ???????????
????????? ???????????? ??. ???????? ??? ??????????? ? ???????????? ????????????? ??????? ???
? ???, ? ??????? ???????? ???? ??????? ??????? ??
????????????? ??????? ╚????╩, ? ????????? ??????? ???? ????????? ???????, ????????? ????.
Ок?ш??к?брм?? зб?лкм?
??? ???????? ??????????? ? ???????? ?????????????? ??????????????, ????????? ??????????
(28 ╟?), ? ??????????? ? ????????? ? ????????????
????????? ???????? ?????????????. ????? ?????????? ??????? ???????? ?? ?????????, ?????????? ??????? ???????????? ?? ????????? ?????????? ? 3?4 ?? ??? ??????????? ???????????
???????????. ?? ????? ????????? ????????
????????????? ? ????? ????????? ?????????????
????? ??????????? ?? ?????????. ????? ???????
Lecompte ????????????? ???????? ? ??????? ? ???? ??????? ???? ? ???????? ???????? ???????????
???????. ??? ??????????? ??????? ????? ??????????? ?????????? ??????? ????? ? ????? ???????.
?? ╚?????????????╩ ???????? ?????????? ??????
?????? (?????????? ????? ???????) ??????????
? 11 ????? ????? ? ????? ??????????? (???. 2, ?).
???? ??????? ??????????? ???? ????????????
?????? ?????????? ??????? [3]. ????? ?? ???????????? ??????? ???????? ????????????? ???????? ?????????? ???? ??????? ? ??? ?????????? ????-
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
?
?
?
???. 2. ????? ?????????? ????????????? ?????????? ??????? ??? ???????????? ???????????? (?????):
? ? ??????????? ??????? (??????) ?? ?????? ???????? ??? ?-??????????? ?????; ? ? ??????????? ??????? (??????) ?? ?????? ???????? ???
D-??????????? ?????; ? ? ????????????? ??????????? ??????? ???????? ?? ????????????? ? ??????????? ???? ??? ?????
??? ??? ????????????? ????????, ???? ????? ????
???? ?????????? ????? 60╟. ?? ? ???? ????????? ???
???????????? ??????? ??? ? ??? ??????????? ??????????? ?????? ??? ????? 120╟, ??? ???????? ?? ??????? 2, ?. ????? ????????????? ?????? ?????????? ??????? ? ?????? ?????? ? ????? ???????????
????????????? ??????????? ??????? ?? ??????????? ????????. ??? ????? ?? ???????????? ???????
?? ????????????? ? ???? ╚??????╩ (???. 2, ?). ??????? ?????????????? ?? ????? ??????? ??????? ??????????? ???????, ????????, ????? ???????, ??? ???????? ???? ?????. ? 7 (50%) ????????? ?????????
????????????? ???: ???????? ???? ?????????
? 5 (35,7%) ???????, ????????????? ???? ????? ?
? 2 (14,3%).
Кз?зкрзкм?
?????? ??????????? ? ?????????????? ?????????
??????????? ? ????????? Microsoft Excel 2010.
???????? ????????? ??????? ?????????, ????????????? ?????? ????????????? ????????, ? ?????
????? ?????? ?????????? ????? ????????, ??
???????????? ?????? ???????????????? ?????????? ????? ???????? ?? ? ???????? ??????????????
??. ?????????????? ?????????? ????????????
? ???? M ╠ ?, ???????????? ? n (%).
Йбашн╦з?з?
?????????????? ????????? ???????????? ? ????
????????? ?? ???? ?????????? ??????????? ?????
????????? ????, ????????? ? ?? ?????? ??????????? ??? ??????????? ????????? ???????? ???????? ?? ????. ??? ???????? ???????? ???????????
???????? ? ???? ????????? ??????????? ?????????????? ???????????????. ???? ??????????? ????
???????? ? 6 (42,8%) ????????? ? ??????? ??????????????? ???????????. ? 3 ?? ???, ????? ????,
??????????? ????????????? ????????? ? ???? ????? ? ???????? ???????? ?????????? ? ????????? ?????????????? ?????????????? (??). ?????????????? ????????????? ??????? ??????????? ? ????-
??? 1?3 ???? ????? ????????. ??????? ???????
?????? ????????? (??) ? ???? ????????? ???? ??
???? 45% ? ??????????? ? ???????? 45?68%
(59,8 ╠ 9,9%). ??????????????? ?? ?????????? ??????? ????? I ??. ?? ???????????. ???????????????
??????????? ??????? ?? ???? ??????? ?? ?????????
I ??. ?? ?????? ??????????? ??????????? ????????
? ????? ?????????? ????? ???????? ? ??????? ????????? 2?10 ?? ??. ??. (5,6 ╠ 2,9 ?? ??. ??.). ????
????????? ????? ?????????? ?? ? ???????? ?????????? ????????? ?????????? ?????????????? ??????? ??????? ? ???? 5?10 ???/??/???, ? 4 (28,5%)
??????? ????????????? ??????????? ??????? ?????????? ? ????????? ???? 0,01 ???/??/???.
?? ????? ??????????? ???????? ???? ?????????
???????????? ????????????? ??????? ??????? ??
???? 12?96 ? (? ??????? 50,4 ╠ 28,8 ?) ??? ??????????? ?? ????? ???? ? ???????????? ????????. ???????? ????? ????????? 83?180 ??? (131,2 ╠ 24,1
???), ????? ?? ? 160?312 ??? (272 ╠ 26,7 ???),
????? ????????? ?? 48?59 ??? (53,5 ╠ 7,7 ???).
????? ??? ????? ???????? ??????????? ? ???????? 96?720 ? (366,8 ╠ 205,8 ?), ??????? ????? ?????????? ? ?????????? ? 4?35 ??? (10,8 ╠ 4,5) ???.
? ?????? ????????????????? ??????? ??????????? ?????????? ? 4 (28,5%) ?????????: ? 1 ? ??????????, ??????? ??? ????????? ????????????
???????? ?????????????? ???????, ? 1 ? ?????????
????? ?????? ? ???? ?????? ??????????????? ?????????????? ??? ????????? ????????????, ??????????? ? ??????? ?? 12-? ????? ????? ????????. ????????? ???? ????????????? ?????????????? ? ??????? 23 ??? ????? ??????? ?? ???????. ? 2
??????? ????????? ???????????? ??????????:
? ?????? ? ?? ???? ???????? ????????????? ?????????, ? ??????? ? ?? ???? ?????????? ???-????????. ? 2012 ?. ???? 1 (7%) ??????? ?? 30-? ????? ?????????????????? ??????? ?????????? ???????, ???????????? ?? ???? ????????????
???-????????. ? ?????????? ????????? ???????
??? ????????? ?? ?? ???????????, ? ? 2013 ?. ???????????? ??????????? ????????? 0%.
27
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
И╥ршй?блкб
? ????????? ????? ???????? ?? ???????? ????????? ?????? ??? ??????? ???????????? ????????????? ??????? ? ????????? ????????? ??? ??
??. ??? ???? ??????????? ?? ?????? ???????? ??
????????? 5,5?6,4% [1, 8, 14, 17?19], ? ????? 1,5%
????? ????? ??????????? ????????? ? ????????
????? ???????? [1]. ? ????? ? ???? ???????? ? ??????????? ??????? ? ???????? ?? ????????????????, ? ?????????? ??????? ??? ?????????? ?? ???? ? ???. ?? ???? ??????????????? ??????????? ???? ?????? ??????????, ??? ???? ???????? ????? 16
????????? ??????? ????????????? ??????????
??????? [2?16] ?? ????? ???????? ?????????????
????????????. ?????? ???? ?????? ? ??????? ???????? ???????????? ? ??????????? ??????? ?????????? ???????? ?? ? ??????????? ?? ?????????
??. ? ??????????? ???? ????????, ??? ??????? ?????????? ??, ??????????? ????????????? ╚?????? ?????╩ (1LCA; 2RCA, CxA), ????? ?????????
????? ?????????? ?????? (OR = 1,2), ? ?? ????? ???
????????? ????? ?????????? ?????? ??? ???????????? ?? ????? ? ????????????? ╚?????╩ ?????????? ??? 2,9 [1]. ???????? ????? ???? ??????????? ??? ?????????????? ???? ??, ?????, ???????? S.K. Pasquali, ????????? ?????? ??????????
?? 6,5. ? ?? ?? ????? E.L. Bove ? ?????. ?? ??????? ????? ????? ????????????? ?????????? ??????
? ????????????? ????????? ?? [2, 3]. ?? ?? ??????, ????????? ????? ???????????? ???????????
????? ???? ???????????? ?? ????? 150 ???, ?????????????? ?????????????? (???????????? ??????? ????? 36 ???) ? ??????? ????????????? ?????????. ?????? ?????????? ????? ?????????
?????????? ???????? ????????????? ??????? ???
??????????? ??. ????????, ??? ???????? ???????? ???????? ?? ?????????? ??????? ?????? ??
????? ???????? ? ????? ?????? ???????? ??????
?????????? ???????????????. ???? ?? ???? ???????????? ?????? ??????? J. Brown ? ?????., ???
?? ????????? ?????????? ?????? ?? ??????? ??
????? ????????? ???????? ??????????? ?? ?? ???????? [17].
??????? ???????? ????????????? ??, ?? ???
??????, ????????? ????????????????? ???????
? ???????? ?? ??? ??????????? ?? ????????
??. ??? ???? ????? ??????????, ??? ??? ???????
????????? ? ? ????????? ????????? ??? ?? ??
? ???, ? ??? ????? ? ? ????????????? ???????
??? ? ???. ? ???? ??????? ??? ????? ???????????? ??????? ??? ??????????? ???????? ???? ??????? (120╟) ?? ??????? ?????? (??. ???. 2, ?), ????? ???????? ?????????? ??????????? ??. ? ?????????? ? ?????????? ? ???????? ????????
W. Jhang ? ?????. ????????, ??? ??????? ????????
????????????? ????????? ????????? ???? ??????????????? ?????????? ???????? ?????????, ????? ??????? ??????????? ???????? ??????????
28
??????????????? ? ?????????? ??????? ?????????? [6].
?? ??? ??????, ??????? ???????? ????????????? ?????????? ??????? ????????? ??????????
??????????????? ?????????? ??????? ? ????????, ? ??? ????? ??? ????????? ????????? ??? ??
??. ?????? ???????? ????????? ????????? ????????????? ?????????? ??????? ? ???????????
????????????, ??????????? ???????? ?????????
? ???? ????????? ????? ????????. ?????????? ???? ??????????????? ?????????? ?????????, ??????? ?????????? ??????? ╚????╩, ????????????? ????? ?????????????? ???????? ???????????????
??????????? ???????.
??????????/References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Pasquali S.K., Hasselblad V., Li J.S., Kong D.F., Sanders S.P.
Coronary Artery Pattern and Outcome of Arterial Switch
Operation for Transposition of the Great Arteries. Circulations.
2002; 106: 2575?80.
Bove E.L. Current technique of the arterial switch procedure
for transposition of the great arteries. J. Card. Surg. 1989; 4:
193?9.
Bove E.L. The arterial switch procedure: closed coronary
artery transfer. Oper. Tech. Thorac. Cardiovasc. Surg. 2009;
11: 309?16.
Chang Y.H., Sung S.C., Lee H.D., Kim S., Woo J.S., Lee Y.S.
Coronary reimplantation after neoaortic reconstruction can
yield better result in arterial switch operation: comparison with
open trap door technique. Ann. Thorac.Surg. 2005; 80:
1634?40.
Cleuziou J., Horer J., Henze R., Schreiber C, Lange R. Surgical
management of single intramural coronary artery in
Taussig?Bing anomaly detected at arterial switch operation.
Thorac. Cardiovasc. Surg. 2008; 56: 170?2.
Jhang W.K., Shin H.J., Park J.J., Yun T.J., Kim Y.H., Ko J.K.
et al. The importance of neo-aortic root geometry in the arterial switch operation with the trap-door technique in the subsequent development of aortic valve regurgitation. Eur. J.
Cardiothorac. Surg. 2012; 42: 794?9.
Mavroudis C., Backer C.L., Duffy C.E., Pahl E., Wax D.F.
Pediatric coronary artery bypass for Kawasaki congenital, post
arterial switch, and iatrogenic lesion. Ann. Thorac. Surg.
1999; 68: 506?12.
Mavroudis C., Backer C.L. Transposition of the great arteries.
In: Mavroudis C., Backer C.L. (eds). Pediatric Cardiac Surgery,
4 rd ed. Philadelphia, PA: Mosby. Inc.; 2013: 492?530.
Mavroudis C., Steward R.D., Backer C.L., Harish R., Patrick V.,
Marshall L.J. Reoperative techniques for complications
following arterial switch. Ann. Thorac. Surg. 2011; 92:
1747?55.
Moat N.E., Pawade A., Lamb R.K. Complex coronary arterial
anatomy in transposition of the great arteries. Arterial switch
procedure without coronary relocation. J. Thorac. Cardiovasc.
Surg. 1992; 103: 872?6.
Murthy K.S., Cherian K.M. A new technique of arterial switch
operation with in situ coronary reallocation for transposition of
the great arteries. J. Thorac. Cardiovasc. Surg. 1996; 112:
27?32.
Parry A.J., Thurm M., Hanley F.L. The use of pericardial hoods
for maintaining exact coronary artery geometry in the arterial
switch operation with complex coronary anatomy. Eur. J.
Cardiothorac. Surg. 1999; 15: 159?65.
Planche C., Bruniaux J., Lacour-Gaet F., Kachaner J.,
Binet J.P., Serraf A. et al. Switch operation for transposition of
the great arteries in neonates. A study of 120 patients.
J. Thorac. Cardiovasc. Surg. 1988; 96: 354?63.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
14.
15.
16.
Rodefeid M.D., Ruzmetov M., Vijay P., Fiore A.C., Turrentine M.W., Brown J.W. Surgical result of arterial switch operation for Taussig?Bing anomaly: is position of the great arteries
a risk factor? Ann. Thorac. Surg. 2007; 83: 1451?7.
Yacoub M.H., Radley-Smith R. Anatomy of the coronary arteries in transposition of the great arteries and method for their
transfer in anatomical correction. Thorax. 1978; 33: 418?24.
Zheng J.H., Xu Z.W., Liu J.F. et al. Arterial switch operation
with coronary arteries from a single sinus in infants. J. Card.
Surg. 2008; 23: 606?10.
17.
18.
19.
Brown J.W., Park H.J., Turrentine M.W. Arterial switch operation: factor impacting survival in the current era. Ann. Thorac.
Surg. 2001; 71: 1978?84.
Li J., Tulloh R.M., Cook A., Schneider M., Ho S.Y., Anderson R.H. Coronary arterial origin in TGA: factors that affect
outcome. A morphological and clinical study. Heart. 2000; 83:
320?5.
Qamar Z.A., Goldberg C.S., Devaney E.J., Bove E.L.,
Ohye R.G. Current risk factors and outcomes for the arterial
switch operation. Ann. Thorac. Surg. 2007; 84: 871?9.
????????? 14.04.2014 ?.
╘ ????????? ???????, 2014
??? 616.126.422-089:616-126.4-053.31-089
????????????? ???????? ??????????? ???????
??? ??? ???????????????, ???????????
????? ??????????? ????????? ??????
????????? ???????????????????? ??????
? ????? ??????? ????????
?.?. ???????????, ?.?. ????????, ?.?. ???????, ?.?. ???, ?.?. ?????
????? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ?
???????? ??? ? ???? ?.?. ???????); ?????????? ?????, 135, ??????, 121552,
?????????? ?????????
??????????? ?????????? ?????????, ????. ???. ????, ?????. ????.,
e-mail: bakhodira@yandex.ru;
???????? T?????? ????????????, ????. ????. ????, ??. ?????. ????., tatiana@box.ru;
??????? ??? ?????????, ???????? ??? ? ????, ???????? ????? ╚?????
??. ?.?. ????????╩;
??? ??????? ????????, ?????? ???. ????, ?????????, ?????????? ??????????;
????? ????? ?????????, ?????? ???. ????, ?????????, ?????????? ???????
????????. ????? ??????????? ????????? ?????? ????????? ???????????????????? ?????? (?? ?????) ? ?????????? ????????????????? ??????? ? 30?50% ??????? ??????????? ????????? ??? ?????????? ??????????????? ??????????? ???????, ?
7?23% ??????? ????????? ? ????????? ????????????? ?????????????. ? ???????? ??????? ?? ?????? ??????? ?????????
???????? ???????, ? ????? ????? ???????? ??????????? ??? ???????????????. ? ????? ? ???? ??? ??????? ??????? ? ??????????? ?????????????? ?????????? ??????????? ? ?????????????? ??????????????? ??????????? ??????????? ??????????
???????? ?????????? ?? ???????????????? ?????? ? ?????????, ?????????? ?? ?????, ? ????????????? ???? ???????????
? ???????????????? ??????????? ??????????? ??????.
???????? ? ??????. ? ?????? ???????? ?????????? ???????????????? ???????????? 30 ?????? ????? ? ???????? ?? 43 ??? ??
36 ??? (? ??????? 15,1 ╠ 3,2 ???), ??????? ????? ???????? ??????????? ????????? ?????. ? ???????? ??????????? ??????
???? ??????? 30 ?????? ????? ???????????????? ????????, ??????? ?????? ??????? ?? ???? ??????? ? ????????????? ????????-?????????? ???????.
??????????. ? ????????? ????? ?? ????? ? ?????????? ?????? 0?6 ??? ????????? ????????? ????????? ?????????? ?????? ??????????? ??????? (?? ??), ? ? ?????????? ??????? 7?12 ??? ? 12?36 ??? ???????? ????????? ?????????? ?? ?? ??
????????? ? ?????????. ??????? ??????????? ??????? ?? ? 2,3?2,4 ???? ????????? ??????? ?????????? ?????? ?? ????
??????? ????? ?? ?????. ?? ???????????? ?????????? ????? ??????? ?? ?? ???????? ???????????? ????????????? ? ????????????? ??????????, ??? ????????? ? ????, ??? ??????? ?? ? ???? ??????? ????????????? ? ??????? ?????? ??????????.
????????????? ????????? ? ????????? ????? ?? ??????? ???????? ???????????? ???? ?? ????? ????????? ????????? ?????? ? ???????? ??????? ???????. ? ????????? ????? ?? ????? ?????????? ????????? ? ????????? ????????????? ??????????-????????? ???????? ??. ?????? ????????? ??????? ? ???????? ??????????????? ?? ? ????????????????? ???????.
29
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
??????????. ? ????? ??????? ???????? ? ????? ???????? ???????? ??????????????? ??????????? ??????? ? ????????????????? ??????? ??????? ???????????????????? ????????? ??????? ? ????????????? ?????????-????????? ???????? ???????.
