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Atrioventricular junction ablation (AVJA) together with the implantation of cardiac pacemaker has become a recognized and effective treatment strategy for patients with symptomatic tachysystolic atrial fibrillation that does not respond to heart rate control drug therapy. Left bundle branch pacing (LBBP) is a physiological alternative to right ventricular and biventricular pacing. The aim. To analyze the clinical results of the average duration with the use of LBBP and AVJA. Materials and methods. Over the period from January 2023 to July 2024, LBBP with subsequent AVJA was applied at the National Amosov Institute of Cardiovascular Surgery in 18 patients as a method of treatment of chronic tachysystolic atrial fibrillation to achieve heart rate control. Results. Mid-term results (at least 1 month) could be monitored in 15 out of 18 patients (84%); in the other three (16%) patients the time between pacemaker implantation and AVJA was too short. The mean period from pacemaker implantation to control examination was 5.07 ± 2.79 months (minimum period 1 month, maximum 12 months). During the period from implantation and ablation to the control observation in the study group, it was possible to observe an increase in left ventricular ejection fraction from 39.12 ± 10.56% to 46.38 ± 7.09%, p = 0.035; decrease in the values of end-diastolic volume from 184.22 ± 76.76 to 167.85 ± 36.93 ml, p = 0.074; decrease in the right ventricular pressure from 43.07 ± 8.29 to 34.38 ± 4.78 mm Hg, p = 0.013. It was also possible to observe a decrease in the left bundle branch capture thresholds from 1.27 ± 0.58 to 0.7 ± 0.39 V at 0.4 ms, p = 0.016; and a decrease in the average LBBP endocardial lead resistance from 638 ± 172.83 to 529.4 ± 120.15 Ohm, p = 0.012. Conclusions. Implantation of the LBBP pacemaker and AVJA was not associated with the occurrence of complications both in the intraoperative and postoperative periods, as well as in the remote period of the average duration in the studied group. The use of this approach in patients with chronic atrial fibrillation made it possible in a series of consecutive patients to improve the systolic function of the left ventricle, to reduce the values of the end-diastolic volume of the left ventricle and the right ventricular pressure at optimal pacing parameters.

We present a case of severe aortic insufficiency diagnosed in the pandemic period with the surgery being postponed due to hygiene concerns and suspicion of COVID-19. One month later the patient’s complaints worsened. Renewed preoperative examinations revealed no difference and no sign of dissection. The suspicion of COVID-19 was eliminated, so immediate aortic valve surgery was performed despite the pandemic. Surprisingly subacute DeBakey type II aortic dissection with complete circular intimal tear came across intraoperatively. Thus, the modified Cabrol procedure was performed successfully. The diagnosis of aortic dissection may be missed, and this rate may increase in natural disasters such as pandemics and earthquakes.

The aim. To explore the current literature and key findings concerning the cytokine storm contribution to pathogenesis of COVID-19 complications and mortality, and summarize clinical and pathologic features of cytokine storm in COVID-19 patients. A cytokine storm is a hyperinflammatory state secondary to excessive production of cytokines by deregulated immune system. It manifests clinically as an influenza-like syndrome, which can be complicated by multi-organ failure and coagulopathy, leading in most severe cases even to death. Cytokine storm has recently emerged as key aspect in COVID-19 disease, as affected patients show high levels of several key pro-inflammatory cytokines, some of which also correlate with disease severity. The current review describes the role of critical cytokines in COVID-19-mediated cytokine storm. Key findings of the studies are provided further. A cytokine storm is associated with COVID-19 severity and is also a crucial cause of death from COVID-19. Impaired acquired immune responses and uncontrolled inflammatory innate responses may be associated with the mechanism of cytokine storm in COVID-19. Cytokine storm is defined as acute overproduction and uncontrolled release of pro-inflammatory markers, both locally and systemically. In COVID-19 patients, pyroptosis triggers the release of proinflammatory cytokines and affects macrophage and lymphocyte functions, causing peripheral lymphopenia. Cytokine storm is characterized by a clinical presentation of overwhelming systemic inflammation, hyperferritinemia, hemodynamic instability, and multi-organ failure. The cytokine storm clinical findings are attributed to the action of pro-inflammatory cytokines like interleukin-1, interleukin-6, tumor necrosis factor alpha, vascular endothelial growth factor.

Ebstein’s anomaly is a congenital heart disease in which the septal and posterior leaflets of the tricuspid valve are displaced to the apex of the right ventricle, forming its atrialization. In contrast, the anatomical position of the anterior leaflet usually remains normal. The aim. To present and analyze a case of surgical treatment of Ebstein’s anomaly with a rare anatomy – isolated displacement of the anterior leaflet of the tricuspid valve. Case report. We present a rare clinical case of isolated displacement of the anterior leaflet of the tricuspid valve into the right ventricular cavity with the formation of a right atrial aneurysm. The diagnosis was made prenatally and confirmed after the birth of the child by echocardiography. Surgical intervention was postponed and successfully performed at the age of six years due to the progression of tricuspid insufficiency and increase in the right atrial aneurysm. We achieved a reduction in the size of the right atrium (diameter 31 mm, volume 25 ml and area 10 cm2) and minimized insufficiency at the tricuspid valve. The total duration of the surgical intervention was 270 minutes. The intra- and postoperative periods were uneventful. The duration of the patient’s stay in the intensive care unit was 4 days. We believe that this pathology of the anterior leaflet of the tricuspid valve should be interpreted as a variant of Ebstein’s anomaly. Conclusion. Isolated tricuspid valve anterior leaflet displacement with right atrial aneurysm is amenable to surgical correction with good immediate and long-term results.

The aim. To study the influence of echocardiography indicators on the choice of surgical intervention on the mitral valve in patients with mitral insufficiency and coronary heart disease. Materials and methods. The study included patients with mitral insufficiency who underwent myocardial revascularization and mitral valve reconstruction (plasty or replacement). The mean age of the study participants was 65.9 ± 4.0 years. The material for analysis was data from the primary medical records: medical history, clinical and instrumental examination data and protocols of operations. The division into study groups was performed retrospectively, according to the mitral valve operation performed: plasty (experimental group) or replacement (control group). Results. We identified the features of the main echocardiographic data that guide the cardiologist when choosing the tactics of surgical correction of the mitral valve. It was established that in patients of the research group, the following was reliably significant: moderate degree of mitral insufficiency (p = 0.02; χ2 = 9.38), decrease in the systolic function of the left ventricle (p = 0.001; χ2 = 10.75); it was found that calcium deposits on the fibrous ring of the mitral valve were insignificant. When analyzing the morphological changes in patients of the experimental group, we found a significantly lower frequency of anterior leaflet prolapse (p = 0.04; χ2 = 4.21) and in general the frequency of all prolapses of any type, while in the control group the frequency of all prolapses was significantly higher (p = 0.04; χ2 = 4.0). In patients of the control group, a significantly higher frequency of akinesis (p = 0.04; χ2 = 4.21) and hypokinesis zones of the posterior-inferior-lateral wall (p = 0.001; χ2 = 19.76) was established, which is an additional sign of involvement of the chordal-muscular apparatus of the mitral valve in pathological process. Conclusions. As a result of the study, echocardiographic differences in the structure of the mitral valve were established, which influenced the selection of the intervention volume. It was found that in patients of the experimental group, the early postoperative mortality and the duration of inpatient treatment were significantly higher than in patients of the control group, which indicates the imperfection of the criteria used by cardiac surgeons when choosing the tactics of surgical correction of the mitral valve in an attempt to perform organ-preserving surgery.

It has been established that 7.2% of patients hospitalized with coronavirus disease (COVID-19) exhibit signs of heart disease, with 23% of these patients experiencing heart failure. Currently, there is a lack of data on chest computed tomography (CT) for diagnosing myocarditis associated with COVID-19. The aim. To justify the feasibility and develop classification models for diagnosing myocarditis in COVID-19 patients based on chest CT data processing. Materials and methods. A retrospective analysis of data from 140 COVID-19 patients was conducted. Chest CT scans were analyzed using DRAGONFLY software, with permission from Object Research Systems. The COVID-CT-MD database, which includes CT data from 169 confirmed cases of SARS-CoV-2 infection, was used to build classification models. The regions of interest were fragments of heart CT images. Texture analysis methods were employed to create diagnostic models. Results. It was shown that the average density of the myocardium of a patient with a confirmed diagnosis of SARS-CoV-2 infection according to the Hounsfield scale does not essentially differ from the densitometric indicators of a healthy person. Therefore, the research was focused on finding structural changes in CT images for their use in constructing diagnostic models. The use of different classification algorithms had little effect on classification accuracy, probably due to the informational content of the input data. However, the obtained accuracy of the diagnostic models is acceptable and allows them to be used to support medical decision-making regarding diagnosis and treatment. Conclusions. Using classic methods, myocarditis was diagnosed in 7.1% of patients with severe pneumonia caused by the coronavirus. The global data closely aligns with the results of our clinical studies. The obtained results allowed for assessing structural changes in the myocardium characteristic of the acute form of SARS-CoV-2 infection. The constructed classification models indicate that specific changes in the myocardium during the acute form of SARS-CoV-2 infection can be identified using CT. The highest diagnostic accuracy on test samples reached 74%. The implementation of the developed diagnostic programs based on texture analysis of CT data and artificial intelligence technologies enables the diagnosis of myocarditis and the assessment of long-term treatment efficiency. Creation of these diagnostic programs using artificial intelligence technologies significantly simplifies the work of radiologists and improves the efficiency of myocarditis diagnosis in patients with SARS-CoV-2 infection.

