[Features hemodynamics and its relationship with some clinical manifestations in women with connective tissue...

To elucidate genetically determined character of cardiovascular pathology with realization of its clinical manifestations at systemic, organ and tissue levels in patients with connective tissue dysplasia (CTD) at obstetric-gynecological setting.

This study involved 614 women with classified and non-classified forms of CTD including 268 primigravidas, mean age 24.8 ± 3.46 yr (group 1) and 346 gynecological patients with genital prolapse, mean age 44.5 ± 10 yr (group 2). Each group was divided into subgroups 1A and 2A with predominant clinical manifestations on the part of the stromal-muscular component and 1B and 2B with the predominance of the vascular component. The methods used included laboratory analysis, ECG, ultrasound, echocardiographic , X-ray, combined urodynamic studies, MGT and laser flowmetry.

Prolapse of mitral valve (PMV) was diagnosed in 100 and 88.3% of the patients in groups 1 and 2 respectively with regurgitation in 1-2 valves in 140 (52.1%) and 143 (47.7%) ones, primary varicosis in 41 (15.2%) and 136 (39.5%), mixomatous degeneration in 65 (24.3%) and 107 (30.9%), predisposition to tissue hemorrhage in 37 (13.8%) and 64 (18.5%), vegetovascular dystonia in 50 and 60%. Patients of subgroup 1A with joint hypermobility and PMV exhibited a higher degree of uterine maturity (4.6 ± 1.75 scores). Rapid labor correlated with apical forms of genital prolapse (subgroups 1A, 2A); in the latter subgroup, they occurred in 83% ofthe patients, grade III rectocele occurred in 62.5%, protrusion and relaxation of pelvic floor in 50%. Pathology of the anorectal segment of pelvic diaphragm was diagnosed in more than 50% of the parous and nulliparous women (subgroups 1A and 2A). End diastolic volume was 102.7 ± 31.08 and 65.7 ± 59.48 ml in subgroups 2A and 2B respectively in association with a decrease of left ventricle mass to 135.6 ± 36.6 and 168.5 ± 86.97 g Hyperemic bloodflow prevailed in subgroup 1A while microcirculation index increased to 6.6 ± 1.84, perfusion coefficient to 2.2 ± 0.91, variation coefficient to 28.9 ± 5.46, relative HF amplitude to 21.9 ± 5.1 (control: 18.3 ± 1.29).

CTD is always realized at the level of cardiovascular system. Its form and the type of dysregulation of suprasegmental CNS regions are genetically determined and inter-related In combination with minor cardiac abnormalities, they determine the type of hemodynamics including microcirculation and the degree of dysmorphism in the form of disorders in pelvic organs and structures including changes in the stromal-vascular histion level. The type of hemodynamics (microcirculation) determines dysregulatory processes in cells and intercellular matrix with the development of pathomorphological changes in the form of rheologic disturbances, vasculitis, thickening and loosening of basal membrane, smooth cell dystrophy, swelling of collagen fibers, loss of their elasticity, and reduction of the collagenous network.