No abstract

There is no doubt that there is a similar genetic predisposition in close relatives to the development of cardiovascular disease, while the features of coronary anatomy and possible commonality of pathological process in close relatives remain beyond research interest. Aim. To study the anatomy of the coronary arteries, the nature and severity of coronary lesion in pairs of male siblings suffering from coronary artery disease, in comparison with control pairs of patients who are not closely related. Materials and methods. This retrospective study included 87 male patients. The main group (58 patients or 29 couples) consisted of siblings with a horizontal hereditary burden for coronary artery disease. The control subgroup included 29 big brothers of the main group and another 29 patients who unrelated to them. To assess the degree of anatomy identity of the coronary bed in pairs of patients, we used a comparative characteristic of 25 segments of the coronary arteries (SyntaxScore). If there was similarity in anatomy and in the severity of the atherosclerotic process, each segment was assigned one point. In terms of the ratio of the total scores to the total number of segments (n=25), each pair of patients was assigned anatomical and atherosclerotic identity indexes. Results. According to the results of the study, the average indices of anatomical and atherosclerotic identity indexes were significantly higher in pairs of sibs compared to control pairs of patients (0.92 versus 0.88, p=0.008 and 0.92 versus 0.76, p0.001 respectively). When analyzing atherosclerotic lesions of the coronary arteries in pairs of sibs, a statistically significant coincidence of lesions in a number of segments of the coronary arteries was revealed, with the highest agreement in the left main coronary artery (=0.869, p0.001) and in the proximal segments of the main branches of the coronary arteries: left anterior descending artery (=0.786, p0.001) and right coronary artery (=0.812, p0.001). In the group of control pairs, such regularities were not revealed. Conclusion. In siblings with horizontal hereditary burden for coronary artery disease along the sibling line, the average anatomical and atherosclerotic identity indexes are significantly higher compared to control pairs. In pairs of siblings, there is the highest and most reliable probability of developing coronary atherosclerosis in the left main coronary artery and in the proximal segments of the left anterior descending artery and right coronary artery.

The introduction of coronary stents into clinical practice has reduced repeated patient visits compared with balloon angioplasty alone. Also, drug-eluting stents substantially reduced the restenosis incidence. Therefore, later complications related to the implantation of a stent coated with a cytostatic-containing polymer became more relevant. The mechanism of late stent complications is multifactorial. It is mainly due to the body's response to the prolonged indwelling of the drug carrier polymer on the coronary stent's surface. There is a trend towards the return of polymer-free drug coating technologies, which are implemented through certain modifications of stent surfaces for better drug retention and proper drug distribution. It is mainly achieved using drug depots in various reservoirs: grooves, nanoparticles in the matrix compound, micropores, through and blind micro reservoirs, etc. New promising technologies for crystallizing cytostatic drugs or depositing them in specially designed reservoirs show good preclinical and clinical results, comparable or even superior to approved coronary stents. Micropores as carriers for antiproliferative agents on the stent surface are a promising direction to rejecting the use of polymers in stents.

Mitral regurgitation is one of the most common valvular heart diseases, with the gold standard of its treatment being an open surgical intervention. However, it is not always performed in patients with a high surgical risk. Atrial fibrillation is a frequent companion of mitral valve regurgitation. It significantly increases the risk of ischemic strokes and systemic thromboembolism and required the administration of anticoagulants. Long-term use of anticoagulants entails an increased risk of hemorrhagic complications. Surgical endovascular closure of the left atrial appendage allows for reduction of the risks both of embolic and hemorrhagic complications. This paper presents a clinical case of the first in Russia successful simultaneous endovascular remodeling of the mitral valve by edge-to-edge leaflet clipping and closure of the left atrial appendage with an Amplatzer Amulet occluder. This was an 85-year old patient with advanced mitral regurgitation, who was not considered a candidate for an open surgery due to his high surgical risk. The severity of the patients condition was related to atrial fibrillation, rectal cancer and severe anemia. The patient underwent simultaneous sequential clipping of the mitral valve leaflets and closure of the left atrial appendage. Control trans-esophageal echocardiography showed a significant decrease in the mitral regurgitation grade. There were no complications during the hospital stay and in the early postoperative period. The lack of convincing data and research makes it impossible to delineate clear indications and contraindications for the combination of two procedures within one surgical session. However, simultaneous endovascular clipping of the mitral valve leaflets and an occluder implantation into the left atrial appendage may become the method of choice in the treatment of patients with severe mitral valve regurgitation, prevention of embolic and hemorrhagic complications in high risk comorbid patients.