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The aim – to present the features of the clinical manifestations and course of two cases of embolism of the coronary arteries, in which fragments of left atrial (LA) tumors served as the embolic substrate. Materials and methods. This article discusses two cases of embolism with tumor fragments of the coronary arteries. In this case, the neoplasms were located in the left heart. Of particular interest is the fact that the clinical manifestations of embolism varied significantly, from severe pain requiring endovascular intervention, to minor discomfort lasting for several hours, without necessity of the inpatient treatment. Results. It should be noted that in both cases, a tumor lesion of the heart was detected several months after primary manifestation of the disease, namely, embolism of the coronary arteries. Echocardiography study made possible to get a correct diagnosis. In one case it was a routine examination 6 months after stenting of the coronary artery. The reason to perform echocardiography in another case was the result of electrocardiography, showing necrotic changes of the left ventricular posterior wall. In both cases, echocardiographic data prompted immediate surgery of the neoplasms. The structure of neoplasm samples obtained as a result of the surgery confirmed the possibility of coronary artery embolism with tumor fragments. Conclusions. Embolic complications may be a first manifestation of cardiac tumor. Fragmentation of the heart neoplasms may lead to damage of the cerebral and coronary arteries. Embolic complications can occur in young patients. Coronary artery embolism in cardiac tumors is associated with diverse clinical manifestations.

The article presents a clinical case of a rare benign heart neoplasm – a cavernous mitral valve hemangioma. Infiltrative growth of the tumor led to deformation of the valve with the development of mitral insufficiency and its replacement with a mechanical prosthesis.

Berkitt lymphoma as a primary malignant tumor of the heart occurs extremely rarely. By the time of the diagnosis, patients already have regional or distant metastases, which greatly worsens their clinical condition and the prognosis of surgical treatment. Hospital mortality in patients with malignant neoplasms is 25–50 %. The article describes an unusual case of Burkitt's lymphoma with heart involvement in a male of 27 years old. Various diagnostic methods were used to determine the nature of the neoplasm. Subsequent treatment methods resulted in a positive long-term outcome.

The article presents the clinical case of the 22-year old patient with malignant tumor of the left atrium. The character and size of the tumor were distinguished only during surgery. This case has a practical value from point of view of the complicated diagnosis, as well as special surgical treatment and unpredictability of the tumor macrostructure. Laboratory and instrumental diagnostic methods were used, including transthoracic and transesophageal B-mode color Doppler echocardiography, which made possible to detect the tumor. After successful surgical treatment of the tumor a patient was discharged at 12 days in satisfactory condition.

The aim – to present experience, results and prospects of repeated interventions in the remote period after radical correction of tetralogy of Fallot. Materials and methods. Results of the repeated 65 surgeries in 62 patients after radical correction of tetralogy of Fallot with long-term follow-up for the period from 1981 to 2014 are presented. The interval between the radical tetralogy of Fallot correction and re-operation ranged from 1 month to 30 years (average – 8.54 ± 6.3 years). Results. Depending on the predominance of one or other complications and its causes we observed: 1) residual defects – 25 (40.4 %) cases; right ventricular dysfunction – 23 (37.0 %) cases; valve pathology – 5 (8.0 %) cases; other rare complications – 9 (14.6 %) cases. In total, 100 complications were identified and eliminated in 62 patients. The most frequent complications that required second surgical correction were: recanalization of ventricular septal defect (36.0 %), right ventricular aneurysm (19.0 %), tricuspid valve insufficiency (13.0 %), the residual obstruction of the outflow tract of the right ventricle (9.0 %), right ventricular dysfunction caused by pulmonary valve insufficiency (6.0 %) and pulmonary trunk aneurysm (5.0 %). Conclusion. Hospital mortality after surgical correction of long-term complications was 8.0 %. All discharged patients with echocardiographic evaluation revealed a positive dynamics of volume and functional parameters of the right and left ventricles

New methods of surgical treatment of rare tumours of heart Among benign heart tumors, except most frequently observed myxomas (89.6 % саses), non-myxomatous benign tumours, including fibromas (0.4 % саses) may be diagnosed. Two cases of tumours of rare localizations, i.e. in right atrium and left ventricle, are presented. In both cases low-invasive technics using videocameras, significantly facilitating procedures inside the heart, were used. Usage of low-invasive approaches with video assistance in cardiac surgery, contrary to standard sternotomy, significantly decreases intrasurgery trauma and blood loss, as well as pain syndrome after surgery. This facilitates early rehabilitation of the patients and decreases its terms. At the same time the complete spectrum of intracardiac surgical manipulations and methods is preserved. The development of this direction in cardiac surgery is very perspective, but the individualized approach to every patient is needed.

