Search

Primary pulmonary artery (PA) sarcoma (PAS) is a rare disease with poor prognosis. Radical resection provides the best curative chances. Our 60-year old male patient underwent PAS excision with pericardial patch repair of the main PA in 2017, but required reoperation in 2019 due to recurrence. Total PA bifurcation replacement was performed using a handmade two-limbed bovine pericardial tube graft, which has not previously been described in the literature. This technique is safe and reproducible, and may offer a valuable alternative surgical strategy for this patient cohort. Our patient is still alive four years after initial presentation.

Cardiological patients with malignant tumors belong to a complex category of patients. We present the world’s first case of simultaneous surgical treatment of severe mitral valve disease and esophageal cancer. The patient underwent simultaneous replacement of the mitral valve and the Ivor-Lewis procedure using right thoracotomy and upper midline laparotomy. The patient underwent 3 courses of chemotherapy (paclitaxel and 5-fluoroucil). Follow-up for 8 months showed no signs of tumor recurrence or cardiac problems. A dextral thoracotomy with the lung deprivation, supplemented by an upper median laparotomy, achieved us convenient access to the mitral valve and to all parts of the esophagus, including groups of compromised lymph nodes. This case demonstrates the modern possibilities of simultaneous cardio and oncosurgery that allows eliminating competitive fatal diseases in 1 surgical and anesthetic intervention.

Various types of sarcomas arise as a result of postradiation chronic fibrous pericarditis. A primary undifferentiated spindle cell pericardial sarcoma is a rare type of sarcoma after radiotherapy. The risk of sarcoma increases with time after treatment of cancer. A 55-year-old woman underwent successful radiation and chemotherapy for Hodgkin lymphoma 20 years ago. She was hospitalized with typical manifestations of severe heart failure. Echocardiography, сomputed tomography of the chest and magnetic resonance imaging scan of the heart detected neoplastic formations of the pericardium. A biopsy of the pericardium was performed. Histological, immunohistochemical, and genetic studies showed a primary undifferentiated spindle cell pericardial sarcoma (an extremely rare type of sarcoma).

Background: Patients with aortic stenosis (AS) and small aortic annulus (SAA) who undergo surgical aortic valve replacement (SAVR) are more likely to receive smaller prostheses, predisposing them to prosthesis patient-mismatch (PPM). Since the Ozaki Procedure (aortic valve neocuspidization–AVNeo) has proved promising, we aimed to assess its immediate results in this scenario. Methods: AVNeo was performed in 106 consecutive patients from January 2017 to March 2019 at three centers. The records were prospectively collected and reviewed retrospectively. Most of the patients were older than 60 years and 97.2% had AS. Preoperative echocardiography showed average peak pressure gradient of 64.9±20.7mmHg and mean pressure gradient of 46.0±12.2mm Hg for patients with AS and an annular diameter of 19.8±1.1mm for all patients. EOA and iEOA averaged 0.7±0.2 cm2 and 0.4±0.2cm2/m2 before surgery, respectively. Results: There was no conversion to SAVR. Four patients needed reoperation for bleeding, but none needed reoperation due to early infective endocarditis. Median intensive care unit and hospital length of stay were 1.5±1.2 and 13.7± 5.1 days, respectively. There were 2 in-hospital deaths due to non-cardiac causes. Postoperative peak pressure gradient averaged 11.8±5.9mmHg and mean pressure gradient averaged 7.3±3.5mmHg, which means statistically significant average decreases of 58.1 and 38.7 mmHg, respectively. Postoperative EOA and iEOA averaged 2.5±0.4cm2 and 1.3±0.3cm2/m2, which means statistically significant average increases of 1.8cm2 and 0.9cm2/m2, respectively. Conclusions: AVNeo is feasible and reproducible with good immediate results. Our findings show that AVNeo produces immediate postoperative low-pressure gradients, larger EOA and minimal regurgitation of the aortic valve. CA extern

