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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.

Prosthetic endocarditis is a serious complication in a long term. Vegetation as a thromboembolic complication leads to neurologic deficit varying in severity. Case description. A 35-year-old female patient F. underwent surgical treatment at the Department of Surgical Treatment of Acquired Heart Diseases of the National Amosov Institute of Cardiovascular Surgery on September 07, 2016: aortic valve replacement with wrapping tape operation II. The patient was discharged from the hospital on the 9th day after surgery in a satisfactory condition. On November 20, 2019, the patient was admitted to the Institute with the diagnosis of late infective prosthetic aortic valve endocarditis, status post aortic valve replacement and wrapping tape operation in 2016, first-degree atrioventricular block, cerebral infarctions in multiple locations with hemorrhagic transformation, with aphasia elements, ataxia, right-sided pyramidal insufficiency and suspected meningitis. After 21 days of drug therapy, the patient responded to treatment successfully and was discharged from the hospital in a satisfactory condition without surgical treatment. Conclusions. Taking into consideration the serious condition of the patient, timely and carefully selected drug therapy can be the correct solution for the treatment of patients with late infective endocarditis. Thus, surgery is not always the treatment of choice.

Coronary heart disease (CHD) is one of the most common cardiovascular diseases and one of the leading causes of death in the world. Diet is the first step in the prevention of CHD. Vegetarians have significantly lower risk of death from CHD, but also have changes in the hemostasis system due to a deficiency of blood clotting factors. Cardiosurgical intervention for patients with hemostatic disorders should be performed in specialized centers with the necessary support. Case description. A 73-year-old patient G. was hospitalized to the National Amosov Institute of Cardiovascular Surgery with angina pectoris, weakness and edema. From the past medical history it is known that the patient has been following a diet with complete exclusion of meat and dairy products for 20 years, rarely eats fish; in addition, he smoked for 20 years at a young age. After coronary angiography, the patient developed bleeding from the oral cavity of unknown origin, which resolved on its own. According to the examination, the patient was found to have a multivessel lesion of the coronary arteries, and cardiosurgical intervention was indicated: coronary bypass surgery. At a case conference with cardiovascular surgeons, anesthesiologist and cardiologist, a decision was made to perform salvage cardiac surgery. The predicted mortality risk was 7.0% by the EuroSCORE II. The early postoperative period was complicated by bleeding with subsequent revision of the pericardium to identify the source of bleeding. Coagulopathy of unknown origin was suspected. Replacement hemostatic therapy was started, which included massive blood transfusions. The pace and level of exudation significantly decreased, the operation was completed. After surgical interventions and hemotransfusions, thromboelastography was performed and plasma hypercoagulation was detected. The patient was discharged for continued cardiopulmonary rehabilitation, and outpatient treatment was prescribed. Conclusions. This case report describes successful treatment of multivessel coronary artery disease by bypass grafting in a vegetarian patient with a coagulation disorder. Studies of the effects of a vegetarian diet on the hemostatic system indicate that vegetarians may have lower concentrations of hemostatic factors and that thrombin time is also prolonged due to the nutritional guidance provided by this diet. In addition, timely detection of a deficiency of blood coagulation factors in the plasma of a patient with such history can facilitate the diagnosis of the hemostasis system.

Supraventricular macro re-entry tachyarrhythmias occupy the leading places among all types of tachyarrhythmias. The most common in this category is typical atrial flutter (AFL). This heart rhythm disorder has a negative impact on the patients’ quality of life. Its complications can lead to disability and death due to possible thromboembolism. Therapeutic treatment is limited in effectiveness. The main method of intervention is catheter radiofrequency ablation (RFA). The standard approach of RFA of AFL is performed without the use of navigation systems under fluoroscopy guidance. However, this results in an increased radiation exposure to the patient and the medical personnel. Modern technologies in the field of invasive electrophysiology make it possible to create anatomical models of heart and reproduce the spread of electrical excitation. However, the routine use of additional navigation methods remains controversial. The aim. To compare the duration of RFA of typical AFL and radiation exposure with the use of anatomical and propagation mapping. Materials and methods. This study is based on the analysis of the treatment results obtained for 53 patients at the National Amosov Institute of Cardiovascular Surgery in the period from 2014 to 2023. Depending on imaging methods, the patients were divided into two groups. The first group included 27 patients with an anatomical mapping of the right atrium. The second group included 26 patients with propagation mapping. Results. In all the patients we have achieved a bidirectional conduction block through cavotricuspid isthmus. In the first group, the total duration of confirming the diagnosis and creating the anatomical model was 312 ± 26 seconds. The mean time to the moment of AFL termination and restoration of sinus rhythm was 230 ± 19 seconds. The average duration of the procedure was 41.5 ± 3.5 minutes, the average fluoroscopy time was 120 ± 10 seconds, the average dose area product (DAP) was 15 ± 1.3 Gy·cm2. In the second group, the average time for creating a 3D propagation model of right atrium and verifying the diagnosis was 748 ± 65 seconds. The average time from the first application to the termination of tachycardia was 227 ± 20 seconds. The average duration of the procedure was 55 ± 4.7 minutes, X-ray time was 93 ± 8 seconds, average DAP was 13 ± 1.1 Gy·cm2. The duration of the procedure in the second group was significantly longer (p = 0.03), however, the radiation exposure and DAP were not statistically different (p = 0.31) between the observation groups. Conclusions. The use of propagation mapping increases the time of the procedure by 24.5% and does not give a significant advantage in reducing the radiation exposure. The use of a navigation system during cavotricuspid isthmus RFA is recommended for concomitant radical treatment of complex supraventricular arrhythmias, such as atrial fibrillation.

Against the background of military operations, post-traumatic stress disorder, the progression of the atherosclerotic process is observed, which can lead to myocardial infarction even in young people. Left ventricular aneurysm (LVA) in military personnel is the result of untimely revascularization of an infarct-related artery, gunshot wound to the heart, chest trauma, etc. The presence of a dyskinetic area promotes formation of blood clots in the LVA cavity. LVA thrombosis is associated with an increased risk of embolism, ischemic stroke, and death. Case description. A 37-year-old military servant A. was urgently hospitalized to the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with a mobile thrombus in the area of LVA, size 4.5 x 3 cm, with signs of lysis and a threat of separation according to echo data. The patient was found to suffer Q-wave myocardial infarction 5 months ago; at the time of examination there was decompensation of the condition and a decrease in the left ventricular contractility to 34%. The patient underwent urgent operation: on-pump coronary artery bypass grafting, LVA resection with thrombectomy. The duration of the operation was 7 hours, the aortic cross-clamp time was 53 minutes, the perfusion time was 93 minutes, the blood loss was 500 ml. The postoperative period was uneventful. The patient was discharged on the 7th day with improvement, the ejection fraction was 40%. Conclusion. The lack of an opportunity to conduct timely electrocardiography and echo for military personnel with acute chest pain reduces the chances of diagnosis and treatment of myocardial infarction within the therapeutic window, which leads to the occurrence of complicated forms of coronary heart disease, namely LVA. Echo is of crucial importance in deciding on emergency cardiac surgery for thrombosed LVA.

In newborns with congenital heart defects and duct-dependent pulmonary circulation, the first stage of palliative intervention may involve the systemic-to-pulmonary artery shunt (SPAS) placement or the patent ductus arteriosus (PDA) stenting. SPAS placement is a traditional method, but the trend towards reducing the invasiveness of surgical interventions has led to PDA stenting use as a preferred method to ensure a reliable source of pulmonary blood flow. The aim. To compare pre- and postoperative indicators, complications, and long-term outcomes in two groups of patients after SPAS placement and PDA stenting. Materials and methods. This single-center retrospective study included 82 newborns who underwent SPAS placement (Group I) and 47 patients who underwent PDA stenting (Group II) from 2015 to 2023. Baseline clinical data were similar in both groups. The arterial blood oxygen saturation (SaO2) was significantly lower in the PDA stenting group compared to the SPAS group (65.7 ± 11.1% vs. 79.2 ± 10.6%, respectively) (p < 0.00001). There was higher percentage of genetic/concomitant pathology in Group II, 13 (27.6%) versus 10 (12.2%), p = 0.02. Results. There was no statistically significant difference between the analyzed patient groups in clinical status indicators in the postoperative period, including: the duration of artificial lung ventilation (165.5 ± 94 and 150 ± 113 in groups I and II, respectively) (p = 0.87) and length of stay in the intensive care unit (14 ± 7 and 13.6 ± 9.4 days) (p = 0.76). However, SaO2 was higher in Group I than in Group II (81 ± 5.5% vs. 85 ± 4.6%, respectively) (p = 0.02). Before the next stage of surgical correction, the Nakata index in Group II was significantly higher than that in Group I (225 ± 87.4 mm2/m2 vs. 168 ± 35.9 mm2/m2, respectively) (p = 0.048). The percentage of reoperations was higher in Group II (17 [36.1%] versus 14 [17.1%]), however, the overall (14.9% and 26.8%) and late (9.1% and 19.5%) mortality rates were lower in Group II. Conclusion. Considering the similar results in both patient groups, stenting may be an effective option to increase the pulmonary blood flow in newborns. Due to its minimally invasive procedure, this method may be a choice for premature newborns and children with complex comorbidities. However, SPAS placement remains an important palliative intervention, particularly in cases where ductus arteriosus is tortuous and in congenital heart defects with complex intracardiac anatomy postponing radical correction until older age.

