Abstract
Introduction. In 2003 L.A. Boсkeria for the first time in clinical practice in the surgical treatment of Ebstein's anomaly there had been used the cellular technologies in order to regenerate the atrialized part of the right ventricle (RV). Up to the present time, there are no sources of other authors in the literature.
Object – to evaluate remote results of surgical correction of Ebstein's anomaly with the use of autologous stem cells CD133+ according to magnetic resonance imaging of the heart and daily electrocardiography monitoring using the Holter method.
Material and methods. From 2009 to 2014 in the Department of Surgical Treatment of Interactive Pathology 23 patients underwent surgical treatment of Ebstein's anomaly with the use of autologous stem cells CD133+; 18 patients underwent surgical treatment of Ebstein's anomaly without the use of autologous stem cells CD133+.
Results. Analysis of the received information in the study according to magnetic resonance imaging of the heart demonstrated statistically significant positive dynamics in both groups (in the first group – RV end diastolic dimension (EDD) from 5.6 ± 1.3 to 4.5 ± 0.97 cm (p = 0.0018), RV end systolic volume (ESD) from 4.5 ± 1.4 to 3.4 ± 0.96 cm (p = 0.004), RV end diastolic volume (EDV) from 228 ± 92 to 161.3 ± 92.5 ml (p = 0.034), RV ESV from 138 ± 72 to 80 ± 39 ml (p = 0.012), improvement of contractile function of the right ventricular myocardium (RV ejection fraction – EF) from 40.0 ± 12.1 to 47 ± 10.5% (p = 0.004), wall thickening of the right ventricle from 2 (2;2) 3 to (2,8;3) mm, reducing regurgitation on the TV from 3 (3;3) to 2 (1.25;2.5) (p < 0.001). In the second group – RV EDD from 5.9 ± 1.3 to 5.0 ± 0.9 cm (p < 0.001), RV ESD from 4.6 ± 1.6 to 5 ± 0.9 cm (p = 0.006), RV EDV from 272 ± 96 to 197 ± 55 ml (p = 0.014), RV ESV from 170 ± 79 to 105 ± 35 ml (p = 0.002), improvement of contractile function of RV EF from 39 ± 12 to 46 ± 8% (p < 0.001), reducing regurgitation on the TV from 3 (3;3) to 3 (2;3) (p = 0.008), the thickness of the myocardium right ventricle without changes up to 2 (2;2) mm after (2;2) mm (p = 0.944)). A statistically significant difference between the two groups was obtained according to the data thickness of the myocardium right ventricle and tricuspid regurgitation (TR) (thickness of the myocardium right ventricle 3 (2,8;3); 2 (2;2) (p < 0.001), TR 2 (1,25;2,5); 3 (2;3) (p = 0.049), in favor of the first group. According to daily ECG monitoring using the Holter method after surgical correction of Ebstein's anomaly in the first group 2 (10%) patients had atrial flutter; in the second group 4 (25%) patients had atrial flutter and 2 (13%) patients had supraventricular tachycardia.
Conclusion. The reliable standard for evaluation of remote results after correction of Ebstein's anomaly with and without the use of autologous stem cells CD133+ is MRI of the heart with contrast enhancement. Based on the remote results it can be concluded that the use of autologous stem cells CD133+ in combination with traditional surgical correction of the defect is probably the most effective and safe method of treatment.
References
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About the authors
- Leo A. Bockeria, Academician of RAS and RAMS, President, ORCID
- Ol'ga L. Bockeria, Dr. Med. Sc., Corresponding Member of RAS, Professor, Cardiologist,
ORCID
- Vladimir N. Makarenko, Dr. Med. Sc., Professor, Head of Department, Radiologist, ORCID
- Irina V. Volkovskaya, Cand. Med. Sc., Head of Department, Cardiologist
- Zamik F. Fatulaеv, Cand. Med. Sc., Chief Researcher, Cardiovascular Surgeon, ORCID
- Tat'yana G. Le, Junior Researcher, Cardiovascular Surgeon,
ORCID
- Lyudmila D. Semenova, Cardiologist, ORCID