The incidences of cancer in patients with ischaemic heart disease and diabetes mellitus (types 1 and 2) were analyzed according to the electronic health records (medical information system qMS). For several years, a predominance of prostate cancer and colorectal cancer in almost 10 thousand patients with ischaemic heart disease were revealed; in patients with diabetes mellitus type 1 lung cancer was prevailed; and in patients with diabetes mellitus type 2 colorectal cancer and lung cancer were prevailed. Prostate cancer and ischaemic heart disease are associated with a general imbalance within estrogen receptors ERα, ERβ, gpER, which occurs in old age with reproductive function fading. Hyperglycemia in diabetes mellitus causes a blocking of the parathyroid hormone-related protein signaling pathway, which creates a favorable environment for carcinogenesis in the lungs. Hyperinsulinemia, as a result of insulin resistance in diabetes mellitus and in metabolic syndrome accompanying ischaemic heart disease, triggers signaling pathways, including mTOR, which contribute to the carcinogenesis in the large intestine epithelium. Three different patient samples showed the different pictures of tumor localization, and for each of the identified predominant cancer localization common signaling pathways with a concomitant metabolic disease can be distinguished.

The manuscript is devoted to the outstanding Russian surgeon Zakharov E.I.. He first performed gastrojejunoduodenoplasty in 1938 (distal stomach repair with small bowel substitute). Zakharov E.I. developed the method of post-resection stomach repair with jejunum segment interposed between the esophagus and duodenum (esophagojejunoduodenoplasty). Further studies confirmed functional advantage of gastroplasty procedures with preserved duodenal passage.Статья посвящена памяти выдающегося отечественного хирурга Е.И. Захарова, в 1938 г. впервые в клинической практике применившего гастроеюнодуоденопластику (замещение дистальной части резецированного желудка участком тонкой кишки). Е.И. Захаров разработал гастропластическое замещение удаленного желудка интерпонированным между пищеводом и двенадцатиперстной кишкой участком тощей кишки (эзофагоеюнодуоденопластика). Дальнейшие исследования доказали функциональное преимущество гастропластических операций с сохраненным дуоденальным пассажем.

Introduction Giant thoracic aortic aneurysms and aortic arch dissections are accompanied by high mortality rates, cardiac and neurologic events and pulmonary complications. Tracheobronchial compression with aorta-tracheal fistula is a rare complication of the aorta aneurysms. Aortic arch replacement in such case presents several formidable challenges. Presentation of case This is the case report of successful surgical treatment of giant aortic arch aneurysm, complicated by airway compression, aorta-tracheal fistula and recurrent community-acquired pneumonia. Discussion Urgent indications for the aortic arch aneurysms surgery include significant size and high risk of rupture. As well as a visceral compression are presented. Bronchoscopy can be used to successfully treatment at all stages from trachea intubation to extubation. Conclusion Aggressive surgical approach with careful pre-operative diagnostic are the key to success and the only one chance for patients with aortic arch aneurysm, complicated by airway compression., Highlights • Aorta-tracheal fistula is rare and formidable complication of the aortic aneurysms. • A giant thoracic aortic aneurism leads to bronchial compression and pneumonia. • Airway compression syndrome is an independent predictor of emergency surgery.

Cardiac myxoma is the most common primary benign cardiac tumor (up to 50% of all primary cardiac neoplasms). The implementation of the modern imaging techniques into the clinical practice, particularly, 2D echocardiography, computed tomography and magnetic resonance tomography (MRI) results to the prompt diagnosis of the myxoma. However, the absence of specific clinical features, insufficient awareness of this condition among the physicians along with a rare prevalence, may lead to a misdiagnosis. This case report is notable for the relatively late diagnosis of a giant left atrial myxoma due to a number of circumstances but with successful surgical treatment.Миксома сердца является наиболее часто встречающейся первичной доброкачественной кардиальной опухолью (до 50% всех первичных новообразований сердца). Внедрение в клиническую практику современных визуализирующих методов обследования, в частности таких, как двухмерная эхокардиография, компьютерная томография и магнитно-резонансная томография, позволяет осуществлять своевременную диагностику миксом. Однако отсутствие специфических клинических проявлений, недостаточная настороженность врачей в отношении данной патологии в связи с редкой встречаемостью могут привести к ошибочному диагнозу. Особенностью представленного случая является достаточно поздняя, в силу ряда обстоятельств, диагностика гигантской миксомы левого предсердия, но с успешным результатом хирургического лечения.