Hypoplastic right heart syndrome (HRHS) is a rare cyanotic congenital heart disease with a wide spectrum of cardiac anomalies characterized by underdevelopment of the right heart. Survival and type of surgery in these patients directly correlate with structural anatomy and circulatory physiology. The aim. To evaluate perioperative characteristics in patients with HRHS, immediate and long-term results after bidirectional cavapulmonary anastomosis. Materials and methods. In the period from 1996 to 2022, 80 patients with HRHS underwent hemodynamic correction at the National Amosov Institute of Cardiovascular Surgery. All the patients were divided into three age groups: group I (n = 18) with patients who underwent hemodynamic correction under the age of 1 year, group II (n = 33) including patients who underwent surgery between the ages of 12 and 36 months, and group III (n = 29) comprised of those operated at the age older than 3 years. Results. In the early postoperative period, 5 (6%) deaths were reported among the patients of three groups: 3 in group I and 2 in group III. There were no deaths among patients of the group II. Median durations of mechanical ventilation, total exudation, hourly and total sympathomimetic support, hospital stay were significantly lower in group II in contrast to the comparison groups. An uncomplicated course of the early postoperative period was observed in 59 (74%) patients. Conclusions. In patients with HRHS, the determination of treatment tactics requires a careful approach, especially in newborns and infants. The implementation of hemodynamic correction shows significantly better results in early childhood.

The aim. To evaluate the efficacy of morphologic left ventricle (mLV) training through pulmonary artery banding (PAB) in pediatric patients with congenitally corrected transposition of the great arteries. Materials and methods. From 2003 to 2023, 12 patients underwent PAB for mLV training at the Ukrainian Children`s Cardiac Center. The mean age of the patients was 30.3 ± 25.1 months, the mean weight was 11.6 ± 5.2 kg. Hemodynamic parameters were assessed to determine the size of the band applied to the pulmonary artery (PA) trunk during the operation. Intraoperative transesophageal echocardiography was performed in 6 patients. Transthoracic echocardiography (TTE) was performed in the early postoperative period. In the remote period, all the patients underwent TTE and X-ray angiography. Results. During PAB, the mLV pressure averaged 58 ± 12.6% (from 40% to 80%) of the systemic arterial pressure. PAB dilatation was required for one patient in the early postoperative period (postoperative day 2) because of significant hemodynamic changes. In the early postoperative period, the maximum gradient across PA measured by TTE averaged 39.3 ± 10.0 mm Hg (from 25 to 60 mm Hg). There was no hospital mortality. The follow-up period averaged 47.2 ± 26.0 months (8 to 113 months). In the long-term observation period, 2 patients (16.6%) died, one 8 months and the other 5 years after the operation. The double switch operation was performed in 6 patients, on average, 48.2 ± 6.9 months after PAB. According to angiography, the mLV pressure before the double switch operation was 90.2 ± 11.6% of that in the systemic right ventricle. The end-diastolic pressure in the mLV averaged 14 ± 4.1 mm Hg. The peak pressure gradient across the PA measured by echo was 81.3 ± 28.8 mm Hg. The mLV mass index averaged 62.9 ± 8.8 g/m2, the mLV ejection fraction averaged 61.2 ± 2.9%. Overall radiographic and echocardiographic data in these patients indicated that mLV is trained and capable of performing the role of a systemic ventricle after anatomical correction. Conclusions. PA banding as a method of mLV training can be used in patients with congenitally corrected transposition of the great arteries with intact ventricular septum, restrictive ventricular septal defects and severe tricuspid regurgitation. To evaluate the effectiveness of PAB for mLV training, a multimodal diagnostic approach is used, including non-invasive and invasive methods such as TTE, transesophageal echocardiography, and cardiac catheterization. The optimal age for PAB in patients of this group for the purpose of training the LV was on average 2-2.5 years.

A topical issue is the determination of the optimal values of activation time of local endograms (LE) and bipolar signal morphology during ablation in patients with idiopathic ventricular arrhythmias (VA) at the site of successful suppression, and the influence of 3D navigation on these values. The aim. To study earliest activation time (EAT) and LE morphology in the area of successful suppression during ablation of idiopathic VA using 3D navigation. Materials and methods. Analysis of the results of ablation in 57 patients with idiopathic VA was made. The patients were divided into two groups. Group I included 30 (52.6%) patients in whom mapping was performed using 3D navigation (EnSite Velocity Cardiac Mapping System). Group II included 27 (47.4%) patients who were mapped using conventional methods. In group I, extrasystole was found in 20 (66.7%) patients, while ventricular tachycardia was observed in 10 (33.3%) patients. In group II, extrasystole was revealed in 16 (59.3%) patients, and ventricular tachycardia in 11 (40.7%) patients. Group I included 21 (70%) patients with right ventricular localization of arrhythmia and 9 (30%) patients with left ventricular localization. Meanwhile, group II included 17 (63%) patients with a focus in the right ventricle and 10 (33%) patients with that in the left ventricle. The morphology of the LE was evaluated according to criteria such as polarity (positive or negative) and degree of signal fragmentation (monomorphic or fragmented). Polarity was determined by the initial direction of the signal during the first 10 ms, regardless of further changes in the endogram. The signal was considered fragmented if there were three or more polarity changes. Results. In group I, EAT of LE was -38.0±7.0 ms, while in group II it was -38.0±8.5 ms. No difference was found between the studied groups (p=0.834). Among all patients in both groups, the average value of EAT of LE at the site of successful arrhythmia elimination was -37.0±8.5 ms. In 92.9% cases EAT of LE was -30 ms or earlier. Only in four (7.1%) patients it was possible to achieve suppression of the arrhythmia with EAT of LE not earlier than -30 ms, while in all these cases the focus was always localized in the right ventricle. The minimum value of EAT of LE at the site of successful suppression of arrhythmia was -27 ms. The dominant morphology at the site of successful suppression among the patients in both groups, regardless of the type of mapping, was positive polarity of endogram. Conclusions. Regardless of the mapping method, in the site of successful idiopathic VA suppression LE must precede QRS by at least 27 ms.

Atrial fibrillation (AF) is one of the most common arrhythmias. Atrioventricular (AV) junction ablation combined with pacemaker implantation has become an accepted, effective strategy for the treatment of symptomatic tachysystolic AF resistant to drug therapy, especially in the elderly. Left bundle branch (LBB) pacing is a physiological alternative to right ventricular pacing. The aim. This study evaluated the effectiveness and safety of a one-stage application of the implantation system for LBB pacing and ablation of the AV junction. Materials and methods. For the period from January 2023 to February 2024, LBB pacing was applied in 8 patients at the National Amosov Institute of Cardiovascular Surgery in the context of treatment of chronic tachysystolic form of AF with subsequent ablation of the AV junction, as a strategy to control heart rate. Results. In all the patients, LBB pacing criteria were achieved: Qr or qR in V1 QRS complex morphology type during pacing (100%); St-V6RWPT interval < 80 ms (mean 75.8 ± 13.9 ms); the difference between the intervals St-V1RWPT – St-V6RWPT > 44 ms (mean 55.57 ± 10.09 ms). In 3 out of 8 patients (37%) it was possible to register LBB potential. Mean paced QRS width in the studied group was 130 ± 18.02 ms. The mean intraoperative LBB pacing threshold was 1.71 ± 0.39 V for 0.4 ms, the anodal pacing threshold was 3.25 ± 0.5 V for 0.4 ms (we could demonstrate it in 6 out of 8 patients [75%]). Intraoperative lead perforation through the interventricular septum could be observed in 2 out of 8 cases (25%), but after that it was possible to successfully reimplant the lead in the area of the LBB. In all the patients of the studied group, it was possible to successfully perform radiofrequency ablation of the AV junction with the aim of heart rate control in chronic tachysystolic AF. There was no endocardial lead dislodgement in the postoperative period in any of the patients. Conclusions. In the studied group, no complications and hemodynamic disturbances were observed in the acute postoperative period and during follow-up one week after the pacemaker implantation for LBB pacing and AV junction ablation. Intraoperative transseptal perforation of the endocardial lead did not complicate reimplantation of the lead in the LBB area. A single-stage pacemaker implantation for LBB pacing and AV junction ablation can significantly shorten the patient’s stay in a medical institution. The subject requires further research on a larger number of patients with long-term follow-up.

