Lebedieva Y. The role of coronary artery tortuosity in the development of myocardial ischemia.

This thesis is the first domestic research on the role of coronary artery (CA) configuration in the development of myocardial ischemia. Using general clinical, invasive and non-invasive instrumental methods of investigation it was found that, in the examined patients with coronary heart disease (CHD), tortuosity of the main branches of the CA was found, either in isolation or in combination with other cardiac pathology, at a rate of 9.4 %; as compared to perfusion of the left ventricular (LV) wall for each area of myocardium that is supplied from both tortuous and non-tortuous CA. The diagnostic significance of CA tortuosity in patients with CHD depending on the presence of hemodynamically significant atherosclerosis of the vascular wall was determined. The leading role in the development of myocardial ischemia belongs to tortuous configuration of the CA in the case of absence of atherosclerotic lesion, and secondary when connected with hemodynamically significant stenosis. It was shown that CA tortuosity in patients without any atherosclerotic lesion of the vascular wall can cause myocardial ischemia which in 98 % of patients manifested typical CHD pain syndrome. In 23.8 % of patients there was acute disorder of coronary circulation in the anamnesis, reduced index of LV myocardium perfusion in areas of vascularization of tortuous CA and decreased of functional reserve. CA tortuosity in patients with hemodynamically significant atherosclerotic lesions of the vascular wall is the factor of coronary hemodynamic disturbances that can increase the frequency of development of LV aneurysms (according to the echocardiography to 16.4 %, according to coronarography to 21.0 %).