Introduction: The autoimmune process in Crohn's disease exacerbates destructive changes in the intestinal wall and leads to complications such as bleeding (21. 9%), strictures (21.6%), and abscesses (19.7%).Case Presentation: The case of a 32-year-old male patient with an 8-year history of Crohn's disease is presented. He was admitted for emergency indications with severe pain in the right lower quadrant, chills, and a fever reaching 39.0°C. The patient had anemia, hypocoagulation and immunodeficiency. Ultrasound and CT scans of the abdominal organs revealed an abscess in the right iliac region. It was immediately drained under ultrasound control and X-ray. A fistulogram showed the fistula between the abscess and the ileum. Routine antibiotic therapy selected in accordance with the sensitivity of the microflora and sanitization of the abscess cavity were not effective. The immunomodulatory therapy, intravenous administration of cryoprecipitate, and the introduction of fibrin glue into the abscess cavity were added to the treatment. After the treatment, the patient's immune status corresponded to normal, the abscess healed, and the fistula was closed.Conclusion: In patients suffering from Crohn's disease with the formation of an abscess and a long-term non-healing intestinal fistula, it is essential that the diagnostic algorithm includes the examination of the immune status. Treatment should include immunomodulators, intravenous administration of cryoprecipitate. To close the fistula in these patients, it is advisable to use fibrin glue that has a local immunomodulatory effect.

Loeffler's endocarditis remains is a very rare disease, develops due to eosinophilic inflammation predominantly of the endocardium with an outcome in fibrosis and massive thrombus formation and. He is generally characterized by an unfavorable prognosis. Clinical case of a 42-year-old patient with Loeffler endocarditis is presented. The development of the disease was preceded by a polyvalent allergy, mild dry eye syndrome and pansinusitis with a single eosinophilia of blood up to 16%. The reason for the hospitalization was the appearance of biventricular heart failure. During the previous year, the level of blood eosinophils remained normal, a threefold increase in the level of eosinophilic cationic protein was observed once. A 20-fold increase in the pANCA level, a 2.5-fold increase in the level of antibodies to DNA, an antibody to the nuclei of cardiomyocytes 1:160 were detected. The diagnosis was made on the basis of electrocardiography data (low QRS voltage, atrial hypertrophy), echocardiography, multispiral computed tomography and magnetic resonance imaging of the heart (thickening and delayed contrasting of the endocardium, massive thrombosis of the left ventricular apex with obliteration of its cavity, encapsulated fluid in the pericardium with compression of the right ventricle). Systolic dysfunction, severe signs of restriction and arrhythmias were absent. Trombectomy, tricuspid valve plasty, pericardial resection, suturing of an open oval window were performed. Signs of active inflammation with single eosinophils, vasculitis, perimuscular sclerosis, endocardial sclerosis were detected in morphological and immunohistochemical studies of endo-, myo-, pericardium. Viral genome was not found. The therapy with methylprednisolone 24 mg/day, azathioprine 75 mg/day was started. Six months after the operation, the symptoms of heart failure are completely absent, the thrombosis did not recur.