???????? ?????: ????? ???????? ??????????????????? ?????; ?????????? ??????; ???????????; ???? ??????? ????????.
THE SURGICAL MORPHOLOGY OF MITRAL VALVE OF IT?S INSUFFICIENCY
AFTER RADICAL CORRECTION OF THE COMPLETE ATRIOVENTRICULAR
CANAL DEFECT IN INFANTS
B.U. Abduvokhidov, T.V. Sukhacheva, L.A. Bockeria, A.I. Kim, R.A. Serov
A.N. Bakoulev Scientific Center for Cardiovascular Surgery; Rublevskoe shosse, 135,
Moscow, 121552, Russian Federatio
Abduvokhidov Bokhodirzhon Ulmasovich, MD, PhD, Research Associate,
e-mail: bakhodira@yandex.ru;
Sukhacheva Tat?yana Vladimirovna, PhD (Biology), Senior Research Associate;
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;
Kim Aleksey Ivanovich, MD, DM, Professor, Chief of Department;
Serov Roman Andreevich, MD, DM, Professor, Chief of Department
Introduction. Moderate or severe mitral valve insufficiency after radical correction of complete atrioventricular canal (CAVC) defect
occurs in 30?50% of cases and 7?23% of patients require repeated surgery. Failure to carry out plastic procedure often leads to valve
replacement. In this regard, to make a decision about the possibility of restoring normal structural and functional relationships of
mitral valve components is necessary their morphometric evaluation in patients undergoing radical CAVC correction and comparison with the corresponding parameters of the normal heart.
Material and methods. The morphological study of 30 children hearts at the age from 43 days to 36 months (mean to 15.1 ╠ 3.2
months) died after radical correction of CAVC were analyzed. As the control group were studied 30 children hearts of the appropriate age, died of causes unrelated to diseases of the cardiovascular system.
Results. In patients after CAVC correction in the age group 0?6 months was observed moderate dilatation of mitral valve annulus,
and in the age groups 7?12 months and 12?36 months ? moderate hypoplasia of mitral valve annulus compared with the control.
The surface area of the mitral leaflets was 2.3?2.4 times larger than the mitral annulus in all groups after CAVC correction. But myxomatous mitral valve tissue did not possess the necessary mechanical and elastic properties, that lead to systolic prolapse of mitral
leaflets into the left atrial cavity. Myxomatous changes in mitral valve tissue structure were the cause of the suture eruption on the
newly created fibrous ring and the front mitral leaflet. In patients after CAVC correction changes in the subvalvular tendon-muscle
structures were found. These changes have led to the development of mitral valve failure in the postoperative period.
Conclusion. The cause of mitral valve insufficiency in infants in the postoperative period after CAVC correction is a connective tissue
dysplasia of the leaflets and subvalvular chordal-muscular valve apparatus.
Key words: complete atrioventricular canal defect; mitral valve; morphometry; infants.
г?б?блкб
????? ???????? ??????????????????? ?????
(?????) ???????? ????? ?? ??????? ?????????? ??????? ??????, ??????????? ? ?????? ???????? ???????? ??????????????????? ???????????
??????. ?????? ????? ??????????????? ????????
?????????????? ????????? ????? ????????????
? ???????????, ???????????? ??????? ????????
? ???????? ???? ?????? ?? ?????? ?????????,
? ????? ?????????? ?????????-????????? ???????? ??????????? ??????? (??) [1?5]. ??????????? ????????? (??) ????? ? ????????? ?????
?????? ?????????? ?, ??? ???????, ???????? ????????? ??????: ???????? ???????? ??????????????? ? ?????????????? ???????????, ?????????? ????????? ?????????? ? ???????????????
???????????????, ????????? ?????????????
?????????? ???????? ??????. ??????????? ??????? ???????? ? ?????? ?????????????????? ??????????? ????? ????????? ??????????? ????????? ?????? [6?10]. ??????, ???????? ?? ???????
??????????, ?????????? ??????????????? ?????
30
??????????? ????????? ??????, ?????????? ?????????? ???????? ????? ????????????. ??? ??????????????, ??????????????? ?????????? ?? ?????,
???????? ? ??????, ??? ? ?????????? ??????? ????? ????????? ????????? ?????? ? 30?50% ??????? ??????????? ????????? ??? ??????????
??????????????? ??????????? ??????? [4, 6, 7, 11].
? ??????? 2 ??? ????? ???????? ?? 7?23% ??????? ????????? ? ????????? ????????????? ????????????? ?? ??. ??? ???????, ? ???????? ??????? ????? ??????? ??????? ????????? ????????
???????, ? ???????? ??????????? ??? ??????????????? [5, 6, 10, 12, 13].
? ????? ? ???? ?????? ???????? ??????????? ??????????????, ???????????????? ?????? ??????????? ??????????? ??????? ? ?????????, ?????????? ?? ?????, ? ????????????? ???? ???????????
? ???????????????? ??????????? ???????????
??????. ??? ?????????? ?????????? ??? ???????
??????? ? ??????????? ?????????????? ?????????? ??????????? ? ?????????????? ??????????????? ??????????? ?????????? ???????? ? ?????
???????.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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?????????????? ??????????? ??????????? ???????
?????? ? ????? ??????? ???????? ??? ??? ???????????????, ???????????? ????? ?? ?????.
Е?зб?к?н к обзс??
??? ???????? ????????? ??????????? ?????????? ???????? ???? ??????????? 30 ?????? ?????
???????? ?? ?????. ???????? ????????? ??????? ? ?????? ????????? ????????? ????????? ???????????????, ????????????? ????????????????
?? III?IV ???????, ??????????? ????? 2?90 ???
(? ??????? 19,0 ╠ 4,6 ???) ????? ?? ?????. ??????? ????? ?? ?????? ?????????????? ????????? ??
43 ??? ?? 36 ??? (? ??????? 15,1 ╠ 3,2 ???). ????
???? ???????? ??????????? ????????? ??, ???????? ??? ?????????? ????????, ??? ? ???????????
????? ????????. ? ??????????? ?? ???????? ???????? 24 ?????? ????? ???? ???????? ? ???? ?,
1 ?????? ? ? ???? ? ? 5 ??????? ? ? ???? ? ?? ????????????? G.C. Rastelli [10]. ? ???????? ??????????? ?????? ???? ??????? 30 ?????? ????? ???????
????????, ??????? ?? ??????, ?? ????????? ? ????????????? ????????-?????????? ???????.
???????? ?? ?????? ????? ?? ????? ? ??????????? ?????? ???? ????????? ?? ??? ??????????
?????????: 0?6 ???, 7?12 ??? ? 13?36 ???. ?????
63,3% ????????? ????? ?? ????? ? 70% ??????????? ??????? ???? ???????? ? ?????????? ????????? ?? 1 ????. ? 22 (73,3%) ????????? ?? ?????? ????? ?? ????? ??????? ??????? ?????.
???????? ???????????????? ???????????? ?????????? ? ???????? ????????? ?????????? ??????????? ??????????? ?????????? ????????:
?) ????????? ?????? (??) ??: ???????, ??????? ???????;
?) ??????? ???????: ?????, ??????, ???????
??????????? ???????, ??????? ??????????????,
???????????, ??????? ????- ??? ??????????? ?????, ??????? ?????;
?) ?????????? ???????: ??????????, ?????, ????? ?????????, ??????????? ??????????, ????????
????????, ?????????, ????????? ???????????
????;
?) ?????????? ?????: ?????, ???????, ??????????, ???????? ?????????? ? ???????, ?????????,
??????? ?????? ?????????.
??? ????????? ???????? ?????? ??????????-????????????? ????????? ???????????? ????? ?????????????? ?????. ??????? ??????? ?? ? ???????
??????????? ??????? ?? ? ??????????? ???? ???????? ?? ??????????? ? ??????? ????????? ImageProPlus 6.0 (Mediacyberneti?s).
????????? ??????? ?? ? ??????????? ?? ??????????? ? 4% ?????????????????, ???????? ? ???????. ????? ???????? 5 ??? ?????????? ??????????? ????? ? ????????? ????????? ?????
(╚Bio-Optica╩, ??????), ????????????????????
? ??????? ?????????????? ????????? (╚Novocastra╩, ??????????????) ???????? ? ??????? ?? ?????????????? ??????.
?????????????? ????????? ?????? ?????????
? ?????????????? ???????????? ???????? ? ???????? ???????????.
Йбашн╦з?з?
Нк╥?салсб мсн╦?с окз??н╦лс?с мн?т?л?
?? ?????? ???????????? ? 1-? ?????? ?????
(0?6 ???) ???????? ??????????? ?????????? ???????? ?? ?? (? ??????? 12,4 ╠ 2,54 ??), ??? ?????????? 114,3% ?? ???????? ??????????? ??????
(? ??????? 10,6 ╠ 2,2 ??). ? ????????? ???? ?????????? ??????? ??????? ?? ?? ? ????? ????? ??
????? ??? ?????? ???????? ????? ???????????
?????? ??????????????? ?????????? ?????????:
?? 2-? ?????? (7?12 ???) ?? ? ??????? ????????
11,8 ╠ 2,16 ?? ? ???????? 86,1% ?? ???????????
???????? (13,8 ╠ 1,9 ??); ? 3-? ?????? (13?36 ???) ?
14,5 ╠ 1,94 ??, ??? ????????? 81% ?? ???????????
???????? (17,9 ╠ 1,6 ??). ?????????? ? ??????? ????? ?? ????? ?????????? ?????????? ?? ??????????? ??????????? ?????? ???????????????? ???????? (p < 0,05).
??????? ??????? ?? ?? ? ????? 1-? ??????
????? ?? ????? ???? ?????? (? ???????
117,1 ╠ 44,5 ??2) ??????? ??????? ?? ?? ? ??????????? ?????? (91,6 ╠ 39,5 ??2) ??????????????? ?????????? ????????? (p < 0,05). ?? 2-? ?
3-? ?????????? ???????, ????????, ??????? ??????? ??????? ?? ?? ? ??????????? ??????
(150,8 ╠ 46,6 ??2 ? 254,6 ╠ 49,5 ??2 ??????????????) ?????????? ????????????? ??? ????????
??????? ?? ?? ? ????? ????? ?? ?????
(112,2 ╠ 40,1 ??2 ? 167,7 ╠ 44,4 ??2 ??????????????).
Кз?с?мк окз??н╦лс?с мн?т?л?
??? ???????????? ??????? ?? ? 18 (60%) ?????
????? ?? ?????, ??????? ???? ??????????? ????????????????, ?????????? ???????????? ???? ??
???????????? ?????????? ???????? ???????, ???
??????? ????? ?? ??????? ?????? ???????? ??????????????? ?? (???. 1, ?). ? 3 (10%) ??????? ???????????? ???? ?? ???????? ??????? ?? ????? ???? ??????? ? ?????????? ??????????? ???????,
????????????? ????????? ?? ?????. ? ?????????
12 (40%) ????????? ????? ?? ????? ??????????
?????? ????????? ????????? ???????? ???????
??? ?????????? ?????? ??????? ?? ? ??????????
?/??? ????????? ?? ?? ????????? ??????? ??????
?????????.
??? ??????????????? ???????????? ??????? ??
? ?????? ????????? ???? ???????? ????? ???????????, ????????? ?? ?????? ????????????? ?????????????? ?????, ??????? ????????? ????????????
?????????? ?????? ????????????????? (???. 1, ?).
? ????????? ??????? ? ???????? ?? ????? ????
31
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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???. 1. ????????????? ????????? ??????? ?????? ???????????????????? ??????? ????? ?? ?????:
? ? ???????????????? ???????, ??? ?? ??????? ?????????? ????? ???????? ??????? ? ?????????????? ???????????. ????????? ??????? ?????
???????????? ???? ????? ???????? ???????. ?????? ??????? ?????? ???????????????????? ??????? ???????????? ???????? ? ?????????????;
?, ? ? ??????????????? ???????? ???????? ??????? ??????????? ??????? ???????? ????? ?? ?????: ? ? ????????? ?????? ?????????????????
? ???????????? ???? ???????????? ?????????? ??????? ?? (??????? ? ??????????? ?????, ????); ? ? ?????????????? ?????? ? ???????????
???? ??????? ?? (??????????????????? ???????????; ??. 100)
???????? ????????? ?????????????? ??????, ????????????? ? ??????????? ???? ??????? ??
(???. 1, ?).
????????? ??????? ??????????? ??????? ??
? ????? ????? ?? ????? ????????, ??? ? 1-? ? 2-?
?????????? ??????? ??? ???? ??????, ??? ? ??????????????? ??????????? ???????, ?? ??????????
?????????? ?? ??????????? ???????? ?????? ?? 2-?
?????? ?????????. ? ??????? 3-? ?????? ??????????? ??????? ??????? ??????????? ??????? ?? ??????? ? ?????? ???????? ?? ???????? (????. 1). ?????
????, ?? ???? ?????????? ?????????? ? ?????????
????? ?? ????? ??????? ??????????? ???????
????????? ? 2,3?3,2 ???? ??????? ??????? ??,
????? ??? ? ??????????? ?????? ??? ???????? ??????????? ?????? ? ???????? 1,4?1,7.
Кш?сйкн╦л?б ?с???
????? ?? ?????? ????????????? ???????????
?????????? ????????? ?? ???????? ???????? ???
?????????-????????? ????????. ??? ??????????
???????? ????????????? ???????? ?? ??????????? ????? ?????????? ?? ???? ? ???? ???????
? ????????????? ? ???????? ?????????? ???? ??.
? ?????????? ????? ?? ????? ??????????? ????? ?? ??????? ????????????? ?? ?????? ? ????????
??????????????? ?????????? ????, ?? ? ? ?????-
????????? (??????????) ?????? (???. 2, ?), ? ????? ??????????????? ? ?????????? ????????? ?????? ?????????. ???????? ?????? ????????? ???????? ??????????? ???????? ????? ??????? ?????????????? ???????? ??????????? ????, ?????? ??
??????????????? ??????????? (???) ? ?????????? ? ???????????? ??????????? ???? ???????
? ? ????? ?????? ??????????? ???????? ???????
?? (???. 2, ?). ????? ????? ???????? ? 48% ?????
??????????. ????? ????? ?????????????? ?????
??????????? ???????? ??????? ?? ? ??? ?, ??????????? ?? ???????? ? ???? ???????, ?????????
?????????? ????????? ?????? ?????? ?????????
(????) ?????? ???????. ???????? ????????????
??????? ??????? ???????? ????? ?? ?????? ???????????? ???? ????? ???????????????? ??????????? ???????? ??????? ?? ? ??????? ? ?????
(???. 2, ?).
????? ???????? ????????? ???? ?? ???? ?????????? ??????? ? ????? ????? ?? ????? ?? ????????? ? ??????????? ?????? ???????? ??????????? ?????????? ?????????? ????, ?????????? ???
? ???????? ??????? ??, ??? ? ? ??????? ???????
? ?????? ??? ???????. ???, ????? ????, ??????????
? ???????? ??????? ??, ? 1-? ?????? ? ??????? ????? ?? ????? ????????? 6,2 ╠ 1,9, ?? 2-? ?
5,8 ╠ 0,8, ? ? 3-? ? 6,2 ╠ 2,3, ??? ???? ??????????
М?╥нк?? 1
Кссзлс╞блкб тнс???к тс?б??лсрзк рз?с?см к тнс???к рб?блк? НД ЕД
? ??шттб мслз?сн? к ш т??кблзс? тсрнб ЙД ИИдгД
???????, ???
??????? ???????????
??????? ??, ??2
??????? ??????? ?? ??, ??2
S ?? / S ?? ??
????????
?????
?? ?????
????????
?????
?? ?????
????????
?????
?? ?????
0?6
129,6 ╠ 54,1
274,8 ╠ 114,7
91,6 ╠ 39,5
117,1 ╠ 44,5*
1,4
2,3
7?12
260,6 ╠ 40,3
359,8 ╠ 105,4*
150,8 ╠ 46,6
112,2 ╠ 40,1*
1,7
3,2
13?36
400,3 ╠ 134,1
404,2 ╠ 164,9
254,6 ╠ 49,5
167,7 ╠ 44,4*
1,6
2,4
* p < 0,05, ?????????? ? ?????? ? ?????????? ???????????????? ??????????? ??????? ?????????? ?????????? ?? ?????? ?????? ???????? ???????????????? ????????.
32
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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???. 2. ????????? ?????? ????? ??????????? ????????? ????? (??? ?? ?????? ?????????):
? ? ???? ??????????? ???????? ??????? ?? ???????????? ????????. ?????????? ????? (??????? ????????) ????????? ???????? ??????? ??
? ??????????????? ???????????, ???????? ????? ?? ?????? ??????? ??????? ???????? ? ?????????? ?????????? ?????; ? ? ?????????? ????????
????? (??????? ?????????) ?? ??????????? ???????? ??????? ?? ????????????? ? ??????????????? ??????????? (???) ? ???????? ????????
???????????? ???? ????? ???????????????? ??????????? ??; ? ? ?????????? ???????????? ???? ?? ????? ?????????????? ???????? ???????
??, ????????????? ????????? ????? ???????.
??? ? ???????? ?????????? ?????; ??? ? ?????? ?????????? ?????
??????, ??? ? ??????????? ?????? (??????????????
9,0 ╠ 0,1, 10,0 ╠ 0,9, 10,9 ╠ 1,4 ?????). ??????????
????, ?????????? ? ?????? ?????????? ?????,
? 1-? ?????? ?????????? 4,0 ╠ 1,0, ?? 2-? ??????
4,0 ╠ 1,2, ? 3-? ? 5,0 ╠ 1,7, ??? ????? ???? ?????????? ??????, ??? ? ??????????? ?????? (?????????????? 9,0 ╠ 0,1, 10,0 ╠ 0,9, 12,3 ╠ 1,8 ?????).
????? ????, ?? ???? ?????????? ?????????? ? ????????? ????? ?? ????? ???????? ?????????
???? ?? ????????? ? ??????? ????????. ?????
????, ?????????? ? ???????? ?????????? ?????,
? 1-? ?????? ????????? 8,7 ╠ 2,9 ??, ?? 2-? ?
9,2 ╠ 1,8 ??, ? 3-? ? 11,3 ╠ 3,4 ??, ? ? ?????? ????
??????? ?????????? ????????? ?????? ???????????
?????? (?????????????? 3,7 ╠ 0,7 ??, 5,0 ╠ 0,9 ??,
8,6 ╠ 2,2 ??). ????? ????, ?????????? ? ?????? ?????????? ?????, ? 1-? ?????? ????????? 8,8 ╠ 1,3 ??,
?? 2-? ? 10,0 ╠ 1,4 ??, ? 3-? ? 9,9 ╠ 3,1 ??, ??? ?????????? ????????? ?????? ??????????? ?????? (?????????????? 3,5 ╠ 0,5 ??, 4,5 ╠ 0,8 ??, 5,8 ╠ 0,5 ??).