The aim. To establish the relationship between coronary bed lesions and glomerular filtration rate (GFR) calculated on the basis of creatinine, cystatin C and urine albumin-creatinine ratio in patients with ST-elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention. Materials and methods. We examined 286 patients with STEMI, aged 39 to 87 years (mean age 62.8 ± 9.8, median age 64, interquartile range 56 to 71 years), 202 (70.6%) were men and 84 (29.4%) were women. All the patients underwent general clinical tests, coronary angiography with subsequent percutaneous coronary intervention, and echocardiography. Results. The most frequent infarct-related coronary artery (CA) was the anterior interventricular branch of the left coronary artery in the proximal and middle segments, and the right coronary artery in the proximal segment. In general, there was no significant difference in the number of affected CAs among the examined patients. The division of patients into groups according to the level of GFR, determined both on the basis of creatinine and cystatin C, did not reveal significant differences in the distribution of infarct-related CAs. At the same time, the number of patients with multivessel lesions significantly increases with decreased GFR. Depending on the level of the urinary albumin-to-creatinine ratio, a significant increase in the number of patients with two- and multivessel lesions of the CAs was noted. Conclusions. Close correlations between multivessel lesions of CAs and gender, age, urinary albumin-to-creatinine ratio, GFR, left and right atrial size, duration of history of hypertension and diabetes mellitus, presence of II-III degree atrioventricular block and mortality were established.

The aim. Analysis of the influence of myocardial ischemia treatment on the left ventricular diastolic function and the levels of N-terminal pro B-type natriuretic peptide (NT-proBNP) in patients with cardiorenal metabolic syndrome. Materials and methods. The study included 97 patients: 76 with confirmed coronary heart disease (CHD) (treatment group) and 21 with excluded CHD (comparison group), all of whom were examined at the Ukrainian Children’s Cardiac Center from January 1, 2023 to December 31, 2023. The main inclusion criterium for the treatment group was the presence of cardiorenal metabolic syndrome (combination of heart failure, stage ≥3A chronic kidney disease and dysglycemia in the form of type 2 diabetes or prediabetes). In 44 (57.9%) patients of the treatment group, stenosing atherosclerosis of the coronary vessels was detected and percutaneous coronary intervention was performed, while the index of coronary blood flow reserve was determined using dipyridamole test in the remaining patients, after which the diagnosis of microvascular angina was made. Microvascular dysfunction was corrected using complex therapy including nicorandil. Results. Patients with cardiorenal metabolic syndrome and CHD with normal indicators of left ventricular diastolic function at rest had disturbances in it during stress echocardiography. Patients also had elevated levels of NT-proBNP with normal left ventricular ejection fraction, indicating the presence of heart failure with preserved ejection fraction. There was a significant decrease in left ventricular diastolic dysfunction (E/e’) and serum NT-proBNP levels (p

The aim. To study the possibilities of various techniques of the left atrial (LA) plasty in the correction of combined mitral-aortic-tricuspid valve diseases (cMATVD) in the presence of left atrial dilation (LAD). Materials and methods. The analysis included the results of surgical treatment of 360 patients with cMATVD combined with LAD, who were operated on at the National Amosov Institute of Cardiovascular Surgery from January 1, 2006 to January 1, 2023. The main group consisted of 73 patients who underwent cMATVD correction combined with original triangular plasty of LA. The comparison group included 287 patients who underwent only cMATVD correction in the presence of concomitant LAD. Results. Of the 73 operated patients in the main group, 3 died at the hospital stage (mortality rate 4.1%). The dynamics of echocardiographic parameters at the stages of treatment were as follows: left ventricular (LV) end- systolic index (ml/m2): 69.1 ± 12.1 (before surgery), 59.3 ± 8.5 (after surgery), and 48.4 ± 9.5 (long-term period); LV ejection fraction (%): 51.0 ± 5.0 (before surgery), 54.0 ± 5.0 (after surgery), and 56.0 ± 4.0 (long-term period); LA diameter (mm): 64.8 ± 4.1 (before surgery), 50.3 ± 2.1 (after surgery), and 51.2 ± 2.2 (long-term period). Of the 287 operated patients in the comparison group, 9 died (mortality rate 3.1%). The dynamics of echocardiographic parameters at the stages of treatment were as follows: LV end-systolic index (ml/m2): 68.3 ± 11.3 (before surgery), 60.4 ± 9.3 (after surgery), and 52.7 ± 7.2 (remote period); LV ejection fraction (%): 52.0 ± 5.0 (before surgery), 53.0 ± 5.0 (after surgery), and 50.0 ± 4.0 (remote period); LA diameter (mm): 65.5 ± 3.7 (before surgery), 64.1 ± 3.3 (after surgery), and 72.5 ± 2.8 (remote period). In the remote period, thromboembolic complications occurred in 5 (7.7%) patients of the main group (1 severe, 1 mild, and 3 fatal) and 25 (9.3%) patients of the comparison group (10 severe, 6 mild, and 9 fatal). The thromboembolic complications rates indicate the advisability of LA plasty simultaneously with resection of its appendage. Conclusions. In the correction of LAD, all plastic reconstructions of the dilated LA are low-traumatic and effective procedures that lead to a significant improvement in the morphometry of the LA both at the hospital stage and in the remote period. The methods are associated with low risk of hospital mortality, as well as a low level of thromboembolic complications in the remote period. In all methods of LA plasty, its appendage was resected, which also excluded conditions for thrombus formation.

The aim. To analyze arrhythmological complications in cardiac surgery patients with coronary artery disease (CAD). Materials and methods. This was a retrospective data analysis of 354 cardiac surgery patients with various forms of CAD who were operated on and discharged from the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. The mean age of the patients was 61.9 ± 9.6 years. All the patients underwent laboratory examinations, electrocardiography, echocardiography, coronary angiography and cardiac surgery. The patients with uncomplicated forms of CAD (n = 194) underwent isolated surgical revascularization of the myocardium, in the case of complicated forms of CAD (n = 160), coronary bypass surgery was supplemented with valvular or ventricular correction. Results. Postoperative atrial fibrillation (AF) occurred in 40 (20.6%) patients with uncomplicated CAD and 43 patients with complicated CAD (26.8%), p = 0.1667. Among patients with complicated forms of CAD, 2 (1.25%) had paroxysms of ventricular tachycardia, which required the implantation of a cardioverter-defibrillator, also in this group of patients complete left bundle branch block occurred more often (p = 0.0020). The postoperative period in patients with impaired glucose metabolism was characterized by more frequent development of AF in patients with type 2 diabetes mellitus (33.3%, p = 0.0006), with impaired glucose tolerance (24.8%, p = 0.0156) compared to patients with normoglycemia (12.6%). Conclusions. There was no statistically significant difference in the frequency of postoperative AF in patients with various forms of CAD (p = 0.1667). In the occurrence of postoperative AF paroxysms, the negative influence of type 2 diabetes mellitus (p = 0.0006), impaired glucose tolerance (p = 0.0156), stage III-IV chronic kidney disease (p = 0.0015) and gouty arthritis (p = 0.0072) has been proven. The presence of postoperative AF was associated with acute encephalopathy (p = 0.0291) and panic attacks (p = 0.0043). The occurrence of postoperative AF increased the length of stay of cardiac surgery patients with CAD in the hospital from 8.2 ± 2.9 to 11.06 ± 6.8 days (p < 0.0001).

The aim. To establish the role of the hereditary factor in the risk of developing premature coronary heart disease (CHD) based on clinical and genealogical analysis of pedigrees. Materials and methods. The study included patients with CHD. The total sample size was 286 people, the mean age of the patients was 58.8 ± 2.9 years. The material for the analysis was the data of a clinical and genealogical analysis, which included the collection of data from the proband about the number of relatives with an indication of consanguinity. On the basis of the obtained data, pedigrees were compiled and the coefficient of family aggregation (FA) was calculated. A comparative analysis was conducted between experimental (n = 108, 25-44 years old) and control (n = 178, 75-90 years old) groups. Results. As a result of the analysis of pedigrees, it was established that in patients who had premature CHD, which developed at the age of 25-40 years, there was a FA of cardiovascular diseases, as evidenced by the determined frequency of the hereditary burden of family history for cardiovascular diseases of 50.9%. When compared with the corresponding frequency in the group of elderly patients, the determined frequency of family burden of 24.2% which was significantly lower than that in young patients, p = 0.0001; χ2 = 33.12. The calculated coefficient of FA was 2.1, which indicates that the risk of premature CHD is two times higher in families with a burdensome family history of cardiovascular diseases. Analysis of the burdensome history of cardiovascular diseases considering the degree of kinship with the proband established that in patients of both groups, the burdensome history was observed with the highest frequency in relatives of the 1st degree of kinship: 86.2% in the experimental and 83.3% in the control groups. Conclusions. It was found that in families with a burdensome family history of cardiovascular diseases, the risk of developing premature CHD is two times higher, as evidenced by the calculated coefficient of FA - 2.1; p = 0.0001; χ2 = 33.12. It was found that in both groups of the study, the prevalence of family history of cardiovascular diseases prevailed, mainly among relatives of the first degree of consanguinity.