Objective:to study potantial of remote ischemic preconditioning (RIP) as method of cardioprotection during coronary artery bypass surgery with cardiopulmonary bypass (CPB) and anesthesia with propofol.Materials and methods.We included in this study 87 patients (7 were excluded) with ischemic heart disease, hospitalized in the clinic of aortic and cardiovascular surgery of the I. M. Sechenov First Moscow State Medical University clinical hospital № 1. All patients had indications for direct myocardial revascularization by coronary artery bypass surgery. One day before operation patients were randomly assigned to 2 groups depending on preparation scheme: main group of RIP and the control group. The frequency of complications during surgery and in the postoperative period was assessed. Troponin I level was measured before, and in 2 and 24 hours after surgery. The level of lactate in the venous blood was measured before and after surgery.Results. Numbers of intraoperative and early postoperative complications in the main and control groups were similar. There were no differences between groups in troponin I and lactate levels after surgery.Conclusions.Remote ischemic preconditioning has no effect on the outcome of coronary artery bypass surgery with cardiopulmonary bypass and anesthesia with propofol.

According to the results of modern researchers, the main techniques used in congenital pathology of the aortic valve in children include balloon catheter dilatation of the aortic valve, surgical valvuloplasty, the Ross procedure and replacement of the aortic valve with a mechanical prosthesis. Many surgeons point out that these techniques in congenital pathology of the aortic valve yield suboptimal results. This is often due to the lack of a clear-cut definition between surgeons as to what operation should be performed in a particular age group. According to the reports of the majority of researchers, biological prostheses undergo early degeneration and structural changes in paediatric cardiac surgery and yield the worst results. Comparing the main techniques, optimal haemodynamics is observed after the Ross procedure. A disadvantage of this operation is the necessity of repeat intervention on the right ventricular outflow tract, which is required in 20 to 40%. Concomitant surgery of the mitral valve and/or aortic arch during the Ross procedure significantly increases the lethality and the risk of postoperative complications. Compared with an adult cohort of patients, children after prosthetic repair of the aortic valve using a mechanical prosthesis are more often found to have postoperative complications and a higher mortality rate. Yet another problem encountered in paediatric valve surgery is the unavailability of commercial prostheses sized ?19 mm. The duration of the intraoperative parameters for reconstructions of the aortic valve, the Ross procedure, and replacement of the aortic valve by the results of many studies averagely amounts to 74±34 min, 100±56 min, and 129±71 min, respectively. Yet another method which can be used for neocuspidization of the aortic valve in reconstructive surgery of the aortic root in paediatric patients is the use of glutaraldehyde-treated autologous pericardium. In our opinion, given the simplicity of the procedure, duration of the intraoperative parameters, and acceptable initial results reported by some researchers, the Ozaki procedure may be performed in children.По результатам современных исследователей основными методиками, которые применяются при врожденной патологии аортального клапана у детей, являются баллонная катетерная дилатация аортального клапана, хирургическая вальвулопластика, процедура Росса и замена аортального клапана механическим протезом. Многие хирурги отмечают, что данные методики при врожденной патологии аортального клапана имеют субоптимальные результаты. Это часто связывают с отсутствием четкого определения между хирургами, в каких возрастных группах какую операцию нужно выполнять. По сообщениям большинства исследователей, биологические протезы подвергаются ранней дегенерации и структурным изменениям в детской сердечной хирургии и демонстрируют наихудший результат. При сравнении основных методик оптимальная гемодинамика наблюдается после процедуры Росса. Недостатком данной операции является необходимость повторного вмешательства на выходном тракте правого желудочка, который достигается от 20 до 40%. Сопутствующая хирургия митрального клапана и/или дуги аорты при процедуре Росса существенно увеличивает летальность и риск послеоперационных осложнений. При сравнении со взрослой когортой больных у детей после протезирования аортального клапана механическим протезом чаще наблюдаются послеоперационные осложнения и летальность. Еще одной проблемой детской клапанной хирургии считается то, что коммерческих протезов менее ?19 мм не существует. Продолжительность интраоперационных параметров для реконструкций аортального клапана, процедуры Росса и замены аортального клапана по результатам многих исследований составляет в среднем 74±34 мин., 100±56 мин. и 129±71 мин. соответственно. Еще одним методом, который возможно применять для неокуспидизации аортального клапана в реконструктивной хирургии корня аорты у детей является использование обработанного глутаровым альдегидом аутоперикарда. По нашему мнению, учитывая простоту техники, продолжительность интраоперационных параметров и первые приемлемые результаты у некоторых исследователей, процедура Ozaki может быть выполнена у детей.