The aim. To examine the significance of microribonucleic acids (miRNAs) and oxidative stress markers in predicting the onset of atherosclerosis and the connection between oxidative stress levels and miRNAs in individuals with coronary heart disease. Materials and methods. Initially, 40 patients were divided as follows: 10 subjects without any lesions in coronary arteries (group 0), 4 patients with non-stenotic atherosclerosis (group 1), and 26 patients with significant multivessel atherosclerotic lesions (group 2). Various biochemical parameters were analyzed, including miRNA expression levels and common oxidative stress markers. Results. The groups were comparable in terms of the patients’ age, but there was unequal distribution of males and females in the angio-groups as per Fisher’s exact test. We also analyzed the data separately for females, but no significant difference was found. There were significant differences in miRNA-122 levels, N-terminal prohormone of brain natriuretic peptide levels, lipid profiles, and oxidative stress markers between group 0 and groups with atherosclerotic lesions. Specifically, miRNA-122 levels were elevated in group 0, along with N-terminal prohormone of brain natriuretic peptide, triglycerides, ratio of triglycerides to high-density lipoprotein cholesterol, and oxidative stress markers. Conversely, compared to group 0, total cholesterol, high-density lipoprotein cholesterol, bilirubin, and specific glutathione levels decreased in patients with coronary lesions. Conclusions. The study demonstrated the potential of miRNAs, particularly miRNA-122, as predictive biomarkers for atherosclerosis. Further research with larger cohorts is warranted to validate these findings and explore additional miRNA candidates and therapeutic interventions for cardiovascular diseases.

Hypertrophic cardiomyopathy (HCM) is a common hereditary disease of the myocardium. Sodium-glucose co-transporter 2 inhibitors are recognized as first-line drugs for the treatment of heart failure, but at the moment there is little known about their use in HCM. The aim. To assess the possibility of using an acute test with empagliflozin in patients with HCM with echocardiographic assessment of left ventricular outflow tract (LVOT) obstruction. Materials and methods. Twenty-six non-obstructive HCM patients were examined. All the patients underwent an acute test with sodium-glucose co-transporter 2 inhibitor using 10 mg of empagliflozin and echocardiographic examination before and 3 hours after administration. Twenty-four patients were included in the further analysis (2 patients were excluded due to arrhythmia). The patients were divided into two groups: group 1 included subjects with an increase in LVOT pressure after empagliflozin (12 patients), group 2 included those without an increase in the gradient (12 patients). Results. During the acute test, an increase in LVOT gradient occurred in 12 patients, and in 6 patients the gradient increased significantly and reached more than 30 mm Hg. The indicator at rest in patients before the test was 11.2 (10.1-19), after the test it was 12.45 (8.9-17) mm Hg (p = 0.042). The indicator at the height of the Valsalva test also increased from 15 (11-29) to 15.45 (10.4-33) mm Hg (p=0.29). Comparative analysis of clinical and echocardiographic data did not show significant difference between the groups. Conclusions. In some patients with HCM without signs of overt or latent obstruction at the baseline, a significant increase in LVOT pressure was noted after acute test with empagliflozin. Conducting an acute test in patients with HCM is appropriate to determine the possibility of the development of LVOT obstruction while taking the drug.

The aim. To analyze the prevalence of coronary microvascular dysfunction (CMD) in patients with coronary artery disease after coronary artery bypass grafting (CABG). Materials and methods. The study was conducted in compliance with the provisions of the Declaration of Helsinki and was approved by the local ethics committee during 2018-2021. Due to recurrent complaints of discomfort/pain behind the sternum or shortness of breath during physical exertion in patients after CABG (average time of occurrence 18 ± 6 months after surgery), as well as positive or doubtful result of the stress testing, 31 patients were re-hospitalized for further examination. To diagnose CMD, echocardiography was performed with intravenous dipyridamole in order to determine the coronary flow reserve. The patency of the grafts was confirmed and newly formed hemodynamically significant coronary artery lesions were excluded during invasive coronary angiography. Results. The mean age was 61.2 ± 2.3 years, the majority of the patients were male (20 [64.5%]). The most common comorbid pathologies in the patients were: hypertension in 29 patients (93.5%), impaired glucose metabolism (diabetes/prediabetes) in 17 (54.8%) subjects, 13 (41.9%) patients had a history of myocardial infarction. Left ventricular ejection fraction according to echocardiography was reduced (less than 55%) in 5 (16.1%) of 31 patients, in others it was preserved. After CABG, there was a trend towards the coronary flow reserve increase, but no significant difference was found (1.89 ± 0.08 vs. 2.11 ± 0.13; p > 0.05). The presence of CMD before and after CABG did not change significantly (13 [41.9%] vs. 12 [38.7%]; p > 0.05). Conclusion. According to the results of the study, CMD is a common pathology in patients with obstructive coronary artery disease and is found in about 40% of patients with repeated myocardial ischemia after CABG. CABG did not affect the frequency of detection of CMD in patients with coronary artery disease before and after the operation.

The aim. To study the dynamics of the internal lumen of the distal part of coronary arteries after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with type 2 diabetes mellitus Materials and methods. This retrospective study included 121 patients with coronary artery disease and type 2 diabetes mellitus after revascularization of coronary arteries through PCI or CABG. In order to evaluate the changes in the condition of the distal sections of the coronary arteries after stenting and CABG, we included patients with type 2 diabetes mellitus in whom repeated coronary angiography was performed 12-60 months after PCI or CABG. The quantitative method (quantitative coronary angiography) and semi-quantitative assessment scales were used to assess the dynamics of the distal part of the coronary arteries. Results. The mean age of the patients was 56.2 ± 0.4 years for patients who underwent CABG and 54.3 ± 0.4 years for patients who underwent PCI. There were 64.7% men in the CABG group and 54.0% in the PCI group. The use of drug-eluting stents didn’t affect the internal lumen of the distal part of the arteries. After implantation of bare metal stents, progression of diffuse atherosclerotic lesions was detected. The use of arterial grafts during CABG improved the condition of the inner lumen of the bypassed vessel. However, after venous grafts placement, the patency of the distal coronary arteries may deteriorate in the future. Conclusions. In people with type 2 diabetes mellitus and coronary artery disease, after cardiac surgery, the smaller branches of the blood vessels can become narrower over the next 1-5 years if a stent without medication or a vein graft is used. However, when a drug-eluting stent or an artery graft is used, the smaller vessel branches stay about the same or even improve over time.

