Modulation of Microrna 15b and Its Downstream Protein Targets in the Heart by Oral Ingestion of Homemade Beetroot Wine: Potential Protective Role Against Doxorubicin Cardiotoxicity

Data on coronary fistulas (CF) available in the literature is non-systemic. No article is specified to explain an abnormal variance of speed (Vmax) and pressure gradient (Gmax) registerable in case of such pathology.

As follows from the analysis of literature and native data we made a conclusion that the imbalance between the registered Vmax and Gmax in the CF projection with the estimates expected taking into account the cardiac chambers and coronary arteries (CA) pressure indicators most commonly must be caused by embryogenesis disturbance. Against this background of abnormalities “sinusoids” are formed by CA extended terminals type proceeding to cardiac chambers, often in the midst of remaining myocardium cancellation due to dividing of CA to segments of 1-2-3 order, pressure in distal segments of coronary flow from 60-90 mm Hg to 18-28 mm Hg. Maximum reduction of speed and pressure in «sinusoids» leads to even higher pressure differential between CA and cardiac chamber, up to 4-6 mm Hg. Such CF, in terms of mechanism of its development and local hemodynamic characteristics of flows, is better to describe genuine CF.

Higher Vmax and Gmax (up to 44-51 mm Hg) more often may be classified as CF/shunts or to CF in proximal compartment of the coronary stream. Unlike genuine CF, the first ones should be classified as proximal/postsurgical CF/shunts.

Reasonability of such division on «genuine» and «proximal/postsurgical» CF is determines by complication probability as well as patient surveillance, physical activity level prescriptions.

Thus, with account of hemodynamic features of pathologic flows, registered between CA and cardiac chambers, practically it is reasonable to divide them into: 1) genuine CF, predominantly with diastolic flows, and either low (distal), or high (proximal) Vmax/Gmax, and 2) secondary (mostly postsurgical) fistula/shunts, with high Vmax/Gmax.