Cardiovascular System In Children Research Articles

Assessment of metabolic indicators of the cardiovascular system in children with nephrotic syndrome

Objective: to evaluate the metabolic parameters of the cardiovascular system in nephrotic syndrome in children Material and methods: 110 children hospitalized with nephrotic syndrome in the nephrology department of the Samarkand Regional Children’s Multidisciplinary Medical Center were examined. Results: Renocardial syndrome with nephrotic syndrome develops in 64.8% of cases, the majority of patients are children 3-6 years of age (44.1%), with a predominance of boys (58.8%). In a cardiometric study in patients with nephrotic syndrome, renocardial syndrome is manifested by significant changes in metabolic and adaptation parameters: oxygen and lactate content - by 1.5 times, creatine phosphate - by 20%, tension index - by 4.8 times and vascular stiffness index - by 5.2 times. Conclusion: Deviation of cardiometry indicators in different age groups indicates a decrease in the intensity of blood circulation in organs and systems, indicating a significant load on the cardiovascular system in nephrotic syndrome.

Children With Cardiac Disease and Heat Exposure: Catastrophic Converging Consequences?

To highlight the worrying paucity of investigative research aimed at differentiating how higher ambient temperatures further tax an already compromised cardiovascular system in children. This commentary describes basic thermoregulatory concepts relevant to the healthy pediatric population and summarizes common heart diseases observed in this population. We describe how heat stress and exercise are important factors clinicians should more readily consider when treating children with heart disease. Countermeasures to physical inactivity are suggested for children, parents, clinicians, and policymakers to consider. As sudden, excessive heat exposures continue to impact our rapidly warming world, vulnerable populations like children with underlying heart conditions are at greater heat health risk, especially when coupled with the negative physical activity and fitness trends observed worldwide.

The surge in heart rate and blood pressure at respiratory event termination is dampened in children with down syndrome

BackgroundChildren with Down syndrome (DS) have a high prevalence of sleep disordered breathing (SDB) and altered cardiovascular autonomic control. We aimed to analyze the effect of DS on the surge in heart rate (HR) and pulse transit time (PTT, an inverse surrogate measure of blood pressure change) at respiratory event termination. Methods44 children (3–19 y) with DS and 44 typically developing (TD) children matched for SDB severity, age and sex underwent overnight polysomnography. Multilevel modelling determined the effect of DS on HR and PTT changes between a 10s pre-event to the latter half of each respiratory event (late-event) and 15s post-event during NREM and REM, accounting for SDB severity and event length. ResultsThe children with DS had a significantly smaller % change in HR late-event to post-event (NREM: DS 26.4 % ± 17.5 % (mean ± SD), TD 30.7 % ± 21.0 %; REM DS 16.9 % ± 15.3 %, TD 21.0 % ± 14.0 %; p < 0.05 for both) compared with TD children for obstructive events, and central events (13.2 % ± 17.0 %, TD 18.8 % ± 17.0 %; p < 0.01) during REM. %change in PTT was significantly smaller in the DS group during NREM and REM from pre-event and late-event to post-event compared with TD children for obstructive and central events. ConclusionThese results suggest children with DS have dampened HR and BP responses to respiratory events compared with TD children. Whether this is symptomatic of autonomic dysfunction or a protective factor for the cardiovascular system in children with DS remains to be elucidated.

Діти з дефектами генів - група ризику щодо розвитку аномалій серцево-судинної системи

To date, the prevalence of congenital heart defects (CHD), the level of disability and mortality from them in children remains an unsolved problem in pediatrics, despite the improvement of preventive measures, diagnostics and treatment in pediatric cardiology. There are a number of genetic diseases that are manifested by congenital anomalies of the cardiovascular system. Purpose - to analyze the abnormalities of the cardiovascular system in children with gene defects for the early diagnosis of genetic diseases in patients and the detection of congenital pathology of the heart and blood vessels in them, followed by their treatment tactics. This article describes a number of genetic syndromes in children, in which congenital anomalies of the heart and blood vessels are the most common. The characteristics of each of the syndromes include its definition, clinical symptoms with an emphasis on the external signs of the patient, the study of abnormalities of the cardiovascular system in this genetic disease, the examination plan for the patient and genetic testing used for the accuracy of the diagnosis. Conclusions. Based on the results of our analysis, we can conclude that there is a certain regularity between genetic diseases in children and the development of CHD in them, according to which certain CHD are formed with certain gene defects. Knowledge of the main clinical symptoms, especially external dysmorphism, in such patients helps in faster diagnosis and treatment of a genetic disease, in particular CHD. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Clinical case of diagnosis of left ventricular non-compaction in a child