The aim. To study the relationship between β1-, β2-adrenergic receptor (β-AR) gene polymorphisms and the effectiveness of bisoprolol and carvedilol in patients with heart failure (HF) and coronary heart disease. Materials and methods. We examined 201 patients with HF on the background of post-infarction cardiosclerosis. Control group included 43 healthy individuals of comparable age and sex. Genotyping was carried out for 3 polymorphisms (rs1801253 and rs1801252 of the β1-AR gene; rs1042714 of the β2-AR gene). The patients were divided into 2 groups: the first group included 104 (51.7%) patients who took bisoprolol during the year of observation; 97 (48.3%) patients of the second group were treated with carvedilol. Statistical analysis was performed using Statistica 10.0 and SNPStats programs. Results. In patients with HF, the mutant C-allele (rs1801253 polymorphism) of the β1-AR gene was associated with a decrease in the probability of heart rate reduction >15 min-1 against the background of the use of β-blocker during the year (odds ratio [OR] = 0.42 [0.16-0.98], p = 0.041, recessive inheritance model; OR = 0.62 [0.40-0.97], p = 0.038; log-additive inheritance model). The probability of positive dynamics of the left ventricular ejection fraction (LVEF) increased in carriers of the wild A-allele of the rs1801252 (Ser49Gly) polymorphism of the β1-AR gene (OR = 4.86 [2.35-10.08], p < 0.0001, codominant model; OR = 5.18 [2.51-10.68], p < 0.0001, dominant model; OR = 4.68 [2.26-9.68], p < 0.0001, over-dominant model; OR = 5.05 [2.48-10.28], p < 0.0001, log-additive inheritance model). The probability of an increase in LVEF within a year increased with treatment with carvedilol in homozygous mutant G/G rs1042714 polymorphism (Gln27Glu) of the β2-AR gene in patients with HF (OR = 6.09 [1.16-31.88], p = 0.038, dominant inheritance model). Conclusions. Patients with HF of ischemic etiology, carriers of the mutant C-allele of rs1801253 polymorphism of the β1-adrenoceptor gene, are worse responders to the use of β-blockers compared to patients with the wild G-allele (a lower proportion of patients with a decrease in heart rate >15 min-1: 6.8% vs. 14.5%, respectively; OR = 0.42 [0.16-0.98], p = 0.041). The frequency of an increase in the value of the LVEF >10% was higher compared to patients with the mutant G-allele (39.3% vs. 11.1%, respectively; OR = 4.86 [2.35-10.08], p < 0.0001) against the background of application of β-blockers. The use of carvedilol was more appropriate in homozygous carriers of the mutant G-allele of the rs1042714 polymorphism (Gln27Glu) of the β2-AR gene compared to bisoprolol (a greater proportion of patients with an increase in the LVEF: 17.6% vs. 9.1%, respectively; OR = 6.09 [1.16-31.88], p = 0.038). No probable associations of rs1801253 and rs1801252 polymorphisms of the β1-AR gene with the pharmacodynamics of bisoprolol and carvedilol in patients with HF of ischemic etiology were found.

Цель. Оценить и сравнить эффективность и безопасность одномоментных и этапных чрескожных коронарных вмешательств и транскатетерных имплантаций аортального клапана. Методы. Поиск источников проводили в базах данных PubMed, Google Scholar и Cochrane Library по ключевым словам. Отобрали наиболее цитируемые исследования, содержащие данные о подходах к эндоваскулярному лечению пациентов с ишемический болезнью сердца и аортальным стенозом при помощи одномоментных и этапных чрескожного коронарного вмешательства и транскатетерной имплантации аортального клапана. Анализировали показатели выживаемости, осложнений и других конечных точек исследований, а также влияние очередности вмешательств на исходы лечения. Результаты. При поиске по ключевым словам в базах данных выявили 1 527 оригинальных источников, из которых в обзор включили 60: проспективные и ретроспективные исследования, а также последние рекомендации профессиональных сообществ по сердечно-сосудистым заболеваниям, данные статистики оперативных вмешательств и заболеваемости, фундаментальные работы. Приблизительно в 70 % случаев используют этапный подход, при котором сначала выполняют чрескожное коронарное вмешательство, а затем транскатетерную имплантацию аортального клапана. В большинстве работ при сравнении различных подходов не выявлено достоверной разницы по конечным точкам, в госпитальном периоде их частота, как правило, в пределах 3 %, а в отдаленном — до 30 %. Тем не менее при детальном анализе частоты определенных контрольных точек в ряде работ выявлены противоречия. Заключение. Несмотря на активное изучение результатов одномоментных и этапных чрескожных коронарных вмешательств и транскатетерных имплантаций аортального клапана, ответ на вопрос о том, какой подход лучше, не определен. Последовательность вмешательств не отражена в современных рекомендациях, большинство крупных работ носит ретроспективный характер, а их выводы неоднозначны. Необходимы дополнительные проспективные исследования, чтобы определить категории пациентов, которым та или иная очередность операций принесет наибольшую пользу. Поступила в редакцию 9 апреля 2024 г. Исправлена 19 мая 2024 г. Принята к печати 2 июля 2024 г. Финансирование Исследование не имело спонсорской поддержки. Конфликт интересов Авторы заявляют об отсутствии конфликта интересов.

Актуальность. Клиническая значимость параметров, характеризующих диастолическую функцию левого желудочка после операций на сердце, недостаточно изучена. Цель. Проверить гипотезу о взаимосвязи эхокардиографических параметров диастолической функции левого желудочка и тяжелого периоперационного повреждения миокарда. Методы. В ретроспективное когортное исследование включили 220 пациентов, перенесших изолированное коронарное шунтирование в условиях искусственного кровообращения. Анализировали степень диастолической дисфункции, характеристики трансмитрального кровотока (скорость раннего диастолического наполнения левого желудочка (пиковая Е) и отношение пиковой Е к скорости наполнения в систолу левого предсердия (E/A)), индекс объема левого предсердия, скорость трикуспидальной регургитации, среднюю скорость движения кольца митрального клапана (е’) и соотношение E/e’ согласно данным эхокардиографии до и после операции. Тяжелое повреждение миокарда (первичная конечная точка) определяли как концентрацию высокочувствительного тропонина I более 5 670 нг/л в первые сутки после операции. Результаты. Согласно результатам ROC-анализа, пиковая Е, превышающая 71 см/с, и E/A более 1,3 были ассоциированы с риском тяжелого повреждения миокарда. Кроме того, диастолическую дисфункцию 2-й и 3-й степеней выявили у 13,1 % пациентов с послеоперационным содержанием тропонина I менее 5 670 нг/л и у 42,9 % пациентов с уровнем более 5 670 нг/л (p = 0,009). Заключение. Послеоперационная степень диастолической дисфункции и параметры трансмитрального кровотока ассоциированы с прогностически неблагоприятным уровнем тропонина I. Поступила в редакцию 26 января 2024 г. Исправлена 31 июля 2024 г. Принята к печати 2 августа 2024 г. Финансирование Исследование не имело спонсорской поддержки. Конфликт интересов Авторы заявляют об отсутствии конфликта интересов. Вклад авторов Концепция и дизайн работы: С.М. Ефремов Сбор и анализ данных: С.М. Ефремов, Р.Е. Шмидт, Т.А. Шмидт, А.В. Зырянова Статистическая обработка данных: С.М. Ефремов, Р.Е. Шмидт Написание статьи: С.М. Ефремов, Р.Е. Шмидт, А.В. Зырянова Исправление статьи: все авторы Утверждение окончательного варианта статьи: все авторы

Цель. Изучить результаты аутоартериальной реваскуляризации с использованием Y-композитных и in situ кондуитов внутренних грудных артерий в госпитальном периоде и через 1 год. Методы. В исследование включили 200 пациентов с ишемической болезнью сердца, которым выполнили коронарное шунтирование с марта 2018 г. по март 2021 г. Пациентов рандомизировали при помощи метода конвертов на 2 группы: в первой использовали аутоартериальные кондуиты из внутренних грудных артерий по методике in situ (n = 100); во второй — с формированием Y-композитных конструкций (n = 100). За первичную конечную точку исследования принимали повторную реваскуляризацию и количество больших неблагоприятных сердечно-сосудистых событий (англ. Major Adverse Cardiac and Cerebrovascular Events, MACCE). Результаты. В уровне свободы от основных неблагоприятных сердечных и мозговых событий достоверной разницы не получили: 97,9 % (95% доверительный интервал 92,1–99,5) для группы in situ и 94,8 % (95% доверительный интервал 88,1–97,8) для группы Y-композитных конструкций, p = 0,24. Через 1 год свобода от повторной реваскуляризации составила для группы in situ 97,9 (95% доверительный интервал 92,0–99,4), для группы Y-композитных конструкций 97,9 % (95% доверительный интервал 91,9–99,4), p = 0,97. Достоверно значимую разницу получили в продолжительности операции, которая в группе in situ составила 235 [197,5; 252,5] против 252,5 [225; 290] мин в группе Y-композитных конструкций, p < 0,002. В группе Y-композитных конструкций инфекционные осложнения на грудине были достоверно значимо чаще, чем в группе in situ, p < 0,023. Заключение. Несмотря на гипотетические преимущества бимаммарного коронарного шунтирования с Y-образной конфигурацией, в результатах между группами in situ и Y-композитных конструкций нет существенных различий. Поступила в редакцию 7 ноября 2023 г. Исправлена 10 июня 2024 г. Принята к печати 24 июня 2024 г. Финансирование Исследование не имело спонсорской поддержки. Конфликт интересов Авторы заявляют об отсутствии конфликта интересов. Вклад авторов Концепция и дизайн работы: А.К. Сабетов, Д.С. Хван, М.О. Жульков Сбор и анализ данных: А.К. Сабетов Статистическая обработка данных: А.А. Шаданов, А.К. Сабетов Написание статьи: А.К. Сабетов Исправление статьи: Д,А. Сирота, Д.С. Хван, А.М. Чернявский Утверждение окончательного варианта статьи: все авторы