Highlights • Cysts are extremely rare disease of the esophagus. • Esophageal cysts should be diagnosed with CT and endoscopic US investigations. • Surgery is the treatment of choice to reduce the risk of malignancy and dysphagia. • Video-assisted thoracoscopic surgery has several advantages over thoracotomy., Introduction and importance Esophageal cysts (EC) are congenital, extremely rare malformation. Up to 80% of EC are diagnosed in childhood, therefore, we can find only few clinical observations of EC in adults in literature. Case presentation During the period from October to December 2019, a successful surgical treatment of 2 patients (1 male and 1 female) with enterogenous and duplication cysts of esophagus was performed at the Clinic of Faculty Surgery at Sechenov University. In both cases thoracic tumors were incidental findings during routine health investigation. Clinical discussion Clinical manifestations of ECs are caused by compression or displacement of the adjacent anatomical structures, therefore, most often patients complain of dysphagia, vomiting, pain in the chest, which may be constant or occur during an act of breathing. There are also observations of neurological symptoms due to compression of the radicular nerves The method of choice in the treatment of ECs is their surgical removal. Conclusion Patients with mediastinal tumors should be treated in specialized hospitals by experienced surgeons who can cope with an unexpected intraoperative finding and carry out the appropriate surgery.

Background: giant thoracic aortic aneurysms and aortic arch dissections are accompanied by high mortality rates, cardiac and neurologic events and pulmonary complications. Aorta-tracheal fistula and tracheobronchial compression are formidable and well-known complications of aneurysms of the thoracic aorta. Twenty-two percent of aneurysms that size >6 cm are ruptured with 80% mortality rate.Case presentation: a 56-year-old man with severe multivascular coronary artery injury and giant aneurysm of ascending aorta and aortic arch, complicated by respiratory failure and recurrent community-acquired pneumonia. Preoperative chest CT showed giant partially-thrombosed ampullary false aneurysm of ascending aorta, aortic arch and initial part of the thoracic aorta, 80x100x65 mm in size. Patient successfully underwent simultaneous surgical intervention with artificial blood circulation, the total time of cardiopulmonary bypass was 190 minutes.Conclusions: tracheobronchial compression syndrome with the aortic arch aneurysms is one of the urgent conditions that needs emergency surgery. Urgent indications for surgery in such cases include both significant size of the aneurysm and high risk of rupture, as well as potential for developing critical respiratory failure and recurrent nonresolving pneumonias. Preoperative CT enables to find out the exact location and evaluate the degree of airway compression, which determines further intraoperative actions. We recommend to use bronchoscopy at all steps of treatment of such patients, from intubation in operating room to extubation in intensive care unit. Thus, aggressive surgical tactics along with careful pre-operative diagnostic are the key to success and the only chance for such patients.

Background Gastric cancer is the second highest cause of morbidity among malignant tumors of the gastrointestinal tract and fifth in overall cancer statistics. Diseases of the cardiovascular system are the leading causes of death in the world. Aneurysm of the abdominal aorta is the most common type of vascular aneurysm, while in 75% of the cases it is asymptomatic. The risk of rupture of aneurysm of the abdominal aorta increases progressively depending on its diameter and the age of the patient. Case presentation A 56-year-old male patient underwent treatment for complaints of pain and discomfort in the epigastric region, general weakness and difficulty in passing food through the esophagus. The neoplasm extended to the esophagus up to 17–20 mm (pT3N3aM0 R0 stage IIIB TNM 8). The aortic diameter at the level of the renal arteries was 18 mm; lower than the main renal arteries, an expansion of up to 60 mm was visualized; the length of aneurysm was 105 mm extending to the bifurcation. A gastrectomy with a resection of the lower thoracic esophagus and application of a manual double-row Roux-en -Y esophagojejunal anastomosis with cholecystectomy and D2 lymphadenectomy was done along with longitudinal aneurysmectomy and thrombectomy. The proximal anastomosis between the aorta and the synthetic linear prosthesis of 18 × 9 × 9 mm in the end-to-end type was formed by a continuous winding suture with the “Prolene” 5-0 thread. The end-to-end distal anastomosis of the prosthesis and aorta branch was formed by continuous winding suture with the “Prolene” 6-0 thread. The postoperative period proceeded without features and complications. On the 7th day after the surgery, the patient was discharged home in satisfactory condition. Conclusions Performing a simultaneous operation allowed the patient to undergo rehabilitation after the treatment of two diseases during one hospitalization and, in the shortest possible time, to proceed to the next stage of gastric cancer treatment—chemotherapy, thereby improving the prognosis of life expectancy. Also, one-stage surgical treatment of concomitant aneurysm of the abdominal aorta and gastric cancer is well tolerated and can avoid financial costs, and patient anxiety involved in a second operation.