Diseases of cardiovascular system in children present an extremely urgent problem nowadays. According to the latest epidemiological studies, there has been an increase by almost 3.2 % in congenital heart disease in Ukrainian children over the past 20–30 years. Left ventricular non-compaction belongs to a group of unclassified cardiomyopathies with undetermined prevalence. At the same time, based on literature, this pathology is characterized by a late diagnosis and very high mortality. In the pathogenesis of the disease, structural changes in the myocardium occur during the embryonic stage, leading to its abnormal development. Left ventricular non-compaction is considered a genetically heterogenous disease, which is inherited in an autosomal dominant pattern. The article deals with a clinical case of diagnosis and management of a child with left ventricular non-compaction, which demonstrates to ge­neral practitioners, pediatricians, and pediatric cardiologists the algorithm for diagnosing and managing patients with a rare disease in order to make earlier diagnosis, prevent complications, and preserve patient’s life. The patient who has been suffered from pneumonia, complained of breathlessness and rapid fatigue during minor physical exertion was timely referred by the family doctor for consultation with a pediatric cardiologist. Laboratory and instrumental studies allowed to suspect a rare congenital heart disease — left ventricular non-compaction. Subsequently, the patient was regularly examined by cardiologists and cardiac surgeons, received protocol therapy, was registered in a state transplant registry, which allowed to wait for a donor with subsequent successful heart transplant surgery.

Functional state of the cardiovascular system in children after COVID-19

Introduction. The new coronavirus infection (COVID-19) in children often occurs in a mild, moderate, or asymptomatic. After experiencing COVID-19, some children, as well as adults, had persistent symptoms over more than 12 weeks and could not be explained by alternative diagnoses. These changes are called Post-acute COVID-19 Syndrome (PACS, post-COVID-19 syndrome or post-covid syndrome). Clinical manifestations of post-covid syndrome in children are very diverse, there are combinations of autonomic, psycho-emotional, cognitive and somatic disorders, including disorders of the cardiovascular system. &#x0D; Aim: analysis of changes in the functional state of the cardiovascular system in children in the post-covid period.&#x0D; Materials and methods. The study included one hundred thirty one child aged of 5 to 17 years 11 months 29 days (mean age 12 years [9.5; 15]). The observed children were divided into 2 groups: group 1 (main) — children who had a mild new coronavirus infection (n = 76). The comparison group consisted of children who did not have COVID-19, suffered from acute respiratory viral infections of unspecified etiology of a mild course (n = 55). All children were analyzed for medical history, underwent clinical examination, electrocardiographic examination (ECG), echocardiographic examination (ECHO-KG), 24-hour Holter ECG monitoring and 24-hour blood pressure (BP) monitoring.&#x0D; Results. Children who have had COVID-19 are significantly more often showed sinus tachycardia (p = 0.025), extrasystole (supraventricular, ventricular) (p = 0.046), atrioventricular blockade of the 2nd degree (p = 0.027) compared with children with ARVI. After undergoing COVID-19, in 19.7% of children an increase in blood pressure was detected, in 15.8% of children there was a significant decrease in blood pressure at night (p = 0.008). In 38.2% of children after COVID-19, there was a decrease in the activity of the parasympathetic division of the nervous system.&#x0D; Conclusion. Children who have had a new mild coronavirus infection were shown to undergo a clinical examination with a mandatory assessment of blood pressure, heart rate and an ECG 3 and 6 months after the illness.