The aim. To analyze the microbiological spectrum of pathogens causing surgical site infections and their antibiotic resistance in surgical patients injured during the military conflict between Ukraine and Russia. Materials and methods. This study was based on 137 bacteriological examinations of biological samples from patients treated in the surgical department of the Kyiv City Oleksandrivska Clinical Hospital in 2022. The samples included 81cultures isolated from postoperative wounds and 56 cultures from the abdominal cavity. Susceptibility to antibacter drugs was determined according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) standards. Statistical analysis was performed using IBM SPSS Statistics. Results. Among the 137 analyzed samples, the most common pathogens were Klebsiella pneumoniae (22.6%), Enterococcus faecalis (13.1%), Staphylococcus epidermidis (13.1%), Pseudomonas aeruginosa (11.6%), and Escherichia coli (10.2%). In the abdominal cavity samples (n = 56), E. coli was predominant (17.9%), followed by K. pneumoniae (16.1%), E. faecalis (16.1%), S. epidermidis (10.7%), Candida (8.9%), and P. aeruginosa (7.1%). In postoperative wound samples (n = 81), K. pneumoniae was found in 27.2%, P. aeruginosa in 14.8%, S. epidermidis in 14.8%, S. aureus in 12.3%, and E. faecalis in 11.1%. K. pneumoniae showed high resistance to amikacin (86.6%), meropenem (74.2%), piperacillin-tazobactam (82.8%), and ceftriaxone (86.2%). E. faecalis exhibited resistance to imipenem (58.8%), levofloxacin (47.1%), and vancomycin (12.5%). S. epidermidis had resistance to gentamicin (13.3%), meropenem (50%), and oxacillin (35.7%). P. aeruginosa demonstrated resistance to ciprofloxacin (45.6%), meropenem (67.4%), ceftazidime (52.3%), and piperacillin-tazobactam (48.7%). Conclusion. The primary pathogens causing surgical site infections in military surgical patients are K. pneumoniae, E. faecalis, S. epidermidis, P. aeruginosa, and E. coli. The pathogen spectrum varies between abdominal cavity infections and postoperative wound infections. There is a clear trend towards increased detection of antibiotic-resistant pathogens, particularly among military personnel. Colonization with resistant microorganisms increases during medical evacuation through different levels of the evacuation chain.

Pulmonary vein isolation using radiofrequency ablation is the most common method of catheter treatment for atrial fibrillation. Performing this procedure involves the use of X-ray radiation, which at certain stages of the procedure is an indispensable method for navigation and visualization of intracardiac structures. Approaches to minimize X-ray exposure during catheter interventions are attracting increased attention of the electrophysiology community due to the potential risks of adverse effects of ionizing radiation on patients and medical personnel. The aim. To evaluate the effectiveness and safety of performing the pulmonary vein isolation procedure with the intention to minimize X-ray exposure of patients and medical personnel. Materials and methods. Forty-three patients with various forms of atrial fibrillation were selected for the study: 28(65%) with paroxysmal and 15 (35%) with persistent forms. All the patients underwent pulmonary vein isolation usingcatheter radiofrequency ablation with the intention to minimize X-ray exposure at the National Amosov Institute of Cardiovascular Surgery in the period from June 2023 to April 2024. Results. In all 43 patients it was possible to electrically isolate all the veins. Catheter ablation of the cavotricuspidisthmus was performed in 5 (31.2%) patients from group A (“Zero-fluoro”), 7 (33.3%) from group B (“Near Zero-fluoro”) and 3 (50%) from group C (“Non Zero-fluoro”) (p = 0.696). Intraoperative reconnection of the pulmonary veins with the left atrium was observed in 6 (37.5%) patients of group A, 11 (52.3%) of group B, and 4 (66%) of group C (p = 0.429). X-ray time for transseptal puncture did not differ between groups A and B (3.56 ± 2.37 vs. 3.69 ± 2.3 min., p = 0.532), however, X-ray time for pulmonary vein isolation in group A was significantly less than that in group B (0.27 ± 0.13 vs. 1.96 ± 1.21 min., p < 0.001). The total time in the left atrium was not statistically different between these two groups (81.33 ± 22.32 vs. 98.6 ± 29.83 min., p = 0.106). In group C (“Non Zero-fluoro”), the aforementioned parameters were not recorded. Total dose area product (DAP) and total radiation dose, as well as total X-ray time and total procedure time, were significantly lower when using the ionizing exposure minimization approach. DAP and total radiation dose in group A were the lowest (7.29 ± 5.16 Gy/cm2 and 76.62 ± 70.82 mGy, respectively) and significantly differed from those in group C (107.67 ± 97.59 Gy/cm2 and 882.32 ± 868.62 mGy, p < 0.001 and p = 0.001, respectively). No intraoperative complications were observed in the studied sample. Conclusions. Minimizing X-ray exposure using modern navigation systems during pulmonary vein isolation using catheter radiofrequency ablation is not associated with increased intraprocedural complications in patients with paroxysmal and persistent atrial fibrillation. This approach allows you to significantly lower total DAP and the radiation dosewithout increasing the time of performing the pulmonary vein isolation procedure.

This article is the result of our own clinical observations and a literature search on the development of aortic calcification and hypertension syndrome in patients with axial spondyloarthritis, as well as the clinical significance of the combination of these pathologies and management thereof. The aim. To increase the awareness of practicing doctors regarding the possible association of aortic calcification and hypertension in patients with axial spondyloarthritis, their diagnosis and possible development mechanisms. Materials and methods. For this article we described two patients with axial spondyloarthritis, calcinosis of descending aorta and high blood pressure and conducted a case-based review of related literature. Results. The article presents the results of studies, where authors tried to explain possible mechanisms of development of aortic calcification and hypertension in patients with axial spondyloarthritis. Despite the fact that the data of these studies are scattered and researchers have not yet reached a certain consensus, the available results allow us to believe that patients with axial spondyloarthritis are at increased risk for the development of aortic calcification and hypertension syndrome. Given the possible consequences of these lesions, this cohort of patients requires increased attention from clinicians of various profiles. Conclusions. Aortic calcinosis can develop in patients with axial spondyloarthritis at its various stages, and also be one of the reasons for the development of high hypertension in such patients. We consider it expedient to conduct a routine examination of the aorta in patients with radiographic axial spondyloarthritis in case of detection of hypertension in them, because this group of patients has a pathophysiological basis for the calcification of vessels of the elastic type, which is given above. This will make it possible to correctly assess the patient’s cardiovascular risks, to draw up more correct plan for their long-term management by a cardiologist in cooperation with a rheumatologist and a cardiac surgeon, as well as to choose more effective therapy for blood pressure correction.

Background. One of the formidable complications of varicose veins of the lower extremities is thrombophlebitis. The risk of developing venous thromboembolic complications remains high even when taking anticoagulants. Most authors do not even consider surgical elimination of the manifestations of acute superficial thrombophlebitis. The aim. To evaluate the effectiveness of minimally invasive surgical treatment of acute tributary varicose veins of the lower extremities. Materials and methods. The surgical treatment of 78 patients with acute varicothrombophlebitis of the tributaries of the great saphenous vein was analyzed. Depending on the treatment performed, patients were divided into two groups: group I including 56 (71.8%) patients who underwent inpatient surgery for thrombotic lesions of varicose veins of the tributaries of the great saphenous vein; group II including 22 (28.2%) patients who received conservative outpatient treatment. Results. The choice of the volume of surgical intervention in patients of group I depended on the condition of thegreat saphenous vein. In the absence of thrombotic and varicose veins in 29 (51.8%) patients, the latter was preserved. With varicose changes in the great saphenous vein, 16 (28.6%) patients underwent radiofrequency ablation after ligationof the thrombosed tributary duct and miniphlebectomy or phlebocentesis with foam-form sclerotherapy. In 11 (19.6%) cases of thrombotic lesions of the great saphenous vein, crossectomy, long/short stripping or phlebocentesis with stem sclerotherapy after ligation of its tributaries and isolation of the latter distal to the thrombotic occlusion was performed. The surgical intervention was supplemented with miniphlebectomy of other varicose veins and ligation of failed perforator veins. In patients of group II, treatment was prescribed similarly to the treatment of deep vein thrombosis. Surgical treatment of patients in group I effectively prevented venous thromboembolic complications and reduced the manifestations of chronic venous insufficiency in 72.9% of cases. Conclusions. Minimally invasive surgical intervention for acute thrombophlebitis of the tributaries of the great saphenous vein allows, on an outpatient basis or in a one-day hospital, to eliminate thrombotic lesions of varicose super-ficial veins and prevent venous thromboembolic complications, reduce or eliminate manifestations of chronic venous insufficiency, prevent recurrence of thrombosis, and reduce the patient’s disability.