????? ???????, ? ??????? ????????? ????? ??
????? ???????? ????????? ???????? ??????????? ?????????? ??????????? ???? ?? ???????
? ?????????? ?? ? ??? ? ??????????? ???????.
???????? ????????? ???? ?????????????? ??????????? ??????????? ?? ????? ? ??????????? ??????????.
Ксрс?мс??б о?╞??
????????????? ???????????????? ????????????? ?????????? ???? ????????? ????? ?? ?????
? ?????? ???????? ??????? ??????????? ?????????? ?????? ???????? ?????????? ???? ?? ????
?????????? ?????????? (????. 2). ? ??????? ?????????? ?????? ????????? (0?6 ???) ????? ?????????? ??????????? ?????????? ??????? ????????
? ?????? ????? ?????????? ????, ? ? ?????????
??????? ????????? ???????????.
? ????????? ????? ?? ????? ???????? ???????????? ?????????????? ?????????? ? ??????? ???????? ?????????? ???? ??. ? 3,3% ????????? ???? 1 ?????????? ?????, ? 86,7% ????????? ? 2,
? 10% ? 3 ?????????? ?????.
??????? ????? ?????????? ????? ???? ?????????? ??? ???????? ???? ╚?????????????????╩ ??,
??? ??????? ??? ????? ?? ??????? ?? ????????
? ???????????? ?????????? ?????. ???????? ???
????????? ???? ????????? ??? ? 1 (3,3%) ??????,
М?╥нк?? 2
Ес?ысобз?к? рсрс?мс??? о?╞? нб?с?с йбнш?с?м? ? мслз?сн╦лсх ??шттб к ш т??кблзс? тсрнб ЙД ИИдгД
???????? ?????????? ?????
???????,
???
??????, ??
?????? ?????????? ?????
???????, ??
??????, ??
???????, ??
??????
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?????
?? ?????
??????
????????
?????
?? ?????
??????
????????
?????
?? ?????
??????
????????
?????
?? ?????
0?6
13,5 ╠ 2,8
12,4 ╠ 3,6*
4,6 ╠ 0,6
6,6 ╠ 2,1*
12,7 ╠ 2,1
11,8 ╠ 3,1*
4,3 ╠ 0,5
5,3 ╠ 1,7*
7?12
18,0 ╠ 0,9
15,4 ╠ 2,1*
7,5 ╠ 1,1
7,0 ╠ 1,8
15,7 ╠ 0,5
11,4 ╠ 4,1
6,8 ╠ 0,6
4,4 ╠ 1,2*
13?36
18,9 ╠ 1,4
17,0 ╠ 3,4*
9,6 ╠ 1,1
8,2 ╠ 2,3
15,8 ╠ 0,5
16,8 ╠ 3,2*
9,0 ╠ 1,4
7,4 ╠ 2,2
* p < 0,05, ?????????? ? ?????? ? ?????????? ???????????????? ??????????? ??????? ?????????? ?????????? ?? ?????? ?????? ???????? ???????????????? ????????.
33
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
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???. 3. ????????? ?????? ????? ??????????? ????????? ????? (??? ?? ?????? ?????????):
? ? ???????????????? ?????????? ??????. ????? ?? ????????? ? ??????? ??????????? ???????? ??????? ? ?????? ??????? ?? ?????????????
? ?????????????????? ???????? ?????????? ????? (???); ? ? ? ??????? ?????? ????????? ??? ?????? ?????????? ????; ??? ????????????????, ??????? (???) ? ?????? ?????????? ????? (???) ???????????????; ? ? ? ??????? ?????? ????????? ??? ?????? ?????????? ????; ??? ??????? ????????, ??? ???????????????. ???????? ?????????? ????? (??????? ?????????) ????????? ?????????? ???????? ??????? ?? ? ??????????????? ???????????
???????? ?? ??????? ???? ?????????? ???? ? ????
?????? ??? ??????????? ????? ?? ????? ???????
????????? ? ???????? ?????????? ?????, ? ? ????????????????? ?????? ?????????? ????? ????????? ????? ?? ???????????? ??????????? ???????
?????????? ???????? ??????? ?? (???. 3, ?).
??? ??????? ???? ?????????????? ?????????
?????????? ???? ? ????? ????????? ????????
? ?????? ?????????? ????? ?????????? ? ?????????? ?????????, ? ?????? ????????????? ????????
? ?????? ?????????? ??????????? ????????? ?????? ?????? ????????? (???. 3, ?). ??? ?????? ????????? ???? ?????????? ????????? ????????
????????? ??????? ?? ? ?????????? ?????? ? ??????? ??????????? ????:
1. ?????????? ?????????? ??????? ?? ? ??????????? ??????? ? 1 (3,3%) ??????. ? ?????? ?????? ??????????? ????? ?? ???????? ??????? ??
????????? ?????? ? ???????? ? ?????? ??????????
??????, ? ?? ?????? ??????? ?? ? ?????? ? ???????
?????????? ?????.
2. ?????????? ?????????? ??????? ?? ? ??????????? ??????? ? 2 (6,7%) ??????. ??? ?????? ????????? ?????????? 2 ???????? ????????? ??????????? ???? ??? ??????? ???? ????? ??????????
????:
? ?? ???????? ? ?????? ??????? ?? ????? ??????????? ???? ????????? ? ??????????????????
???????? ?????????? ?????, ? ?? ??????????????? ????????? ? ?????? ??????? ?? ????? ????????? ? ????????????????? ??????? ??????????
?????. ??? ???? ?? ???????????? ???????????
???????? ??????? ?? ? ?? ??????????????? ????????? ??????????? ????? ????????? ?????? ? ????????????????? ?????? ?????????? ????? ? 1
(3,3%) ?????? (??. ???. 3, ?);
? ?? ?????? ??????? ? ??????????????? ????????? ???????? ??????? ?? ??????????? ????? ????????? ? ?????? ?????????? ?????. ?? ??????????????? ????????? ???????? ??????? ?? ? ?? ???34
??? ??????? ??????????? ????? ????????? ? ??????? ?????????? ?????, ? ?? ???????????? ??????????? ???????? ??????? ?? ??????????? ?????
????????? ?????? ? ???????? ?????? ??????????
????? ? 1 (3,3%) ??????.
??????? ???????? ?????????? ???? ? ???????
????????? ????? ?? ????? ???????????. ? 10%
??????? ????????? ?????????? ???????? ?????????? ????? ??? ?????????? ???????? ?????? ?????????? ?????, ? 20% ??????? ???????? ?????????? ?????? ?????????? ????? ??? ??????????
???????? ???????? ?????????? ????? (???. 3, ?),
? 6,7% ??????? ???? ??????????????? ??? ?????????? ????? (???. 4, ?).
? ???? ??????? ? ??????? ????????? ????? ??
????? ???????? ????????????? ??????????
????, ??????? ?????????????? ?? ???? ???????????? ????????? ??????? ? ?????? ?????? ?????????
?????? ???????? ????? ?????????? ???? (6,7%),
?????? ?????? ????? ?????????? ???? (6,7%) ???
????? ????? ?????????? ???? (16,7%). ????? ????, ?????????? ???????????????? ??????? ??
??????? ?????? ????????? ???????? ??????????
????? (6,7%) ??? ????? ?????????? ???? (3,3%).
? ????? ?????? ? ??????? ???????? ??????????
????? ????????? ???????-????????????? ???????????, ??????? ?????????? ???? ???????? ???? ??? ????????????? ????????????. ? ????? ???????????? ????????? ??????????? ???????????
??????????? ???? ?? ??????? ??. ??? ???? ??????
?????????? ????? ???? ??????????????? ? ??????? ?? ??????? ?????? ?????????, ? ??? ?????????
????? ??????????? ???? ?? ??????????????? ????????? ???????? ??????? ?? ? ?? ?????? ???????
(???. 4, ?). ?????? ??? ????????? ??????????
???? ? ??????????? ???? ??????? ????? ?? ??????? ?????? ?????????? ??????????? ??????????
????, ??????? ?????????????? ?????????? ????????????? ??????? ? ?????????????? ?????????
??????????????? ??.
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???
???
???
?
?
?
???. 4. ????????? ?????? ????? ??????????? ????????? ????? (??? ?? ?????? ?????????):
? ? ?????????? ????? ????????? ?????????? ???????? ??????? ?? ? ??????????????? ??????????? ? ???????????? ?? ???????? (??????? ?????????); ??? ? ??? ???????????????; ? ? ??? ???????????????? ? ??????? ? ????????? ?????? ?????????, ??? ???????????????. ???????? ????? ?? ??????????? ???????? ??????? ?? (??????? ????????) ????????????? ? ??????????????? ???????????; ? ? ??? ????? ????? ?????????
? ????????????????? ?????? ? ???????? ? ???????? ??????? ?? ? ??????? ??????????? ????; ??? ???????????????, ? ?????, ?????????? ? ???,
????????
? 5 (16,7%) ??????? ? ?? ???? ???????? ????????????????? ????? (???. 4, ?). ?????? ?????
???? ???????????? ???????? ????????????,
????? ??????? ?? ?????????? ?????, ??? ????????????? ??????????? ???????? ?????????? ????? ? ??????? ????? ? ??? ????? ?????????, ????? ????? ????????? ??????????? ??????? ????????? ???????? ?????. ?????????????????
????? ???? ???????????????? ? 4 ??????? ? ??????????????? ? 1 ????????, ?????? ? ?????? ??
??????????? ?????? ???? ??????? ?????? ? ????? ??????.
???????? ????????? ???????? ???????? ??????????? ???? ? ?????????? ???? ??, ??? ????????? ?? ???? ??????? ? ??????? ???????????????
?? ?? ???????? ????? ????? ??????????-????????? ???????? ? ????????? ????? ?? ?????
? ??????? ????????. ????? ??????????-????????? ???????? ???????? ?????????? ????? ? 1-?
?????????? ?????? ?????????? 21,1 ╠ 6,1 ??,
?? 2-? ? 24,6 ╠ 3,4 ??, ? 3-? ? 28,3 ╠ 2,2 ??, ???
?????????? ????????? ??????????????? ????????? ? ??????????? ?????? (??????????????
17,2 ╠ 3,6 ??, 23,0╠1,4 ??, 27,5╠2,1 ??). ?????
??????????-????????? ???????? ?????? ?????????? ????? ? 1-? ?????????? ?????? ??????????
20,6 ╠ 5,4 ??, ?? 2-? ? 21,4 ╠ 2,9 ??, ? 3-? ?
26,7 ╠ 2,0 ??, ? 1-? ? 3-? ??????? ??? ?????????
?????????? ????????? ??????, ?????????? ? ??????????? ?????? (?????????????? 16,2 ╠ 2,6 ??,
20,2 ╠ 1,2 ??, 21,6 ╠ 1,3 ??). ????? ???????, ? ?????? ????????? ????? ?? ????? ?????????? ????????? ??????????-????????? ???????? ????????
??????? ?? ? 1,1?1,2 ????, ? ??????????-????????? ???????? ?????? ??????? ? ? 1,2?1,3 ???? ??
????????? ? ?????????.
????? ????????? ??????????-????????? ???????? ???????? ? ?????????? ??????????? ???????????? ?????????? ??????? ?? ? ??????????????? ?? ? ??????? ?????? ??????????.
И╥ршй?блкб
? ?????????? ???????????? ???????????? ? ????????? ????? ?? ????? ???? ???? ??????????
????????? ? ????????? ?????????? ??????, ???????
??????? ? ??? ????????????? ????????. ?????? ????????? ??????? ???????? ??????????????? ??.
? ????????? ????? ?? ????? ?????? ????
? ??????? ?????????? ?????? (0?6 ???) ?????????
????????? ????????? ?? ??, ? ? ????? ???????
?????????? ??????? (7?12 ??? ? 12?36 ???) ? ???????? ????????? ?????????? ?? ?? ?? ?????????
? ?????????. ??? ????, ???? ??????? ???????????
???????????? ?????????? ??????? ?? ? 2,3?
2,4 ???? ????????? ??????? ?????????? ?????? ??
???? ??????? ????? ?? ?????, ??????? ?? ?? ????????? ????????????? ???????, ? ???? ???????????????? ????????????????? ??. ??-????????,
????? ??????? ?? ???????? ???????????? ????????????? ? ????????????? ?????????? ? ??????? ??
? ???? ??????? ????????????? ? ??????? ??????
??????????, ??? ????????? ? ???????????? ?? ??.
????? ????, ?????? ????????? ? ????????? ?????
?? ??????? ???????? ???????????? ???? ?? ?????
????????? ????????? ?????? ? ???????? ???????
???????.
? ????? ?????????????, ??????????? ?????,
? ????? ??????? ???????? ? ????? ???? ?????????? ????????????? ????????? ????? ??????? ??,
??????? ?????????? ?? ?????? ? ?????????,
?? ? ? ????????? ?????????? ????????? ?????
??????? ?? [14]. ? ???????????? ??????????
???????? ?? ???????? ????????? ?????? ?????????????????, ????????????? ? ?????????????
???????????? ???????????? ???????. ????? ????,
????????????????????? ??????? ?????? ? ???????????? ?????????? ???????? ?? ? ???? ????????? ?????????????? ?????????????????, ??????????????, ? ?????? ? ?????????????? ???????????????. ?????????? ??????? ???????????? ?????
35
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???????? ???????? ? ??????? ? ??????? ????????
???????????? ?? ??. ? ??? ?? ????????? ?????????? ???? ??????????? ???????????? ???? ?????
?? ?????. ? ????? ? ???? ? ????? ??????? ???????? ? ????? ??? ?????????? ????????- ? ?????????????? ???????????? ??????????? ?? ? ?????
???????????? ???????????? ???? ? ??????????
????? ??????????????? ?????????? ?????? ????
???? ?????????? ???????? ?????????? ?????????? ?????? ?? ???????? ?? ???????????????????? [15].
???? ???????????? ????????, ??? ?????????
??????????? ???????????? ????????? ???????????
?????????? ???????? ? ????? ????? ?? ????? ???????? ???????? ?????????? ??????? ??? ??????
???????? ??????????? ???? ?? ??????? ?????? ?????????. ????? ? ???? ????????? ????? ????? ????????? ??????????? ????, ??????????? ???????
?? ? ??????????? ???????. ??????? ??? ????????? ????? ?????????? ????????? ???????????
???????? ????????????? ???????? ? ??????? ????????????? ????????.
???????? ?????? ???? ??????? [4, 6, 16], ??? ???????? ?????? ????? ??????????? ??????? ? ????? ?????????? ??? ??????? ?????????? ????
? ????? ?????????? ??? ???????? ?????????? ????????????? ??????? ?? ???????? ??????? ?? ?????
???????? ?????? ???? ?????????? ?? ??????????? ?????????? ???? ????? ?????????? ???????????? ??? ?????????? ???????? ???? ????? ??????????? ??????? ? ??????? ?????? ?????????.
?? ?????? ?????? ???????, ??? ?????????? ???????????????????? ????????? ???? ?????????????
??????? ?? ?????????????? ????????? ? ? ??????????? ??????? ????????? ??? ?????????????? [7,
11, 17, 18].
??? ??????? ????????????????? ?? ??????????? ????????? ?????? ???????????? ?? ??????
??????????? ??????????? ????, ?? ? ???????????
????? ????????? ???? ? ????? ?????????, ????????? ??? ???? ? ???? ???? ??????? ???????????
???? ????? ???? ????-???????????? ????? ????????? ???? ? ??. ? ????? ??????? ?? ????????? ???????? ??????? ?? ???? ?????? ?? ? ???? ?????? ??
??????????? ??????? ??????????? ????????
??????? ?? [5, 8, 19], ? ?????? ??????????? ??????????? ???????????? ?????????? ?????, ? ??????? ???????? ??? ????? ?? ??????? ??????? [6, 10,
12, 17].
????? ???????, ???????? ???????? ?? ? ?????
????? ?? ????? ????????, ??? ??? ??????? ??????
?????????? ??????? ?????? ???????? ????????
??????? ?? ? ??? ????????????? ????????. ??? ??????????????? ???????????????????? ??????????
??????? ??????? ? ?????????? ????????? ??????????? ?????????? ??????????? ???? ?? ???????
? ????????? ?? ? ?????????? ?????? ? ?????? ?????? ?????????, ? ????? ?????????? ??????????
?????????? ????. ??? ????????????? ?????????36
?? ???????? ??????????? ?????????? ???????? ???????????? ????????????? ?? ????????? ??? ???????????? ?????????? ??????? ???????? ?? ????????? ??????.
??????????
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
??????? ?.?., ??????? ?.?., ?????? ?.?., ????????? ?.?.
??????????? ????????? ??????????-???????????? ???????? ?? ??????????? ???????????????? ????????????. ????????? ????? ??. ?.?. ????????. 2005; 6 (1):
5?25.
??????? ?.?., ????????? ?.?. ????????????? ????????
??????. ? 3 ?. ?.: ????? ?? ?.?. ???????? ????; 2006.
??????? ?.?., ????????? ?.?. ?????? ???????????? ??????????? ???????. ??????? ??????? ?????? ? ???????.
2010; 3: 70?80.
??????? ?.?. ???????? ??????????????????? ?????: ????????????? ????????, ??????????? ???????????? ? ?????????? ?????????: ???. ? ?-?? ???. ????. ?.; 2002.
Milano A., Codecasa R., De Carlo M., Nardi C., Tartarini G.,
Verunelli F., Bortolotti U. Mitral valve annuloplasty for degenerative disease: assessment of for different techniques.
J. Heart Valve Dis. 2000; 9 (3): 321?6.
??????? ?.?., ?????????? ?.?., ???????? ?.?. ?????????? ??????????????? ??????????? ???????. ?.: ???-??
????? ?? ?.?. ????????; 2003.
??????? ?.?., ?????? ?.?., ?????? ?.?., ??????? ?.?. ?????? ???????????????? ??????????? ?????????????? ??????????? ???????. ??????? ???????? ??. ?.?. ???????.
2009; 5: 9?12.
David T.E., Ivanov J., Armstrong S., Christie D., Rakowski N.
A comparison of outcomes of mitral valve repair for degenerative disease with posterior, anterior, and bileaflet prolapsed.
J. Thorac. Cardiovasc. Surg. 2005; 130: 242?9.
El-Najdawi E.K., Driscoll D.J., Puga F.J., Dearani J.A.,
Spotts B.E., Mahoney D.W., Danielson G.K. Operation for partial atrioventricular septal defects: a forty-year review.
J. Thorac. Cardiovasc. Surg. 2000; 119 (5): 880?90.
Rastelli G.C., Ongley H.A., McGoon D.C. Surgical repair of
complete atrioventricular canal with anterior common leaflet
undivided and unattached to ventricular septum. Mayo Clin.