Актуальность. Синдром гипоплазии левых отделов сердца — критический врожденный порок сердца, занимающий ведущее место в структуре смертности от врожденных пороков, несмотря на низкую распространенность (до 0,2 на 1 000 новорожденных). Цель. Представить комплекс хирургической, медикаментозной и амбулаторно-профилактической помощи новорожденным и детям первого года жизни с синдромом гипоплазии левых отделов сердца в стационарном и межстадийном периодах лечения. Методы. Методика состоит из 5 этапов: 1-й этап — раздельное суживание легочных артерий; 2-й этап — продленная инфузия простагландина Е1 и симптоматическая терапия (в том числе процедура Рашкинда по показаниям). Рекомендованная длительность этапа — не менее 18 дней — при необходимости увеличивается или уменьшается в зависимости от вида осложнений. В настоящем исследовании рекомендованную продолжительность соблюли 3 из 8 пациентов, в остальных случаях этап длился 9–15 дней; 3-й этап — операция Норвуда; 4-й этап — динамическое стационарно-амбулаторное наблюдение и лечение; 5-й этап — двунаправленный кавопульмональный анастомоз. Результаты. По предлагаемой методике пролечено 8 пациентов. Всем выполнили раздельное суживание с последующей операцией Норвуда без летальных исходов. В процессе динамического наблюдения 3 больным провели стентирование перешейка аорты после операции Норвуда. Один пациент умер по месту жительства. Шести больным выполнили двунаправленный кавопульмональный анастомоз без летальных исходов. Заключение. Предлагаемый подход многоэтапного лечения пациентов с синдромом гипоплазии левых отделов сердца позволяет улучшить непосредственные результаты операции Норвуда и снизить межстадийную летальность вследствие раннего выявления и устранения осложнений. Поступила в редакцию 19 января 2024 г. Исправлена 19 мая 2024 г. Принята к печати 22 мая 2024 г. Финансирование Исследование не имело спонсорской поддержки. Конфликт интересов Авторы заявляют об отсутствии конфликта интересов. Вклад авторов Концепция и дизайн работы: А.А. Свободов, Е.Г. Левченко, Д.А. Горбань Сбор и анализ данных: А.А. Свободов, Е.Г. Левченко, Д.А. Горбань Статистическая обработка данных: А.А. Свободов, М.В. Макаренко Написание статьи: А.А. Свободов, М.Р. Туманян, А.И. Ким, Е.Г. Левченко, А.Ю. Эргашов, Д.А. Горбань Исправление статьи: А.А. Свободов, М.Р. Туманян, А.И. Ким, Е.Г. Левченко, Р.С. Гуласарян, Е.З. Голухова Утверждение окончательного варианта статьи: все авторы

Актуальность. Разработка гибридных протезов нового поколения призвана улучшить результаты хирургического лечения комбинированных поражений дуги и нисходящего отдела аорты. Цель. Оценка биосовместимости нового браншированного гибридного стент-графта. Методы. Разработанный гибридный стент-графт состоит из двух частей: сосудистой части и стент-графтовой части с дополнительной стентированной браншей для реконструкции левой подключичной артерии. Для оценки биологической совместимости имплантировали стент-графт 25 крупным свиньям в позицию нисходящего грудного отдела аорты. Оценивали операционную смертность, послеоперационные осложнения, результаты селективной ангиографии аорты и гистологического исследования через 6 мес. Результаты. Имплантация гибридного стент-графта во всех случаях прошла успешно, без осложнений. В раннем периоде погибли 3 животных, причинами смерти стали дыхательная недостаточность из-за баротравмы легкого, интраоперационное кровотечение и внезапная сердечная смерть. Остальные свиньи дожили до окончания срока наблюдения (6 мес.) без осложнений, после чего были выведены из эксперимента. Длительность перфузии посредством сонно-бедренного шунтирования составила 55 [50; 60] мин. Объем пропотевания крови через сосудистую часть протеза — 2,28 ± 0,23 мл/см2/мин. Объем кровопотери за первый час по дренажам — порядка 70,2 ± 8,9 мл. По данным ангиографии аорты через 6 мес. после операции, основное тело и ветви гибридного стент-графта полностью проходимы. Миграции, деформации или эндоликов не наблюдалось. Результаты анализа гистологических срезов показали наличие конфлюэнтного слоя неоинтимы, непрерывно и равномерно распространенного по всей луминальной поверхности кондуитов, включая боковые бранши и анастомозы. Неоинтима представлена слоями однонаправленных клеток фибробластного ряда, гиперплазирована, ее луминальная поверхность покрыта слоем эндотелиоцитов. Заключение. Продемонстрированы техническая возможность и безопасность применения нового гибридного стент-графта с дополнительной стентированной браншей. Поступила в редакцию 16 июля 2024 г. Исправлена 1 августа 2024 г. Принята к печати 15 августа 2024 г. Финансирование Исследование выполнено в рамках проекта № 22-15-20005 (соглашение № 22-15-20005 от 22.03.2022 г. с Российским научным фондом, соглашение № р-12 от 13.03.2023 г. с Министерством науки и инновационной политики Новосибирской области). Конфликт интересов Авторы заявляют об отсутствии конфликта интересов. Вклад авторов Концепция и дизайн работы: А.М. Чернявский, И.Ю. Журавлева, Д.А. Сирота, А.А. Шаданов Сбор и анализ данных: А.А. Шаданов, Д.А. Сирота, М.М. Ляшенко, С.В. Владимиров, Т.П. Тимченко, А.А. Докучаева, В.П. Бородин, А.К. Сабетов, Д.В. Хомушку, М.Н. Муртазалиев, Я.Л. Русакова, Е.В. Кузнецова Статистическая обработка данных: А.А. Шаданов Написание статьи: А.А. Шаданов, Д.А. Сирота Исправление статьи: И.Ю. Журавлева, Д.А. Сирота, А.М. Чернявский Утверждение окончательного варианта статьи: все авторы

Актуальность. Механические протезы клапанов сердца при всем многообразии моделей имеют общий недостаток: их форма и особенности строения запирающих элементов создают препятствие току крови. В основе конструкции механического протеза «МедИнж-СТ» (ЗАО НПП «МедИнж», Пенза, Россия) лежит принцип полнопроточности, что должно увеличить эффективную площадь отверстия клапана при сохранении тех же размеров импланта. Результаты применения данного типа протезов недостаточно изучены. В литературе имеются единичные публикации без сравнения с другими моделями. Цель. Сравнить непосредственные результаты протезирования аортального клапана полнопроточным и стандартным механическими протезами. Методы. В ретроспективное исследование включили 246 пациентов, перенесших протезирование аортального клапана механическим протезом с 2015 по 2021 г. Стандартный двустворчатый протез «МедИнж-2» имплантировали 134 пациентам, полнопроточный протез «МедИнж-СТ» — 112 больным. Для устранения исходных различий между группами провели псевдорандомизацию (propensity score matching). Первичная конечная точка — уровень транспротезного градиента. Результаты. После псевдорандомизации получили 2 группы по 90 человек в каждой. Госпитальная летальность в группах «МедИнж-СТ» и «МедИнж-2» составила 2,2 и 6,7 % соответственно (р = 0,178). В раннем послеоперационном периоде не выявили различий между группами в ремоделировании полости левого желудочка. В группе «МедИнж-СТ» отметили значимо более низкие транспротезные градиенты (средние градиенты 12,6 и 16,1 мм рт. ст., р

Актуальность. Миксома — наиболее распространенная доброкачественная опухоль сердца. В левом предсердии ее типичной локализацией является межпредсердная перегородка в области овальной ямки; любое другое расположение считается атипичным. Результаты хирургического лечения миксом достаточно изу­чены, однако нет данных о результатах лечения атипично локализованных миксом левого предсердия. Цель. Анализ результатов хирургического лечения атипично локализованных миксом левого предсердия с оценкой пред- и послеоперационных факторов риска, эмболических осложнений. Методы. Выполнен ретроспективный обзор результатов хирургического лечения атипично локализованных миксом левого предсердия (n = 52) в период с 2008 по 2022 г. Результаты. Нелетальные госпитальные осложнения развились у 15 пациентов (29 %). Госпитальная летальность составила 6 % (n = 3). Сравнительный анализ данных трансторакальной эхокардиографии перед операцией и на момент выписки продемонстрировал снижение конечного диастолического объема левого желудочка и уменьшение размеров левого предсердия к моменту выписки (p < 0,001). Факторы риска нелетальных осложнений на госпитальном этапе: хроническая сердечная недостаточность III функционального класса по классификации Нью-Йоркской ассоциации кардиологов (ХСН III ФК по NYHA) (p < 0,001), значение по шкале EuroSCORE II (p = 0,03). Факторы риска госпитальной летальности: пожилой возраст (p = 0,03), EuroSCORE II (p = 0,03). Выявлена связь между предоперационными эмболическими осложнениями и локализацией миксомы на задней стенке левого предсердия (p = 0,02), ворсинчатой формой миксомы (p

Background: Various physical phenomena come into use in medicine; however, to date, universal physical methods have not been developed to optimize the course of the wound healing at all treatment stages. In combustiology, the first stage of burn treatment is debridement; then it is important to create an optimal biological environment, normalize blood circulation, suppress pathogenic flora, and stimulate proliferative processes in the wound.Objective: To determine the effectiveness of low-temperature argon plasma (LTAP) and ultrasonic cavitation in deep burn wound treatment based on clinical observations and cytological findings.Materials and methods: We studied impression smears from burn wounds of 36 patients with deep burns of various etiologies who were treated using LTAP and ultrasonic cavitation in the Thermal Injuries Unit at the Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine (Saint Petersburg, Russian Federation) between 2022 and 2023.Results: We found that cytogram findings in the study area changed from the inflammatory type to the regenerative-inflammatory one on day 3-7 when LTAP and ultrasonic cavitation were used, while such change in the control area was observed only after 10 days of treatment. Thanks to the use of LTAP and ultrasound after necrosectomy for deep dermal burns, the wound preparation for autologous skin grafting takes less time than it does with standard methods of local burn wound care. Ultrasonic cavitation should be used in cases of severe exudation and slough, whereas LTAP should be used when reparative processes in a burn wound slow down.Conclusions: Burn wound treatment using ultrasonic cavitation and LTAP enables to prepare the wound surface for autologous skin grafting with a high engraftment rate. The procedure allows to effectively and atraumatically debride the wound and suppress pathogenic microflora. Further research is planned in patients with large deep burn wounds.