The coronarovirus disease 2019 (COVID-19) pandemic is still a significant cause of morbidity and mortality, with a rapidly increasing number of infections and deaths worldwide. The possibility of heart involvement in patients with COVID-19 has received great attention since the beginning of the pandemic. In the present review, we summarize the current knowledge on myocardial involvement in COVID-19, provide an overview of the incidence, pathogenetic mechanisms and clinical implications of cardiac injury in this setting. Recent evidence suggests an interplay between COVID-19 and cardiovascular diseases. Cardiac involvement plays a key role in the management and prognostication of patients with SARS-CoV-2 infection. Heart failure is a common state that can be encountered at different stages in the course of COVID-19 patient presentation. New or existing heart failure in the setting of COVID-19 can present a set of unique challenges that can complicate presentation, management andprognosis. It is still unclear whether heart failure in COVID-19 is due to direct effect of SARS-CoV-2 on the myocardium or it is indirectly caused by hypoxia, cytokine release, volume overload, overwhelming critical illness. Careful understandingof hemodynamic and diagnostic implications is essential for appropriate triage and management of these patients. Abnormal cardiac biomarkers are common in COVID-19 and can stem from variety of mechanisms that involve the viral entry itself through angiotensin I converting enzyme 2 receptors, direct cardiac injury, increased thrombotic activity,stress cardiomyopathy etc. Data on the impact of COVID-19 in chronic heart failure patients and its potential to trigger acute heart failure are lacking. The cytokine storm observed in this pandemic can be a culpit in many of the observed mechanisms and presentations of this infection.

Absent pulmonary valve syndrome (APVS) is a rare form of congenital heart defect. Among the various variations of this rare anomaly are non-confluent branches of the pulmonary artery (PA) with anomalous origin of one of the PA branches from the patent ductus arteriosus (PDA). Constriction of the PDA in early neonatal age may result in cessation of blood supply to one of the pulmonary artery branches, leading to exclusion of one lung from circulation and gas exchange processes. PDA stenting creates a reliable source of blood flow, and as a first step, an endovascular approach was chosen for treatment. Case report. A newborn (3 kg) with a prenatal diagnosis of APVS and a non-confluent left PA branch filling through PDA was chosen for PDA stenting. Considering the complex anatomy of the heart defect, it was decided to perform PDA stenting to delay total repair until the patient reaches optimal age and weight. Our patient successfully underwent PDA stenting as the first stage, which provided conditions for blood supply to one lung. The second stage involved total repair with good long-term results. Conclusion. APVS treatment may have several options of surgical correction, differing from each other depending on the anatomical features of the defect and the patient’s age. Palliative treatment options help the child transition from the neonatal period and gain optimal weight for total repair.. Analyzing the data from the presented literature, it is noted that prenatal diagnosis is an important stage in determining the urgency and choice of treatment tactics for this defect.

Providing high-quality cardiac care for the population is impossible without a thorough analysis of the number of healthcare facilities that can provide such services, the distribution of cardiologists and cardiovascular surgeons per appropriate number of the population, and proper monitoring of specialized examinations required for patients seeking such care. The aim. Getting inside the scope of the network, staffing, and activities of the healthcare system and cardiology service of Kyiv oblast. Materials and methods. Data on mortality, morbidity of the population, the structure of healthcare institutions, and the performance of the network of healthcare facilities of Kyiv oblast were the material of the study. The general scientific approach, i.e. synthesis, generalization, interpretation, system analysis, and medical statistics, was used to attain the aim. Results. The absence of cardiologists was noted in some territorial units of Kyiv oblast, either entirely or at certain time intervals. At the same time, the supply of cardiovascular surgeons was also inadequate. The dynamics of the number of beds in the region showed negative trends from 2018 to 2021. The increase in the workload of cardiac surgeons had a steady upward trend during 2018-2021, along with a peak number of operations and a statisticallysignificant correlation with an increase in patient mortality. The number of specialized cardiology examinations carried out for the population in the region is also insufficient. Conclusions. The network, staffing and activities of the cardiology service of Kyiv oblast do not meet the needs of the population and require a systematic approach to provide reforms at the level of the regional leadership to solve the issue of optimizing cardiac care for the population, taking into account the formation of local communities.

The article analyzes the results of surgical treatment of atrial fibrillation or flutter in patients with an atrial septal defect (ASD). The aim. To increase the effectiveness of surgical treatment of concomitant atrial fibrillation (AF) / atrial flutter (AFL) in patients with ASD. Materials and methods. The study included 124 people, with a mean age of 38.3 ± 4.4 years. The patients were divided into 3 groups. Group 1 included patients with ASD and concomitant AF/AFL who underwent closure of the ASD and radiofrequency ablation, while group 2 included patients with ASD and concomitant AF/AFL who underwent only closure of the ASD. The third group included patients over 18 years old with ASD without obvious AF/AFL who underwent ASD closure. Results. It was established that severity of the perioperative period after ASD plasty is due to the duration of the operation and the need for radiofrequency fragmentation of the atria. It was found that performing radiofrequency fragmentation of the atria leads to an increase in the time of artificial blood circulation and the time of artificial lung ventilation. The criteria for forming the research groups were the presence of arrhythmia and surgical tactics used to eliminate ASD. It was established that the duration of ASD plasty was significantly longer in patients from the 1st group (271.0 ± 43.1 min) compared to the corresponding indicator in patients from the 2nd group (211.0 ± 29.4 min) and of the 3rd group (191.3 ± 28.0 min) (p = 0.001, χ2= 18.02). The time of artificial blood circulation was also significantly longer in the 1st group (80.2 ± 13.0 min), compared to the corresponding indicator in the 2nd (45.0 ± 8.4 min) and 3rd groups (47.4 ± 7.3 min), which is caused by performing radiofrequency fragmentation of the atria (p = 0.001, χ2= 17.52). Conclusions. It was established that complexity of the treatment of ASD is due to the duration and traumatic nature of the operation and the need for radiofrequency fragmentation of the atria. It was found that performing radiofrequency fragmentation of the atria leads to an increase in the time of use of artificial blood circulation and, accordingly, reliably extends the time of the patient’s stay on artificial lung ventilation. At the same time, radiofrequency atrial fragmentation provides high clinical efficacy in eliminating AF/AFL.

The presence of ischemic heart disease (IHD) in patients with aortic dissection increases the risk of intraoperative and postoperative complications during aortic repair. Researches on the effect of IHD on the treatment outcomes of patients with type B aortic dissection have not been carried out often. Only single publications based on relatively small statistical material are devoted to this problem in the literature. The cohort of patients with aortic dissection and IHD is extremely complex, and surgical correction of this comorbid condition is still a controversial topic. The aim. To analyze the impact of IHD with prior correction of coronary artery lesions on the results of hybrid and endovascular treatment of patients with thoracic aortic aneurysms. Materials and methods. From 2017 to 2023, on the basis of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, 245 patients with thoracic aortic aneurysm were treated using hybrid and endovascular techniques. Of these, 14 (5.7%) patients with coronary malperfusion underwent previous cor-rection of IHD either alone or in combination with prosthetics of the aortic valve, ascending aorta and arch of the aorta, initial section of the descending aorta (elephant trunk) with a good outcome. The comparison group included 30 (12.2%) patients who underwent endovascular or hybrid correction of the descending thoracic aorta without coronary pathology. Results. In the experimental group, 5 complications (42.9%) were detected (3 in the intraoperative period and 2 in the postoperative period). The frequency of complications of a similar nature in patients without concomitant IHD (com-parison group) was 13.3%. Endoleak type 1 was also dominant in this group. In most cases, it was eliminated by balloon dilatation of the stent graft. Only in 1 case, Endoleak type 1b was the reason for re-intervention with placement of an additional stent after 6 months. Conclusions. Studies show that the presence of even corrected IHD complicates the course of endovascular and hy-brid surgical treatment of thoracic aortic aneurysms, as evidenced by significantly higher rates of postoperative compli-cations, longer length of stay in the intensive care unit, as well as time on mechanical ventilation. Preliminary myocardial revascularization in patients with IHD should be one of the main conditions for the endovas-cular treatment of aortic aneurysms, taking into account the specifics of performing such operations and the possibility of fatal complications with hemodynamically significant narrowing of the coronary arteries.