Proc. 1969; 44: 335?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.
Ann. Thorac. Surg. 2008; 86: 147?52.
Kanani M., Tsang V., Cook A., Kostolny M. Re-repair of the left
atrioventricular valve in AV septal defects the morphologic
approach to the role of Gore?Tex band reduction annuloplasty. Eur. J. Cardiotorac. Surg. 2010; 37: 273?8.
Feringa H.H., Shaw L.J., Poldermans D., Hoeks S., van der
Wall E.E., Dion R.A., Bax J.J. Mitral valve repair and replacement in endocarditis: a systematic review of literature. Ann.
Thorac. Surg. 2007; 83: 564?70.
???????? ?.?., ??????????? ?.?., ??????? ?.?., ????? ?.?., ??? ?.?., ??????? ?.?. ???????-??????????????? ????????? ? ????????? ??????????? ??????? ? ?????
??????? ???????? ? ???????? ??????????????????? ???????. ??????? ????. 2012; 10: 18?28.
??? ?.?., ??????????? ?.?., ?????? ?.?., ?????????? ?.?.,
????????? ?.?., ?????????? ?.?. ???????????????? ?????????? ???????? ?????????? ?????? ??????????? ??????? ? ????? ??????? ???????? ? ??????????? ??????? ?? ???????????????????? (Gore-Tex). ?????? ????????. 2011;
2: 10?3.
Newcomb A.E., David T.E., Lad V.S., Bobiarski J., Armstrong S., Maganti M. Mitral valve repair for advanced myxomatous degeneration with posterior displacement of the mitral
annulus. J. Thorac. Cardiovasc. Surg. 2008; 136: 1503?9.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
17.
18.
19.
Flameng W., Meuris B., Herijgers P., Herregods M.C. Durability
of mitral valve repair in Barlow disease versus fibroelastic deficiency. J. Thorac. Cardiovasc. Surg. 2008; 135: 274?82.
Oppido G., Davies B., McMullan D.M., Cochrane A.D.,
Cheung M.M., d?Udekem Y., Brizard C.P. Surgical treatment of
congenital mitral valve disease: Mid-term results of a repairoriented policy. J. Thorac. Cardiovasc. Surg. 2008; 135:
1313?21.
Fornes P., Heudes D., Fuzellier J.F., Tixier D., Bruneval P.,
Carpentier A. Correlation between clinical and histologic patterns of degenerative mitral valve insufficiency: a histomorphometric study of 130 excised segment. Cardiovasc. Pathol.
1999; 8: 81?92.
9.
10.
11.
12.
References
1.
2.
3.
4.
5.
6.
7.
8.
Bockeria L.A., Makhachev O.A., Panova M.S., Losevskaya T.Yu. Standard parameters of atrioventricular valves
according to results of morfometric research. Bulleten?
Nauchnogo Tsentra Serdechno-Sosudistoy Khirurgii imeni
A.N. Bakuleva Rossiyskoy Akademii Meditsinskikh Nauk.
2005; 6 (1): 5?25 (in Russian).
Bockeria L.A., Berishvili I.I. Surgical heart morphology. In 3
vol. Moscow: Nauchnyy Tsentr Serdechno-Sosudistoy
Khirurgii imeni A.N. Bakuleva Rossiyskoy Akademii
Meditsinskikh Nauk; 2006; Vol. 2: 178?205 (in Russian).
Bockeria L.A., Berishvili I.I. Defects of mitral valve formation.
Detskie Bolezni Serdtsa i Sosudov. 2010; 3: 70?80 (in
Russian).
Khamidov A.V. Atrioventricular canal defect: Surgical morphology, particulars of hemodynamics and outcome of repair.
Dr. Med. Sci. Diss. Moscow; 2002 (in Russian).
Milano A., Codecasa R., De Carlo M., Nardi C., Tartarini G.,
Verunelli F., Bortolotti U. Mitral valve annuloplasty for degenerative disease: assessment of for different techniques.
J. Heart Valve Dis. 2000; 9 (3): 321?6.
Bockeria L.A., Kagramanov I.I., Bondarev Yu.I. Congenital
Mitral Insufficiency. Moscow: Nauchnyy Tsentr SerdechnoSosudistoy Khirurgii imeni A.N. Bakuleva Rossiyskoy
Akademii Meditsinskikh Nauk; 2003 (in Russian).
Eliseev L.E., Isakov S.V., Sukhova I.V., Gordeev M.L.
Immediate results analysis of mitral valve repair. Vestnik
Khirurgii imeni I.I. Grekova. 2009; 5: 9?12 (in Russian).
David T.E., Ivanov J., Armstrong S., Christie D., Rakowski N.
A comparison of outcomes of mitral valve repair for degenerative disease with posterior, anterior, and bileaflet prolapsed.
J. Thorac. Cardiovasc. Surg. 2005; 130: 242?9.
13.
14.
15.
16.
17.
18.
19.
El-Najdawi E.K., Driscoll D.J., Puga F.J., Dearani J.A.,
Spotts B.E., Mahoney D.W., Danielson G.K. Operation for partial atrioventricular septal defects: a forty-year review.
J. Thorac. Cardiovasc. Surg. 2000; 119 (5): 880?90.
Rastelli G.C., Ongley H.A., McGoon D.C. Surgical repair of
complete atrioventricular canal with anterior common leaflet
undivided and unattached to ventricular septum. Mayo Clin.
Proc. 1969; 44: 335?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.
Ann. Thorac. Surg. 2008; 86: 147?52.
Kanani M., Tsang V., Cook A., Kostolny M. Re-repair of the left
atrioventricular valve in AV septal defects the morphologic
approach to the role of Gore?Tex band reduction annuloplasty. Eur. J. Cardiotorac. Surg. 2010; 37: 273?8.
Feringa H.H., Shaw L.J., Poldermans D., Hoeks S., van der
Wall E.E., Dion R.A., Bax J.J. Mitral valve repair and replacement in endocarditis: a systematic review of literature. Ann.
Thorac. Surg. 2007; 83: 564?70.
Sukhachova T.V., Abduvokhidov B.U., Lashneva A.S.,
Serov R.A., Kim A.I., Bockeria L.A. Clinical-morphological
comparison of the pathology of mitral valve in infants with atrioventricular canal defect. Vestnik Rossiyskoy Akademii
Meditsinskikh Nauk. 2012; 10: 18?28 (in Russian).
Kim A.I., Abduvokhidov B.U., Rogova T.V., Zakharchenko A.G, Nikiforov V.S., Kharitonova S.S. Immediate results for
mitral valve annuloplasty with Teflon stripe (Gore-Tex) in
infants. Annaly Khirurgii. 2011; 2: 10?3 (in Russian).
Newcomb A.E., David T.E., Lad V.S., Bobiarski J., Armstrong S., Maganti M. Mitral valve repair for advanced myxomatous degeneration with posterior displacement of the mitral
annulus. J. Thorac. Cardiovasc. Surg. 2008; 136: 1503?9.
Flameng W., Meuris B., Herijgers P., Herregods M.C. Durability of mitral valve repair in Barlow disease versus fibroelastic
deficiency. J. Thorac. Cardiovasc. Surg. 2008; 135:
274?82.
Oppido G., Davies B., McMullan D.M., Cochrane A.D.,
Cheung M.M., d?Udekem Y., Brizard C.P. Surgical treatment of
congenital mitral valve disease: Mid-term results of a repairoriented policy. J. Thorac. Cardiovasc. Surg. 2008; 135:
1313?21.
Fornes P., Heudes D., Fuzellier J.F., Tixier D., Bruneval P.,
Carpentier A. Correlation between clinical and histologic patterns of degenerative mitral valve insufficiency: a histomorphometric study of 130 excised segment. Cardiovasc. Pathol.
1999; 8: 81?92.
????????? 19.09.2014 ?.
37
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
╘ ????????? ???????, 2014
??? 616.126.4-089:616.126.52-007.271-089
?????? ????????? ?????????? ??????????????
??????? ? ??????? ????? ????? ???????????
??????????? ????????? ?????? ?????????
???????????????????? ??????
?.?. ????????, ?.?. ???????, ?.?. ????????, ?.?. ??????
????? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ?
???????? ??? ? ???? ?.?. ???????); ?????????? ?????, 135, ??????, 121552,
?????????? ?????????
???????? ?????? ?????????, ?????? ???. ????, ?????????, ??. ?????. ????.;
??????? ??????? ??????????, ?????? ???. ????, ???. ?????. ????., e-mail: kovalevdv@mail.ru;
???????? ???? ??????????, ????. ???. ????, ??. ?????. ????.;
?????? ????? ????????????, ?????????
? ?????????? ????? (?? 1 ?? 13 ???) ????? ??????????? ????????? ?????? ????????? ???????????????????? ?????? (?????)
? 1?7% ????????? ??????????? ?????????? ????????? ?????? ?????? ?????????. ? ????????? ?????? ?????????? ???????? ????????? ?????????? ?????????????? ??????? ? ????????????? ??????????????? ??????????????? ??????????? ??????? ?
??????? ????? 12 ??? ????? ??????????? ????????? ?????. ???????? ????????????? ?????????? ??????? ???????????
??????????????? ??????????? ? ?????????? ? ????????????? ???????????? ???????? ??????? ??????????? ??????? ? ????????? ??????????? ???????.
???????? ?????: ????????????? ??????; ?????????? ????????? ?????? ?????? ?????????.
CASE OF SUCCESSFUL REMOVAL OF SUBAORTIC STENOSIS IN PATIENT
AFTER REPAIR OF COMMON ATRIOVENTRICULAR SEPTAL DEFECT
M.R. Chiaureli, D.V. Kovalev, A.A. Nezhlukto, A.V. Minaev
A.N. Bakoulev Scientific Center for Cardiovascular Surgery; Rublevskoe shosse, 135,
Moscow, 121552, Russian Federation
Chiaureli Mikhail Ramazovich, MD, DM, Professor, Chief Research Associate;
Kovalev Dmitriy Viktorovich, MD, DM, Leading Research Associate, e-mail: kovalevdv@mail.ru;
Nezhlukto ?nna ?rkad?evna, MD, PhD, Senior Research Associate;
Minaev ?nton Vladimirovich, Resident Physician
Despite of significant progress in immediate results of biventricular repair of common atrioventricular septal defect (CAVSD), some
patients develop late complications that require repeat surgical correction. Secondary subaortic stenosis during from 1 to 13 years
after complete repair of common atrioventricular septal defect rises up to 7%. In this paper the case of successful experience of the
subaortic stenosis incision with simultaneous supra-annular mitral valve replacement in 12 years after previous complete correction
of CAVSD is described. The hypertrophy of the interventricular septum and bulging of the mitral valve anterior leaflet in subaortic
space due to its abnormally chords attachment were the causes of subaortic obstruction in this case.
Key words: secondary subaortic stenosis; left ventricular outflow tract obstruction.
г?б?блкб
???? ??????????? ????????? ?????? ?????????
???????????????????? ?????? (?????) ??????????? ??? ????? 50 ???, ? ??? ??? ??? C.W. Lillehei
? 1955 ?. ??????? ???????? ???????? ????????.
? ????? ?????? ?????? ??????????? ????????? ?????? ???? ????????? ?.?. ??????????? ? 1961 ?.
??????, ???????? ?? ??????????? ?? ????????? ???? ?????? ? ??????? ??????? ??????, ? ??????????
????? ????????? ??? ??????????, ??????? ???????
????????? ????????????? ????????????. ????? ??
????? ?????????? ???????? ???????? ??????????38
???? ???????, ??????? ??????????? ? 1?7% ????????? ????? ??????????? ????????? ? ????? ?? 1 ??
13 ??? [1?5].
???? ??????? ????????? ? ??????????? ??????
????????? ?????????? ?????????????? ???????
? ????????????? ??????????????? ??????????????? ??????????? ??????? ? ??????? ????? ?????
??????????? ??????????? ????????? ?????.
Иткр?лкб рнш???
? ? ? ? ? ? ? , 13 ???, ????????? ? ????????? ? ???????? ?? ????????????, ???????? ?????????????
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??????? ??????? ?????? ? ???????, ? 4, 2014
? ?????????? ????????. ??????????? ?????? ?????
??????? ???? ????????? ??????????? ?????????
????? (??? ?) ????????????? ???????. ??? ??????? ????? ???????? ?????????? ??????????? ??????????????? ?? ?????????????? ??????????
? ??????????????? ????????, ???????? ?????????????? ???????? (???) ????? ????? ??????????
(??) ? ?????? ????????????.
??? ??????????? ???? ??????? ???????? 159 ??,
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??????????????, ????????? ?????? ? 19?20 ??, ???????????? II ???????. ???????? ????? ?????? ????????? (????) ????? ?? ???? ??????????????????
??????????????? ??????????? (???), ????????
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???????????????????? ???????? ???????? ??????? ?? (???. 1, ?). ???????? ??????? ?? ?????????,
????????, ?????????? ? ????????, ??????? ?????????? ?????? ??? ????? 30 ??, ???????????? ??????????????? II ??. ??????? ???????????????? ??????? ?????? ?????????, ????????? ?????? ? 35 ??,
???????????? I ??. ??????? ??????? ?? 70%.
?? ?????? ????????????????? (???) ? ?????????????? ???????? ?????? ???? ???????? ?????????? ?????????? ????, ???????? ?????????????? ???????? ????? ?? ? ?????? ????????
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? ????? ? 100 ?? ??. ??. (???. 1, ?).
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?????????? (26 ╟C) ? ???????????????? ???????????? (128 ???).
????? ?????????? ???????????? ?????????????? ???????? ??????? ?????????? ?????. ? ????????????? ???????????? ????????? ????????????? ??????, ???????????? ??????????????????
??? ? ?????????? ? ????????????? ????????????
???????? ???????? ?? ? ????????? ???????????
? ??? ?????????? ? ?????????? ??????? ?? ???????? ??????? (???. 2, ?). ??????????? ?????????? ?? Morrow. ???????? ?? ?? ??? ? ???? ?? ??????????????? ?????? ???????? ???????? ???
? 17, ???? ?????, ??? ???????? ??????????? ????????? ?? ?? ? ????? ??????? ???????? ??????? ??
? ????????????? ???????????. ?????? ? ?? ????????????? ????? ?????????????? ???????????,
??????? ???? ????????? ???????. ??? ??????? ??
??????? ??? ?????????? ?????? ???????? 30?32 ??,
??????? ???????? ????????, ?????????, ?????????? ?????????? ???????? ??????? (???. 2, ?).
? ????? ? ???, ??? ????????? ????????? ????????????? ?????????? ??? ?????????? ??????? ??
? ???????????? ???????? ?? ?????????????? ?????????, ???? ??????? ??????? ? ??? ??????????????. ??????? ? ??????????????? ?????????????? ???? ??????????? ???, ??? ??? ?????????????
??????? ? ??????? ????????? ?????????? ??????
?? ??????? ? ???????? ??????? ??????????? ??????? ???? ?? 2/3 ??? ????????. ??????? ?? ???
????????? ??????? ? ??????????? ??????????????? ??? ???????????? ???????? ╚Carbomedics╩
? 25 ?? 14 ?-???????? ????, 5 ?? ??????? ??
?????????? ????????? ????? ?????????????? ???????????, ????? ???? ? ???? ???????? ????????
??? ? 20 (???. 2, ?). ? ?????? ??????????????
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? ? ??????????????? ? ???????? ??????? ???, ????????? ??????? ????????????? ?????????? ?? ???? ?????????????????? ??? ? ???????????
????????? ??????????? ???????? ??????? ??; ? ? ????? ????????????????, ??????????????? ??????? ╚??????? ???╩, ????????? ??????? ?????????? ??????? ?????? ?? ?? ? ?????.
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? ? ?????????????? ??: ???????? ??????? ??????????? ???????? ?????????? ???????, ??????????, ?????????? ?????, ????????? ??????????
? ????; ? ? ???????? ??????? ?? ? ??????? ????? ?? ?????????; ? ? ??????????????? ??????????? ??????????????? ?????????????? ??, ???????? ?????? ???????????? ?????? ? ??? ? ???????????, ?????????? ?? ??????? ?????????????? ???????????. ??? ?????? ???????? ????????? ????? ?????? ????? ? ????
?????? ????????????????? ?????? ????????
??? ??????????. ???????????? ????????????? ?????????? ?????? ????????? 9 ?, ?????????? ? ????????? ??????????? ??????? ? 19 ?. ????????? ???????? ????????? ? ???? 3 ???/??/??? ? ???? ???????? ? ?????????????????? ????????? ?? 12-? ?????
????? ????????. ???? ?????? ??? ??????? ? ????????? ? ??? 80 ??/???. ?? ?????? ??????????????? ??????? ???????? ?? ??????? ?? ????????
8,5 ?? ??. ??., ??????? ? 4,2 ?? ??. ??., ??? ?????
?? ? ?????? ???????? 10 ?? ??. ??., ??????? ??????? ?? ? 62%.
И╥ршй?блкб
????????????? ?????????? ????? ?????????
???????? ??????????????????? ????????????
? ?????????? ????????? ??????? ?????????? ?????: ?? ????????? ??????????? ??????? ?????????
? ?????????????, ??????? ???????? ? ????????
?????? ?????? [1, 3, 6?8]. ??????????? ??? ???????
?????? ???????? ????????? ????????? ?? ?????????? ??????????? ???????? ????? ?????????? ?????? ??? ??? ???? ?????? ???? ? ???????????
???????????? ????? ????? ???????? ????? ??????? ? ?????????? ???? ?????? ???. ????? ???????????? ????? ????????? ? ??????? ???????? ?????,
? ????? ????? ??????????? ?????, ???????? ??????
?????????? ???????, ???????? ?????????-?????????? ??????? [6, 8]. ??????????? ????? ????????
??????? ????, ??? ?????? ??????????????? ???
????? ???????????????? ? ???? ??? ?????????? ╚??????? ???╩.
???????? ??????? ????????? ??????????????
??????? ? ?????????? ????? ???????? ???????????????? ????????, ??????????? ???, ?????????
?????????? ?????? ?????? ????????????????????
???????, ???????? ?????????-???????????? ????40
????. ??? ???????, ? ???????? ??????????? ????????? ????????? ????????? ??????. ???????????
???????? ?????????????? ??????? ????? ??????????? ????????? ?????? ????, ???? ?????????? ?????????? ??????? ?? ?????? ??????????, ?? ? ????????? ??????? ???, ? ??????????? ??, ?????????? ????????? ????? ??????????? ????
? ???????? ??????? ????? ????????? ????????????
????? ?????. ??? ????? ???????? ????????-???????? ????????, ??????? ???????? ???????? ?????? ???????????????? ???????? ??????????, ??????????? ??? ????????? ????????? ? ??????? ?????????? ?????????????? ? ???? [1, 2, 4, 5].
