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Carotid-cavernous fistula (CCF) is a pathologic communication between carotid arteries and cavernous sinus. The goal of endovascular treatment is to completely interrupt the carotid-cavernous communication with preserving normal blood flow in carotid arteries. Embolization can be performed via transarterial or transvenous access depending on anatomy and angioarchitecture of fistula. In this report, we present a 64-year-old woman with indirect CCF. Effective and safe embolization of indirect CCF was performed using distal radial access for diagnosis and navigation and cubital vein for simultaneous venous access for therapeutic endovascular manipulations, completely avoiding femoral access.

Left ventricular hypertrophy - is one of the most frequent structural changes in the heart. This article is devoted to the assessment of modern views on the causes of myocardial hypertrophy of the donor heart, indications and contraindications for the heart trans‑ plantation, the outlook of expanding the pool of effective donors through the use of these hearts. Here are considered the issues of post-transplantation remodeling of the donor heart myocardium, The pathogenesis features, the nascence risk and possibilities of drug regulation of the transplanted heart's myocardial hypertrophy of the left ventricle.

Currently, the analysis of the fibrosis severity during the restructuring of the surrounding extracellular matrix (ECM) is studied in most of the research works devoted to “cardiac remodeling”. At the same time, the role of the basal membrane of cardiomyocytes in heart diseases was not studied. The basal membrane of cardiomyocytes is a highly organized layer of the ECM which is located on the outer side of the sarcolemma. Degradation of ECM components is carried out by different types of matrix metalloproteinases (MMP), which have proteolytic activity and are actively involved in the process of ECM remodeling, destroying its components such as collagen, elastin, fibronectin, glycosaminoglycans and other structural components.Aim. To evaluate the ECM status in patients with coronary artery disease and its effect on left ventricular myocardial remodeling.Material and methods. Morphological and immunohistochemical (IHC) examination of left ventricular myocardial biopsies was performed in 16 patients undergoing left ventricular reconstruction in combination with coronary artery bypass grafting.Results. The IHC study revealed the accumulation of matrix metalloproteinase-9 in the cytoplasm of cardiomyocytes. This accumulation was combined with partial or complete destruction of the basal membranes (BM) of cardiomyocytes formed by type IV collagen.Conclusion. Type IV collagen destruction in basal membranes of left ventricular cardiomyocyteswasrevealed. It iscausedbytheactionofmatrixmetalloproteinase-9, which accumulates in the cell cytoplasm.

Mandibular arteriovenous malformation (AVM) is a rare lesion, but it often can be presented with life-threatening bleedings. Endovascular treatment of mandibular AVMs has multiple approaches including transarterial embolization, transvenous embolization, direct puncture, and sclerotherapy. In this case study, we present a patient with mandibular AVM complicated by hemorrhage. The patient was treated with transarterial embolization, followed by transvenous sclerotherapy with balloon occlusion of venous outflow. But radical occlusion of AVM was achieved only by transvenous embolization of AVM with Onyx via double lumen balloon, which occluded the venous outflow. Keywords: Mandibular arteriovenous malformation, Transvenous, Embolization, Onyx

Optimal surgical strategy for secondary tricuspid regurgitation is still under discussion. First of all, this is due to rare organic disease of tricuspid valve and tricuspid regurgitation is almost always classified as secondary insufficiency. Fibrous annulus enlargement of tricuspid valve is the most common cause of tricuspid regurgitation. Annular dilatation may by the result of left ventricular failure due to myocardial or valvular diseases, right ventricular enlargement, pressure or volume overload. No surgical correction of tricuspid insufficiency during cardiac surgery for other leading disease aggravates short- and long-term results. Considering the wide interest and disputes around optimal surgical strategy for tricuspid regurgitation, this review is devoted to modern methods of surgical treatment of secondary tricuspid insufficiency.Тактика хирургического лечения трикуспидальной недостаточности все еще является предметом широкого обсуждения прежде всего потому, что органическое заболевание трехстворчатого клапана встречается редко и почти всегда классифицируется как вторичное. Недостаточность трехстворчатого клапана возникает главным образом из-за расширения фиброзного кольца вследствие левожелудочковой сердечной недостаточности от миокардиальных или клапанных причин, увеличения объема правого желудочка, перегрузки давлением или расширения сердечных камер. Отсутствие хирургической коррекции недостаточности трикуспидального клапана во время проведения оперативного вмешательства по поводу основного заболевания сердца отрицательно влияет на непосредственные и отдаленные результаты.

This case presents an episode of electrical storm (ES) in post-myocardial infarction patient results from myocarditis. ES was interrupted by aneurysmectomy and additional isolation of VT origins by radiofrequency catheter ablation. The histological evaluation of aneurysm material proved acute myocarditis. The key findings indicating acute inflammation in myocardium was an increased level of peripheral inflammatory biomarker IL6 and autoantibodies to beta1-adrenergic receptor (β1-AAbs). Gated SPECT with phase images analysis turned out to be appropriate imaging strategy in visualizing potentially reversible causes of ventricular arrhythmias such as myocarditis. Taking together our findings might add some information on the pathogenesis and predisposing factors of ventricular arrhythmias especially in the cases of electrical storm.

Aim . To analyze approaches to pretransplant treatment of potential heart recipients and heart donation criteria, directed to reduction of mortality on a waiting list and to increase of volume and effi ciency of heart transplantations. Methods and results. Data on 285 HT recipients (performed in 2008–2013) were analyzed. The analysis and comparison of patients with circulatory support before heart transplantation, using «high-risk» donors (aged over 40 years, with left ventricular hypertrophy ≥ 1.5 cm, after cardiopulmonary resuscitation, with the reduced systolic function of the left ventricle (< 40%), with potentially repair pathology of the heart valve and coronary arteries); to high risk recipients (over 60 years, with high pulmonary hypertension and earlier operated) were made. Conclusion . The proposed scientifi c, technological and organizational solutions made possible the timely performance of heart transplantation to patients with an inevitable lethal outcome as a result of heart failure.

