smjournalСпортивная медицина: наука и практикаSports medicine: research and practice2223-25242587-9014NEICON10.47529/2223-2524.2022.1.2smjournal-384Research ArticleФУНКЦИОНАЛЬНАЯ ДИАГНОСТИКАFUNCTIONAL TESTINGОтрыв хорд митрального клапана у высокотренированных мужчин в ранние сроки после COVID-19. Серия клинических случаевAcute mitral chodae rupture in the early postcovid in heavy physical active men. Case serieshttps://orcid.org/0000-0002-7858-7820СукмароваЗ. Н.SukmarovaZ. N.

Сукмарова Зульфия Наилевна, к.м.н., врач-кардиолог, врач функциональной диагностики

107014, Москва, ул. Большая Оленья, 8а+7 (965) 157-65-88

Zulfiya N. Sukmarova, Ph.D. (Medicine), cardiologist, functional diagnostics doctor

8A, Bolshaya Olenya str., Moscow, 107014

suzulfia@gmail.comhttps://orcid.org/0000-0003-1843-087XОвчинниковЮ. В.OvchinnikovYu. V.

Овчинников Юрий Викторович, д.м.н., доцент, заслуженный врач РФ, начальник кафедры терапии неотложных состояний

107392, Москва, ул. Малая Черкизовская, 7

Yuryi V. Ovchinnikov, M.D., Ph.D. (Medicine), Head of the Department of Emergency Medicine

7, Malaya Cherkizovskaya str., Moscow, 107392

https://orcid.org/0000-0002-2484-5249ЛаринаО. М.LarinaO. M.

Ларина Ольга Михайловна, к.м.н., врач-рентгенолог, зав. отделением лучевой диагностики

121059, г. Москва, ул. Б. Дорогомиловская, 5

Olga M. Larina, Ph.D. (Medicine), radiologist, Head of the Department of radiology

5, Bolshaya Dorogomilovskaya str., Moscow, 121059

https://orcid.org/0000-0001-8670-8787ЛепендинС. О.LependinS. O.

Лепендин Сергей Олегович, хирург кардиохирургического подразделения

107014, Москва, ул. Большая Оленья, 8а

Sergey O. Lependin, surgeon

8A, Bolshaya Olenya str., Moscow, 107014

https://orcid.org/0000-0003-0114-106XАфонинаО. В.AfoninaO. V.

Афонина Ольга Владимировна, врач-кардиолог

107014, Москва, ул. Большая Оленья, 8а

Olga V. Afonina, cardiologist

8A, Bolshaya Olenya str., Moscow, 107014

https://orcid.org/0000-0002-9014-9022ГромовА. И.GromovA. I.

Громов Александр Игоревич, д.м.н., профессор кафедры лучевой диагностики; заведующий отделением лучевой диагностики Клинической больницы № 2 АО Группы компаний «МЕДСИ»

127473, Москва, ул. Делегатская, 20/1125284, Москва, 2-й Боткинский пр-д, 5/4

Aleksander I. Gromov, M.D., Ph.D. (Medicine), Professor of the Department radiology; Head of the Department of Radiology of the Clinical Hospital “MEDSI”

20/1, Delegatskаya str., Moscow, 1274735/4, 2nd Botkinsky proezd, Moscow, 125284

ФКУ «Центральный военный клинический госпиталь им. П.В. Мандрыка» Министерства обороны Российской ФедерацииРоссияP.V. Mandryka Central Millitary Clinical HospitalRussian FederationФилиал ФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова»РоссияS.M. Kirov Military Medical AcademyRussian FederationФГБУ «Федеральный научно-клинический центр спортивной медицины и реабилитации Федерального медико-биологического агентства»РоссияFederal Research and Clinical Center of Sports Medicine and Rehabilitation of Federal Medical Biological AgencyRussian FederationФГБ ОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Министерства здравоохранения Российской ФедерацииРоссияA.I. Yevdokimov Moscow State University of Medicine and DentistryRussian Federation2022300420221217785Copyright © Сукмарова З.Н., Овчинников Ю.В., Ларина О.М., Лепендин С.О., Афонина О.В., Громов А.И., 20222022Сукмарова З.Н., Овчинников Ю.В., Ларина О.М., Лепендин С.О., Афонина О.В., Громов А.И.Sukmarova Z.N., Ovchinnikov Y.V., Larina O.M., Lependin S.O., Afonina O.V., Gromov A.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.smjournal.ru/jour/article/view/384

Мнение о том, что COVID-19 представляет большую угрозу только для пожилых, несколько изменилось в течение последнего года. В то же время накопился опыт ведения осложнений разной степени тяжести у молодых пациентов, до инфекции отличавшихся оптимальными показателями здоровья. Наибольшие опасения как в краткосрочном, так и в долгосрочном прогнозе вызывают последствия миокардита, особенно у спортсменов и военнослужащих, тренирующихся даже в период локдауна. Мы представляем серию клинических случаев спонтанного отрыва хорд митрального клапана у высокотренированных мужчин среднего возраста в раннем постковидном периоде. Инфекция во всех случаях протекала субклинически, верифицировать SARS-CoV-2 удалось только по анализу на IgM. Спустя 1–2 недели после заражения на фоне рутинного тренировочного процесса пациенты ощутили боль в области сердца, которую недооценили. К врачу обратились на 2-й и 10-й неделе со стойким снижением переносимости нагрузок и одышкой умеренных напряжений, не свойственной ранее. По ЭхоКГ был диагностирован отрыв одной из хорд передней створки митрального клапана на фоне признаков миокардита с развитием клапанной недостаточности 1-й степени. К моменту обращения патологии других лабораторных данных и ЭКГ не наблюдалось. Контроль через 6 месяцев показал у первого пациента очаг фиброза миокарда по МРТ, минимальное повышение NT-proBNP, снижение переносимости физических нагрузок, у второго пациента — отсутствие видимого фиброза, нормальный NT-proBNP и полное восстановление переносимости нагрузок, но снижение локальной деформации миокарда по данным ЭхоКГ.

The opinion that COVID-19 is a greater threat only to the elderly people has changed over the past year. Experience has been accumulated in the development of complications of varying severity in young patients who had optimal health indicators before infection. The consequences of myocarditis are most dangerous, especially in athletes and military personnel. We present a series of clinical cases of spontaneous mitral valve chordae rupture in highly trained middle-aged men in the early post-COVID period. In all cases, the infection proceeded subclinically; SARS-CoV-2 was verified only by analysis for IgM. 1–2 weeks after infection, against the background of a routine training process, patients felt pain in the heart area, which was underestimated. Patients presented for help at 2 and 10 weeks with complaints of reduced endurance and shortness of breath. Echocardiography revealed rupture of one of the chords of the anterior part of the mitral valve against the background of signs of myocarditis with the development of valvular insufficiency of the 1st degree. By the time of treatment, the pathology of other laboratory data and ECG was not observed. The control after 6 months showed in 1 patient a focus of myocardial fibrosis according to MRI, a minimal increase in NT-proBNP, a decrease in exercise tolerance, in 2 patients there was no visible fibrosis, normal NT-proBNP and complete restoration of exercise tolerance, but a decrease in local myocardial deformation according to echocardiography.

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The authors declare that there are no conflicts of interest present.