Clinical strategy for such patients is, and based on the general principles of therapy long-CH provides for a careful inhibitors and angiotensin receptor blocking angiotenzina II dioretikov and cardiac glycosides,? -blokatorov And spironolakton. These patients are potential candidates for heart transplantation. Stratification of risk of sudden death in patients SCOP For the majority of authors, the true factors at high risk for Sun Majnoon are young age (<14 years); That the patients obmorokov and heavy jeludockovh of rhythm (spontaneous sustained ventricular tachycardia, ventricular fibrillace) episodes fragile ventricular tachycardia as a result of daily Ekg-monitorirovania; inadequate growth of arterial pressure during exercise test; expressed (more than 3 cm) myocardial hypertrophy LV, as well as a reference to the Majnoon and / or sudden death in the family history. Moreover, in the view of some analysts, the likelihood of increased aircraft if the patient atrial fibrillation (paroxizmalna, continuous tahiforma mertzatelna adults), expressed Cerebral infarction and obstruction output tract LV. Great importance is detectable in patients with a family nature of mutations associated with the heavy projection. The high-risk Court determines the need for special, a more active practice tactics for this category of patients (more drug therapy, the use of peismekerov, defibrillatorov-cardiowerterov, surgical interventions). The best curative activity is the implantation defibrillatora-cardi verter to a primary or secondary prevention жизнеугрожающих arrhythmias, and eventually improve the prognosis. Surgical treatment Unfortunately, a significant number of patients SCOP traditional pharmacotherapies can effectively control the disease symptoms, and quality of life are not happy patients. In such cases, left with the question of the possibility of using other nemedikamentozhnykh therapeutic approaches. The tactic further identified separately in patients with obstructive and neobstrugua forms SCOP. In the absence of clinical effects on the active drug therapy symptomatic patients quite functional class in the classification of the New York Heart Association to the concerns asymmetric overdetermination la subaortalnam and pressure gradient at rest equal to 50 mm Hg. Art. and more shows surgical treatment. The classic method is to чрезаортальная септальная миэктомия proposed A. G. Morrow. Patients who are younger with a family history SCOP with severe clinical manifestations, including the Sun earlier with relatives testimony should be extended. In some centres, it is also where a large latent obstruction. In general, potential candidates for the prompt treatment are not less than 5% of all patients SCOP. Operation provides a good symptomatic effect to the full elimination or significant reduction vnutrijeludochkovogo pressure gradient in 95% of patients and a significant decline konechno-diastolicesc th pressure in the LV most patients. Surgical case now greatly diminished and is about 1-2%, which is comparable with the annual rate for drug therapy (2-5%). While most previous studies were unable to find a significant impact surgical treatment at Majnoon forecast, recent studies have shown improvement year survival surgical patients to 84% compared with 67% in the group treated with medication. There are reports of the observation 40s after the септальной миэктомии. In some cases, subject to the availability of additional evidence to reduce the symptoms of obstruction and mitralna regurgitation instantly operation valvuloplastiki or prosthetic mitral valve nizkoprofilnym dentures. Improve the remote operation could follow prolonged therapy verapamilom as improves diastolicescoy LV function, which is not obtained at surgery.
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