Vol 21, No 2 (2017)

Literature review discusses questions of hemodynamic significance of Patent Ductus Arte-riosus, methods of its surgical and drug (non-surgical) treatment and features in premature newborns.

Arterial hypertension (AH) is highlighted as a complication of bronchopulmonary dys-plasia (BPD) in children. The review provides information on the incidence, pathophysiology, diagnosis and treatment of AH in children with BPD. After analyzing the studies, were identified risk factors for hypertension in children with BPD, the role of endothelial dysfunction in raising systemic blood pressure, analyzed therapy and consequences of AH in children with BPD.

The article gives an overview of modern methods of endovascular treatment of acute and chronic venous pathology. And also the experience of using rheolytic thrombectomy (RT) as a method of treatment of flotation thromboses in the system of the inferior vena cava. The influence of the timing of the manifestation of flotation thrombosis on the efficacy of RT was assessed. The high efficiency of RT in patients with thrombosis up to 7 days from the moment of manifestation was demonstrated. The necessity of preliminary implantation of a temporary cava filter during RT is shown.

Functional recovery or irreversible negative remodeling of injured myocardial segments has different prognostic implication in patients with myocardial infarction (MI) undergoing coronary percutaneous intervention (PCI). Increased pulse wave velocity (PWV), a non-invasive index of arterial stiffness, is one of the important risk factors of cardiovascular events in different clinical conditions. The aim of the study was to assess the relationship between PWV and changes of left ventricular (LV) systolic function in patients with acute MI. Adverse cardiac remodeling was revealed in 72% of patients and they more often had non-recovery of left ventricular longitudinal function. Higher baseline PWV is associated with less effective recovery of LV function.

The article presents 2-year results of endovascular treatment of 68 patients with peripheral arterial disease, chronical limb ischemia stage 2B-4 (by Fontain-Pokrovsky), with the vascular lesions of type D according to TASC II classification, which is characterized by long, over 20 cm occlusion of the superficial femoral artery, popliteal artery involvement and/or arteries of the lower leg. The rationale to perform endovascular recanalization and stenting of extended occluding lesions of the arteries infrainguinal segment in our study were the results of the analysis of the literature data on the treatment of patients with occlusions of the femoro-popliteal segment, namely the development of postoperative complications after femoral-popliteal bypass surgery, such as lymphorrhea, primary thrombosis of the bypass, bleeding, acute renal failure and infection complications; occlusion of femoro-popliteal bypass grafts at 2 years after surgery reaching 60%, the need to perform repeated operations in 45% of patients; prolonged postopera-tive rehabilitation and therefore low quality patients. Analyzing treatment results testified the effectiveness and safety of endovascular method. Technical success of recanalization, angioplasty and stenting of arteries was successfully performed in all patients. Restenosis occurred in 13 patients (15%) at 1 year. After 2 years restenosis was revealed in another 4 patients. Primary patency during the first year of follow-up was 74.7 per cent, for 2 years - 72%. Secondary patency after 2-year follow-up after performing balloon angioplasty in patients with restenosis segment was 100%. Fatal complication of retroperitoneal bleeding developed in 1 patient. The overall incidence of complications was 6%. Most patients were discharged after 3 days. We continue to accumulate clinical observation and study long-term results of endovascular treatment of patients with peripheral arterial disease, with the vascular lesions of type D according to TASC II classification.

Pulmonary hypertension and pulmonary heart are severe complications of broncho-pulmonary dysplasia, accompanied by poor prognosis and high mortality. Based on Doppler echocardio-graphy in 100 children with bronchopulmonary dysplasia, the frequency of pulmonary hypertension de-velopment and pulmonary heart formation was determined. The risk factors for these complications and mortality outcomes have been defined. The quantitative evaluation of the informative value of electro-cardiographic, radiographic, computer tomographic signs of pulmonary hypertension in children with bronchopulmonary dysplasia was performed. The correspondence of the functional classes of pulmonary hypertension in the Panamanian classification of hypertensive vascular lung disease in children (2011) to the degree of increase in systolic pressure in the pulmonary artery and the severity of hypoxemia was defined.

The article is devoted to the study of a one-center experience of routine application of transradial access (TRD) by default in the treatment of patients with ACS in a short-term clinic, which has neither a vascular or cardiovascular surgery department. The experience of treatment of 3436 patients with acute coronary syndrome was analyzed, of which 72.64% were patients with acute myocardial infarc-tion. The use of TRD was considered successful in the case of completion of the procedure of stenting through the arm without the need for conversion of arterial access to the thigh. By default, right transradial access was used, except for cases of known anamnesis of mammarocoronary shunting. Time for puncture of the radial artery, installation of the introducer and catheterization of the arch of the aorta was 2.8 - 1.1 min. The average duration of fluoroscopy was 13.36 ± 8.86 minutes. The immediate success of the intervention, performed by transradial access, was 98%, of which the need for conversion to contralateral access was in 6.5% of patients. In total, two patients developed access point hematomas, which required the transfusion of blood components, managed to stop bleeding conservatively, in no case did vascular surgeons need help.

Article is devoted to analysis of models and methods for planning and forecasting in the reform of health care. Approaches to strategic planning and forecasting are shown by the example of the Federal program of the state guarantees of rendering to citizens of the Russian Federation of free medical aid.

Superior vena cava syndrome (SVCS) is a relatively common complication of malignant mediastinal tumors and can cause severe functional impairment. Over the past 20 years, in addition to the conventional management of the disease, interventional treatment of this syndrome has become a viable option for alleviating the symptoms of SVCS. Thus, multidisciplinary care can maximize the effectiveness of treatment for patients with SVCS.