Calcification of the lower extremities arteries is an unfavorable factor for vascular surgery. Extensive lesions of the femoral segment are an indication for femoropopliteal bypass surgery. Calcification of the femoral arteries complicates the construction of a proximal anastomosis because it precludes clamping the arteries. In addition to technical difficulties in the construction of an anastomosis, significant calcification increases the risks of bleeding and embolic complications and the duration of surgery. In cases of total calcification of the femoral and iliac arteries, balloon occlusion during the construction of an anastomosis makes it possible to occlude the arteries without clamping, which reduces the risks of perioperative complications. We report a case of femoropopliteal bypass surgery in a patient with total calcification of the iliofemoral segment and occlusion of the superficial femoral artery.

Objective: To study and compare surgical risks and immediate effectiveness of surgical treatment in patients with multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB).Materials and methods: We examined immediate treatment outcomes of 1180 patients who underwent surgery for destructive MDRTB, pre-XDR-TB, and XDR-TB between 2011 and 2023. The patients were grouped: group 1 for patients with MDR-TB (744 cases) and group 2 for patients with pre-XDR-TB and XDR-TB (436 cases). Moreover, patients were further subdivided based on the extent of surgery.Results: The complete clinical response, ie, cavity closure and elimination of bacilli (CV-, MBT-), was achieved in all 405 patients who underwent radical surgery, in 673 (97.1%) of 694 patients who underwent semiradical surgery, and only in 10 (12.3%) of 81 patients who underwent palliative surgery.Conclusions: The immediate outcomes of surgical treatment for MDR-TB were superior in all parameters compared with those for pre-XDR-TB and XDR-TB; however, we found no significant differences when we evaluated treatment effectiveness in patients who underwent radical and semiradical surgery.

Cor triatriatum dexter is a rare congenital heart anomaly in which the right atrium is divided into 2 chambers by a membrane. Clinical manifestations vary depending on the degree of the right atrium separation and the presence of concomitant anomalies. We report a case of asymptomatic cor triatriatum dexter diagnosed during transthoracic echocardiography. The diagnosis was confirmed by transesophageal echocardiography, computed tomography, and magnetic resonance imaging. Transthoracic echocardiography is a sensitive primary diagnostic tool for such congenital heart disease as cor triatriatum dexter.

Introduction: Multiple sclerosis (MS) is an inflammatory and demyelinating disease of the central nervous system accompanied by neurodegeneration contributing to cognitive dysfunction. Cognitive impairment occurs in 40%-65% of patients with MS and can manifest even in the early stages of the disease.Objective: To evaluate cognitive dysfunction features in patients with MS.Materials and methods: The study included patients with MS (n=30; age, 40.8±9.74 years; disease duration, 9.67±6.96 years; Expanded Disability Status Scale [EDSS] score, 4.76±2.11) and healthy individuals (n=30; age, 40.3±12.24 years). Cognitive impairment was assessed using the Montreal Cognitive Assessment Scale (MoCA) and the Paced Auditory Serial Addition Test (PASAT).Results: Cognitive impairment in the group of MS patients was found in 73.3% of the cases. The mean MoCA, PASAT-3, and PASAT-2 scores of MS patients were 13.56%, 24.31%, and 29.48% lower than those in the control group, respectively. In women, the cognitive level in MS patients remains higher than in men. Analysis of the PASAT-3 and PASAT-2 results in MS patients did not reveal any statistically significant differences between the groups of patients aged 18-35 years and those aged 36-44 years and the groups of patients aged 18-35 years and those aged 45-59 years. The results of the MoCA and hearing tests in patients with higher and secondary education were not statistically significant. We found an inverse relationship between EDSS and PASAT-2 (R= −0.49; P< .05), EDSS and PASAT-3 (R= −0.37; P< .05). The most severe cognitive impairment was observed with high EDSS (7.5-9).Conclusions: We have identified features of cognitive functions in MS. Follow-up and therapy of MS patients require cognitive dysfunction assessment using appropriate scales.

Background: Although there is a significant incidence of spinal metastases and hematolymphoid tumors, the treatment strategy (decompression or decompression+stabilization surgery) for patients with impending spinal instability (Spinal Instability Neoplastic Score [SINS] values of 7-12) has not been clearly defined.Objective: To examine the rationale of decompression or decompression+stabilization surgery in patients with impending spinal instability (SINS values of 7-12) due to spinal metastases and hematolymphoid tumors and to assess treatment results within the specified range of SINS values.Materials and methods: The study included 92 patients with spinal metastases and hematolymphoid tumors who underwent surgery between January 1, 2014 and December 31, 2022 at the National Medical Research Center for Oncology (Rostov-on-Don, Russian Federation). The main inclusion criterion was SINS values of 7-12. All patients underwent palliative surgical treatment: either decompression and stabilization or decompression alone.Results: Stabilization of the spinal column was performed in 71 (77%) patients; in 21 (23%) patients, the affected segment was not fixed during surgery. Patients who underwent decompression had a higher rate of postoperative complications, with an increase in postoperative instability of the affected segment being the most significant. As for patients who underwent decompression + stabilization we found a moderate positive correlation between the lesion level and the number of fixed segments (r = 0.33, P< .05) and a weak negative correlation between the residual height of the vertebral body and the number of fixed segments (r = −0.26, P< .05).Conclusions: Stabilization in patients with impending spinal instability (SINS = 7-12) due to tumors is a more justified treatment strategy than decompression alone

Introduction: Hydatidiform mole with a normally developing fetus is a rare case associated with an increased risk of bleeding, preterm birth, preeclampsia, congenital anomalies, and intrauterine fetal death.Case report: We report a case of a twin pregnancy with a hydatidiform mole and a normal fetus. The pregnancy was conceived via in vitro fertilization. The complete hydatidiform mole was diagnosed during the first screening. We extended the pregnancy until 38 weeks’ gestation. Thanks to the control of beta-human chorionic gonadotropin levels and dynamic ultrasound monitoring, the woman successfully gave birth.

Background: One-lung ventilation is used to improve surgical visualization and facilitate thoracoscopic manipulations; however, it induces ventilation/perfusion mismatch, exacerbating the inflammatory response that causes hypoxemia in the perioperative period. Opioid analgesics are the main analgesic drugs used during video-assisted thoracoscopic surgery (VATS), but their use is associated with adverse effects and higher risk of respiratory complications. Corrective measures to eliminate hypoxemia, reduce the inflammatory response, control pain, and minimize opioid-induced adverse effects are crucial in thoracic surgery.Objective: To study the efficacy of dexmedetomidine in reducing lung damage and postoperative complications after VATS.Materials and methods: We examined 100 patients who underwent lobectomy via a thoracoscopic approach. The patients were grouped based on anesthetic management: group 1 (n = 50) with intraoperative dexmedetomidine and group 2 (n = 50) without it. We determined the level of pro-inflammatory cytokines IL-6, IL-8, and TNF and calculated PaO2/FiO2 and A-aDO2. We also assessed the postoperative pain intensity, need for trimeperidin promedol and tramadol, and incidence of postoperative complications.Results: During one-lung ventilation, patients from group 1 had higher PaO2/FiO2 values (P = .025). The A-aDO2 value was higher in group 2 (P = .006). After surgery, we found differences in the content of TNF and IL-8 (P < .001). Twenty-four hours after surgery, we recorded a more significant prevalence of the studied cytokines in group 2 (P < .001). There were no significant differences in the pain dynamics on the first postoperative day (P > .05). Opioid analgesics were less needed in group 1 than in group 2 (P < .001). The incidence of postoperative complications did not differ significantly.Conclusions: Dexmedetomidine in thoracic surgery improves the oxygenation and reduces the percentage of intrapulmonary shunting by inhibiting the release of pro-inflammatory cytokines. In the postoperative period, dexmedetomidine reduces the need for opioid analgesics, but does not affect the pain level or incidence of complications.

This article aims to review the literature regarding assessment of the gut microbiota effect on kidney stone formation. We sought to determine whether several specific gut bacteria or a wider number of members of the gut microbiota are responsible for this association based on the literature data. We conducted an extensive literature search (publications on kidney stones and gut microbiota dated 2013-2023) in PubMed, Cochrane CENTRAL, and Web of Science Core Collection.A large number of earlier studies were focused on physical and chemical properties of crystals formed by kidney stones. In recent years as diagnostic technologies advance, there has been a tendency to study the association of the gut microbiota and the development of other unrelated diseases. Studies have emerged showing the gut microbiota effect on the development of urolithiasis, which suggests that stone formation can be prevented or caused by changing the structure of the gut microbiome. However, further research is needed to identify which genera or types of the gut microbiota break down oxalate and reduce the risk of kidney stone formation.