The aim. To study the structural and functional changes of the mitral valve (MV) in patients with infective endocarditis, taking into account demographic differences that may affect early postoperative mortality. Materials and methods. The study included patients (n = 107) with a history of infective endocarditis with the MV damage. All the patients underwent surgical treatment taking into account the functional lesions of the MV. The material for the analysis was the data from medical records, findings of physical, clinical and instrumental examination, and the operation report. The patients were divided into two study groups: experimental group (n = 67) with the subjects who underwent MV repair, and control group (n = 40) with those who underwent MV replacement. Results. Analysis of gender-specific length of hospital stay showed that deceased male patients were treated for significantly less time compared to those who survived: 3.5 vs. 13.4 bed days (p = 0.02, χ2= 5.12). Assessment of length of stay in the intensive care unit (ICU) showed that deceased patients of experimental group stayed in the ICU significantly longer than those who survived: 14.2 vs. 4.2 bed days (p = 0.02, χ2= 4.85). It was established that there was a significant difference in gender-specific length of stay in the ICU: in male patients of experimental group (p = 0.03, χ2= 4.55) and in women of experimental group (p = 0.02, χ2= 5.24). It was found that deceased patients from the experimental group stayed in the ICU significantly longer compared to similar patients from the control group: 14.2 vs. 4.0 bed days (p = 0.02, χ2= 5.12). Among patients who died, the frequency of urgent operations was significantly higher than in those who survived: 28.6% vs. 12.0% (p = 0.006, χ2= 7.52). The frequency of scheduled operations in control group was significantly higher than that of urgent operations: 92.5% vs. 7.5% (p = 0.04, χ2= 3.98). The incidence of severe MV insufficiency was significantly higher in female patients of the experimental group who were discharged for rehabilitation compared to those in the control group: 100.0% vs. 62.5% (p = 0.02, χ2= 5.47). Conclusions. When analyzing the structural and functional changes in the mitral valve that could cause early post-operative mortality, it was found that severe mitral insufficiency was the most common (93.5%). It was established that mitral valve damage by massive vegetations with the threat of detachment was 57.0%. It was found that mitral valve abscesses were absent in 77.6% of patients, and among deceased patients they were not detected at all. Reliable features of providing qualified care to patients with MV lesions against the background of infective endocarditis are established; these are related to the duration of inpatient treatment, stay in the ICU, and urgency of surgical interventions.

The aim. To analyze the early and long-term results of minimally invasive mitral valve repair in young and middle-aged patients and compare the outcomes with mitral valve repairs performed through standard sternotomy. Materials and methods. From 2016 to 2021, 128 patients with mitral insufficiency were operated in the Ukrainian Children’s Cardiac Center. Exclusion criteria included patients under 18 or over 59 years old and patients with concomitant pathology of the aortic valve, aorta, and coronary arteries. Results. In the investigated group, the average duration of cardiopulmonary bypass and aortic cross-clamping time was longer than in the comparative group. However, the average duration of mechanical ventilation, average time in theintensive care unit, and average length of hospitalization were shorter in the investigated group. Patients in the investigated group less frequently required red blood cell transfusion (5.6% vs. 14.6%) and plasma transfusion (9.4% vs. 14.6%). The percentage of postoperative complications was almost half lower in the investigated group (3.6% vs. 6.6%). None of the patients in the investigated group showed a severe degree of mitral insufficiency, while two patients in the comparative group had severe mitral insufficiency. Conclusions. Minimally invasive mitral valve repair is associated with a lower percentage of postoperative complications. Early and long-term observation results indicate the high effectiveness and safety of the minimally invasive method.

Among patients with congenital heart disease diagnosed in infancy, 7.7% of infants have anatomical variants with functional single ventricle physiology which is often accompanied by depleted pulmonary blood flow. The type of these defects is clinically associated with cyanosis, in most cases caused not by mixing of blood at the level of the heart chambers, but by the presence of ductal-dependent pulmonary blood flow, which requires urgent surgical intervention. The aim. To evaluate the immediate and long-term outcomes of hemodynamic correction in patients with single-ventricle heart physiology with depleted pulmonary blood flow. Materials and methods. In the period from 2010 to 2022, 114 patients with reduced pulmonary blood flow underwent systemic-pulmonary anastomosis at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. Among these, 64 patients had biventricular circulation and subsequently underwent radical correction. The other 50 patients had single-ventricular heart physiology and underwent placement of systemic-pulmonary anastomosis as the first stage of the hemodynamic strategy according to Fontaine, so their data became the main material of this study. Results. Hospital mortality after systemic-pulmonary anastomosis was 8% (4 patients). An uncomplicated course of the early postoperative period was observed in 38 (76%) patients, and 16 complications were observed in the remaining 12 (24%) patients. The median follow-up period was 40 [3; 160] months. During the follow-up period, 2 (4.3%) patients died due to anastomosis thrombosis as a result of self-discontinuation of anticoagulant therapy, 3 (6.5%) patients were lost to follow-up and did not come for examination. The second stage of hemodynamic correction in the form of bidirectional cavopulmonary anastomosis was performed in 41 (82%) patients of the study group. Conclusions. Patients with single-ventricular heart physiology with depleted pulmonary blood flow are a group of extremely complex children who require an individual approach at all stages of hemodynamic correction, and early diagnosis and palliative systemic-pulmonary anastomosis continues to be a reliable alternative for these children, despite the fact that mortality after the first stage remains quite high.

Infective endocarditis (IE) is a rare but devastating disease. The main complications of IE are heart failure (HF), sepsis (in particular, due to perivascular spread of infection), and embolic events, most often those of cerebral local-ization. The diagnosis of IE combines various factors that are not specific to IE when considered separately. Echocardiog-raphy remains the first-line imaging modality for the diagnosis of IE. The aim. To determine the features of intracardiac complications that occur in patients with IE at the preoperative stage using ultrasound diagnostics. Materials and methods. The study included clinical data of 120 patients with IE who underwent examination and treatment from 01/01/2019 to 06/30/2020 at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. The diagnosis of IE was established in accordance with the modified Duke/Eu-ropean Society of Cardiology 2015 criteria. The mean age of the studied patients was 46.3 ± 1.37 (19-69 years). Results. A high rate of nosocomial factors in the development of the disease was determined: 49 (40.9%) cases, of which 15 (12.5%) cases and 25 (20.8%) cases were urological and general surgical interventions, respectively. Preopera-tive HF was found in 16 (13.3%) cases. In the group of patients with acute HF, cases of left heart valve disease with peri-annular complications dominated: 9 (56.3%) cases of abscesses and 3 (18.8%) cases of fistulae. Significant differences were found in the assessment of the cardiac index: in the group of patients with IE without signs of HF, the cardiac index was 4.9 ± 0.2, and in the group of patients with preoperative HF it was 3.7 ± 0.4 (p = 0.098). Patients with acute HF were characterized by a higher level of acute kidney injury (creatinine 168.2 ± 40.7 μmol/L, urea 13.3 ± 2.5 mmol/L). Conclusions. The obtained results indicate a high incidence of intracardiac complications in patients with IE, in par-ticular, those caused by nosocomial infections and medical interventions. Ultrasound diagnostics (echocardiography) is an important tool for detecting and monitoring intracardiac complications at the preoperative stage, which can affect the treatment strategy and prognosis. A thorough examination of a patient with IE allows to identify critical features of cardiac hemodynamic disorders and ensure timely cardiac surgery.