????????????? ????????? ?????????????? ???????, ???????????? ????? ??????????? ?????????
? ?????????? ?????, ??????? ?? ???? ? ????? ??????????. ??? ????????? ???? ??????? ?????? ???????? ????????? ????????????? ???????? ? ????????? ? ????????? Morrow, ???????, ?? ?????? ????
???????, ????????? ???? ???????? ????????? [9].
?????? ????? ?????? ?????????????? ??????, ??????????? ?? ??, ??? ??????????????? ???????? ????????-???????? ?????? ???????? ?????????????,
????????? ?? ????????? ????????? ????????????
?????????. ??????? ?????? ????? ????? ?????????????? ????????? ??????????, ??? ???????????
????????? ????????? ????????-???????? ??????????? [2]. ???? ?? ????????? ????????????? ??????? ? ?????? ????????????? ?????? ?????????????? ??????? ? ??? ???????? ╚???????????╩ ??????? ??????? ?????? ???????????????????? ???????
[10]. ???????? ??????????? ? ????????? ?? ?????????? ?????? ?????????????? ????? ??????????? ????????? ???????? ??????? ??????????? ?????????? ??????? ? ?????????? ?? ?? ???? ????????
? ?????? ??????????????? ???????. ??? ?????????? ????????? ????????????? ???????? ? ?????????? ?????????? ???? ? ??????????? ???? ? ???
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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????????????? ????????? ?????????????? ??????
???????????????????? ??????? [1]. ?????? ???????
????????, ??? ?????????????? ??????????? ?????????? ??? ???? ????? ???????????. ?????????,
? ??????? ??????????? ??????, ????? ???? ????
????????? ? ??????? ???, ? ?????? ??????? ???
???? ????? ????????? ? ??????? ?????? ?? ??, ??????? ???. ???????, ???? ???????????????? ???????
??????? ????? ????????? ?? ????????? ??????,
?? ?????????? ??? ? ????? ???????? ????????????? ??????????? ?? ?????????????? ???????????,
???????? ??????????? ?????? ??????????? ????????????? ? ??????????????? ???????.
???????????? ?????? ?????? ??????? ????????? ?????? ????????????? ?????????? ? ??????????? ??? ? ?????????? ???????? ??????? ??
? ????????????? ???????????? ? ????????? ??????????? ???????. ????????????? ???????? ???????????????? ?????????????? ?? ????????? ????????? ????????? ????????????? ?????? ?, ????????? ??? ????????, ??????? ???? ?????????
? ?????????? ???????.
??????????
1.
2.
3.
4.
5.
6.
7.
Van Arsdell G.S., Williams W.G., Boutin Ch., Trusler G.A.,
Coles J.G., Rebeyka I.M. et al. Subaortic stenosis in the spectrum of atrioventricular septal defects. Solution may be complex
and palliative. J. Thorac. Cardiovasc. Surg. 1995; 5: 1534?42.
Gurbuz A.T., Novick W.M., Pierce C.A., Watson D.C. Left ventricular outflowtract obstruction after partial atrioventricular
septal defect repair. Ann. Thorac. Surg. 1999; 5: 1723?66.
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: 1352?59.
Myers P.O., Del Nido P.J., Marx G.R., Emani S., Mayer J.,
Pigula F.A. et al. Improving left ventricular outflow tract
obstruction repair in common atrioventricular canal defects.
Ann. Thorac. Surg. 2012; 94: 599?605.
Tlaskal T., Gebauer R., Gilik J., Tomek V. Experience with the
surgical treatment of atrioventricular septal defect with left
ventricular outflow tract obstruction. Interact. Cardiovasc.
Thorac. Surg. 2014; 6: 789?96.
??????????? ?.?., ??????? ?.?. ??????????? ?? ????????-?????????? ????????. ?.: ????????; 1989.
Ebels T., Ho S.Y., Anderson R.H., Meijboom E.J., Eijgelaar A.
The surgical anatomy of the left ventricular out_ow tract in atrioventricular septal defect. Ann. Thorac. Surg. 1986; 41:
483?8.
8.
9.
10.
Chung-I-Chang, Becker A.I. Surgical anatjmy of left ventricular
outflow tract obstruction in complete atrioventricular septal
defect. J. Thorac. Cardiovasc. Surg. 1987; 94: 897?903.
????????? ?.?., ?????? ???, ????? ?.?., ?????????? ?.?.,
???????? ?.?., ?????? ?.?. ????????? ???????? ? ????????????? ??????? ?????????????? ???????, ????????????
????? ????? ??????????? ??????????? ????????? ????????? ?????????? ??????? ??????. ??????? ? ????????-?????????? ????????. 2001; 4: 71?3.
Mace L., Dervanian P., Folliguet T., Grinda J.M., Losay J.,
Neveux J.Y. et al. Atrioventricular septal defect with native
subaortic stenosis: Correction by extended valvular detachment. J. Thorac. Cardiovasc. Surg. 1994; 3: 943?5.
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Van Arsdell G.S., Williams W.G., Boutin Ch., Trusler G.A.,
Coles J.G., Rebeyka I.M. et al. Subaortic stenosis in the spectrum of atrioventricular septal defects. Solution may be complex and palliative. J. Thorac. Cardiovasc. Surg. 1995; 5:
1534?42.
Gurbuz A.T., Novick W.M., Pierce C.A., Watson D.C. Left ventricular outflowtract obstruction after partial atrioventricular
septal defect repair. Ann. Thorac. Surg. 1999; 5: 1723?66.
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: 1352?59.
Myers P.O., Del Nido P.J., Marx G.R., Emani S., Mayer J.,
Pigula F.A. et al. Improving left ventricular outflow tract
obstruction repair in common atrioventricular canal defects.
Ann. Thorac. Surg. 2012; 94: 599?605.
Tlaskal T., Gebauer R., Gilik J., Tomek V. Experience with the
surgical treatment of atrioventricular septal defect with left
ventricular outflow tract obstruction. Interact. Cardiovasc.
Thorac. Surg. 2014; 6: 789?96.
Burakovskiy V.I., Bockeria L.A. Cardiovascular Surgery.
Moscow; 1996 (in Russian).
Ebels T., Ho S.Y., Anderson R.H., Meijboom E.J., Eijgelaar A.
The surgical anatomy of the left ventricular out_ow tract in atrioventricular septal defect. Ann. Thorac. Surg. 1986; 41:
483?8.
Chung-I-Chang, Becker A.I. Surgical anatjmy of left ventricular
outflow tract obstruction in complete atrioventricular septal
defect. J. Thorac. Cardiovasc. Surg. 1987; 94: 897?903.
Podzolkov V.P., Khassan Ali, Cheban V.N., Bondarenko I.E.,
Dekhkanov O.Kh., Drobot D.B. Mechanisms of development
and surgical treatment of subaortic stenosis that developed
after previously performed some correction of congenital heart
defects. Grudnaya i Serdechno-Sosudistaya Khirurgiya.
2001; 4: 71?3 (in Russian).
Mace L., Dervanian P., Folliguet T., Grinda J.M., Losay J.,
Neveux J.Y. et al. Atrioventricular septal defect with native
subaortic stenosis: Correction by extended valvular detachment. J. Thorac. Cardiovasc. Surg. 1994; 3: 943?5.
????????? 28.07.2014 ?.
41
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
╘ ????????? ???????, 2014
??? 616.132.2-007.253-053.3
??????? ????????????????? ??????? ? ??????? ?????
?.?. ???????????, ?.?. ?????????, ?.?. ?????????, ?.?. ????????
????? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ?
???????? ??? ? ???? ?.?. ???????); ?????????? ?????, 135, ??????, 121552,
?????????? ?????????
??????????? ????? ???????, ???????? ???. ????, ??????? ?????. ????.,
e-mail: jatropha@mail.ru;
????????? ????? ????????, ?????? ???. ????, ??. ?????. ????.;
????????? ???????? ??????????, ?????? ???. ????, ?????????, ?????????? ???????;
???????? ?????? ??????????, ????. ???. ????, ??. ?????. ????., ?. ?. ??????????? ??????????
????????????????? ??????? ???????? ?????? ?????????? ???????? ?????????? ???????. ??? ????? ???????? ?? ?????, ?????????? ???????, ???????? ??????? ? ????????????? ? ?????? ?????? ?????? ??? ????????????? ?????? ??????. ?? ???????????? ??? ?????? ??????????? ? ????????? ??????? ????????????????? ?????? ? ????????? 5 ? 9 ???.
???????? ?????: ????????????????? ???????; ?????????? ???????????? ???????; ????????? ?????? ??????????; ???????????????; ???????????? ??????????; ???????????.
MAJOR CONGENITAL CORONARY CARDIAC FISTULAS IN INFANCY
I.Yu. Baryshnikova, D.O. Berishvili, V.N. Makarenko, I.E. Nefedova
A.N. Bakoulev Scientific Center for Cardiovascular Surgery; Rublevskoe shosse, 135, Moscow,
121552, Russian Federation
Baryshnikova Irina Yur?evna, MD, PhD, Junior Research Associate, e-mail: jatropha@mail.ru;
Berishvili David Olegovich, MD, DM, Chief Research Associate;
Makarenko Vladimir Nikolaevich, MD, DM, Professor, Chief of Department;
Nefedova Inessa Evgen?evna, MD, PhD, Senior Research Associate, Acting Chief of Department
Coronary cardiac fistulas are a rare pathology of coronary arteries. They may originate from the aorta, coronary arteries, pulmonary
artery and drained into the various chambers of the heart or great vessels of the heart. We present two cases of diagnosis and successful treatment of coronary cardiac fistulas in patients 5 and 9 months years old.
Key words: coronary cardiac fistulas; coronary artery fistula; aneurysm of sinus of Valsalva; echocardiography; computed tomography; angiography.
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??????? ????? ??????????????? ???????? ??? ?????????? ???????????????. ? ??????????? ???????
??????? ??????????? ??????????????, ????????
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????????, ????????????????? ?????? (???) 0,59.
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???? ?????? ??????????; ?, ? ? ???????????? ??????????: ? ? ?????????? ????????????? ??????; ? ? ???????? ???????????? ?????????????
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???????? ??? ??????????. ??????? ??? ???????
????? ?? 10-? ???? ????? ????????.
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??????????? ??????????? ?????????? ???????????? ??????? ??? ?????? ? ???????????????
????????? ????????. ????????? ???????? ? ??????? ???????? ???? ???????????, ? ?????? ???????,
??????? ???????? ?????? ? ?????????? ??????????????? ? ??????????? ??????? ???????????. ????? ??????? ????????? ? ??????????? ?????? ???-
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????? ????????? ??????????????? ???????, ????????? ?? ????? ???????? ??????? ? ???????????????
????? ????????????.
??????? ????????????? ? ????????? ?? ?????????????????????? ? ???????????????????? ???????????? ?????????? 0,1?0,8% [1, 3, 4]. ???????
???????? ?????????????? ??????, ?????? ??? ????? ???????? ??????? ????? ????????? ????????????. ????????????? ??? ?????????? 14% ?????
?????????? ???????? ?????????? ???????, ? 0,4%
????? ???? ?????????? ??????? ??????. ????????
????? ?????????? ? ???????? ?????, ???????? ???????? ??????? ? ????, ???????? ????????????
????????, ???? ?/??? ????, ???????? ????????
??????? [5, 6].
???????? ????? ??????????? ??????? ??????
?? (60%), ????????? ????? ?????????? ???????
?????????? ????? 5% ?????????? [4?6]. ? 92% ??????? ?????????-????????? ??????? ??????????
? ?????? ??????????, ?????? ??????????? ??? ???????? ???????? ? ????? ?????????? ? ?????????? ???????, ????? ??????????, ????? ???????????, ???????? ????? ??? ??????? ????? ????? [6].
?????? ????????? ??????? ????? ??? ? ???????
?????? ???????? ????? ?????? ??????????? ? ?????????? ?????????????? ??? ?????? ????? [5, 7].
??????? ??? ?????? ??????? ?? ??????????
??????. ????????????? ??????? ???, ?????????
? ????? ?????? ??????, ??????? ???? ???????
D.T. Arani ? 1978 ?. [3]. ?????????? ???????????????? ?????????? ????????? ?????? ??? ? ?????
??????????? ?? ??????? ?????? ??????????? ??????
??????????, ??? ??? ?????? ????????? ????? ?????
???? ??????? ??????? [5, 7]. ??? ???????, ??????????? ??? ??????????? ? ???? ?????? ?????, ??????
????????????? ?????? ??????????? ????? ? ?????????? ??? ?????????? ?????????, ???????? ???
??????? ???????? ??????? ? ????????? ??????????????? ????????????.
?????????????? ?????????? ????????????????? ?????? ???????? ??????? ?? ?????? ???????
[6, 8, 9]. ??????????? ?????????? ??????? ??? ???
???? ??????? ?????? ?????????? ??????????? ??????? ??????, ????? ? ????????? ??????? ????? ??????????? ???????? ???????????? ??????????? ?????????. ??????? ?????????? ??????, ???????? ???????????????-????????????, ????? ????????
? ???????? ???????? ???????????? ???????????.
??? ?? ????? ??? ???????????? ?????? ? ????????????? ???????? ????????????, ?????????? ????????????????? ???????????????-???????????? ????????, ???? ????????? ????????????. ???????
????????????????? ????????? ?????????? ????????? ??? ?????????? ???????????? ?? ??????
??? ??????????, ??? ? ????????????? ???????
??????. ?????? ??????????? ???????? ?? ??????
??????????????? ????????????, ?? ? ??????? ???????. ??????? ?????????? ??????? ????? ????
??????????? ??? ??????????????. ?????????
?????????? ???, ?? ???? ?????????, ???????? ???????????? ?????????????? ???????????, ????????????? ?????? ???????? ???????????? [3, 5].
? ????????? ????? ???? ???????? ??????????
??????? ????????????? ????????????? ???. ????????, ??? ??? ??????? ? ??????????? ??????????????? ??????? ???????. ????????????? ??? ????
???????? ????? ?????????? ?????????? ?????????????, ?????????????????? ???????, ??????????? ??????????????????, ??????????? ????????????, ?????????????? ??????????? ???????, ?????????? ??? ??????? ???????? ????????. ?????
????????????? ??? ????? ????????? ? ??????????
??????????, ?????????????, ??????, ????????????
?????????? ??????????? [4]. ????????????? ?????? ?????????? ??????? ?????????? ?? ????????????? ???????? ?????? ? ???????, ? ???????
??????????? ??????? [4, 6].
??????????? ???????? ???????????? ??????????? ???????????? ?????????? ? ????????????????? ??????? ???? ????????????????? ? ???????????? ???????? ?????? ? ???????. ????????????????? ?????????? ???????????? ?????????? (????)
?????????? ??????? ???????? ???????????? ?????
??????? ????????????, ??????? ???? ??????? ?????????????? ??? ???????????? ???????????? ?????????? ??????? ? 2000 ?. [10, 11]. ? ??????????
???? ?????? ???????? ????????? ?????????????
??????????? ???? ??????????. ???-????????????? ????????? ???????????????? ?????????????????? ???????????, ???????? ???? ?????????? ?????, ?? ???? ????? ????????????? ?????? ??????,
?????????? ??????? ? ?????????? ????. ?????????, ?? ???????????? ??????????? ??? ????
? ?????? ?????????? ??????? ? ????? ??????? ????
????? ???????? ????? ?????? ??????? (?????
2 ??), ??????? ???????????? ????? ?????? [11].
???????? ?????? ??????? ????????????? ????????????? ????????? ???????-????????????????????? ???????????? ? ???? ? ????????????????? ??????? ??? ???????????? ??????? ???????????? ? ??????????? ? ???????? ????????????????
??????? ? ????????? ????????? ???????? ?????????? ???????. ?????????? ?????? ????????? ?????????? ????????????? ??????????? ????? ???????
???????????.
??????????
1.
2.
3.
4.
Fernandes E.D., Kadivar H., Hallman G.L., Reul G.J., Ott D.A.,
Cooley D.A. Congenital malformations of the coronary arteries: the Texas Haert Institute experience. Ann. Thorac. Surg.
1992; 54: 732?40.
Krause W. эber den Ursprung einer akzessorischen a. coronaria aus a. pulmonalis. Z. Ratl. Med. 1865; 24: 225?7.
Arani D.T., Greene D.G., Klocke F.J. Coronary artery fistulas
emptying into left heart chambers. Am. Heart J. 1978; 96:
438?43.
Carrel T., Tkebuchava T., Jenni R., Arbenz U., Turina M.
Congenital coronary fistulas in children and adults: diagnosis,
surgical technique and results. J. Cardiovasc. Surg. 1996; 37:
29?34.
45
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
5.
6.
7.
8.
9.
10.
11.
????????? ?.?., ?????? ?.?., ??????? ?.?., ????????? ?.?., ???????? ?.?., ?????? ?.?., ????????? ?.?.
?????????? ????????????????? ???????: ???????,
??????????? ? ?????????? ?????????????? ???????. ??????? ? ????????-?????????? ????????. 2001; 3: 30?4.
Latson L. Coronary artery fistulas: how to manage them.
Cathet. Cardiovasc. Interv. 2007; 70: 110?6.
Gowda R., Vasavada B., Khan I. Coronary artery fistulas: clinical and therapeutic considerations. Int. J. Cardiol. 2006; 107:
7?10.
Cheng T. Left coronary artery-to-left ventricular fistula:
demonstration of coronary steal phenomenon. Am. Heart J.
1982; 104: 870?2.
Douglas C., Masauki H., White H. Cardioaortic fistulas and
aneurisms of sinus Valsalva in infancy: a report of an aortic-left
atrial communication indistinguishable from a ruptured
aneurysm of the aortic sinus. Pediatrics. 1961; 27: 415.
Early S.A., Meany T.B., Fenlon H.M., Hurley J. Coronary
artery fistula; coronary computed topography ? the diagnostic
modality of choice. J. Cardiothorac. Surg. 2008; 3: 41.
Schroeder S., Achenbach S., Bengel F., Burgstahler C.,
Cademartiri F., de Feyter P. et al. Cardiac Computed tomography: indications, applications, limitations and training requirements. Eur. Heart J. 2008, 29: 531?56.
2.
3.
4.
5.
6.
7.
8.
9.
10.
References
1.
Fernandes E.D., Kadivar H., Hallman G.L., Reul G.J., Ott D.A.,
Cooley D.A. Congenital malformations of the coronary arteries: the Texas Haert Institute experience. Ann. Thorac. Surg.
1992; 54: 732?40.
11.
Krause W. эber den Ursprung einer akzessorischen a. coronaria aus a. pulmonalis. Z. Ratl. Med. 1865; 24: 225?7.
Arani D.T., Greene D.G., Klocke F.J. Coronary artery fistulas
emptying into left heart chambers. Am. Heart J. 1978; 96:
438?43.