Toxoplasmosis of the brain is a pressing issue in the practice of neurologists and neurosurgeons. Most patients with cerebral toxoplasmosis are persons with AIDS. However, toxoplasmic encephalitis can develop in patients with any immunodeficiency conditions that lead to reactivation of toxoplasmosis infection in the central nervous system. Although cerebral toxoplasmosis is not a neurosurgical pathology, patients sometimes require neurosurgical interventions: diagnostic biopsy and lesion removal. Moreover, literature shows cases of removal of brain lesions initially mistaken for a brain tumor, which, as a rule, occurs when the patient’s HIV status is unknown and the severity of their condition does not allow for a comprehensive additional examination.This article reviews Russian and foreign publications on neurosurgical interventions in patients with cerebral toxoplasmosis.

Introduction: The main disadvantage of bioprosthetic valves is the susceptibility of their leaflets to structural changes, leading to bioprosthetic valve dysfunction requiring a repeated surgical intervention. This group of patients is characterized by high comorbidity, which increases the risk of hospital mortality during repeated interventions. At the same time, low left ventricular ejection fraction (LVEF) is the main independent predictor of adverse outcomes. Transcatheter valve-in-valve implantation can be an alternative to an open intervention in patients with high surgical risk. However, this technique is often associated with prosthesis-patient mismatch due to a smaller effective orifice area of a bioprosthetic valve, as well as with the high incidence of intraventricular conduction disorders and/or the need for a pacemaker, preventing the LVEF recovery even in the late period after the procedure.Objective: To demonstrate the role of transluminal balloon valvuloplasty in staged surgical treatment of bioprosthetic aortic valve dysfunction. Case report: We present our experience of successful staged surgical treatment of biodegenerative dysfunction of a biological prosthetic aortic valve using balloon valvuloplasty followed by “open” repeated valve replacement in a patient at very high cardiovascular risk.Conclusions: This staged approach may be justified in patients with extremely low LVEF to minimize risks and improve surgical outcomes.

Introduction: Total anomalous pulmonary venous return (TAPVR) is a congenital heart defect in which there is no direct connection between pulmonary veins and the left atrium. Hospital mortality in patients with TAPVR, depending on the anatomical type of the defect, ranges from 14% to 35%. Without surgical correction, children with obstructive TAPVR die in the neonatal period. The mortality rate of children with nonobstructive TAPVR reaches 80% by the first year of life.Objective: To evaluate the capabilities of transthoracic echocardiography (TTE) and cardiac computed tomography (CT) in TAPVR diagnosis and surgical planning of its correction.Materials and methods: The study included 17 children with an initial diagnosis of TAPVR. The age of the patients was 28.5 (11; 91) days. All the infants underwent TTE; 15 patients underwent cardiac CT, and 4 patients, cardiac catheterization with conventional angiography. We evaluated and compared the capabilities of these methods in the diagnosis and determination of the TAPVR type and concomitant anomalies. All data were compared with conventional angiography findings and intraoperative data. The interval between TTE, cardiac CT, and angiography or open surgery was less than 5 days.Results: The accuracy of TTE in diagnosing TAPVR was not significantly inferior to that of cardiac CT (88% vs 100%); erroneous results of TTE were found in 2 patients with heterotaxy syndrome (right isomerism). Both methods showed 100% diagnostic efficiency in determining the TAPVR type. The accuracy of TTE in diagnosing obstructive TAPVR was 81.2%, whereas that of cardiac CT, 94%. There was no statistically significant difference in diagnostic efficiency between CT and TTE in the diagnosis of TAPVR and its obstructive forms.Discussion: Our findings demonstrate the high efficiency of TTE in diagnosing TAPVR, determining its anatomical type, and identifying obstructive forms. This method has limited diagnostic capabilities in determining TAPVR in patients with heterotaxy syndrome and other congenital anomalies of the atria. Cardiac CT has proven to be a highly accurate tool in diagnosing TAPVR and determining obstructive forms and associated heart anomalies.Conclusions: In children with isolated TAPVR and normal arrangement of the organs (situs solitus) with good acoustic window, TTE is the initial and final tool for surgical planning of TAPVR correction. In children with TAPVR and concomitant heart defects, heterotaxy syndrome and other atrial anomalies, TTE should be supplemented by cardiac CT. Cardiac CT in children with TAPVR is an alternative to invasive cardiac catheterization with conventional angiography and should be a preferred diagnostic tool. Conventional angiography should be used in children with TAPVR for assessment of functional, not anatomical characteristics of the defect.

We discuss main challenges of much-debated endovascular treatment in patients with “false” bifurcation stenoses of the left main coronary artery. There are no convincing literature data on the rationale of planning complete bifurcation stenting using 2 stents and clear indications for this procedure. We highlight the importance of studying the effectiveness and safety of the complex routine use of various intravascular imaging during the left main coronary artery percutaneous coronary intervention. We analyzed observations in which a “false” bifurcation lesion can only be considered an ostial stenosis, which will affect the stenting strategy. We focus on the development of universal algorithms for performing endovascular interventions, including those using intravascular imaging which role at each stage of surgery should be additionally studied.

Leakage of intestinal anastomoses remains an issue in view of the increasing number of patients who need reconstructive interventions in different parts of the gastrointestinal tract. Researchers around the world are actively looking for methods of strengthening intestinal anastomoses. The literature presents various approaches to sealing intestinal anastomoses in experimental animals using allografts, biological sealants, polymer film materials, etc. This article classifies and analyzes innovative methods of strengthening intestinal anastomoses to prevent their leakage. We also describe a concept of developing polymer membranes for interventions on hollow organs and our experience in this field of work and making of medical devices at the premises of a university research laboratory.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer mortality worldwide. The effectiveness of its standard treatment in some cases remains poor.We report a case of a patient with Barcelona Clinic Liver Cancer stage C cryptogenic HCC whose life duration was 26 months after diagnosis.A 46-year-old woman, a former smoker, presented with elevated alpha-fetoprotein and a left liver lobe mass diagnosed as HCC. Pulmonary nodules (presumably metastatic) were previously found and remained stable. The left lobe of the liver was resected. Intrahepatic recurrence developed 1.5 months later. Lenvatinib+pembrolizumab therapy was prescribed and later switched to olaparib following the detection of somatic and germline BRCA1 mutation. The patient underwent a liver transplant and was prescribed a combination of tacrolimus and everolimus, later supplemented with extracorporeal photopheresis. Pulmonary nodules that were found to be metastases were treated with radiation therapy. A lethal outcome occurred 21.3 months after the transplant.The first literature review related to this case report discusses the problem of neoadjuvant immune checkpoint inhibitor therapy prior to a liver transplant. More than 100 patients have been described in 40 articles and 113 patients, in 2 multicenter studies. Although 16.7%-27.7% of patients developed rejection, such approach may be effective in downstaging the disease.

Malignant sinonasal tumors are rare and account for 1% of all neoplasms. Most of these carcinomas are poorly differentiated or undifferentiated tumors. Due to overlapping features, both young and experienced physicians encounter difficulties in their diagnosis. We present 2 cases of 2 tumors of the sinonasal tract, which belong to small round blue cell tumors: sinonasal small cell neuroendocrine tumor and esthesioneuroblastoma.

Background: Early necrosectomy with immediate or delayed skin grafting is the gold standard in treatment of burn injuries. Despite all advances in active surgical treatment of burn patients, the optimal time of necrosectomy as well as methods and timing of skin grafting remain the subject of debate among burn surgeons. Reliability and practicality of methods to determine the viability of affected skin tissues act as a limiting factor to advances in surgical strategies for early treatment of burn injuries.Objective: To improve methods of early surgical treatment of patients with deep burns using biological dressings.Materials and methods: Our study analyzed treatment outcomes of 34 patients (age, 18 to 60 years) diagnosed with third-degree burn wounds of different localizations involving 5%-20% of body surface area (according to ICD-10). Group 1 included 18 (53%) patients who underwent skin grafting right after surgical removal of necroses; biological dressings (Chitopran) were applied. Group 2 comprised 16 (47%) patients who also underwent early surgical treatment (autografting), but autografts were covered with synthetic dressings (Voskopran).Results: We found that in group 1 the average time to engraftment after skin grafting followed by Chitopran application was 5.0 (5.0-6.0) days. In group 2, the average time to engraftment after skin grafting followed by Voskopran application was 6.0 (6.0-6.3) days. The statistical data demonstrated that biological dressings had an advantage over synthetic ones in terms of time to engraftment.Conclusions: We can conclude that biological dressings have an advantage over synthetic ones in surgical treatment of partial thickness and deep burn wounds.

The article discusses the problem of colonic anastomotic leakage in patients who underwent resection for colorectal cancer. We describe risk factors for colonic anastomotic leakage and diagnostic approaches. Particular attention is given to noninvasive early diagnosis of anastomotic leakage using laboratory tests with specific biochemical markers.

The history of medicine is interesting and instructive. In each of the many branches of medical science, the specificity of pathology determines diagnosis and treatment. These processes inevitably continue in time and space in accordance with the conditions existing in a given place and in a given period of time. Spine injury is one of the most striking examples of the longevity and duration of this process. Humanity relatively recently discovered what diabetes is and how it should be treated, but this branch of medicine also has its own history, although not a very long one. Spinal injuries have accompanied man and his predecessors almost always, disrupting the usual rhythm of life, and therefore they have been required to be treated since time immemorial. A true professional is always interested in the history of his specialty. Spine surgeons are no exception. What we managed to collect bit by bit, of course, is not everything, but it is impossible to grasp the immense, and it is necessary to know the past in order to better understand the present and the future.

