Adult-onset Still’s disease in pregnancy complicated by macrophage activation syndrome
N.I. Artishevskaia, T.G. Rayeuneva, S.E. Aliakseitshik, E.A. Mikhnevich, A.M. Malyuta
Adult-onset Still’s disease is a rare polygenicautoinflammatory disease characterized by the classic triad of persistent high spiking fevers, joint pain (arthritis), and a distinctive salmon-colored bumpy rash. In the past decade, some pathophysiological mechanisms of the disease have been clarified and some sensitive and specific diagnostic criteria have been suggested. The disease is considered a diagnosis of exclusion. The course of the disease can be either relatively favorable or severe and disabling. Treatment is based on the use of glucocorticoids, immunosuppressive therapy and monoclonal antibodies. In the early 21 st century, descriptions of isolated cases and small series of adult-onset Still’s disease in pregnancy appeared in literature.
2020 Том 4, №1
Inherited coagulation disorders in newborns in the early neonatal period
T. N. Voitovitch, O.A. Platonova, E.N. Alferovich, I.N. Evstigneev, E.A. Sarzhevskaya, V.V. Dmitriev
The article presents a rare case of a hereditary coagulation disorder (factor VIII deficiency). Тhe reported rare case of hemophilia A manifestation in a child in the early neonatal period emphasizes the need for an accurate collection of a family history of bleeding, as well as an assessment of specific clinical and laboratory data and a differential diagnosis with other disorders of the blood coagulation system. The clinical manifestations of hemorrhagic syndrome were not specific; they allowed us to determine the direction of the laboratory search for violations of primary and secondary hemostasis. Clarification of the diagnosis and the choice of gemostatic therapy were performed after a laboratory study of blood coagulation. The presented studies reflect the most typical errors at the stages of diagnosis and correction of blood coagulation disorders, which will improve the quality of medical care for newborns in the future.
2020 Том 4, №1
Giant left ventricular aneurysm: sonographer’s view
N.V. Zatoloka, A.A. Popova, E.G. Komarovskaya
Aneurysm of the left ventricle is a well-defined area of a thin scar deprived of the muscle layer that develops after myocardial infarction with systolic akinesia or dyskinesia, which impairs its normal geometry and contractility and, as a result, reduces the ejection fraction. There are two strategies for treating left ventricular aneurysm, i.e. medication and surgery. Surgical treatment is absolutely indicated for patients with dyskinetic (akinetic) aneurysms with an increase in the endsystolic index > 80 ml/m 2 and in the end-diastolic index > 120 ml/m 2 , as well as with the threat of rupture or the development of a false aneurysm. A clinical case of a 72-year-old patient is presented. After myocardial infarction there developed a giant aneurysm of the left ventricle filled with a large thrombus. Due to the ineffectiveness of conservative treatment and the impossibility of surgical remodeling of the left ventricle using standard methods, the patient will have to undergo an orthotopic heart transplantation. This case is of interest due to the rare occurrence of such a clinical scenario of this pathology.
2020 Том 4, №1
Elimination of post-puncture arteriovenous femoral fistula
N.A. Rogovoy, V.A. Yanushko, I.P. Klimchuk, V.V. Komisarau, Y.A. Melnichuk
This article presents clinical cases of successful surgical treatment of arteriovenous fistula is formed after angiographic examination by transfemoral access. This pathology is quite rare and was identified as a random finding when we were examining patients with complaints of intermittent claudication and an angiographic exemiation in history. Treatment approaches of these patients are not completely clear. As a result, there are no generally accepted recommendations. The optimal treatment methods for these patients search for many reseachers. Surgical treatment of patients gave a positive clinical result. It is consistent with most literature data showing the advantage of surgical treatment.
2020 Том 4, №1
Double lung transplantation for primary pulmonary arterial hypertension under extracorporeal membrane oxygenation support
Sh.Z. Sharipov, E.V. Kotov, V.A. Shilo, E.A. Vilkotski, M.Ju. Gurova, V.V. Erohov, M.V. Kachuk, A.V. Sherbo, D.V. Korchemkin, A.M. Dziadzko, O.O. Rummo, N. P. Mitkovskaya, S.V. Golovinskiy
The surgical procedure of choice for treatment of patients with end stage of primary pulmonary arterial hypertension is double lung transplantation. Adequate systemic hemodynamics and gas exchange during the perioperative period of lung transplantation for such patients can be effectively and safely provided by venoarterial extracorporeal membrane oxygenation. The article presents a case report of successful lung transplantation under veno-arterial extracorporeal membrane oxygenation (central cannulation) to 22-year old patient with idiopathic pulmonary arterial hypertension complicated by right-ventricular heart failure with cardiomegalia due to expansion of the right chambers and congestive hepatopathy. This clinical case is the first one in the practice of Belarusian transplantology.