The aim – to analyze the frequency and nature of lesions of the valve apparatus, to evaluate the results of surgical correction of the affected valves in heart myxomas. Materials and methods. In one-centre study, during period from 01.01.1969 to 01.10.2020, 962 patients with morphologically verified primary heart tumors were observed. Myxomas of the heart were found in 856 (89.0 %) patients. The pathology of the valve apparatus in combination with cardiac myxomas was noted in 70 (8.1 %) patients. The volume and nature of valve damage differed and depended on size, consistency and localization of myxoma, the degree of its mobility, and the presence of areas of pronounced fibrosis and calcification on the tumor. Results. Surgical correction of lesions of valve structures was performed in 65 patients. In 5 patients, it was possible to remove tumor tissue from the valve apparatus, followed by prevention of disease recurrence without damaging valve and subvalvular structures. Surgical techniques included both plastic manipulation and valve replacement. The features of the long-term postoperative period in such patients include progressive valve dysfunction manifested by the progression of insufficiency due to further deformation of the valve apparatus. Conclusions. Alongside with myxoma removal, it is necessary to conduct a thorough examination of the valve apparatus and correction of valve damage by various methods, including plastic surgery and valve replacement, depending on the nature and severity of the damage.

The article describes an unusual course and complex differential diagnosis of fibrotic pericarditis, which imitated a heart tumor at the base of aorta. The key point in the progression of the disease was the appearance of concomitant fungal infection, which led to the emergence of its clinical manifestations. Due to the external compression of the main trunk of the left coronary artery up to 90 %, its stenting was performed. A biopsy followed by histopathological examination, along with other diagnostic methods, allowed to prescribe an adequate treatment for this pathology

Concurrent valvular pathology is a complication of cardiac myxoma leading to hemodynamic disturbances and difficulties in differential diagnostics. Treatment of concurrent valvular pathology should be referred to the concept of hemodynamic radicality of a surgical treatment of cardiac tumors. This paper describes a clinical case of giant left atrial myxoma with mitral valve involvement and coexisting coronary artery disease. Damaged mitral valve anterior cusp with mitral regurgitation was discovered only during surgery after the myxoma had been removed. The condition hasn’t been recognized at transesophageal echocardiography or computed tomography. Undoubtedly, mitral valve regurgitation and cusp damage were tricky to determine due to large size of the tumor and its proximity to the damaged cusp. Moreover, the tumor mass held the damaged cusp in place preventing the development of severe regurgitation.

The aim – to characterize the difficulties of diagnosis, the choice of tactics and the application of a new approach to the surgical treatment of malignant neoplasms, aimed at reducing the likelihood of recurrent intracardiac tumor growth. Materials and methods. The article presents a case of observation of a malignant tumor of the left atrium (LA) – angiosarcoma – in a patient aged 41 years, hospitalized with a previously established diagnosis of stage II lung sarcoidosis and myxoma of the LA. Results. Taking into account the severe obstruction of the mitral valve by the neoplasm, a decision was made on emergency surgical treatment. Neoplasm was visualized in the LA cavity, filling almost its entire cavity. A tumor 12 × 7 × 5 cm was removed. Histological examination of the tumor revealed a low-grade angiofibrosarcoma. Two weeks after discharge, computed tomography revealed atrial tumor recurrence. Given the observed fast recurrence, it was decided to separate the tumor tissue from the lumen of the LA and to avoid direct contact with blood. Therefore, the mouth of the right lower pulmonary vein was closed with a patch from the autopericardium. The control CT studies after a course of chemotherapy recorded moderate tumor growth in the projection of the lung tissue; there was no recurrent tumor growth in the cavity of the LA. Conclusions. Surgical treatment of malignant heart tumors should be aimed at the most radical removal of the neoplasm, the restoration of adequate intracardiac hemodynamics, and in cases of the impossibility of performing a radical operation, at isolating the tumor tissue from direct contact with the blood to prevent rapid recurrent intracardiac growth of the neoplasm.

The aim – to determine the features of surgical treatment of the malignant heart tumors, aimed at their most radical removal. Materials and methods. At the M.M. Amosov National Institute of Cardiovascular Surgery of NAMS of Ukraine, during the period 1970–2018 66 patients with malignant neoplasms of the heart of various types and localization were observed, which accounted 6.9 % of the total number of patients with heart tumors (n = 939). Results. Hospital mortality during the surgical treatment was 19.7 % (13 patients). Among 66 operations, 55 (83.3 %) were performed using artificial blood circulation, including 21 (3.8 %) conditionally radical cardiac surgeries with good hemodynamic effect. Conclusions. To achieve the conditional radicalism of the surgery and the maximum hemodynamic effect, it is necessary to use advanced techniques for reconstructing damaged cardiac structures in combination with active detoxification therapy and urgent chemotherapy.