Gonchar M. Clinical, instrumental and biochemical comparison of the cardiovascular system in children with congenital heart disease.

The work covers the problem of improvement the efficiency of preventing the development and progression of heart failure, monitoring and rehabilitation of children with congenital heart disease (CHD) in preoperative and a long-term postoperative periods by the study of heart remodeling, function of the cardio-vascular system, myocardial injury biomarkers, and activity of brain natriuretic propeptide; creating the concept of disease development and development of an algorithm for early diagnosis of heart failure. For the first time on the basis of integrated clinical, instrumental and biochemical assessment of the cardiovascular system in 801 children with congenital heart disease the the peculiarities of the heart failure manifestations in patients with depletion and enrichment of pulmonary circulation have been revealed. The expediency of use of troponin I and brain natriuretic propeptide in the clinical management of patients with CHD has been proved, the additional criteria to individualize therapy and rehabilitation have been proposed. The frequency of myocardial dysfunction in children with CHD before and after the cardiac surgery has been investigated; the necessity of its determination as a preclinical stage of heart failure has been justified. The algorithm for early diagnostics of heart failure in children with congenital heart defects has been developed. Based on the analysis of variations in heart remodeling in a long-term period after surgical correction of CHD, studying their relationship with the formation of myocardial systolic and diastolic ventricular dysfunction, and estimating the levels of cardiac biomarkers, the additional informative criteria to evaluate the functional state of the heart have been determined, the necessity and the amount of syndromal and pathogenic rehabilitation has been justified.