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09.08.2014, 16:25 | |
Резюме Резюме Summary Рецензент: д.мед.н., проф. Ю.Г. Бурмак УДК 616.12-007-053.1 ГЗ «Луганский государственный медицинский университет» State Establishment "Lugansk State Medical University" boba@dsip.net Cavity of the right ventricular (RV ) can be divided into three divisions: the supply department , musculo- trabecular and output [1,4] . Hypoplasia of the right ventricle - is a congenital heart disease (CHD ), in which the internal cavity of the prostate reduced in size [3]. Cause a decrease in RV cavity is hypoplasia or supply departments ventricular muscle [5]. RV hypoplasia sometimes develops due to a pronounced increase in volume ( hypertrophy ) of trabecular muscle (muscle) of the ventricle [12]. Hypoplastic right ventricle syndrome is almost always combined with a patent foramen ovale, ASD or interventricular septum . This rare CHD , was first described by D. Cooley et al in 1950 [11]. In the world literature contains only 29 observations, but in conjunction with other malformations , hypoplastic right ventricle syndrome is much more common [9,14]. In Ukraine are born every year 4.5 - 6 thousand children with disorders of the heart, but the clinical manifestations of CHD to occur in patients 13-15 years. With age, there are signs of right heart failure, i.e. stagnation of blood in the veins of the liver and systemic circulation [6]. It is therefore extremely important , timely diagnosis of this pathology and provedeniyae appropriate surgical correction [5]. The basic treatment is a surgical method of Glenn [3]. The operation Glenn is " bi-directional ": anastomosis connects the superior vena cava as the right and left pulmonary arteries. While blood from the superior vena cava flows in two directions: in the left lung and right. This operation allows you to improve the quality and increase the life expectancy of the patient [10]. At the end of the above quote a rare clinical case. In July 2012 in the cardiovaskular admissions in LOKD was a patient S., 33 years old, with a diagnosis of CHD, RV hypoplasia, functional single left ventricle, ventricular septal defect (5 mm), the state after imposition of kava - pulmonary anastomosis (1993, Moscow) . Complications: Acute decompensated moved CH 2 B st., which is translated in CH 2 A st. Absolute pulmonary hypertension. Related: encephalopathy, the consequences of stroke (2002) in the form of scarring left frontal lobe. Hemomicrocirculatory dysfunction syndrome. The patient complained of shortness of breath inspiratory nature, pain in the heart compressing character, rare swelling of the lower extremities. From history: before 1993 the patient was not aware of the presence of her current vice. At age 13, she had her manifestations CH II B st. with signs of decompensation blemish. About decompensation vice operation was performed overlay bidirectional cava- pulmonary anastomosis. The patient's condition improved ( CH II B st. was transferred to the CH II A st.). On admission : state of moderate severity, diffuse cyanosis, muffled heart sounds, systolic murmur 3-4 intercostal space at the left sternal border, which takes place in the axillary and interscapular region. Blood pressure in patients 90/60 mm Hg. In the EKG signs on left ventricular hypertrophy and right atrial (P-pulmonale), which is typical for this blemish. When echocardiography study - hypoplasia of the right ventricle to the atrial septum in the basal part is determined by "riding sedentary " tricuspid valve in the upper third of the interventricular septum defect to 5 mm, signs of hypertrophy of the right atrium. Echocardiography results are final and most reliable in the diagnosis of hypoplastic pancreas. Following the examination to clarify the diagnosis was made a correction to the treatment regimen . Two weeks later, with the improvement being the patient was discharged with a further observation and address the issue of re- operative treatment . Литература
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