The aim. To study the relationship between β1-, β2-adrenoceptor (β-AR) and LGALS-3 genes polymorphisms with the course of heart failure (HF) in patients with 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 4 polymorphisms (rs1801253 and rs1801252 of the β1-AR gene; rs1042714 of the β2-AR gene and rs2274273 of the LGALS-3 gene). Statistical analysis was performed using Statistica 10.0 and SNPStats programs. Results. In patients with HF, the A allele (A/G-A/A) of the rs1801252 polymorphism of the β1-AR was associated with a reduced risk of rehospitalization (RH) within a year (odds ratio [OR] = 0.44 [0.20-0 .98], p = 0.036, dominant inheritance model). The data on the reduction of the risk of RH in patients with HF in the presence of the A allele of the rs1801252 polymorphism of the β1-AR gene were also confirmed in the log-additive (OR = 0.44 [0.20-0.96], p = 0.027) and, mainly, in excessively dominant (OR = 0.48 [0.21-1.06], p = 0.059) inheritance models. The analysis showed a higher frequency of allele A of the rs1801252 polymorphism of the β1-AR gene in the group of patients with HF who did not have RH due to decompensation during the year, compared to patients with RH (14.9% versus 7.0%, respectively; χ2 = 4.304; p = 0.039). The A allele of the specified gene polymorphism was also associated with a reduced risk of persistent atrial fibrillation (AF) (OR = 0.34 [0.14-0.84], p = 0.018, dominant inheritance model). This regularity was confirmed in the overdominant (OR = 0.27 [0.11-0.69], p = 0.0048) and in the codominant (OR = 0.28 [0.11-0.72], p = 0.0081) inheritance models. The A allele (A/G-A/A) of the rs2274273 polymorphism of the LGALS-3 gene was associated with an increased risk of AF in patients with HF (OR = 6.63 [1.31-33.53], p = 0.032, codominant inheritance model). Data on the increase in the risk of AF, provided that the A allele of the aforementioned polymorphism is present, were also confirmed in the recessive (OR = 5.12 [1.08-24.24], p = 0.017) and log-additive (OR = 2.11 [1.13-3.94], p = 0.015) inheritance models. The risk of RH in patients with HF and concomitant diabetes mellitus increased in patients with heterozygous (G/C) polymorphism rs1801253 of the β1-AR gene (OR = 3.91 [1.03-14.87], p = 0.0041). Conclusions. The course of HF was associated with genetic differences β1-AR, in particular: the A allele of the rs1801252 polymorphism of the specified gene reduced the risk of RH within a year (14.1 % vs. 27.0 %; OR = 0.44; p = 0.036, dominant inheritance model) and AF (18.3 % vs. 39.5 %; OR = 0.34; p = 0.018, dominant inheritance model). The risk of RH of patients with HF and accompanying diabetes mellitus was higher with heterozygous (G/C) rs1801253 polymorphism of the β1-AR gene (24.4 % vs. 11.1 %; OR = 3.91; p = 0.0041). The A allele of the rs2274273 polymorphism of the LGALS-3 gene was associated with an increased risk of AF in patients with HF (20.0 % vs. 4.7%; OR = 6.63, p = 0.032, codominant inheritance model). No probable association of the rs1042714 polymorphism of the β2-AR gene with the course of HF was found.

Background. Coronary artery disease (CAD) is caused by atherosclerotic process in coronary arteries. Due to extraordinary risk for atherosclerosis in diabetic patients, it is also counted as a vascular disease. Diabetes mellitus (DM) is a direct major associated risk factor in the development of cardiovascular disease with some studies from high income countries reporting correlation between duration of DM and severity of CAD. However, data from Pakistan is scarce. The aim. To determine the correlation between duration of DM and severity of CAD in patients undergoing coronary angiography at the tertiary care cardiac center. Materials and methods. This cross-sectional study was conducted in the Department of Cardiology, Civil Hospital Karachi, among 160 patients who were scheduled for coronary angiography with comorbid DM. Correlation between duration of DM and severity of CAD (as assessed by the modified Gensini score) was statistically measured and reported employing Pearson’s correlation coefficient (r). Results. Significant correlation between DM duration and total Gensini score was shown with r = 0.759 and p = 0.000001. With the increase in the duration of DM, the severity of CAD also increased. Conclusion. DM duration is positively associated with the modified Gensini score and the significant determinants of CAD severity tend to be relevant.

The aim. To analyze the perioperative course of cardiac surgery patients with coronary artery disease (CAD) and heart valve dysfunction. Materials and methods. Retrospective analysis of 41 consecutive cardiac surgery patients (mean age 61.6 ± 7.8 years) with CAD and heart valve dysfunction who were operated on and discharged from the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. All the patients underwent standard clinical and laboratory examinations, coronary angiography, on-pump cardiosurgical intervention. Results. The patients were divided into three subgroups: patients with post-infarction left ventricular aneurysm (LVA) combined with insufficiency of atrioventricular valves, n = 15 (36.6%); those with ischemic mitral insufficiency (MI), n = 11 (26.8%); and patients with CAD combined with aortic valve disease, n = 15 (36.6%). During echocardiographic study, decreased left ventricular ejection fraction was found in patients with LVA and with ischemic MI: 33 ± 6.4% and 39.4 ± 7.8%, respectively, and in patients with aortic valve disease, left ventricular ejection fraction averaged 48.2 ± 9.9% (p < 0.0001). According to the EuroSCORE II scale, the average risk was 11.8 ± 7.3%. All the patients were discussed by the heart team to choose the optimal method of cardiosurgical correction. In order to reduce the ischemic time, off-pump coronary bypass surgery was performed at the first stage, and the second stage was on-pump correction of valvular dysfunction. The average number of grafts was 2.8 ± 1.4, but the largest number of grafts was in the subgroup of ischemic MI: 4 ± 0.9 (p < 0.005). Mitral valve replacement in patients with LVA was performed through LVA in 12 patients. Acute heart failure, acute renal failure often developed in patients after correction of ischemic MI (p < 0.005). On the 1st day after the operation, there was an increase in average glucose values from 6.6 ± 2.8 to 10.3 ± 2.9 mmol/L (p < 0.0001), a decrease in glomerular filtration rate from 72.1 ± 15.3 to 57 ± 18.8 mL/min/1.73 m2 (p = 0.0001), the above indicators returned to the initial level at discharge (p < 0.0001). Conclusions. Off-pump myocardial revascularization in patients with CAD and dysfunction of the heart valves can significantly reduce the ischemic time. The method of mitral valve replacement through LVA developed in the department allowed to reduce the perfusion time (p = 0.0023) and the duration of the operation (p < 0.005). Preoperative discussion of examination data of patients by the heart team, thorough preparation for cardiac surgery, timely response to changes in laboratory parameters with correction of drug treatment avoid complications.

The aim. This study aimed to determine the effectiveness of the OMI AI deep learning model for the diagnosis of myocardial infarction in patients with non ST-elevation acute coronary syndrome. Materials and methods. This single-center retrospective observational study analyzed the data of 238 patients admitted to the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with a primary diagnosis of non ST-elevation acute coronary syndrome. The inclusion criteria for the study were: age ≥18 years, symptoms of acute coronary syndrome, at least one 10-second 12-lead electrocardiography on admission, no changes typical of ST-segment elevation myocardial infarction on electrocardiography, and at least one laboratory blood test for biomarkers of myocardial damage. Results. The final analysis included data from 116 patients, 69 (59.5%) men and 47 (40.5%) women aged 43 to 88 years (mean age 67±11 years), of whom 34 were older patients (≥75 years). Of these, 29 (25%) patients were discharged with a diagnosis of acute myocardial infarction, 60 (51.7%) with a diagnosis of unstable angina, and 27 (23.3%) patients with other diagnoses. When analyzing electrocardiographic data by the OMI AI model, true positive results were obtained in 23 cases (19.8%), true negative results in 76 cases (65.5%), false positive results in 11 cases (9.5%), and false negative results in 6 cases (5%). Accordingly, the model’s sensitivity was 67% and specificity was 93%. The positive and negative predictive values for the model under study were 0.793 and 0.874, respectively. The accuracy of the model was 85.34% (95% CI: 77.78% to 90.64%). Conclusions. The use of the artificial intelligence tools has the potential to improve the accuracy of diagnosis of myocardial infarction during hospitalization, accelerate the provision of specialized care and improve prognosis in patients with non ST-elevation acute coronary syndrome.

Of all benign neoplasms of the heart, cardiac myxomas (CM) are found in 50-90% of cases. National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine has experience in surgical treatment of 968 heart tumors. Of these, CM was observed in 868 cases. The aim. To conduct an analysis of the frequency of detection of complicated forms of CM, to present the causes and methods of diagnosis and surgical treatment of these complications. Material and methods. Pathology of the valvular apparatus combined with CM occurred in 70 (8.1%) patients: an isolated lesion of the mitral valve (MV) was observed in 27 (38.6%) patients, concomitant relative insufficiency of the tricuspid valve (TV) was found in 10 (14.3%) cases. Results. During the surgical treatment of valvular pathology, we performed valve replacement in 15 (21.4%) patients (MV in 12, TV in 1, aortic valve [AV] in 1, AV + MV in 1 patient), reconstructive operations with a positive functional effect in 50 (71.4%) patients, and isolated tumor removal from the valve apparatus in 5 (7.1%) cases. Relapses after surgical treatment of CM in our cohort of patients occurred in 1.8% cases. Among patients with sporadic myxomas of the heart, recurrence was observed in 13 cases (1.5%). If the principle of radical removal of CM followed, relapses occurred in 1.3% (10 cases out of 772). In 7 cases of myxoma syndrome, the recurrence rate was 42.5%. Embolic complications of the course of CM were determined in 58 (6.7%) cases. Damage to cerebral vessels was found in 46 (77.9%), embolisms of peripheral vessels in 10 (16.9%), and embolisms of coronary arteries in 2 (5.1%) patients. In 41 patients with CM (4.2%), a significant lesion of the coronary arteries was found, which required surgical intervention. To correct the pathology of the coronary vessels, the following was performed: stenting in 3 cases (7.3%), coronary bypass surgery in 35 (85.4%), dissection of the muscle bridge that narrowed left anterior descending artery in 2 (4.9%), left ventricular aneurysm plastic surgery in 1 case (2.4%). Conclusions. Calcium changes in left atrial myxoma were most often accompanied by mechanical damage to the leaflets and chordal apparatus of the mitral valve. Hyperthermia was a frequent manifestation of CM (56.8%). In isolated cases, the temperature reaction may be associated with the tumor infection process.