Carrel T., Tkebuchava T., Jenni R., Arbenz U., Turina M. Congenital coronary fistulas in children and adults: diagnosis, surgical technique and results. J. Cardiovasc. Surg. 1996; 37: 29?34.
Podzolkov V.P., Alekyan B.G., Gadzhiev A.A., Alidarova S.M.,
Kardenas I.E., Zotova L.M., Alekseeva M.A. Congenital coronary artery fistulas: clinics, diagnosis and outcome. Grudnaya
i Serdechno-Sosudistaya khirurgiya. 2001; 3: 30?4 (in Russian).
Latson L. Coronary artery fistulas: how to manage them.
Cathet. Cardiovasc. Interv. 2007; 70: 110?6.
Gowda R., Vasavada B., Khan I. Coronary artery fistulas: clinical and therapeutic considerations. Int. J. Cardiol. 2006; 107:
7?10.
Cheng T. Left coronary artery-to-left ventricular fistula:
demonstration of coronary steal phenomenon. Am. Heart J.
1982; 104: 870?2.
Douglas C., Masauki H., White H. Cardioaortic fistulas and
aneurisms of sinus Valsalva in infancy: a report of an aortic-left
atrial communication indistinguishable from a ruptured
aneurysm of the aortic sinus. Pediatrics. 1961; 27: 415.
Early S.A., Meany T.B., Fenlon H.M., Hurley J. Coronary
artery fistula; coronary computed topography ? the diagnostic
modality of choice. J. Cardiothorac. Surg. 2008; 3: 41.
Schroeder S., Achenbach S., Bengel F., Burgstahler C.,
Cademartiri F., de Feyter P. et al. Cardiac Computed tomography: indications, applications, limitations and training requirements. Eur. Heart J. 2008, 29: 531?56.
????????? 27.07.2014 ?.
╘ ????????? ???????, 2014
??? 616.141-007.271-053.1-053.3-07
?????? ??????????? ?????????? ????????
???????? ??? ? ??????? ? ???????? 2,5 ???????
?.?. ????????, ?.?. ?????????, ?.?. ?????, ?.?. ????????
????? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ?
???????? ??? ? ???? ?.?. ???????); ?????????? ?????, 135, ??????, 121552,
?????????? ?????????
???????? ?????? ??????????, ????. ???. ????, ??????????? ???????????? ?????????;
????????? ???????? ????????????, ?????. ????., ????;
????? ????? ?????????, ?????? ???. ????, ?????????, ?????????? ???????;
???????? ????? ??????????????, ????????, e-mail: dasha_ivashenko@mail.ru
?????? ?????? ???????? ????????? ??????? ?????? ??????????? ??????? ???????? ??? c ???????? ???????????? ? ???????
? ???????? 2,5 ???, ???????? ? ????????? ?????????? ?? 4-? ????? ????? ?????????????? ??? ????????, ??????????? ? ?????
?????????? ???????????? ???????????? ????????? ??????? ??????? ? ??????? ????????.
???????? ?????: ??????????? ?????????? ????? ??????; ??????????? ??????? ??? ???????? ???????? ??? ? ????????
???????????.
46
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
A CASE OF DIAGNOSTICS OF CONGENITAL PULMONARY VEIN STENOSIS
IN A 2,5-MONTH-OLD CHILD
I.E. Nefedova, G.S. Netalieva, R.A. Serov, D.K. Ivaschenko
A.N. Bakoulev Scientific Center for Cardiovascular Surgery; Rublevskoe shosse, 135, Moscow,
121552, Russian Federation
Nefedova Inessa Evgen?evna, MD, PhD, Deputy Chief of Department;
Netalieva Gul?nara Saypollaevna, Research Associate, Physician;
Serov Roman Andreevich, MD, DM, Professor, Chief of Department;
Ivaschenko Dar?ya Konstantinovna, Postgraduate, e-mail: dasha_ivashenko@mail.ru
This article is a description of a rare case of congenital stenosis of the pulmonary veins and pulmonary hypertension in 2,5-monthold child, who died in the intensive care department on the 4th day of hospitalization without surgery, which is published in order to
develop recommendations regarding a possible treatment strategy in this difficult situation.
Key words: critical congenital heart disease; operational approaches in case of pulmonary vein stenosis and pulmonary hypertension.
г?б?блкб
?????? ????????? ? ?????????? ??????? ???????? ??? ??????????? R. Reje ? ??????????
1951 ?. [???. ?? 1]. ?????? ????????? ? ? ???? ???
????????? ????? ?? ???????? ?????? ???????????
???????. ??? ???????? ?????????? 0,04% ?? ?????? ????? ???. ????????????????? ????? ???????
????????? ?? 5 ??? ?? 10 ???, 2-?????? ???????????? ?????????? 43% [2?4]. ???? ?? ???????????
?????????????? ?????, ??????? ???????? ???
??????????? ? ??????? ???????? ?? 2?3 ???? ? ???.
??????? ??????? ??????????? ?????? ??????????????? ? ??????? ??? ?? ??????? ???????????? ???????, ??? ? ?? ?????????? ?????????? ???. ???,
?? ?????? J.P. Breinholt ? ?????., ?????????? ? ????????? ?? ????????? 3?4 ???????? ??? ???? ??
83% ?? ????????? ? ??????????, ? ??????? ?????? 1?2 ???? [3]. ???? ????????, ??? ???????????
????????? ??????? ? ?????? ???????? ???? ??? ??????? ??????? ???? ????? ???????? ???? ? ?????????? ?????? ????????? ? ????????? ??????????????? [1]. ?????? ?????????? ? ???????? ???????????
??????????? E. Romberg, C. Aust (1891 ?.), ??????? ????????????, ??? ????????? ?????????????? ????????? ?????? ??????? ?????? ??????? ???????? ???????? ????????? ??????????????? ? ???????????? ??? ???????? [???. ?? 1]. ????????????
???? ???????? ??? ????? ??????? ??????????? ?
?????????? (?????????) ? ????????????? ????????
???????????. ??????? ????????????? ?????? ????????? ?? ????? 1%, ? ??????? ?????? ??????????????? [1]. ???????? ?????????, ???????? ? ????????????????? ???????? ??? ? ???????? ????????????, ????????? ???? ?????? ???????????? ???????
??? ?????? ????????????? ?????.
Иткр?лкб рнш???
? ? ? ? ? ? ? , 2,5 ???, ??? 3,3 ??, ???? 49 ??, ???????? ? ??????? ? ?????? ??????? ?????????: ???????, ??????????? ? ????????? ???????????????, ??-
??????? ?? 38,8 ╟?. ?????? ??????? ?????????
(? ???????? ???????? ??????? ??????????????
???????, ?????????? ?????????????? ?????).
?? ???????? ????????, ??? ?? 5-? ????? ????? ? ??????? ???????? ?????? ?????? ????????? ???????,
???????????????? ?????????? ????????.
?? ?????? ??????????????? ?????? ??????
?????? ????? ?????????, ????? ? ? ???????? ?????. ???????? ???????? ???? 4 ??, ????? ????? ???????. ?????? ?????? ????????????? ???????? ???
? ?????????? ???????? 24 ?? ??. ??., ?????? ?????
???????????? ???????? ??? ? ?????????? 20 ?? ??. ??.
????? ???????? ??????? ????? ????????, ????????
? ??? ?????????? 40 ?? ??. ??., ???????? ? ??????
????????? 48 ?? ??. ??.
??????? ? ????????? ????????? ?? ????????????? ?????????? ??????, ?????? ??????????, ?????????????, ????????????????? ? ??????????????????? ???????, ???????, ???????? ?????.
??? ?????????? ???????????? ???????? ??????
? ?????????????????? ??????? ???????????.
???? ????????? ???????????????? ???????????? ?????????? ? ????????????????? (???. 1):
??????? ??????????? ???????/??????????? ??????????? ???????? ??? ? ????? ??????, ???????? ???????? ????, ?????? ???????????????
???????????, ?????????? ???????? ?????????
??????? ??????????????? ? ?????? ????? ? ????? ?????? ? ?????????? ?????? ? ??????????????
?????????.
?? ????? ?????????? ???? ???????????????
???????? ????????? ??????? ?????????? ??????
???????: ???????? ?????????, ??????????? ??????????????? ? ?????????????? ???????????? ??????????????? ? ???????? ?????????? ??????????????? ??????, ??? ?? ????????? ??????????? ?????-???? ??????? ?????????????? ?????????????
? ????????? ???????? ?????????? ??????.
??? ????????????????????? ???????????? ????????????? ?????????? ????? ??????: ??????
???????? ???? ??? ???????? ? ????? ??????????
?????????? ? ?????????, ??????? ???????? ??????47
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
И╥ршй?блкб
? ????? ?????? ??????????? ???????? ???????
???????? ??? ??????? ? ?????????? ???????? ????????? ????? ???????? ???? ?? ??????? ??????
??????????????? ????????. ??????????????? ????? ??????? ????????: 1) ????????? ? ???????? ???? ? ????? ?? ???????? ? ????? ?????????? ??? ????????????? ??????????; 2) ??????? ????????????
?????? ????; 3) ????????? ?????? ????; 4) ??????
??????? ???- ? ??????????????? ???????? ????. ???
???? ??????? ????? ?????????? ? ?????? ????????,
??? ?????? ??????????? ???????????????? ????????? ???? [2]. ??? ??????????????? ????????????
??? ???????? ????????? ?????? ?????????? ??????????? ????????? ?????. ????????? ? ???????? ???? ????? ???? ?????????? ????????????? ?????????????? ??????? ? ?????????????? ?????. ? ?????? ?????????? ???????? ???? ??? ????? ???
?????????? ????. ? ?????? ??????????????? ???????? ? ?????? ????????? ???? ????????? ?????
?????, ????????????? ?? ??????? ?????????, ???
?? ?????????????? ?????????? ?? ?????? ?? ???????? ???. ????? ???????? ? ????? ?????????? ???????? ??? ? ????? ??????????? ?????????? ???????? ???????? ????????, ??? ???????? ? ????????
???????????, ??????????? ??????? ?????????
? ????????????????? ???????????????.
?? ??????????? ???? ????? ????????, ??? ????????????? ??????? ???????? ???? ??????? ? ????????????? ????????? [5]. ????? ???????? ???????? ?????????? ??????? ? ???????? ???????????
????????? ???????? ??? ? ????? ???????????.
??????? ?? ???????? ????????? ?????? ???????? Y. Kawashima ? ?????. ? 1971 ?. [6]. ???????? ????????? ??????????????? (????? ????????
???? ????????? ????? ? ????????? ??????????, ??????? ????), ??????? ????????? ? 1996 ?.
F. Lacour-Gayet ? ?????. [7], ??????? ???????? ????????? ??????? ?????????????? ??????? ??????
???. 1. ???????????????? ???????????? ?????????? ???????
??????? ?????? ? ?????????????????. 3D-?????????????
(VRT), ??? ?????. ??????? ??????????? ??????? ?/??? ??????????? ??????????? ???????? ???
??? ??? ???????? 4 ??, ????? ???????? ???? ?????
?????????? ? ?????? ?????????, ??????? ????????
???????? 4,5 ?? (???. 2). ???????? ?? ???? ???????? ?????????? ??????????? ???????? ???????
????????? (????? ?????? ????????? 35 ?, ???????
?????? ?????? ????????? ? 0,7 ??, ??????? ?
0,8 ??). ??? ??????????????? ???????????? ?????
?????? ???????????? ??????? ?????????? ???????? ??????????? (II?III ?????? ?? ?????????????
?????????????). ? ???????? ??????? ????? ?????
?????????? ??????????? ??????? ???????? ? ???????????? ?????? ?????????? ???????? (???. 3);
? ???????? ?????? ??????? ??????? ???????????
?????????? ??????.
????? ???????
?????? ???????
?????? ????
1,5
?????? ????
2
3,5
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3,5
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??????? ????
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4,5
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4
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??????? ????
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2
????? ??????????
48
???. 2. ????????????? ??????????? ?????????? ??? ????????????????????? ???????????? ???????? ?????? ? ????? ???????? ???
? ????????? ??????? ????, ???????????? ? ??????????? ???????
(? ???????????)
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???????????. ????????, ??? ?? ???????? ??????
????? ?????? ????????? ? ??? ?????.
??????????
1.
2.
3.
4.
5.
???. 3. ??????????????? ???????????? ????? ???????, ???????????????, ??????? ?????????????? ? ???????, ??. ??. 20,
??. 10. ? ??????? ??????? ????? ????? ?????????? ??????????? ??????? ???????? ? ???????????? ?????? ??????????
????????
6.
7.
8.
????????. ??? ?????????? ?? ?????????, ???
?????????? ????????????? ???????? ????? ???????? ? ???????? ??????????? ?????????????? ????? ? ????????? ???????? [5]. ?? ????????? ??????, ??????? ?? ?????????? ? ??????? 5 ??? ?????????? 50% [8]. ? ???????, ????? ?? ???????
?????????? ?????????? ???????? ?????? ? ?????????? ?????????????? ??????????? ???????,
?? ?????? ??????????, ????????????? ??????????? ???????? ??????????? ??????? ???????, ???
??? ???? ????? ????????? ??????????????? ???????? ??????? ????? ??????????????? ???????? ??????????? ?????????? ???????????? ??????????????? ????????????? ?????????, ? ????? ??-?? ??????? ???????? ??????? [1]. ???????????????
??????? ?? ?????????? ???????, ??? ??? ???????????????? ????????? ????? ?????????, ?????????????? ?????????????????????, ?? ???????????
???????, ???, ????????, ??????? ? ???????????????? ????????????? ?????? ????????? [5]. ??? ?????????????? ????????? ????????????, ??? ???????? ? ????????? ?????? ???? ?? ????????, ????
?? ????? ????????? ??????? ?? ??????????? ?????????? ???????? ????????????, ??????? ? ????????? ????? ??????? ??????? ? ???????????
??????????????? ????????????? ?????????? ??????, ????????? ?????? ?????, ??????????????????
?????????? ??????????? [9]. ?????????? ?????????? ?????? ??????? ????????? ????????? ?????
?????????????? ? ???????? ?????????? ???????.
????? ????, ????? ????????, ??? ?????? ????????
????????? ? ??????? ????????? ????????????????, ????????????? ??????? ???????? ???????????? ???????????? ????? ?????? ????????? ???
╚????╩ ? ??????????????. ???? ????? ????? ??????????? ? 1991 ?. [10]. ?? ??????? 9-??????? ?????
?????????? ?? 145 ?????????? ????????, ??? ? ??????? 6 ??? ????? ????????? ?????????? ???????-
9.
10.
??????????? ?.?., ??????? ?.?. (???.) ????????-?????????? ????????: ???????????. ?.: ????????; 1996: 237?8.
Latson L.A., Prieto L.R. Congenital and acquired pulmonary
vein stenosis. Circulation. 2007; 115: 103?8.
Breinholt J.P., Hawkins J.A., Minich L.A., Tani L.Y., Orsmond G.S., Ritter S., Shaddy R.E. Pulmonary vein stenosis
with normal connection: associated cardiac abnormalities and
variable outcome. Ann. Thorac. Surg. 1999; 68: 164?8.
Sadr I.M., Tan P.E., Kieran M.W., Jenkins K.J. Mechanism of
pulmonary vein stenosis in infant with normally connected
vein. Am. Cardiol. 2000; 86: 577?9.
Mortenson W., Lundstrom N.R. Congenital obstruction of the
pulmonary vein at their atrial junctions. Review of literature
and a case report. Am. Heart J. 1974; 87: 359?62.
Kawashima Y., Ueda T., Natio Y., Morikawa E., Manabe H.
Stenosis of pulmonary veins: Report of a patient corrected surgically. Ann. Thorac. Surg. 1971; 12 (2): 196?202.
Lacour-Gayet F., Rey C., PlanchИ C. Pulmonary vein stenosis.
Description of a sutureless surgical procedure using the pericardium in situ. Arch. Mal. Coeur. Vaiss. 1996; 89: 633?66.
Yun T.J., Coles J.G., Konstantinov I.E., Al-Radi O.O., Wald R.M.,
Guerra V. et al. Conventional and sutureless techniques for
management of the pulmonary veins: evolution of indications
from post repair pulmonary vein stenosis to primary pulmonary vein anomalies. J. Thorac. Surg. 2005; 129: 167?74.
Kennaugh J.M., Kinsella J.P., Abman S.H., Hernandez J.A.,
Moreland S.G., Rosenberg A.A. Impact of new treatments for
neonatal pulmonary hypertension on extracorporeal membrane oxygenation use and outcome. J. Perinatol. 1997; 17:
366?69.
Mikus E.I., Stepanenko A., Krabatsch T., Loforte A.,
Dandel M., Lehmkuhl H.B. et al. Reversibility of fixed pulmonary hypertension in left ventricular assist device support
recipients. Eur. J. Cardiothorac. Surg. 2011; 40: 971?7.
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Burakovskiy V.I., Bockeria L.A. (eds) Cardiovascular surgery:
A Guide. Moscow: Meditsina; 1996: 237?8 (in Russian).
Latson L.A., Prieto L.R. Congenital and acquired pulmonary
vein stenosis. Circulation. 2007; 115: 103?8.
Breinholt J.P., Hawkins J.A., Minich L.A., Tani L.Y., Orsmond G.S., Ritter S., Shaddy R.E. Pulmonary vein stenosis
with normal connection: associated cardiac abnormalities and
variable outcome. Ann. Thorac. Surg. 1999; 68: 164?8.
Sadr I.M., Tan P.E., Kieran M.W., Jenkins K.J. Mechanism of
pulmonary vein stenosis in infant with normally connected
vein. Am. Cardiol. 2000; 86: 577?9.
Mortenson W., Lundstrom N.R. Congenital obstruction of the
pulmonary vein at their atrial junctions. Review of literature
and a case report. Am. Heart J. 1974; 87: 359?62.
Kawashima Y., Ueda T., Natio Y., Morikawa E., Manabe H.
Stenosis of pulmonary veins: Report of a patient corrected surgically. Ann. Thorac. Surg. 1971; 12 (2): 196?202.
Lacour-Gayet F., Rey C., PlanchИ C. Pulmonary vein stenosis.
Description of a sutureless surgical procedure using the pericardium in situ. Arch. Mal. Coeur. Vaiss. 1996; 89: 633?66.
Yun T.J., Coles J.G., Konstantinov I.E., Al-Radi O.O., Wald R.M.,
Guerra V. et al. Conventional and sutureless techniques for
management of the pulmonary veins: evolution of indications
from post repair pulmonary vein stenosis to primary pulmonary vein anomalies. J. Thorac. Surg. 2005; 129: 167?74.