Ураження серцево-судинної системи у дітей з COVID-19

Purpose - to assess the diagnostic and prognostic value of the E-selectin marker in relation to manifestations of damage to the cardiovascular system in children with COVID-19. Materials and methods. We conducted a cohort, observational, retrospective study involving 88 patients aged 1 month to 18 years with laboratory-confirmed COVID-19 by polymerase chain reaction. The children were hospitalized in Kyiv City Children’s Clinical Infectious Disease Hospital. We divided the examined cohort into two groups according to the course of the disease - the main group, which included 42 patients with a complicated course of COVID-19, and the control group - 46 patients with an uncomplicated course of the disease. In the study, we took into account the data of ECG, patient complaints and clinical symptoms. During the comprehensive examination of the patients on the first day of their stay in the hospital, the blood serum of the patients was collected for the purpose of its further examination for the level of E-selectin by enzyme immunoassay. Statistical, analytical methods and the method of empirical research were used in the research. To calculate the obtained results, we used the statistical program “Statistical software EZR v. 1.54”. Results. In patients of the control group, E-selectin was observed at the level of 12.02±1.7 ng/ml, while in the children of the main one, the indicator was higher, it was 15.04±1.9 ng/ml (p=0.034). According to the assessment of the prognostic value, we found that an increase in the level of E-selectin above 10 ng/ml is associated with a significant increase in the risk of the appearance of clinical symptoms of the cardiovascular system in children with COVID-19 (p&lt;0.05). We also noted a tendency for the marker to grow with objective changes on the ECG. Conclusions. We discovered the diagnostic and prognostic value of the E-selectin marker in children with COVID-19 regarding the manifestations of damage to the cardiovascular system in children with COVID-19. An increase in the level of E-selectin above 10 ng/ml is associated with a significant increase in the risk of the appearance of clinical symptoms of damage to the cardiovascular system (p&lt;0.05) and objective changes during instrumental examination (p&lt;0.1). The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. Written consent from patients was not required, as the study is retrospective and uses data from routine medical records. No conflict of interests was declared by the authors.

Analysis of the results of functional diagnostic studies of the cardiovascular system in children after surgical correction of congenital heart defects

Objective. To evaluate the features of the cardiovascular system in children after surgical correction of congenital heart defects revealed by functional diagnostic studies.Materials and methods. A functional diagnostic examination of the cardiovascular system (CVS) was performed in 43 children aged 5 to 17 years with the main clinical diagnosis: “Congenital heart disease” (CHD), of which 33 children of the main group (MG) had corrected CHD, in 10 children of the comparison group (CG) CHD correction was not performed due to the presence of certain contraindications. Patients were on a routine examination and treatment for CHD in the cardio-rheumatology department of the institution “Gomel Regional Children’s Clinical Hospital” in the period 2020-2022.Results. Based on the statistical processing of the results of the study, which included an assessment of clinical and anamnestic data and indicators of functional diagnostic methods for examining the CVS in children with CHD, the need for a comprehensive cardiological examination in children with this pathology was established, regardless of the method of performed surgical intervention. It was found that the majority of children with corrected CHD on the ECG had rhythm and conduction disturbances, as well as combined arrhythmias, and one third of the patients had cardiac complaints. According to the Holter monitoring (HM) and bicycle ergometry (BEM) tests, the children showed signs of electrical instability of the myocardium and a decrease in the adaptive reserves of the cardiovascular system.Conclusion. Children with corrected CHD require a comprehensive functional and diagnostic examination, which makes it possible to identify an “arrhythmogenic substrate” and establish signs of myocardial electrical instability, thereby optimizing the tactics of treatment and rehabilitation of this group of patients.

Computational Analysis of Cardiovascular Effects of COVID-19 Infection in Children

Background: The COVID-19 disease can involve any body part; nevertheless, the most serious consequences affect respiratory and cardiocirculatory systems with variable symptoms. Although the effects of COVID-19 are not fully understood yet, clinical evidence has shown that the virus may cause acute myocardial injury and chronic damages to heart and blood vessels. There is no or limited experience on pathophysiological effects of COVID-19 infection in children’s cardiovascular system. The aim of this work is to assess the effects of COVID-19 on the cardiovascular system in children, in terms, e.g., of increased pulmonary resistances, reduced cardiac contraction capacity. Methods: We used a computational model based on lumped parameters to describe the whole blood circulation. The model was calibrated to account for data coming from pediatric patients. Results: There were total of 17 pediatric patients diagnosed to have COVID-19 infection based on laboratory and clinical findings. The median age was 15 years (range 7 to 17 years), median weight 61 kg (range 25 to 153 kg), median height 165 cm (range 132 to 191 cm) and median body surface area 1.7 (range 0.95 to 2.8). Our results highlighted that the effect of COVID-19 on the cardiovascular system in all children was characterized by the reduction in cardiac blood pressures and volumes. We analyzed in detail two patients showing a correlation between myocardial compromise and severity of the infection. Conclusion: Our study demonstrates that COVID-19 infection causes a complex pathophysiological state to the cardiovascular system, both in asymptomatic and symptomatic pediatric patients. This information is very helpful to prevent long term cardiovascular complications of COVID-19 infection in children. A prospective study with regular cardiology follow-up is recommended.