Objective. To evaluate early and medium-term results of surgical treatment of early-onset scoliosis using the principle of growth-friendly systems. Material and Methods. A retrospective analysis of the medical records of 54 patients treated using surgical distractible metal implants was carried out. Patients were divided into 4 etiological groups: congenital (n = 17), systemic (n = 12), idiopathic (n = 16) and neurogenic scoliosis (9). The boy/girl ratio was 11/43. The average age at which patients started treatment was 9.6 years, and at the end of treatment – 13.2 years. Results. Radiometric parameters were assessed during and after completion of treatment. The Cobb angle of the main curve of deformity before treatment averaged 56.1°, after the primary operation – 31.8°, and after completion of treatment – 23.2°. Correction of the main deformity curve for the entire period of multi-stage surgical treatment was 57.8 %. The highest initial magnitude of deformity was noted in the group of neuromuscular scoliosis (67.6°), and the lowest in the group of congenital pathology (50.4°). In the groups of systemic and idiopathic scoliosis, the preoperative values were very close: 53.4° for systemic scoliosis and 57.6° for idiopathic scoliosis. According to the results of staged treatment in the neuromuscular scoliosis group, the residual curvature of the main curve was the lowest, and the percentage of its correction was the highest – 18.9° and 73.6 %, respectively, versus 24.5° and 49.7 % in the congenital scoliosis group. The effectiveness of treatment with an assessment of the percentage of correction after final instrumentation in groups of idiopathic and systemic scoliosis was close: 23,0° and 62.3 %, and 28.5° and 51.5 %, respectively. Identical average values of the main curve angle after final instrumentation were noted in all four etiological groups (on average, 23.2°). Changes in thoracic kyphosis and lumbar lordosis were insignificant. During the treatment, 22 unplanned surgical interventions were performed in 15 patients. Conclusion. This study revealed a number of key points that in the future may help in the formation of clearer algorithms of selecting the most optimal technique: neurogenic scoliosis is most successfully corrected by growing systems, and congenital scoliosis shows less pronounced correction of deformity and a greater relative number of complications per patient with a single use of growing systems, which requires caution during staged surgical treatment.

Classical concepts of embryogenesis of the spine, supplemented by modern data on the role of extracellular matrix factors, specific cell adhesion molecules, signaling molecules, and Hox and Pax genes are presented. They allow us to get closer to understanding the molecular genetic cascades possibly regulating the development of the axial skeleton. Particular attention is paid to the data on the influence of these factors on the morphogenesis of the craniovertebral zone and its defects, primarily associated with segmentation disorders.

Objective. To perform clinical testing of a pediatric modification of the 18-point Japanese Orthopedic Association (mJOA) scale for assessing pathology of the spine and spinal cord in children. Material and Methods. Functional and neurological status was assessed in 143 pediatric patients with pathology of the spine and spinal cord using the mJOA scale with three age versions (0.5–1.5 years, 1.5–4 years and 4–18 years). The control group included 10 adult patients with a similar pathology profile, who were assessed using the mJOA scale as modified by Benzel. Results. An initial analysis of mJOA scores across five age groups (0.5–1.5, 1.5–4, 4–8, 8–18, and over 18 years) did not reveal signifi- cant differences in final scores. Repeat assessment (mean 3.1 years, range 1–10 years) also showed no significant differences either within or between groups. A secondary analysis was performed in patients with pathology at the cervical, thoracic and lumbar levels of the spinal cord: no significant changes in scale scores were found within the groups over time. At the same time, patients with pathology at the cervical level demonstrated a significantly higher score; they were less likely to have deformity of the lower extremities and dependence on a wheelchair, while sensitivity and movements in the upper extremities were significantly worse than in other groups. Conclusion. The proposed pediatric mJOA scale demonstrated age consistency and utility. The results of assessing the functional and neurological state of patients using this scale, in addition to being comparable with each other, are comparable with the results of the Benzel mJOA scale in adults.

Objective. To present a literature review assessing the effectiveness of surgical treatment methods for tethered spinal cord syndrome of secondary origin in spina bifida. Material and Methods. The Pubmed, EMBASE, eLibrary, and Cochrane Library databases were searched for prospective cohort clinical studies published from 2009 to 2024 and evaluating the effectiveness of methods for correcting tethered spinal cord syndrome in spina bifida. The study was carried out in accordance with the guidelines for Preferred Reporting Items for writing Systematic Reviews and Meta-Analyses (PRISMA). Results. During this period, 20 articles were published assessing the effectiveness of surgical methods for correcting tethered spinal cord syndrome. Of these, 15 are pragmatic clinical trials and 5 are randomized clinical trials. The average level of evidence is III. Conclusion. Currently, it can be stated that there is an intra-expert consensus regarding functional radiological criteria for tethered spinal cord syndrome of secondary origin in spina bifida. However, the issue of the effectiveness of surgical intervention directly depends on the availability of objective methods for clinical assessment of the severity of functional deficit and the reversibility of morphofunctional changes in the nervous tissue. Despite the variety of clinical scales and questionnaires, there is no unified assessment system for neurological, urological and orthopedic deficits in patients with tethered spinal cord syndrome. In this context, functional MRI (spinal MR tractography) can be considered a promising method for objectifying the pathological process. However, the phenomena revealed during the examination are not fully studied and require further research.

Objective. To conduct a meta-analysis of studies focused on the conservative treatment of thoracolumbar burst fractures, and to determine the efficacy and safety of this method in the observed group of patients. Material and Methods. The study was performed following PRISMA guidelines. Inclusion criteria for meta-analysis were as follows: availability of full-text version of the article in English or Russian; A3 or A4 type fractures according to the AOSpine classification, or burst fractures of types IIA, IIB or IIC according to the Denis classification, or a direct indication of the presence of a burst fracture without its classification; absence of neurological deficit; age over 18 years; detailed description of treatment outcomes or complications; and a follow-up for at least one year. Results. The meta-analysis included 29 articles describing the results of treatment of 1107 patients. At the time of admission, the following radiographic parameters were calculated for patients: mean kyphotic angle, 13.6 (95 % CI, 10.8–16.5), degree of vertebral body compression, 39.9 % (95 % CI, 27.7–52.0), and the degree of compression of the spinal canal lumen, 41.7 % (95 % CI, 29.2–54.2). A follow-up examination revealed a significant increase in segmental kyphosis by 3%, in vertebral body compression by 3.7 %, and lysis of bone fragments with a decrease in the degree of spinal canal stenosis by 2 times. The incidence of neurological deficit and progression of thoracic and lumbar spine instability was 5.8 % (95 % CI, 4.1–8.1) and 6.5 % (95 % CI, 4.5–9.3), respectively. Recovery of work ability according to Denis scale was as follows: W1 and W2 – 74.7 % (95 % CI, 63.9–83.1); W3 – 14.1 % (95 % CI, 10.2–19.3); and W4 and W5 – 14.8 % (95 % CI, 8.8–23.9). Conclusion. Conservative treatment of neurologically intact thoracolumbar burst fractures can be an effective and safe option if the angular deformity does not exceed 16 degrees and the anterior vertebral body compression rate is up to 52 %. With conservative therapy, a twofold reduction in spinal canal stenosis was observed due to the lysis of bone fragments. The pooled prevalence of radiculopathy or myelopathy with conservative therapy was 5.8 %. Orthopedic intervention due to the progression of instability of the damaged segment may be required in 6.5 % of patients. More than 90 % of patients returned to full-time work following conservative therapy. Comparative studies on the effectiveness of conservative therapy versus surgical treatment should be continued to form clear recommendations for the choice of treatment tactics for patients with uncomplicated fractures of the thoracic and lumbar spine.

Objective. To analyze the results of surgical treatment of patients with fixed spinal deformity due to osteonecrosis of the vertebral bodies of the thoracic and lumbar spine. Material and Methods. The data obtained from the case histories of 40 patients operated on for kyphosis due to osteonecrosis of the vertebral bodies were studied. The patients underwent staged surgical interventions in one surgical session. Demographic data and radiological results of surgical treatment before surgery, after surgery and up to 1 year after surgery were assessed. Results. As a result of surgical interventions, local kyphosis was corrected on average from 30° to -0.25°. After correction of kyphosis, statistically significant changes in the sagittal curves of the spine were revealed: an increase in thoracic kyphosis and a decrease in lumbar lordosis. There was an improvement in sagittal balance indicators in the form of a regression in the number of imbalanced patients – 17 (42.5 %) patients improved balance indicators. During the follow-up period, a statistically significant improvement in VAS and ODI scores was noted. Intra- and postoperative complications accounted for 35 %, and 8 (20 %) mechanical complications were identified during dynamic observation. Predictors ofmechanical complications were the presence of imbalance: 2 and 3 points according to the balance modifier of the Formica classification and the GT index (global angle) > 7°, and insufficient correction of kyphosis (LK postOp > 4°), T-score index < -3.35. Conclusion. Simultaneous staged surgical interventions allow for complete correction of the deformity, restoration of the sagittal profile, thereby improvement of the patient’s quality of life. To reduce mechanical complications when planning and performing surgical intervention, it isnec- essary to take into account the identified predictors.

