Cardiac ArrhythmiasCardiac ArrhythmiasCardiac ArrhythmiasCardiac Arrhythmias2782-42842782-4233Eco-Vector10916010.17816/cardar109160Case reportsКлинические случаиResearch ArticleA Case of Mitral Annular Disjunction Combined with Ventricular ArrhythmiasСлучай митральной аннулярной дизъюнкции в сочетании с желудочковыми нарушениями ритмаhttps://orcid.org/0000-0003-4655-02973401-0329NovikovaTatiana N.НовиковаТатьяна Николаевна
Russian Federation

docent

доцент

novikova-tn@mail.ruhttps://orcid.org/0000-0001-5639-16353202-6874BasovaVeronika A.БасоваВероника Анатольевна
Russian Federation

Cand. of Sci. (Med.), Associate Professor

канд. мед. наук, доцент

Chudovskaya@hotmail.comhttps://orcid.org/0000-0002-7731-01093780-9470EvdokimovaLarisa S.ЕвдокимоваЛариса Сергеевна
Russian Federation

radiologist

врач-рентгенолог

Larisa.Evdokimova@szgmu.ruhttps://orcid.org/0000-0003-4798-533XGnevashevaNatalia A.ГневашеваНаталья Анатольевна
Russian Federation

Cand. of Sci. (Med.), Assканд. мед. наук, доцентociate Professor

канд. мед. наук, доцент

natasha-line@yandex.ruhttps://orcid.org/0000-0001-8352-3955ItskovichIrina E.ИцковичИрина Эммануиловна
Russian Federation

MD, PhD

д-р мед. наук, профессор

Head of the Department of Radiation Diagnostics and Radiation Therapy

itskovichirina@mail.ruhttps://orcid.org/0000-0002-2493-63006909-3377NovikovVladimir I.НовиковВладимир Игоревич
Russian Federation

MD, PhD, Professor

д-р мед. наук, профессор

novikov-vi@mail.ruhttps://orcid.org/0000-0001-7319-2734565124530002174-6400SaiganovSergey A.СайгановСергей Анатольевич
Russian Federation

MD, PhD, Professor

д-р мед. наук, профессор

sergey.sayganov@szgmu.ruhttps://orcid.org/0000-0001-8325-1937ShcherbakovaVladislava A.ЩербаковаВладислава Александровна
Russian Federation

student

студентка

shcher.vl@yandex.ruNorth-Western State Medical University named after I.I. MechnikovСеверо-Западный государственный медицинский университет им. И.И. Мечникова Минздрава РоссииInstitute of Emergency Medicine Nikiforov’s All-Russian Center for Emergency and Radiation Medicine of the Emergencies Ministry of RussiaИнститут дополнительного профессионального образования «Экстремальная медицина» Всероссийского центра экстренной и радиационной медицины МЧС России имени А.М. Никифорова250920222241500307202204082022Copyright ©; 2022, Novikova T.N., Basova V.A., Evdokimova L.S., Gnevasheva N.A., Itskovich I.E., Novikov V.I., Saiganov S.A., Shcherbakova V.A.Copyright ©; 2022, Новикова Т.Н., Басова В.А., Евдокимова Л.С., Гневашева Н.А., Ицкович И.Э., Новиков В.И., Сайганов С.А., Щербакова В.А.Copyright ©; 2022, Novikova T., Basova V., Evdokimova L., Gnevasheva N., Itskovich I., Novikov V., Saiganov S., Shcherbakova V.2022Novikova T.N., Basova V.A., Evdokimova L.S., Gnevasheva N.A., Itskovich I.E., Novikov V.I., Saiganov S.A., Shcherbakova V.A.Новикова Т.Н., Басова В.А., Евдокимова Л.С., Гневашева Н.А., Ицкович И.Э., Новиков В.И., Сайганов С.А., Щербакова В.А.Novikova T., Basova V., Evdokimova L., Gnevasheva N., Itskovich I., Novikov V., Saiganov S., Shcherbakova V.https://creativecommons.org/licenses/by-nc-nd/4.0https://journals.eco-vector.com/cardar/article/view/109160

The article presents a clinical case of a combination of mitral valve prolapse (MVP), mitral annular disjunction (MAD), and ventricular arrhythmia. The presence of MAD worsens the prognosis in MVP and predisposes to life-threatening ventricular arrhythmias. In a 42-year-old patient, MAD was detected during echocardiography to determine the indications for surgical correction of mitral insufficiency in MVP. Severe myxomatous degeneration of the mitral valve leaflets, polysegmental prolapse, and typical auscultatory pattern (systolic click followed by systolic murmur in the second half of systole) were the indications for the targeted search for MAD. Multi-day (ECG) monitoring recorded nonsustained ventricular tachycardias and premature ventricular complexes (PVCs). Cardiac magnetic resonance imaging was performed for confirmation the diagnosis and searched for left ventricular myocardial fibrosis accompanying MAD. Finally, MAD was confirmed, but myocardial fibrotic changes were not detected. Owing to the absence of myocardial fibrosis, the patient was treated conservatively with a beta-adrenoblocker (25 mg/day slow-release metoprolol succinate) in combination with 25 mg/day allaforte. Repeated 24-h ECG monitoring did not detect ventricular tachycardias and nonsustained registered a significant decrease of number of PVCs. The patient is followed up prospectively due to high risk factors for fibrosis and worsening prognosis, which may require surgical correction of the existing disturbances and/or implantation of a cardioverter-defibrillator.

В статье представлен клинический случай сочетания пролапса митрального клапана (ПМК), митральной аннулярной дизъюнкции (МАД) и желудочковых нарушений ритма. Наличие МАД ухудшает прогноз при ПМК и предрасполагает к жизнеугрожающим желудочковым аритмиям. У пациентки 42 лет МАД выявлена при эхокардиографическом обследовании, которое она проходила для определения показаний к хирургической коррекции митральной недостаточности на фоне ПМК. Выраженная миксоматозная дегенерация створок митрального клапана, полисегментарный пролапс, классическая аускультативная картина (систолический клик, следующий за ним систолический шум во второй половине систолы) стали основанием для прицельного поиска МАД. При многосуточном мониторировании электрокардиографических данных зарегистрированы неустойчивые желудочковые тахикардии, частая желудочковая экстрасистолия. Для подтверждения диагноза и поиска фиброза миокарда левого желудочка, аккомпанирующего МАД, выполнена магниторезонансная томография сердца. Наличие МАД подтверждено, фиброзные изменения миокарда не выявлены. В связи с отсутствием фиброза миокарда принято решение о консервативном лечении бета-адреноблокатором (метопролола сукцинат замедленного высвобождения в дозе 25 мг в сутки) в сочетании с аллафорте 25 мг в сутки. На фоне терапии при повторном суточном мониторировании ЭКГ не зарегистрированы неустойчивые желудочковые тахикардии, уменьшилось количество желудочковых экстрасистол. За пациенткой осуществляется проспективное наблюдение в связи с наличием факторов высокого риска появления фиброза и ухудшения прогноза, которые в свою очередь могут потребовать хирургической коррекции имеющейся патологии и/или имплантации кардиовертера-дефибриллятора.

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