Brain natriuretic peptide and catecholamines in adolescents with juvenile idiopathic arthritis

Juvenile idiopathic arthritis is a group of chronic diseases of uncertain etiology, in which an immuno­inflammatory process develops with systemic damage to the vascular endothelium, leading to the involvement of vital organs and systems against the background of persistence of the inflammatory process.&#x0D; Objective — to determine the level of excretion of catecholamines in the daily urine and natriuretic peptide in the blood of adolescents with juvenile idiopathic arthritis.&#x0D; Materials and methods. The study involved 56 patients with juvenile idiopathic arthritis, aged (13.28 ± 0.38) years, including 17 boys, 39 girls. The polyarticular form of the disease was diagnosed in 48 patients (86 %), the oligoarticular form was in 8 (14 % of patients). The duration of the disease was (68.96 ± 6.29) months (from 12 to 180 months). All patients received methotrexate for more than 12 months, the average dose of which was (11.73 ± 0.39) mg/m2 per week. The control group consisted of 46 (27 boys and 19 girls) practically healthy peers (14.72 ± 0.28) years. The content of catecholamines (adrenaline and norepinephrine) in daily urine was studied by iodine oxidation with the formation of fluorescent trihydroxyindoles (adrenolutin and norepinephrine) and subsequent fluorimetry, as well as the level of brain natriuretic peptide in the blood by competitive immunoassay.&#x0D; Results and discussions. In patients with juvenile idiopathic arthritis, the level of excretion of catecholamines in the daily urine remains within the age norms, but significantly lower than in healthy peers (p &lt; 0.01), the adrenaline/norepinephrine ratio also decreases (p &lt; 0.05). A significant increase in the level of brain natriuretic peptide in the blood was found in patients with juvenile idiopathic arthritis (p &lt; 0.01), especially in children aged 11—14 years and disease duration up to 5 years (p &lt; 0.05).&#x0D; Conclusions. The change in the ratio of catecholamine excretion and blood natriuretic peptide level determines the processes of formation of morphofunctional disorders of the cardiovascular system in children with juvenile idiopathic arthritis.

Consumption of very low-mineral water may threaten cardiovascular health by increasing homocysteine in children.

Homocysteine (Hcy) is a critical factor for cardiovascular injury, and the elevation of Hcy in children will inevitably increase the risk of cardiovascular disease in adulthood. This study explored the effect of very low-mineral water on children's Hcy and cardiovascular health. This was a retrospective cohort study that recruited two groups of 10-13-year-old children who had consumed direct drinking water (DDW) in school for 4 years. The control group (NW) (119 boys, 110 girls) consumed normal DDW (conductivity 345 μs/cm). The very low-mineral water consumption group (VLW) (223 boys, 208 girls) consumed very low-mineral DDW (conductivity 40.0 μs/cm). Serum Hcy, Hcy metabolites, cofactors of Hcy metabolism, and cardiovascular biomarkers were assessed and standardized by age- and sex-specific Z-scores, and the differences between the two groups were analyzed with independent t-test. The relationships between Hcy metabolism biomarkers and key factors, cardiovascular biomarkers, serum Ca, and mineral intake were analyzed with linear regression. Compared with the NW group, the VLW group had significantly higher serum Hcy, Apo-B, Apo-B/A1, and oxLDL, and lower serum 1,25,(OH)2D3, vitamin B6 and B12, 5-methyltetrahydrofolate, and Apo-A1. Serum Hcy was positively associated with serum Apo-B and Apo-B/A1, and negatively associated with Ca intake from water and serum 1,25,(OH)2D3. This study suggested that drinking very low-mineral water may increase Hcy level and oxidative stress, worsen lipid profile, and threaten the cardiovascular system in children. Reducing 1,25,(OH)2D3, and disordering of calcium metabolism might play important roles. This study first established an association between demineralized drinking water and cardiovascular health in children, suggesting a new environmental concern risk to cardiovascular health.