Elderly and aged patients appear to have a significantly increased risk from a cardiosurgical intervention combining three-valve reconstruction and prosthetic repair of the ascending portion of the aorta. Triple-valve pathology in pronounced mitral insufficiency is often accompanied by concomitant dilatation of the left atrium, i. e., atriomegaly. With the aim to eliminate the syndrome of compression of surrounding tissues and normalize intracardiac haemodynamics, reduction of the left atrium should become an inherent procedure for atriomegaly in patients with multiple-valve pathology.У больных старческого и преклонного возраста риск от кардиохирургического вмешательства существенно увеличивается при сочетанном выполнении трехклапанной реконструкции с протезированием восходящего отдела аорты. Трехклапанная патология при выраженной митральной недостаточности часто сопровождается сопутствующей дилатацией левого предсердия – атриомегалией. С целью ликвидации синдрома сдавления окружающих органов и нормализации внутрисердечной гемодинамики редукция левого предсердия должна стать неотъемлемой процедурой при атриомегалии у пациентов с многоклапанной патологией.

Patients with anterior mediastinum tumors fall into a difficult category due to high risk of invasion of vital structures and complexity of surgical correction. We report resection of recurrent hemangioma of anterior mediastinum with aortic arch replacement and simultaneous resection of left atrial myxoma in a 35-year-old woman. Successful treatment of these patients correlates with aggressive surgical approach followed by total resection of tumor and all affected vessels and other tissues.Пациентов с опухолью переднего средостения относят к сложной категории по причине высокого риска инвазии жизненно важных структур и сложности хирургической коррекции. Представляем случай резекции рецидивиной гемангиомы переднего средостения с протезированием дуги аорты и одномоментным удалением миксомы левого предсердия у женщины 35 лет. Успех в лечении больных различными образованиями средостения коррелирует с агрессивной хирургической тактикой, направленной на полное иссечение опухолевых масс вместе с пораженными сосудами и другими тканями.

Objective: To examine the results of various myocardial revascularization techniques in pediatric patients to better understand the strategies for surgical treatment of coronary artery pathologies. Methods: We analyzed 61 publications dedicated to the indications, methods, and results of coronary bypass surgery in children. Due to the small size of this cohort, case reports are also included in our review. Results: The main indications for coronary bypass grafting in children are Kawasaki disease, myocardial revascularization as a necessary procedure during the congenital cardiac surgery, to manage intraoperative iatrogenic damage to coronary arteries, and homozygous familial hypercholesterolemia. The use of internal thoracic arteries as conduits for coronary bypass grafting in children with Kawasaki disease showed significantly better results in long-term functionality compared to autovenous conduits (87% and 44%, respectively, P