Kennaugh J.M., Kinsella J.P., Abman S.H., Hernandez J.A.,
Moreland S.G., Rosenberg A.A. Impact of new treatments for
neonatal pulmonary hypertension on extracorporeal membrane oxygenation use and outcome. J. Perinatol. 1997; 17:
366?69.
Mikus E.I., Stepanenko A., Krabatsch T., Loforte A.,
Dandel M., Lehmkuhl H.B. et al. Reversibility of fixed pulmonary hypertension in left ventricular assist device support
recipients. Eur. J. Cardiothorac. Surg. 2011; 40: 971?7.
????????? 14.05.2014 ?.
49
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??????? ??????? ?????? ? ???????, ? 4, 2014
╘ ????????? ???????, 2014
??? 616.132.2-007.271-089
?????? ????????????? ?????????
??????????? ??????? ??????????? ??????
?.?. ????????????, ?.?. ??????, ?.?. ??????????, ?.?. ???????
????? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ?
???????? ??? ? ???? ?.?. ???????); ?????????? ?????, 135, ??????, 121552,
?????????? ?????????
???????????? ?????? ??????????, ?????? ???. ????, ?????????, ?????????? ??????????;
?????? ????? ??????????, ?????? ???. ????, ???. ?????. ????.,
e-mail: shmaltzanton@inbox.ru;
?????????? ?????? ?????????????, ???. ??????????? ??????????;
??????? ??????? ??????????????, ????????
? ?????? ?????? ?????? ?????? ????????????? ????????? ??????????? ??????? ??????????? ?????? ? ??????? 4 ??? 8 ???.
???????????? ???????????? ?????? ???? ??????????????? ?????????????? ? ????????? ?? ????????? ?????????????? ???????????? ???????? ?????? ?????????. ??????? ?????????? ? ??????? ???????????????, ???????????? ??????????, ?????????????? ???????????? ????????, ????????????? ?????? ? ?????????????????. ???????? ??????????? ?????? ? ???????? ?????????????? ?????????????? ????????? ??????? ????????? ????? ? ???????? ????????????? ????????? ?????????????? ??????????? ???????? ??? ? ?????? ????????????????? ???????.
???????? ?????: ?????? ??????????? ??????; ?????????? ????? ??????; ???????? ?????????????? ??????????? ????????.
CASE OF SURGICAL CORRECTION CONGENITAL STENOSIS
OF THE CORONARY SINUS
S.V. Gorbachevskiy, A.A. Shmal?ts, M.A. Grenaderov, U.A. Mazhidov
A.N. Bakoulev Scientific Center for Cardiovascular Surgery; Rublevskoe shosse, 135, Moscow,
121552, Russian Federation
Gorbachevskiy Sergey Valer?evich, MD, DM, Professor, Chief of Department;
Shmal?ts Anton Alekseevich, MD, DM, Leading Research Associate,
e-mail: shmaltzanton@inbox.ru;
Grenaderov Mikhail Aleksandrovich, Deputy Chief of Department;
Mazhidov Ulugbek Abdisattarovich, Postgraduate
The rare case of surgical correction of a congenital stenosis of a coronary sinus at the child of 4 years and 8 months is resulted. Clinical
displays of defect were heart failure in a combination with lowered contractility of the myocardium left ventricle. The diagnosis is
established by means of an echocardiography, a computer tomography, radioisotope scintigraphy of the myocardium, heart
catheterization and angiocardiography. The repair of the coronary sinus stenosis with cardiopulmonary bypass has allowed to eliminate defect and to achieve essential increase contractility of the myocardium already in the early postoperative period.
Key words: stenosis of a coronary sinus; congenital heart disease; decrease contractility of the myocardium.
????????? ????????? ?????????????? ??????????? ???????? ?????????? ??? ??????????
???????? ???????????? ??????? ?????? ? ??????????? ?????????? ?????????? ???????, ????????-????????? ? ????????-???????? ??????. ??
???????? ?????? ?????? ???????? ????????????
?????? ?????????, ?????????????? ???????? ??????????? ??????.
Иткр?лкб рнш???
? ? ? ? ? ? ? ?., 4 ??? 8 ???, ???????? ? ?????????
?????????????? ??????? ??????????? ?????? ? ??????????????? ???????? ???????????? ?????
??. ?.?. ???????? 20.01.2014 ?. ? ???????? ??
50
?????? ? ???????????? ??? ?????????????? ?????????? ????????. ????????? ????????? ??????? ???????? ???????? ? ??????? ????????? 4?5 ???, ????? ?? ??? ???????????? ??? ???????? ??? ? ??????? ?????? ? ???????? ???????? ??????? ???????
?????? ?????????. ?? ????????? ???????????????????? ?????? ???? ??????????? ????????-????????? ???????. ??????????????? ??????? ?? ???????.
??? ??????????? ???????????? ? ????????? ??????? ?? ??????????????? ??????????????, ?????? ????????? ??-??? ???????? ???? ?? 3 ??, ????????? ?????????? ???????? ???????? ??????.
?? ??????????????????? ? ????????? ?????????? ? ???????? ?????????? 120 ??/??? ? ?????,
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?????????? ????????? ????????????? ??? ??????,
??????????? ?????? ?????????; ??????????? ????????? ???????????.
??? ???????????????????? ???????????? ?????? ??????????????????? ?????????????????,
??????, ????????????????? ? ??????? ????????
??????????? ???. ????? ????????? ???????????,
???????? ?????????????? ????? 96 ??/?2, ?????????????? ??????????? ???????? ???????, ??????? ??????? 29%. ??????? ?????? ????????????
??????, ????????? ?????? ??????????? ???????
????????????, ??????? ??????????????? II ???????.
??????????????? ??? ?????????? ??????? ???????? ????????. ? ??????? ??????????? ??????
?????????? ????????????????????? ????? ????????? 2 ?? ? ?????????? ?????????????? ???????? 20 ?? ??. ??. ????????? ????????????? ???????? ? ?????? ????????? 62 ?? ??. ??.
??? ???????????? ?????????? ?????? ? ????????????????? ????????? ?? ??????? ??????????
??????? ?? ????????. ?????????? ????? ? ?????????? ??????? 10 в 6 ??, ??????? ? ?????? ??????????, ? ????? ????? ?? 2?3 ?? (???. 1). ?? ??????????? ?????? ? ??????????? ?????? ?????? ?????????? ??????? ?????????? ????????? 6 ??
? ?????? 12 ??, ? ????? ?????????? ?? ??????????? ?????? ??????? ??????????? 2 ??. ??? ??????????????????? ?????????? ??????? ???????????.
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?????? ?????. ?????????? ????? ???????????? ? ????? ???????? ? ?????? ??????????, ??????? ????????? ????? ?????????? ??????? ? ????? ???????????.
?? ? ????? ??????????; ?? ? ?????? ??????????; ?? ? ????? ?????????; ?? ? ?????? ?????????
??????? ?????????????????? ? ???????? ?????????????, ?????????? ????????? ???????? ?????????? ????????? ? ??????? ??????? ????????? ?????????????? ?????? ?????? ?????????.
??? ????????????? ?????? ? ?????????????????
??????? ?????? ????? ??????????? ?????? ? ?????????? ???????? ???????? 16 ?? ??. ??. (????????
? ?????????? ?????? 27/14, ??????? 25 ?? ??. ??.,
??????? ???????? ? ?????? ?????????? 9 ?? ??. ??.)
? ??????? ?????????, ???????????????? ??????????????? ?????????, ????? ?????????? ???????
? ????? ???????????. ??????? ??????? 6 ??, ? ????? ?????????? ?? ??????????? ?????? ? 2 ??. ????? ? ?????? ?????????? ??????? ??? ?????????.
???????? ? ???????? ??????? 53/22 (32) ?? ??. ??.
?? ????????? ???????????? ???????????? ????????? ???????: ?????? ????? ??????????? ??????.
??????? ????? ?????????? ??????? ? ????? ???????????. ?????????? ????????? ???????? ?????????????? ??????????? ?????? ?????????. ?????????? ??????????????? II ??. ???????? ???????????.
04.02.2014 ?. ? ???????? ?????????????? ??????????????, ?????????? ? ???????????????? ???????????? ????????? ???????? ? ??????????
? ???????? ??????????? ??????, ???????? ??????? ????? ?????????? ??????? ? ????? ??????????? (?????? ? ????????? ?.?. ????????????). ?????? ? ?????? ????? ????????? ???????????. ????? ??????? ?? ?????????????. ????? ?????????
????? ? ????? ??? ?????? ????????????? ??????????????, ????? ????????? ?????????? ????? ?????
?????? ???????? ???. ???????? ????? ????,
??????? ?????? ??????????. ?? ??????????? ?????? ????????? ????? ????? ?????. ???????? ?????,
????????? ??????????? ???????????? ?????????
╚?????????╩.
??? ??????? ????? ??????????? ?????? ??????
?? 2?2,5 ?? ?? ?????????? 3?4 ??. ??????????
????? ???????? ?? ??? ????? ?? ????????? ?????????????? ???????????. ??? ???????? ??????
??????????? ?????? ????? ????????, ???????? ????????, ? ????????? ????????? ?????? ?????? ????? ?????????? ???????? ?????; ????????????
????????? ?????? ??????????. ?? ???????? ???????
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?? ?????????? 15 ?? ?? ????? ??????? ?????????
????? ?????????? ??????? ? ????? ???????????
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???????? ??????????? ?????? ? ?????????? ??????????????? ????????? ??????????????????? ???????? ? ????????????? ????????? ?????? ? ?????? ??????????. ????????????? ??????????????
????????? ??????????.
??????? ??????? ?????????????????? ???????
??? ??????????. ??????? ??????? ?? ??????????
?? 12-? ????? ????? ???????? ? ?????????????????? ?????????. ??????? ??????? ?????? ????????? ??? ??????? ????????? 48%, ???????????????
??????????? ??????? ?? ????????? I ???????.
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Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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??
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????
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??
??
???
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???. 2. ????????????? ???????? ??????? ??? ??????? ????? ??????????? ?????? [2]:
??
??
? ? ? ???????? ????? ? ????? ?????????? ????? ???????; ? ? ? ???????? ????? ? ?????? ?????????? ?????
?????????? ????????????? ??????? ????? ????.
?? ? ?????????? ?????; ?? ? ?????? ??????????;
?? ? ????? ??????????; ??? ? ?????? ????? ????;
???? ? ?????????????? ??????? ????? ????;
???? ? ???????????? ??????? ????? ????; ?? ? ?????????? ????
??
??
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И╥ршй?блкб
?????? ??? ??????? ????? ??????????? ?????? ?
?????? ?????????? ???????? ???????? ???????
??????. ??????? ????? ?????? M.S. Prows ? 1943 ?.
?? ????????? ????????????? ??????? [1]. ? 1995 ?.
R.V. Lucas, K.A. Krabill ??????????? 15 ???????
???????? ?? ???????? ??????????? ?????? [2].
?????????? ????? ?? ???? ??????? ??? ??????
???????????, ? ??? ???????????????? ?????????
???????? ??? ????????? ??????? ?????????, ????????? ? ?????????? ????????. ? 13 ??????? ?????? ?????????????? ???? ?????? ?????: ? 6 ???????
?? ??????? ?????????? ???????????? ??????? ????? ????, ? 5 ? ??????????? ????????? ????, ? 1 ?
????????????? ?????????? ????? ? ?????????????? ??????????, ??? ? 1 ? ????????? ?????
?????????? ??????? ? ?????? ????? ?????
(???. 2). ??? ??????? ??? ??????????????? ????
?????? ?? ??????????? ?????? ?????? ????? ?????
????????. ? 12 ?? 15 ??????? ??????? ????????????? ?????????? ?????? ??????.
???????? ??????????? ??????????? ???????
??????????? ?????? ???????? ?????? ????????
(?????? ? ????????? ????????? ???????? ? ?????),
? ??????? ??????? ??????? ?? ??????? ? ????????
??????????????? ???? ?????? ?????. ? ?????????
?????? ??????? ????????? ??????????? ??????
? ?????? ? ????? ????????????, ??? ?????????
????? 2 ??, ??????? ? ????????? ??????? ?????? ??
???????? 4 ??? 8 ???. ????????, ??? ????? ?????????? ?????????? ?? ???????? ???????????????????
?????-???? ??????????? ?????????. ?????? ???
???????????? ???????? ???? ???????? ????????????? ????????????? ?????????????????? ??
????????? ??? ?????????? ? ??????? ??????? ????????? ?????????????? ?????? ?????? ?????????.
??????? ????????? ? ??????? ?????? ???????
? ??????????????????? ???????? ??????????? ??????, ??????? ?? ????? ????????? ?????? ?????????? ??????? ?????? ???? ?????????? ?????????? ????????????? ????? ???? ?????? ???????? [3].
??????????/References
1.
2.
3.
Prows M.S. Two cases of bilateral superior vena cava, one
draining a closed coronary sinus. Anat. Rec. 1943; 87:
99?106.
Lucas R.V., Krabill K.A. Abnormal systemic venous connections. In: Emmanouilides G.C., Reimenschneider T.A.,
Allen H.D. (eds). Heart Disease in Infants, Children and
Adolescents. 5th ed. Baltimore: Williams & Wilkins; 1995:
874?902.
Yokoto M., Kyota I., Kitano M. Atresia of the coronary sinus
orifice: Fatal outcome after intraoperative division of the
drainage left superior vena cava. J. Torac. Cardiovasc. Surg.
1980; 98: 30?2.
????????? 28.07.2014 ?.
52
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
??????? ??? ???????
????????? ??????!
???????? ???? ???????? ?? ??, ??? ?????? ?????? ? ??????????????? ??? ???????? ???????
????????????? ??????? ???????? ? ???????, ? ??????? ?????? ???? ???????????? ???????? ?????????? ??????????? ?? ????????? ?????? ??????? ??????? ? ????????? ????, ? ????? ? ????????????? ?????????????? ??????? ? ???? ??????, ??? ???????????? ??????????? ??????? ??????
?????? ?????? ????????? ????????? ???????.
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. ? ????53
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??????? ??????? ?????? ? ???????, ? 4, 2014
????? ???????????(??) ?????, ????? ??? ?????? ?????????? ???????? ?????????? ???????
????????????.
??????? ?????????? ?????:
????????????? ?????????? ??????? ??????
? ???? ??????????? ??????????????????? ??????
?? ?????????? ????????????? ???????
?.?. ????????1, ?.?. ????????1, ?.?. ???2, ?.?. ?????2
1
???? ╚????????????? ????????? ??????????? ???????????????? ?????╩, ???????????????
????????, 106, ?????????, 400008, ?????????? ?????????;
2 ????? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ?
???????? ??? ? ???? ?.?. ???????); ?????????? ?????, 135, ??????, 121552, ??????????
?????????
???????? ?????? ????????, ????????, e-mail: k.o.kirillov@mail.ru;
???????? ??????? ??????????, ???. ???????? ?????;
??? ??????? ????????, ?????? ???. ????, ?????????, ?????????? ??????????;
????? ???? ?????????????, ????. ???. ????, ???. ?????. ????., ????????????
EPIDEMIOLOGY OF CONGENITAL HEART DISEASE
AND WAYS OF OPTIMIZATION OF CARDIAC SURGICAL CARE
IN THE VOLGOGRAD REGION
K.O. Kirillov1, V.V. Nachinkin1, A.I. Kim2, I.A. Yurlov2
1 Volgograd regional clinical cardiological centre, Universitetskiy prospekt, 106, Volgograd, 400008,
Russian Federation;
2 A.N. Bakoulev Scientific Center for Cardiovascular Surgery; Rublevskoe shosse, 135, Moscow, 121552,
Russian Federation
Kirillov Kirill Olegovich, Postgraduate, e-mail: k.o.kirillov@mail.ru;
Nachinkin Valeriy Viktorovich, Deputy Chief Physician;
Kim Aleksey Ivanovich, MD, DM, Professor, Chief of Department;
Yurlov Ivan Aleksandrovich, MD, PhD, Leading Research Associate, Cardiac Surgeon
6. ?????????? ???? ?????????? ???????????? ?????? ?????? ???? ?????????: ??????,
???????? ?????, ??????? ????????, ?????????? ????????? ??????? ? ??????? ????????? ??????,
? ?????? ?????????? ????????????, ???????? ? ??????, ?????????? ? ??????????, ?????? ?? ??????? ??? ??????????, ?????? ???????????? ??????????.
?????? (???????, ?????????) ? ???????? ? ???????? ???????? ????? ??????. ? ????????????
??????? ??? ????? ???????? ?????? ????????? ????????? ?????? ? ???????? ?????? ???????: ╚????╩
(????????????? ???????? ? ??????????? ????????); ╚???????? ? ??????╩ (?????? ????????????,
????????? ????????, ???????????, ????????????????, ?????????????????, ?????????????? ? ?????? ????????; ╚??????????╩ (???????? ?????????? ?????????? ? ?? ?????????????? ??????????);
╚??????????╩ (???????? ????? ????????????).
????????? ?????? ? ?????? ???????? ???????? ?????????? ?????????? ? ????????????? ? ?????????? ?????????????? ???????? ? ????? ??????, ????????????? ??????. ????????? ??????
???????? ?? ????????? ???????????? ?? ????? ????? ??. ?.?. ???????? ??? ????????? ?????????
? ???? ???????? ? ????????????? ???????? ?????????? ?????????. ????????? ?????? ?????? ????
???????????? ?? ??????? ? ?????????? ??????.
54
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
?? ????????? ? ?????? ???????? ?????? ???? ??????? ???? ????????????, ?? ??? ?? ??????
??????????, ????? ?? ?????????? ? ??????? ?????? ?????? ??? ????????? ???????????? ??? ?????
????????? ??????????. ?????????? ???????? ????????????? ? ????????????????? ??????????.
???????????? ???????? ????? ??????????? ? ?????? ????????????? ????????, ?????? ?????????,
???????, ??????? ??????????? ???????????? ??????, ? ????? ??????, ???????, ?? ??????
??????, ????? ???????????? ????????.
? ?????? ?????????? ?????? ?? ?????? ??????????? ????????, ???????????? ? ????????.
??????? ????????? ???????? ????? ?? ?????? ??????, ?????? ?????? ???? ????????? ? ?????,
???????? ?? ?????????????? ??????????, ?????? ??????? ????, ????? ? ?????????? ????????????.
? ?????? ?????????? ?????? ??????? ???????? ??????? ?????????????? ???????????, ??? ???????? ?????????? ???????????? ????????, ? ?? ????????? ?????.
?????????? ? ???????? ???????????, ????? ???????????????????, ????????? ? ?????????????? ??????? ??? ???? ?? ??????????? ? ??????????? ??? ?????? ???????????? ? ?????????
??????.
????? ?????? ?????????? ?????? ???????????? ??????????? ?????????? (??????? ????????,
?? ??????? ????????? ?/??? ???????????? ?????????), ?? ?????? ?????????? 100?350 ????.