Features of left ventricle longitudinal strain in children from one to five years old, born with low, very low, and extremely low body weight

Purpose. The study assessed left ventricle longitudinal strain of the endocardial, middle, and epicardial layers in children from one to five years old, born with low, very low, and extremely low body weight.Material and methods. The study was performed in 204 children aged from one to five years; of these, 53 children were prematurely born late in pregnancy, 103 children were born very preterm, and 48 children were born healthy and full-term. The left ventricle longitudinal strain of the endocardial, middle, and epicardial layers was assessed off-line using the Speckle Tracking Imaging-2D Strain technology.Results. Disturbance of the transmural gradient strain of left ventricle wall were detected in 11.32% of prematurely born late in pregnancy children and in 16.5% of very preterm children. A decrease of left ventricle segments strain was registered in 33.96% of children prematurely born late in pregnancy and in 18.44% very preterm children. In children of the same age, born healthy and full-term, transmural wall gradient disturbances and decrease of strain in left ventricle segments were not observed. In children prematurely born late in pregnancy, the disturbance of the transmural strain gradient of left ventricle and the decrease of strain in left ventricle segments are not associated with left ventricle remodeling.Conclusion. The development of the cardiovascular system in children of early and preschool age, born prematurely with low, very low, and extremely low body weight, is characterized by disturbances in the transmural strain gradient of left ventricle wall, due to the processes of postnatal growth and development of the child’s heart, which requires monitoring on an outpatient basis in polyclinic in childhood — by a pediatric cardiologist and a pediatrician, and in adulthood — by a cardiologist and therapist.

Complications from the cardiovascular system in children who have had COVID-19

The article discusses the state of the cardiovascular system in children who have had COVID-19, depending on the severity of the course of the infectious process. We conducted a retrospective analysis of the case histories of 88 children of various ages who were hospitalized with a confirmed diagnosis of a new coronavirus infection COVID-19 in September-November 2020.There were 48 boys (54.6%), girls - 40 (45.4%). According to the classification, the examined children were divided into 4 groups: pre-preschool period (1-3 years) - 9 (10.2%), pre-school period (from 3 to 7 years) - 32 (36.4%), junior school period ( 7-11 years old) - 29 (32.9%) and senior school period (from 12 to 16 years old) - 18 (20.4%) . An analysis of the characteristics of the course of COVID-19 depending on the severity showed that the moderate and severe course of the disease mostly developed in boys (58.5 and 60.0%), the mild course was typical for girls (66.7%).

Эффективность программы физической реабилитации детей с корригированными врожденными пороками сердца

Children with repaired congenital heart diseases (CHD) have low physical activity that causes a decrease in cardiorespiratory endurance. This is one of the risk factors for cardiovascular events. Physical exercises are recommended for children and adolescents with repaired CHD at all stages of rehabilitation after surgery. The purpose — to assess the effectiveness of physical rehabilitation program in children with repaired congenital heart diseases. Material and methods. 96 patients aged 8–13 years with repaired non-cyanotic CHD without obstructive heart lesions were studied. The children of the main group completed a physical exercise program and took ubidekarenone for a month twice a year. The children of the comparison group took only ubidecarenone. The cardiovascular system functioning was assessed in all subjects with the treadmill exercise test using the modified Bruce protocol. Results. After rehabilitation, the children of the main group had higher maximum systolic blood pressure, inotropic reserve, chronotropic reserve, work done, maximum double product and its reserve than the children of the comparison group. There was a decrease in the resting heart rate and a decrease in the time to restore the heart rate after the exercise test. In the main group, more children than in the comparison group had a normotonic type of hemodynamic reaction to physical exercise after completing the rehabilitation program. The functions of the cardiovascular system increased in 87.5%, 42/48 (p &lt; 0.001) children of the main group and in 25.0%, 12/48 children of the comparison group. Conclusion. The rehabilitation program using physical exercises and ubidecarenone had a positive effect on the functional state of the cardiovascular system in children with repaired CHD.