2020 Том 4, №1
A rare case of focal mid-ventricular form of Takotsubo syndrome
E.A. Vertinsky, L.Yu. Ushakova, M.V. Novikova
Stress cardiomyopathy, also called Takotsubo syndrome (TTS), broken heart syndrome and stress-induced cardiomyopathy, is characterized by transient regional systolic dysfunction of the left ventricle (LV) in the absence of angiographic evidence of obstructive coronary artery disease or acute plaque rupture as well as by regional wall motion abnormalities that extend beyond a single coronary vascular bed. TTS accounted for 1,7% to 2,2% of cases presenting with suspected acute coronary syndrome (ACS) or ST-elevation infarction in a systematic review. According to the International Takotsubo Registry, of 1750 patients with TTS, 89.8% were women (mean age 66,8 years). Complete recovery of LV systolic function is necessary to confirm the diagnosis of Takotsubo cardiomyopathy and can happen over a period of days to weeks. The typical and most common description of TTS is the apical type (81,7%), evident in the characteristic abnormality of a ballooned left ventricular apex with basal segmental hyperkinesis. However, atypical variants of this syndrome with mid-ventricular (14,6%), basal (2,2%) and focal (1,5%) wall motion patterns are increasingly diagnosed. We present a patient who developed a mid-ventricular dyskinetic TTS pattern.
2019 Том 3, №2
Allergic purpura in the therapeutical practice
L. N. Romanchuk, V. M. Pyrochkin, Y. I. Karpovich, E. V. Chalaya, A. L. Belyaeva, Y. L. Karpovich, А.А. Shchetko
The article describes the clinical case of the Henoch-Schönlein disease in a patient of 53 years as an example of the relevance of the anamnestic data careful analysis, objective examination of the patient and the differential diagnosis for early detection. Polymorphism of cutaneous manifestations and visceral lesions can cause difficulties in the diagnosis of allergic purpura. Early administration of pathogenetically justified combined treatment leads to stabilization of the inflammatory process, avoidance of possible destruction of the internal organs as well as development of complications and relapses.
2019 Том 3, №2
A case of complete detachment of the conduit of the ascending aorta and aortic valve
A.P. Shket, E.V. Vasilevich, A.A. Komarovski, S.I. Kozlov, O.I. Kozlov, V.A. Tokunov, A.A. Khadanovich, Y.A. Selyn
In cardiac surgery departments, repeated operations are increasingly performed in patients who have undergone valve correction or coronary bypass surgery in the past. The operational risk in this group of patients is much higher than in the group of primary operations, and is due to the adhesive process, the risk of re-access to the heart, various anatomical and pathological scenarios of pathology. A clinical case of a 47-year-old patient is presented. Primary surgery was performed in 2006 for aortic stenosis and aneurysm of the ascending aorta. On the second operation, the separation of the conduit of the ascending aorta and aortic valve, the complete separation of both ostiums of the coronary arteries with the formation of a false aneurysm of the ascending aorta was revealed. The patient underwent a replacement of the aortic valve, ascending aorta, the left coronary artery reimplantation, CABG to RCA. This case is of great interest due to the extremely rare occurrence of such a variant of pathology.
2019 Том 3, №1
Cardiac myxoma - difficult diagnosis cases
E.L. Trisvetova, M.I. Guseva, K.M. Kaminsky, E.I. Shkrebneva
Absence of characteristic signs leads to late diagnosis of myxoma of the heart, complicated by congestive heart failure, embolism in various vascular regions, cardiac arrhythmias, sudden cardiac death. Nonspecific clinical syndromes due to the presence, localization or structural features of the tumor including systemic manifestations, congestive heart failure caused by obstructive intracardiac disorders or embolism in the vessels of the systemic and pulmonary circulation justify the performance of diagnostic methods of heart visualization. An informative noninvasive method of diagnosis is echocardiography, which, in two cases of observation, revealed myxoma of the heart.
2018 Том 2, №2
Successful surgical repair of ventricular septal defect and left ventricle aneurysm in acute myocardial infarction
A.V. Yanushko, S.L. Salauyou, Yu.T. Liutkevich, I.L. Kiziukevich
Postinfarction ventricular septal defect (VSD) is a rare, but fatal complication developing within the first two weeks from the onset of myocardial infarction (MI). Patients with VSD most frequently die of acute decompensated heart failure within several days. Nevertheless, the timing of surgical repair still remains under consideration. A more «aggressive» approach implies closing the defect in the shortest possible time period after VSD is diagnosed; whereas some surgeons advocate stabilization of patients’ hemodynamics by means of circulatory support devices with the subsequent delayed surgical treatment. We present a clinical case of the patient with acute myocardial infarction who underwent successful surgical treatment for two life-threatening complications of acute MI: VSD and posterior aneurysm of the left ventricle.
2018 Том 2, №2