Aim of study. The demonstration of our own experience in heart transplantation after valve reconstruction. Methods and results. From May 2012 to March 2013 3 mitral valve annuloplasties were performed to recipi- ents, requiring urgent HT and having extremely unfavorable prognosis of survival without HT. The recipients were classi fi ed as United Network for Organ Sharing (UNOS) IB, and all of them were on inotropic support. In one case, HT was performed after reconstruction of rheumatic mitral stenosis, in two other cases – after dege- nerative mitral regurgitation. The technical aspects are reviewed of ex-vivo mitral and tricuspid valves repair with concomitant heart transplantation. All patients were discharged from the hospital having excellent postope- rative recovery. Conclusion. Taking into consideration the demonstrated satisfactory result of surveillance and presence of signi fi cant experience in performing of reconstructive valve surgery among no-HT cardiosurgical patients, an increase in the pool of suitable donor organs is expected due to the liberalization of the selection criteria and the possibility of the innovative valve reconstruction procedures ex vivo .

Aim of our clinical study was evaluation own initial experience of high-urgency ortotopic heart transplantation (OHT) in recipients, who were bridged on peripheral Vena-Arterial Extracorporeal Membrane Oxygenation (VA ECMO). Materials and methods. In this study was included 17 patients (14/3 M/F, age 16–66 (40.1 ± 4.2 yrs)) who underwent OHT while on peripheral ECMO support. In all cases we used peripheral surgical can- nulation technique via femoral vessels – arterial cannula 15–19 Fr, venous cannula – 21–25 Fr, arterial cannula or vascular catheter 8–10 Fr for anterograde leg’s perfusion. Results. Duration Vena-Arterial Extracorporeal Membrane Oxygenation before OHT was 81 ± 17 h. VA ECMO support was blood fl ow 4.8 ± 0.6 l/min or 2.63 ± 0/04 l/min/m 2 , gas fl ow 4.8 ± 0.6 l/min, FiO 2 0.86 ± 0.07. Vena-Arterial Extracorporeal Membrane Oxygenation support was continued in “protective mode” (blood fl ow 1.9 ± 0.2 l/min) 4.3 ± 0.5 days after OHT. Thirteen pa- tients (76.4%) were weaned from VA ECMO successfully and survived to be discharged. ICU and hospital LOS after orthotopic heart transplantation was respectively 6.7 ± 0.8 and 32.3 ± 4.6 days in group of survived patients. The reasons of a lethal outcome (n = 4, 23.5%) were sepsis and multiorgan failure (n = 3), sudden cardiac arrest (n = 1). Conclusion. Vena-Arterial Extracorporeal Membrane Oxygenation is a favorable short-term method of circulatory support in patients who needed in high-urgency heart transplantation.

The paper describes a rare case of successful surgical treatment for mitral insufficiency due to heart valvular apparatus damage in the acute period of severe concomitant injury. Prosthetic mitral valve replacement was done on day 3 after injury. The patient was switched to spontaneous breathing on day 7 postoperatively and transferred to a surgical unit on day 11. Timely diagnosis, a comprehensive therapeutic approach, active surgical policy, the availability of up-to-date medical equipment, and the presence of high-quality physicians allowed severe cardiopulmonary insufficiency to be eliminated and the patient was discharged from hospital in a satisfactory state on day 25 after injury. Key words: severe concomitant injury, blunt chest injury, mitral valve damage, cardiac surgery.

Purpose Increasing number of recipients 1A-B UNOS, who need the urgent heart transplantation (HTx), is one of the most actual problem of HTx. Using hearts from ABO-incompatible donors can solve this problem. Methods and Materials There were performed 115 HTx during the period from 03.2010 to 10.2012 in Federal V.Shumakov Research Center of Transplantology and Artificial Organs, among them 6 (5,2%) were made from ABO-incompatible donors (the mean age 35,71±12,59 years). All recipients, who were ABO-incompatible with donors, were related to UNOS 1A-B status, 4 (66,67%) of them were on mechanical circulatory support (3 – ECMO, 1 – “EXCOR” BVAD), 2 patients (33,33%) had continuous inotropic support (dopamine > 7,5 μg/kg/min). 2 HTx were performed from A(II) donors to B(III) recipients, 2 – from AB(IV) donors to O(I) recipients, 1 – from B(III) donor to O(I) recipient and 1 – from A(II) donor to O(I) recipient. The average time of ischemia is 133,86±15,97 min. Results All patients had accelerated AMR ater HTx (patients were treated with steroids, i.v. immunoglobulin, Rituximab, plasmapheresis with basic calcineurin inhibitors immunosupression). During the early postoperative period 3 recipients demonstrated primary graft dysfunction (that required implantation or extension of ECMO) and multiorganic failure (MOF). Another survived patients after ABO-incompatible HTx had no heart failure. The average follow-up is 325,67±346,12 days. 4 patients (66,67%) were discharged from the clinic, 2 patients died. Only in one case death was caused by secondary graft dysfunction depended on accelerated antibody-mediated rejection (AMR) in combination with MOF (AB(IV) to O(I)). Conclusions HTx from ABO-incompatible donors is a forced measure and it is accompanied by episodes of accelerated AMR in 100% of cases. Nevertheless, HTx is acceptable for urgent 1 A-B UNOS recipients and it requires early prophylaxis and treatment of AMR.