Accuracy of physical examination of cardiovascular system in the diagnosis of common congenital heart diseases in children

BackgroundIt is widely perceived that the value of physical examination in paediatric cardiology has diminished with the increasing availability of echocardiography. The accuracy of physical examination of cardiovascular system in...

Changes in the cardiovascular system in children with pediatric multisystem inflammatory syndrome temporally associated with COVID-19 – A single center experience

BackgroundPediatric multisystem inflammatory syndrome temporally associated with COVID-19 (PIMS-TS) is a serious complication of a previous SARS-CoV-2 infection in the group of pediatric patients. Despite the fact that this disease affects only about 1 of 1000 children, it may be severe, and changes in the cardiovascular system may cause long-term complications and the need for longitudinal patient care.MethodsIt is a single-center retrospective study considering 51 patients with PIMS-TS. The aim of this study was to analyze patients with PIMS-TS, taking into account demographic data, clinical course, laboratory tests and cardiovascular system assessment (electrocardiography, echocardiography, etc.).ResultsFrom June 2020 to October 2021, 51 patients with PIMS-TS were hospitalized in our center. In the studied group, 26/51 children (51%) were girls. The mean age of patients was 7 years. Changes in electrocardiograms were found in 21/51 patients. Echocardiography revealed pericardial fluid in most patients. In addition, heart valve insufficiency was found. Changes in the coronary vessels in the form of dilatations and even aneurysms were found in 42 patients. Myocardial hypokinesis was visualized in more than 1/4 of the patients. Sixteen patients (31.3%) required transfer to the intensive care unit (ICU) due to severe hypotension. Laboratory tests revealed increased levels of markers of heart failure and enzymes of myocardial damage.ConclusionsChanges in the cardiovascular system in the course of PIMS-TS are of various nature, but in most patients they require close cardiac supervision and long-term follow-up.

Патология сердечно-сосудистой системы у детей с синдромом Шерешевского — Тернера

Статья посвящена изучению структуры патологии сердечно-сосудистой системы у детей с синдромом Шерешевского — Тернера. Результаты работы основаны на данных обследования 42 больных с синдромом Шерешевского — Тернера в возрасте от 1,5 до 17 лет. Показано, что у 80,9 % больных с синдромом Шерешевского — Тернера отмечаются патологические изменения со стороны сердечно-сосудистой системы разной степени выраженности. Наиболее часто встречаемыми врожденными пороками сердца при синдроме Шерешевского — Тернера являются коарктация аорты, двустворчатый аортальный клапан и дефект межпредсердной перегородки. Синдром Шерешевского — Тернера в 35,6 % случаев ассоциирован с нарушениями электрической работы сердца, в частности с синдромом удлиненного интервала QT. Атерогенные изменения липидного профиля у больных с синдромом Шерешевского — Тернера в 21,4 % случаев наблюдаются с детства.

The Impact of Gestational Diabetes in Pregnancy on the Cardiovascular System of Children at One Year of Age.

Gestational diabetes mellitus (GDM) is a common complication in pregnancy. The effect of GDM on the cardiovascular system after birth is still unclear. Between August 2015 and December 2018, 205 pregnant women were included in the prospective controlled observational study. Patients with GDM were assigned to the study group (n = 99), whereas (n = 107) healthy women served as controls. Postnatal follow up of their offspring was performed at 12 months of age. All included children (n = 125) underwent a specific standardized protocol including anthropometric data, such as weight, height, body mass index (BMI), blood pressure (BP) recordings and ultrasound measurements of the abdominal aortic intima-media-thickness (IMT). Furthermore, at least 10 min 3-channel electrocardiogram recording was done to evaluate the autonomic nervous system (ANS) by phase rectified signal averaging. There were no significant differences in anthropometric data between the groups, neither in the blood pressure nor in the intima-media-thickness of the aorta abdominals. However, in the study group, significantly lower average acceleration capacity (AAC) (study group −20.10 ± 3.04 ms, control group −18.87 ± 4.00 ms, p = 0.02) was found, indicating ANS activation at one year of age. Further studies are required to determine if these results are persistent and if these findings have long-term effects.