Background. Complications of systemic atherosclerosis (myocardial infarction, ischemic stroke) are the main causes of mortality and disability in the modern world. The relevance of this problem is determined by its scale: the number of deaths from cardiovascular disease has gradually increased from 12.1 million in 1990 to 18.6 million in 2019 and is on the rise. Today, the standard treatment regimen for dyslipidemia includes statins and ezetimibe. For patients who do not achieve the required lipid lowering, intensification of therapy with a relatively new group of drugs – PCSK9 inhibitors – is available. The aim. To study the effectiveness of inclisiran in the complex therapy of dyslipidemia in patients with very high cardiovascular risk. Materials and methods. The study design was a series of clinical cases, the data of which are described for comparison in dynamics. On the basis of the Department of Cardiometabolic Diseases of the Ukrainian Children’s Cardiac Center, a group of 7 patients with very high cardiovascular risk who did not achieve the target lipid parameters on standard therapy with rosuvastatin and ezetimibe was selected. Results. All the patients in the study group of very high cardiovascular risk with dyslipidemia resistant to standard combination treatment who took inclisiran as part of complex lipid-lowering therapy achieved a significant reduction in total cholesterol, but more importantly, they reached the target low-density lipoprotein cholesterol values. We did not find any side effects when using inclisiran. Conclusions. The present series of clinical cases demonstrates high efficacy of inclisiran as part of complex lipid-lowering therapy in patients with very high cardiovascular risk, who have a combination of coronary heart disease and type 2 diabetes mellitus. These results suggest the possibility of wider use of inclisiran in patients with very high cardiovascular risk to reduce cardiovascular morbidity and mortality.

The aim. To establish the relationship between structural-functional and laboratory parameters in patients with myocardial infarction (MI) and heart failure (HF) undergoing percutaneous coronary intervention (PCI). Materials and methods. We examined 308 MI patients who were divided into 3 groups: 161 patients without signs of acute heart failure (AHF) (group I), 99 with Killip class II-III AHF (group II) and 48 with Killip class IV (cardiogenic shock) (group III). All the patients underwent general clinical examinations: complete blood count, lipid profile, creati-nine, quantitative determination of troponin I, D-dimer, creatine kinase-MB, electrocardiography, coronary angiography with PCI, focused cardiac ultrasound and standard echocardiography over 3-5 days. Results. According to the focused cardiac ultrasound, the majority of MI patients with signs of AHF had preserved left ventricle function, and only 8.2% of patients had left ventricle ejection fraction (LVEF) ˂40%. The most significant structural and functional changes were observed in group II. After PCI, a significant increase in left ventricle contractility was found in all groups, but in the group II, the increase in LVEF was more pronounced. The severity of HF manifestations increased depending on the severity of diastolic dysfunction. Many correlations were established: an inverse relationship between LVEF and the presence of HF, the number ofaffected vessels, proximal left anterior descending artery lesions, low-density lipoprotein cholesterol, and atrium fibrilla-tion; a direct relationship between LVEF and hemoglobin levels and glomerular filtration rate. Conclusions. The vast majority of patients with MI and signs of AHF had preserved left ventricle contractile function. High-grade HF manifestations increase depending on the severity of diastolic dysfunction. Myocardial revascularization in MI pa-tients significantly improves functional and volumetric parameters of myocardial function. Numerous correlations between structural-functional and laboratory parameters in patients with MI and HF who underwent PCI have been established.

Pulmonary artery stenosis with distal aortic arch reconstruction and coarctation of the aorta in newborns is an effective palliative procedure for single ventricle and high pulmonary hypertension on the way to total cavo-pulmonary anastomosis. The aim. To present a case of complex correction of a single ventricle of the heart with tricuspid valve atresia and high pulmonary hypertension, obstruction of the distal aortic arch and coarctation of the aorta, and a final effective Fontan procedure with a good long-term outcome. Case report. On December 15, 2011, a 9-day-old newborn patient M. was admitted for treatment at the Department of Cardiovascular Surgery of Odesa Regional Children’s Clinical Hospital with a diagnosis of: a single ventricle of the heart, transposition of the great arteries, tricuspid atresia, distal arch hypoplasia, coarctation of the aorta, patent ductus arteriosus, high pulmonary hypertension. The first stage of surgical treatment was carried out on December 19, 2011: main pulmonary artery banding, reconstruction of the distal arch of the aorta through modified Amato technique, closure of the patent ductus arteriosus, resection of the coarctation of the aorta and extended end-to-end aortoplasty. At the age of 1 year (December 27, 2012), the second stage was performed: bidirectional Glenn procedure with plastic surgery of bifurcation and right pulmonary artery branch. The third stage was performed at the age of 3 years 11 months (November 19, 2015): Fontan procedure with extracardiac conduit. Conclusions. Early elimination of pulmonary hypertension by pulmonary artery banding ensures the preservation of the pulmonary vascular bed with low resistance, which is a crucial condition for the effective final hemodynamic correction of the single ventricle of the heart – the Fontan procedure. In case of hypoplasia of the distal aortic arch with coarctation in newborns, one of the alternative approaches is the use of modified Amato technique avoiding artificial circulation.

Функціональні закрепи в дітей стали серйозним медичним питанням, яке потребує негайного вирішення. Вони можуть суттєво обмежити фізичну активність і соціальну інтеграцію дітей, що підкреслює актуальність надання їм ефективної допомоги. Мета - проаналізувати та поліпшити результати комплексного застосування препарату на основі лактулози та фітоциліндрів профілактичних із ліпофільним комплексом плодів шипшини та екстрактом ромашки у лікуванні функціональних закрепів у дітей. Матеріали та методи. Обстежено 78 дітей із закрепами за останні 3 роки. Дітей поділено на дві групи. До першої групи увійшло 36 (46,2%) пацієнтів, до другої - 42 (53,8%). Пацієнти першої групи отримували стандартне лікування згідно з протоколами Міністерства охорони здоров’я України, пацієнти другої групи - аналогічне лікування та додатково лактулозу у вигляді сиропу і препарату на основі фітоциліндрів профілактичних із ліпофільним комплексом плодів шипшини та екстрактом ромашки протягом курсу лікування щоденно у вигляді ректальних свічок. Результати. Більшість пацієнтів були жіночої статі (60,2%), мали середні параметри фізичного розвитку. Тривалість закрепу становила від 1 до 3 міс, затримка випорожнень - від 3 до 5 діб. На момент початку спостереження відмічалися скарги на зміну форми й консистенції випорожнень, болючу дефекацію, метеоризм, періодичний біль у животі, сильне натужування під час дефекації, страх чи неспокій у дітей перед актом дефекації. Аналіз анамнестичних даних показав, що в третини пацієнтів закреп спостерігався під час переходу з грудного вигодовування на штучне. Висновки. Аналіз додавання до комплексу лікування функціональних закрепів, крім лактулози, ще й препаратів на основі фітоциліндрів профілактичних із ліпофільним комплексом плодів шипшини та екстрактом ромашки є безпечним і досить дієвим методом корекції цих порушень у дітей раннього віку, про що свідчать отримані результати. Дослідження виконано відповідно до принципів Гельсінської декларації. Протокол дослідження ухвалено Локальним етичним комітетом зазначеної в роботі установи. На проведення досліджень отримано інформовану згоду пацієнтів. Автори заявляють про відсутність конфлікту інтересів.