Objective. To analyze characteristics, diagnostic features and results of surgical treatment of patients with traumatic spinal injuries associated with ankylosing spondylitis. Material and Methods. A retrospective analysis of the results of surgical treatment of 32 patients (25 men and 7 women) operated on in 2019–2022 was performed. Results were followed-up during 12 months in all patients. Patient characteristics, diagnostic features, clinical outcomes, and the range of postoperative complications were reviewed. Results. The number of damaged levels in the cervical, thoracic and lumbar spine was 39. Low-energy injury (fall from a height and from a sitting position) was observed in 20 patients (62.5 %), and high-energy injury (fall from a height of more than 1 m and a road traffic accident) – in 12 patients (37.5 %). Type B3 fractures according to the AOSpine classification were present in 23 patients (71.8 %), and type C translational fractures – in 9 (28.2 %). CT of the spine and verification of the diagnosis were performed within 24 hours after the injury in 24 patients (75 %). The remaining 8 (25 %) patients underwent primary diagnosis later – in 19.8 ± 24.4 days (range 5–46 days). All patients underwent posterior fixation with or without decompression. The time of surgical intervention depended on the presence of neurological symptoms. Twenty one (65.6 %) patients with complicated injury underwent surgical intervention within 8 hours after admission to the hospital. In the remaining 11 (34.4 %) neurologically uncomplicated patients, operations were performed within 3.2 ± 1.4 days. In-hospital mortality was 6.25 % (n = 2), and 1-year mortality was 28 % (n = 9). There were no neurological symptoms before or after surgery in 11 patients (36.7 %). In the group of patients with initial neurological complications (n = 21), 3 (14.3 %) patients had complete regression of neurological symptoms (from AIS D to AIS E), 4 (19 %) - incomplete regression of symptoms (from AIS C to AIS D), and 14 (66.7 %) patients did not show significant positive dynamics. Pulmonary embolism (PE) and pneumonia were observed in 5 (15.6 %) and 6 (18.75 %) patients, respectively. In the postoperative period, the deep vein thrombosis of the lower extremities was most frequent (n = 9; 28.1%), and in 5 cases it was complicated by PE. Conclusion. The basis for diagnosing fractures in patients with ankylosing spondylitis is clinical data (increased pain after a fall and/or the appearance of neurological deficit) and radiological data (CT scan of the whole spine). Fractures in ankylosing spondylitis are characterized by absolute instability with a high risk of developing secondary neurological deficits in the case of conservative treatment or delayed surgical intervention. The essence of the surgery is the use of extended fixation with 8 screws in the cervical spine and more than 10 screws in the thoracic and lumbar spine. The most common complications of the early postoperative period include liquorrhea, surgical wound suppuration, pulmonary embolism, pneumonia, and loosening of transpedicular screws.

Objective. To determine the influence of the urgency of performing surgical decompression of the spinal cord (SC) on the course of acute and early periods of complicated injury of the lower cervical spine. Material and Methods. The results of treatment of 75 patients with acute complicated injury of the lower cervical spine with ASIA A and ASIA B severity of spinal cord injuries were retrospectively analyzed. Two groups were formed, depending on the timing of surgical decompression of the spinal cord after injury. Group I included 33 patients in whom the SC decompression was performed within the first eight hours after the injury, and Group II included 42 patients in whom the SC decompression was performed in more than eight hours after the injury. Results. The mean age of patients in Group I was 29 [25; 39] years, in Group II – 35 [30; 42] years (p = 0.129). There were 31 (94.0 %) male patients in Group I and 38 (90.5 %; p > 0.999) in Group II. The time from the moment of injury to decompression of the spinal cord was 6.1 [5.0; 7.5] hours in Group I and 16.9 [11.8; 39.6] hours in Group II (p < 0.001). Pneumonia developed in 55 % [38 %; 70 %] of patients in Group I and in 86 % [72 %; 93 %] of patients in Group II (p = 0.004). The duration of pneumonia in Group I was 18 [8; 20] days, and in Group II – 28 [20; 39] days (p < 0.001). It was shown that the risk ratio for developing pneumonia in patients with delayed decompression of the spinal cord was 2.08 [1.17; 3.67] times higher (p = 0.01). The duration of mechanical ventilation in Group I was 12 [7; 17] days versus 19 [11; 26] days in Group II (p = 0.001). Maintaining the target blood pressure levels ≥ 85 mm Hg was required in 73 (97.3 %) patients with a duration of hemodynamic support of 6 [3; 10] days in Group I versus 10 [5; 15] days in Group II (p = 0.019). It was shown that SC decompression within the first eight hours after injury reduced the proportion of patients with a SOFA score of 4 points or more by 20 % in the acute period and by 42 % by the fifth day of the early period of injury. Positive dynamic in neurological status was recorded in 30.0 % [17.0 %; 47.0 %] of patients in Group I and only in 2.0 % [0.0 %; 12.0 %] of patients in Group II (p < 0.001). The duration of treatment in the ICU was 20 [16; 25] days in Group I and 29 [23.5; 41.75] days in Group II (p = 0.001). The total length of hospital stay was 38 [27; 46] days in Group I versus 57 [45.75; 67.50] days in Group II (p < 0.001). Mortality was recorded only in Group II and amounted to 5.3 %. Conclusion. Decompression and stabilization surgery within the first eight hours after the injury, together with a complex of intensive care measures for acute complicated injury of the lower cervical spine have a significant positive effect on the course of the acute and early periods of traumatic SC disease.

Introduction. Roux-en-Y gastric bypass (RYGB) is one of the most popular bariatric procedures. However, the Impact of alimentary and biliopancreatic loops lengths on the results of Roux-En-Y Gastric Bypass with a maximum restrictive component remains insufficiently studied.Aim. To compare the long-term results of RYGB with a maximum restrictive component at different lengths of alimentary and biliopancreatic loops.Materials and methods. Our retrospective study included 170 patients: 98 (57.6%) in the group with long alimentary and biliopancreatic loops, 72 (42.4%) in the group with short loops. Follow-up examinations were carried out with a follow-up period of at least 24 months (median follow-up 38 months). In the first group, the lengths of the alimentary and biliopancreatic loops were 150 and 100 cm, in the second group – 100 and 60 cm respectively. In the preoperative period, all patients underwent a standard set of examinations with an obligatory determination of the skeletal muscle mass index using the bioelectrical impedance analysis. The size of the gastroenteroanastomosis was assessed 12 months after surgery using fibrogastroscopy.Results. Both groups showed good results in weight loss and control of associated diseases. The prevalence of moderate sarcopenia in the group of RYGB with long loops was 24.5% (19.4% in the preoperative period), severe sarcopenia was observed in 3% of the subjects (initially severe sarcopenia was not detected in any patient). In the group of RYGB with short loops, the incidence of sarcopenia increased from 13 to 16% (the difference is statistically insignificant). No pronounced sarcopenia was detected in this group after surgery.Conclusion. If patients have signs of moderate sarcopenia according to bioelectrical impedance analysis, type 2 diabetes mellitus, as well as in the elderly, it is advisable to perform RYGB with a minimal malabsorptive and maximum restrictive component.

Cyanoacrylate adhesive closure (CAC) is currently one of the main non-thermal ablation modalities of incompetent saphenous veins. High efficacy and safety of the method is supported by international clinical practice guidelines as well as the real-world practice. In contrast to thermal ablation, CAC is advantageous in terms of low periprocedural pain and bruising, fast procedure time and postprocedural recovery, high patient comfort and satisfaction rates as well as avoidance of postprocedural compression. This publication summarises the practical tips and tricks of glue ablation procedure based on 5-year experience (2019–2023) at the “SM-Clinic” Phlebology Centre, Moscow. Indications for the preferred use of CAC are formulated, such as: low pain threshold; contraindications (or unwillingness) to postprocedural compression; extensive comorbidity and fragile patients; concomitant morbid obesity; the presence of axial reflux along the saphenous veins; the need for simultaneous ablation of several incompetent truncal veins; below-the-knee incompetence of saphenous veins, including recurrent varicose veins; extensive lipodermatosclerosis and/or venous leg ulcer; patient’s HIV and viral hepatitis positive status. A step-by-step interventional protocol of glue ablation is described, including the modified protocols of the procedure. The immediate and long-term outcomes of the CAC according to current data are discussed. Special attention is paid to adverse events following CAC, as well as technical aspects of their prevention. Despite high efficacy and safety profile, today’s limitations for adoption and wider use of CAC are cost issues and lack of reimbursement.

The problem of finding an ideal method for the correction of vertical venous reflux in lower extremity varicose disease is highly relevant due to the rapid development of technologies and the opening of new treatment methods, including minimally invasive ones. According to many researchers, the main parameters for choosing the optimal surgical technique should be low invasiveness, compliance with the anatomical, including ultrasound, picture, the possibility of using local anesthesia, taking into account concomitant pathology and individual intolerance of various drugs by patients, effectiveness of venous vessel obliteration, and minimal risk of possible complications. The review considers a comparative characterization of endovascular treatment methods for varicose disease, as well as lists the main possible complications of each of them. In terms of obliteration effectiveness and the least pronounced complications, the leading position is occupied by the method of cyanoacrylate obliteration. There is an increasing amount of information in the literature about the use of cyanoacrylate composite in the treatment of lower extremity varicose disease. Since this method is relatively new, the number of publications describing complications of this procedure is increasing. We describe a number of specific adverse events that occur during this surgery (extravasation of cyanoacrylate composite with the formation of aseptic granulomas and, in some cases, phlebitis-like phenomena, formation of rigid subcutaneous bands limiting mobility in the knee joint, migration of cyanoacrylate into the deep venous system of the lower extremities), possible mechanisms of their occurrence, and various approaches to treatment. Special attention is paid to proximal migration of cyanoacrylate composite into the area of the saphenofemoral junction, with a description of a specific clinical case and a discussion of further management tactics for this category of patients.