Современные подходы к лечению вторичной аритмогенной кардиомиопатии у детей

Цель: изучить особенности морфофункциональных характеристик сердечно-сосудистой системы у детей и подростков с нарушениями ритма, а также основные нейрогуморальные факторы, сопровождающие формирование вторичной аритмогенной кардиомиопатии (вАКМП) у этой категории пациентов, а также установить эффективность терапевтических комплексов для восстановления нарушенных структуры и функции сердца у подростков с вАКМП. Материалы и методы. Обследовано 134 подростка в возрасте 13–18 лет с нарушениями ритма и проводимости, без органической патологии сердца, из них 55 (41,0 %) девушек и 79 (59,0 %) юношей. Функциональное состояние сердечно-сосудистой системы обследовали с помощью электрокардиографии, ультразвукового исследования. Для оценки активности симпатоадреналовой системы (САС) проводили исследование катехоламинов (норадреналин, адреналин) в моче. Исследование системы «ренин — ангиотензин — альдостерон» (РААС) включало определение активности ренина плазмы, содержания ангиотензина II и альдостерона в периферической венозной крови. Изучение субклинического воспаления включало определение в крови ФНО-a, ИЛ-1b, ИЛ-6. Для восстановления нарушенной функции сердца были использованы терапевтические комплексы патогенетического или метаболического действия. Результаты. Установлено, что длительно существующие у ребенка любого возраста нарушения ритма способствуют развитию вАКМП, проявлением которой является ремоделирование миокарда с расширением полостей и нарушениями в первую очередь диастолической, а затем и систолической его функции. Установлено, что дезадаптивное ремоделирование миокарда сопровождается снижением вариабельности сердечного ритма, повышением активности САС и РААС, а также провоспалительных цитокинов. Использование комплекса патогенетической терапии, а именно препаратов из группы ингибиторов АПФ и бета-адреноблокаторов, более эффективно способствует восстановлению морфофункциональных параметров сердца, нормализации показателей нейрогуморальных систем и факторов субклинического воспаления. Выводы. Дети с признаками вАКМП требуют более активного наблюдения и назначения препаратов, предупреждающих прогрессирование дисфункции миокарда, а также средств его метаболической поддержки.

Порушення ниркової й периферичної гемодинаміки в розвитку серцево-судинних розладів у дітей із хронічним пієлонефритом

Актуальність. Своєчасне виявлення змін з боку серцево-судинної системи в дітей із хронічним пієлонефритом важливе для уповільнення розвитку артеріальної гіпертензії, прогресування хронічної хвороби нирок. На сьогодні сучасними неінвазивними методами ранньої діагностики серцево-судинних порушень є добове моніторування артеріального тиску та ультразвукова допплерографія судин нирок. Мета: визначити прогностичне значення ультрасонографічної симптоматики порушень ниркової гемодинаміки та показників добового артеріального тиску в дітей із хронічним пієлонефритом. Матеріали та методи. Проведено кореляційний аналіз показників добового моніторування артеріального тиску та ультразвукового допплерографічного обстеження в 107 дітей із хронічним пієлонефритом віком 3–17 років. Результати. Статистично вірогідні зв’язки були виявлені між такими показниками: пульсаційним індексом, індексом резистентності, систоло-діастолічним співвідношенням на рівні стовбурової й сегментарних ниркових артерій і добовими індексами (артеріального тиску, систолічного й діастолічного тиску), коефіцієнтом варіації нічним, середнім діастолічним тиском та діастолічним тиском вночі. Кореляційні зв’язки між ультрасонографічними показниками ниркової гемодинаміки та добового моніторування артеріального тиску на рівні інтерлобарних ниркових артерій були статистично невірогідними. У дітей із хронічним пієлонефритом на фоні аномалій сечовивідних шляхів був найбільш сильний зв’язок між індексами периферичного опору на рівні стовбурової ниркової артерій та показниками добового моніторування артеріального тиску. Висновки. Показники ниркової гемодинаміки — пульсаційний індекс, індекс резистентності, систоло-діастолічне співвідношення на рівні стовбурової й сегментарних артерій нирки можуть бути використані для характеристики ниркової гемодинаміки й прогнозування розвитку ренальної АГ у дітей із хронічним пієлонефритом. У 57 % випадків вираженість відхилень цих показників від норми ниркової гемодинаміки визначає тяжкість артеріальної гіпертензії.