Osovska N. Small heart anomalies: stratification of risk factors and principles of medicaments' correction.

This dissertation was devoted to the optimization of medical treatment for the patients with small structural heart anomalies (SSHA): mitral valve prolapse (MVP) and abnormal chords of left ventricle (ACLV). The optimization was made on the basis of the stratification of risk factors and revealing of unfavorable prognosis criterion. It has been determined that in patients with MVP the degree of myxomatous degeneration (MD) of leaflets was the most significant factor for the prognosis. In patients with ACLV ? the quantity of ACLV, their thickness and calcinosis were the most significant prognostic factors. According to the data of ambulatory ECG and blood pressure monitoring the MVP and ACLV were accompanied with the disorders of rhythm, depolarization and blood pressure profile. Also the moderate disorders of both systolic and diastolic function of left ventricle (LV) were revealed. Such factors as the existence and the degree of leaflet's MD, the multiple character of ACLV, the degree of papillary muscles' abnormal traction, the heart rate meaning, the increase of Q-T interval dispersion, the blood pressure variability and the speed of morning BP rise, the feature of hypersympathicotonia had the greatest significance on the prognosis of structural and functional disorders of myocardium and arrhythmic features. The patients with multiple ACLV and left ventricular non-compaction (LVN) had a similar alteration of structure and function of LV. The principles of differentiation of LVN and dilatation cardiomyopathy were developed. The expedience of separation of patients with small structural heart anomalies on groups with low, moderate and high risk for different treatment was established.