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?????. ?? ╚????????╩ ?? ????????? ??????? ???????????? ??????? ???????????? ????????????
???????????? ? ????????????? ??? ???????? (???? ????????????).
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????????????? ??????????? ????????? ? ???????? (Mendelian Inheritance in Men, ??.
http://ncbi.nlm.nih.gov/Omim).
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????????????, ? ?? ???????????? ?????. ??? ???????????? ???????????? ?????? ???? ????????. ??????? ????????? ?????????? ????????? ????? ??????? ? ?????? ??? ? ??????? ??????? ????? ?? ??????????. ???? ??? ?????????? ? ??????? ???????? ? ????? ????????, ?? ?? ??????? ???????? ????? ??????? ????? ????????? ???????.
9. ?????????? ? ????????. ? ?????? ??? ??????????? (??????????, ?????, ?????????,
??????? ? ?.?.) ????????? ?????????. ?? ??? ??????? ? ?????? ?????? ???? ???? ??????. ??????? ?????? ????????????? ??????????????? ????? ??????, ? ??????? ??? ??????????? ???????.
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??????.
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?????????? ???????? ???????????? ?????????? ? ??????? ?????????? ???????? ??????? ????, ???
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? ??????? ??? ????????.
? ???????????? ??????? ??????????? ??????????? ?? ????? 25 ??????????, ? ??????? ?????????? ? ?? ????? 50, ? ?????? ?????????? ? ?? 15. ???????????? ?????? ????????? ?????? ???????????????? ????? ?????????? ?? ????????? 5 ???.
? ?????? ?????????? ??? ?????? ????????????? ? ??????? ???????????. ?????????????????
?????? ? ?????? ?????? ?????? ? ?????????? ??????? ????????. ?????? ?? ???????????????? ?????? ?? ???????????.
????????????????? ???????? ?????: ?????(?), ????????, ????? (??? ??????), ????? ????????? ?
???????? ????????????; ????? ????? ? ??????? ? ??? ???????. ???? ?????? ?????? ?? ????? ?? ?????:
??????, ???????? ?????, ????? ????? ???????? ╚? ??.:╩ ??? ╚In:╩ ? ???????(?) ??????(??) ??? ?????????(??), ????? ???????? ????? ? ???????? ??????.
????????????????? ???????? ?????? ?? ???????: ?????(?), ???????? ??????, ???????? ???????, ???, ???, ? ??????? ????? ???????, ????? ????????? ????? ?????? ? ????????? ??????? ???????????.
??? ????????? ?????????? ?? 6 ??????? ???????????? ??????????? ???, ??? ??????? ?????????
??????????? ? 6 ?????? ??????? ╚? ??.╩, ? ??????????? ╚et al.╩; ???? ? ???????? ??????? ???? ????????? ?????????, ????? ??????? ??????? ??????? ╚???.╩, ? ??????????? ╚ed.╩.
?? ????? ????????, ??????????? ?????????? ????? ????????????? ?????? ???????????,
??? Web of Science ? Scopus, ????????????????? ?????? (References) ?????? ? ????????????
???? ?????? ? ?????????????? ?????? ???????? ?? ?????? ?? ????? ?????????, ?? ? ?????????
(????????? ?????????). ??????? ?????? ?????? ?????? ?????? ?????? ?????????? ? ???? ?????????: ???? ?? ????? ????????? (????????????? ????????? ? ??????????, ???????????? ? ?????????), ??? ???? ??????? ?????, ? ????????? ?????? ??? ?? ?????? ?????????? (References)
? ????????? ???????? ??? Scopus ? ?????? ?????????? ??? ??????, ???????? ? ??? ??? ????????? ??????????, ?????????? ?? ????, ??????? ?? ????? ??? ???????????. ???? ? ?????? ????
?????? ?? ??????????? ??????????, ??? ????????? ??????????? ? ??????, ??????????? ? ????????? ????????.
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? ????????? ???????? ??? ????????????? ?????????? ????????? ????????? ????????? ????????????????? ??????: ?????(?) (??????????????), ??????? ???????? ????? ??? ?????? ?? ?????????? ????, ???????? ????????? (??????????????), ???????? ?????? ? ???????? ???????, ???????? ?? ???? ?????? ? ??????? (in Russian).
?????????? ?????????? ?????? ? ?????????????? ???????
?????????????? ?????????????? ? ???????????
?? ????? http://www.translit.ru ????? ????????? ??????????????? ?????????? ??????????????
???????? ?????? ? ????????. ????????? ????? ???????.
1. ?????? ? ????????? Translit.ru. ???????? ??????? ?????????????? BGN (Board of Geographic
Names). ????????? ? ??????????? ???? ???? ????? ????????????, ????? ???????? ????? ??? ??????,
?? ??????? ????? ? ???????? ?????? ╚? ????????╩.
2. ???????? ??????????????????? ????? ? ??????????? ?????? References.
3. ????????? ? ??????? ??????????? Google ??? ???????? ?????????, ????? ??????? (????????
?????, ??????, ????????????? ? ?. ?.) ?? ?????????? ????, ????????? ??? ? ??????????? ??????.
???????, ??????????, ??????? ??????????????, ??????? ?????? ????? ?????????? ???????? ????????, ??????????? ?????????? ????.
4. ?????????? ???????? ? ????????? ? ??????????, ???????? ? ???????????? ? ????????? ?????????. ??? ???? ?????????? ???????? ????? ??????? (Moscow), ???????? ????????
(Molekulyarnaya meditsina) ?, ????????, ?????? ????????? ??????????? ????????.
5. ? ????? ?????? ? ??????? ??????? ??????????? (in Russian). ?????? ??????.
??????? ?????????????? ????????????? ?????????? ??????????
??? ????????????? ????? ??????
?????? ?? ???????:
Belushkina N.N., Khomyakova T.N., Khomyakov Yu.N. Diseases associated with dysregulation of programmed cell death. Molekulyarnaya meditsina. 2012; 2: 3?10 (in Russian).
Zagurenko A.G., Korotovskikh V.A., Kolesnikov A.A., Timonov A.V., Kardymon D.V. Technical and economic optimization of hydrofracturing design. Neftyanoe khozyaistvo. 2008; 11: 54?7 (in Russian).
?????? ?? ???????????? ???????:
Swaminathan V., Lepkoswka-White E., Rao B.P. Browsers or buyers in cyberspace? An investigation of
electronic factors influencing electronic exchange. Journal of Computer-Mediated Communication. 1999;
5 (2). Available at: http://www.ascusc.org/jcmc/vol5/issue2/ (Accessed 28 April 2011).
????? (??????????, ???????):
Kanevskaya R.D. Mathematical modeling of hydrodynamic processes of hydrocarbon deposit development. Izhevsk; 2002 (in Russian).
From disaster to rebirth: the causes and consequences of the destruction of the Soviet Union. Moscow:
HSE Publ.; 1999 (in Russian).
Latyshev V.N. Tribology of cutting, vol. 1: Frictional processes in metal cutting. Ivanovo: Ivanovskii Gos.
Univ.; 2009 (in Russian).
????????? ???????????:
Usmanov T.S., Gusmanov A.A., Mullagalin I.Z., Muhametshina R.Ju., Chervyakova A.N., Sveshnikov A.V.
Features of the design of field development with the use of hydraulic fracturing. In: New energy saving subsoil technologies and the increasing of the oil and gas impact. Proc. 6th Int. Symp. Moscow, 2007; 267?72
(in Russian).
58
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
????????-??????:
??? Style (2011). Available at: http://www.apastyle.org/apa-style-help.aspx (accessed 5 February 2011).
??????????? ???????????:
Semenov V.I. Mathematical modeling of the plasma in the compact torus. Dr. phys. and math. sci. Diss.
Moscow; 2003 (in Russian).
Grigor'ev Yu.A. Development of scientific bases of architectural design of distributed data processing systems. Dr. tech. sci. Diss. Moscow: Bauman MSTU Publ.; 1996 (in Russian).
????:
State Standard 8.586.5-2005. Method of measurement. Measurement of flow rate and volume of liquids
and gases by means of orifice devices. Moscow: Standartinform Publ.; 2007.
??????:
Palkin M.V. et al. The way to orient on the roll of aircraft with optical homing he; d. Patent RF,
?2280590; 2006 (in Russian).
??????? ?????????? ?????? ?? ??????????
??? ????????????? ????? ??????
?????? ?? ???????:
??????? ?.?., ?????????? ?.?., ????? ?.?., ??????? ?.?., ????? ?.?., ??????? ?.?. ? ??. ??????????????? ??????????? ????????? ??? ?????????????? ??????????? ???????? ?. ??????? ???????????. 2012; 1: 45?8.
??????? ?.?. ?????: ????? ???????? (??????????? ???????). ?????????????. 2010; ????. 1: 3?8.
Aiuti A., Cattaneo F., Galimberti S., Benninghoff U., Cassani ?., Callegaro L. et al. Gene therapy for
immunodeficiency due to adenosine deaminas deficiency. N. Engl. J. Med. 2009; 360 (5): 447?58.
Glauser T.A. Integrating clinical trial data into clinical practice. Neurology. 2002; 58 (12, Suppl. 7):
S 6?12.
?????:
????? ?.?. ?????????????? ?????????: ???????, ??????????? ????????? ? ??????????? ????????.
?.: ????????; 2003.
???????? ?.?. (???.) ??????????? ?? ???????????. 3-? ???. ?. 3. ?.: ?????????; 2005.
?????????? ?.?. (???.) ?????????????: ??????? ???????. ?.: ????; 2008.
Beck S., Klobes F., Scherrer C. Surviving globalization? Perspective for the German economic model.
Berlin: Springer; 2005.
Michelson A.D. (ed.) Platelets. 2nd ed. San Diego: Elsevier Academic Press; 2007.
Mestecky J., Lamm M.E., Strober W. (eds) Mucosal immunology. 3rd ed. New York: Academic Press;
2005.
????? ?? ?????:
??????? ?.?. ????????? ? ??????? ?????? ????????? ??????. ? ??.: ?????? ?.?., ???????????
?.?. (???.) ??????????????? ???????? ?????? ? XXI ????. ?.: ????-??????; 2009: 110?31.
Silver R.M., Peltier M.R., Branch D.W. The immunology of pregnancy. In: Creasey R.K., Resnik R. (eds).
Maternal-fetal medicine: Principles and practices. 5th ed. Philadelphia: W.B. Saunders; 2004: 89?109.
????????? ??????? ???????????, ???????????:
?????????? ??????? ??????????? ? ???????????????: ????????? ??????-???????????? ???????????. 8 ???? 2009 ?. ?????-?????????. ???.; 2009.
????? ?.?., ?????????? ?.?. ?????????? ??????? ??? ?????????????? ?????? ?????. ? ??.: ????????? IV ??????????? ?????? ╚???? ? ????╩. ?.; 2000; ?. 1: 516?9.
59
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ??????? ?????? ? ???????, ? 4, 2014
European meeting on hypertension. Milan, Jine 15?19, 2007. Milan; 2007.
Harnden P., Joffe J.K., Jones W.G. (eds) Germ cell tumours V: Proceedings of the 5th Germ cell tumour
conference. 2001, sept. 13?15; Leeds; UK. New York: Springer; 2001.
?????????? ?.?. ???????-????????????? ? ??????????????? ????????? ?????? ? ??????? ?
??????????? ?????????????: ???????. ???. ... ?-?? ???. ????. ?.; 2008.
Borkowski M.M. Infant sleep and feeding: a telephone survey of Hispanic Americans: diss. Mount
Pleasant (MI): Central Michigan University; 2002.
??????????? ????????:
??????????????? ?????? ╚? ????????? ???????? ????????? ?????????? ???? ? 2009 ????╩.
Available at: http://www.minzdrav.rkomi.ru/left/doc/docminzdr
Abood S. Quality improvement initiative in nursing homes: the ANA acts in an advisory role. Am. J. Nurs.
2002; 102 (6). Available at: http://www.nursingworld.org/AJN/2002/june/Wawatch.htm
????? ????? ??????????????? ?? ???????????? ????????????????? ??????.
??? ????????? ?????????? ???????????? ?????? ????????? ??????????? ???????? ??????????
?????????? ?? ??????: 121552, ??????, ?????????? ?., 135, ????? ??. ?.?. ????????,
????????? ??????? ???????????? (e-mail: kupriashov2007@rambler.ru).
??? ????????? ????????? ?????? ?????? ??????????????? ?? ?????.
????? ?? ?????????? ????????? ?? ?????????.
60
??? ??????????? ?????????? ???????????? ??????????????? ????????????? ?????????, ? ????? ??-?? ??????? ???????? ??????? [1]. ???????????????
??????? ?? ?????????? ???????, ??? ??? ???????????????? ????????? ????? ?????????, ?????????????? ?????????????????????, ?? ???????????
???????, ???, ????????, ??????? ? ???????????????? ????????????? ?????? ????????? [5]. ??? ?????????????? ????????? ????????????, ??? ???????? ? ????????? ?????? ???? ?? ????????, ????
?? ????? ????????? ??????? ?? ??????????? ?????????? ???????? ????????????, ??????? ? ????????? ????? ??????? ??????? ? ???????????
??????????????? ????????????? ?????????? ??????, ????????? ?????? ?????, ??????????????????
?????????? ??????????? [9]. ?????????? ?????????? ?????? ??????? ????????? ????????? ?????
?????????????? ? ???????? ?????????? ???????.
????? ????, ????? ????????, ??? ?????? ????????
????????? ? ??????? ????????? ????????????????, ????????????? ??????? ???????? ???????????? ???????????? ????? ?????? ????????? ???
╚????╩ ? ??????????????. ???? ????? ????? ??????????? ? 1991 ?. [10]. ?? ??????? 9-??????? ?????
?????????? ?? 145 ?????????? ????????, ??? ? ??????? 6 ??? ????? ????????? ?????????? ???????-
9.
10.
??????????? ?.?., ??????? ?.?. (???.) ????????-?????????? ????????: ???????????. ?.: ????????; 1996: 237?8.
Latson L.A., Prieto L.R. Congenital and acquired pulmonary
vein stenosis. Circulation. 2007; 115: 103?8.
Breinholt J.P., Hawkins J.A., Minich L.A., Tani L.Y., Orsmond G.S., Ritter S., Shaddy R.E. Pulmonary vein stenosis
with normal connection: associated cardiac abnormalities and
variable outcome. Ann. Thorac. Surg. 1999; 68: 164?8.
Sadr I.M., Tan P.E., Kieran M.W., Jenkins K.J. Mechanism of
pulmonary vein stenosis in infant with normally connected
vein. Am. Cardiol. 2000; 86: 577?9.
Mortenson W., Lundstrom N.R. Congenital obstruction of the
pulmonary vein at their atrial junctions. Review of literature
and a case report. Am. Heart J. 1974; 87: 359?62.
Kawashima Y., Ueda T., Natio Y., Morikawa E., Manabe H.
Stenosis of pulmonary veins: Report of a patient corrected surgically. Ann. Thorac. Surg. 1971; 12 (2): 196?202.
Lacour-Gayet F., Rey C., PlanchИ C. Pulmonary vein stenosis.
Description of a sutureless surgical procedure using the pericardium in situ. Arch. Mal. Coeur. Vaiss. 1996; 89: 633?66.
Yun T.J., Coles J.G., Konstantinov I.E., Al-Radi O.O., Wald R.M.,
Guerra V. et al. Conventional and sutureless techniques for
management of the pulmonary veins: evolution of indications
from post repair pulmonary vein stenosis to primary pulmonary vein anomalies. J. Thorac. Surg. 2005; 129: 167?74.
Kennaugh J.M., Kinsella J.P., Abman S.H., Hernandez J.A.,
Moreland S.G., Rosenberg A.A. Impact of new treatments for
neonatal pulmonary hypertension on extracorporeal membrane oxygenation use and outcome. J. Perinatol. 1997; 17:
366?69.
Mikus E.I., Stepanenko A., Krabatsch T., Loforte A.,
Dandel M., Lehmkuhl H.B. et al. Reversibility of fixed pulmonary hypertension in left ventricular assist device support
recipients. Eur. J. Cardiothorac. Surg. 2011; 40: 971?7.
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Burakovskiy V.I., Bockeria L.A. (eds) Cardiovascular surgery:
A Guide. Moscow: Meditsina; 1996: 237?8 (in Russian).
Latson L.A., Prieto L.R. Congenital and acquired pulmonary
vein stenosis. Circulation. 2007; 115: 103?8.
Breinholt J.P., Hawkins J.A., Minich L.A., Tani L.Y., Orsmond G.S., Ritter S., Shaddy R.E. Pulmonary vein stenosis
with normal connection: associated cardiac abnormalities and
variable outcome. Ann. Thorac. Surg. 1999; 68: 164?8.
Sadr I.M., Tan P.E., Kieran M.W., Jenkins K.J. Mechanism of
pulmonary vein stenosis in infant with normally connected
vein. Am. Cardiol. 2000; 86: 577?9.
Mortenson W., Lundstrom N.R. Congenital obstruction of the
pulmonary vein at their atrial junctions. Review of literature
and a case report. Am. Heart J. 1974; 87: 359?62.
Kawashima Y., Ueda T., Natio Y., Morikawa E., Manabe H.
Stenosis of pulmonary veins: Report of a patient corrected surgically. Ann. Thorac. Surg. 1971; 12 (2): 196?202.
Lacour-Gayet F., Rey C., PlanchИ C. Pulmonary vein stenosis.
Description of a sutureless surgical procedure using the pericardium in situ. Arch. Mal. Coeur. Vaiss. 1996; 89: 633?66.
Yun T.J., Coles J.G., Konstantinov I.E., Al-Radi O.O., Wald R.M.,
Guerra V. et al. Conventional and sutureless techniques for
management of the pulmonary veins: evolution of indications
from post repair pulmonary vein stenosis to primary pulmonary vein anomalies. J. Thorac. Surg. 2005; 129: 167?74.
Kennaugh J.M., Kinsella J.P., Abman S.H., Hernandez J.A.,
Moreland S.G., Rosenberg A.A. Impact of new treatments for
neonatal pulmonary hypertension on extracorporeal membrane oxygenation use and outcome. J. Perinatol. 1997; 17:
366?69.
Mikus E.I., Stepanenko A., Krabatsch T., Loforte A.,
Dandel M., Lehmkuhl H.B. et al. Reversibility of fixed pulmonary hypertension in left ventricular assist device support
recipients. Eur. J. Cardiothorac. Surg. 2011; 40: 971?7.
????????? 14.05.2014 ?.
49
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e-mail: shmaltzanton@inbox.ru;
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? ?????? ?????? ?????? ?????? ????????????? ????????? ??????????? ??????? ??????????? ?????? ? ??????? 4 ??? 8 ???.
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