Objective: To determine the feasibility of aortic valve neocuspidization (AVNeo) with glutaraldehyde-treated autologous pericardium. Methods: One hundred and seventy (170) AVNeo (84 males/86 females) were performed from January 2017 through March 2019 in three centers. All the records were prospectively collected and retrospectively reviewed. Results: Most of the patients were older than 60 years and over 95% were operated for aortic stenosis. Preoperatively, pressure gradients were 69.9±21.3 mmHg for patients with aortic stenosis, and the surgical annular diameter was 21.0±2.0 mm for all patients. Effective orifice area (EOA) and indexed EOA (iEOA) averaged 0.7±0.3 cm2 and 0.4±0.2 cm2/m2 for patients with aortic stenosis before surgery, respectively. There was no conversion to prosthetic aortic valve replacement. Eight patients needed reoperation for bleeding, but no patient needed reoperation due to early infective endocarditis. There were five in-hospital deaths due to noncardiac cause. Compared to preoperative echocardiographic measurements, postoperative peak pressure gradient decreased significantly (-58.7±1.7 mmHg; P mild). Conclusion: AVNeo is feasible and reproducible with good clinical results. Hemodynamically, AVNeo produces immediate postoperative low-pressure gradients, large EOA, and minimal regurgitation of the aortic valve. Further studies are necessary to evaluate mid- and long-term evolution.

A review is devoted to carotid endarterectomy for symptomatic carotid stenosis in acute period of ischemic stroke. Patient selection criteria, dates of surgical intervention and perioperative risk were analyzed.Приведен обзор литературы по выполнению каротидной эндартерэктомии симптомного стеноза сонной артерии в острейший период ишемического инсульта. Проанализированы критерий отбора пациентов и время выполнения хирургического вмешательства, оценен возможный периоперационный риск развития в острейшем периоде ишемического инсульта.

Primary sarcomas of the pericardium are extremely rare malignant tumors of the heart. The incidence of sarcoma increases after radiation therapy in the field of breast. The specific features of this case report are the difficulties in diagnostics of undifferentiated spindle-cell sarcoma of the pericardium and the connection between the disease and the radiation therapy for Hodgkin’s lymphoma.

Introduction There are high incidence of pulmonary complications and acute respiratory failure (3,2—28,6%)¹ after cardiac surgery with cardiopulmonary bypass. The study aimed to evaluate the effectiveness of various tactics of respiratory support during cardiopulmonary bypass (CPB) for the prevention of postoperative pulmonary complications. Methods This is a prospective, randomized, controlled clinical study in parallel groups. The study was approved by a local ethics committee. Informed consent was obligatory for all participants. Sixty patients were divided into two groups. In group 1 we provided a continuous positive airway pressure (CPAP) of +5 cm H2O during CPB. In group 2 patients underwent mechanical ventilation with reduced volume (volume control (VC) mode, tidal volume 3 ml / kg of ideal body weight) and respiratory rate of 6 breathes per minute with positive end-expiratory pressure + 5 cm H2O. The primary end-point of the study was the value of the partial pressure of oxygen in arterial blood to oxygen fraction in inhaled gas mixture ratio (paO2/FiO2) at different stages of perioperative management: T1 (after the beginning of mechanical ventilation, T2 (before the CPB), T3 (after CPB), T4 (at the end of the surgery), T5 (upon admission to the ICU), T6 and T7 (6 and 12 hours after surgery, respectively). Secondary end-points were the common lung complications rate (pneumonia, pleural effusion, atelectasis, pneumothorax), the frequency of recruitment maneuvers during the mechanical ventilation, the need for non-invasive ventilation after extubation, the frequency of re-intubation of the trachea. Statistical analysis was carried out in SPSS for Mac v19 (IBM, Inc, USA). Data were presented as mean (±standard deviation) or number (percent). A comparison of the quantitative characteristics was performed using the Mann Whitney U-test. Fisher's exact test was used for the incidence of complications between groups. A p value of less than 0.05 was considered statistically significant. Results The results are presented in Tables 1 and 2. The paO2/FiO2 in the VC group was higher than in the CPAP group at stages T3 and T5. The frequency of recruiting maneuvers in the VC group was lower than in the CPAP group. There was a lower incidence of atelectasis in the VC group than in the CPAP group (Table 2). The low-volume lung ventilation during the CPB is beneficial for oxygenating function of the lungs in comparison with CPAP respiratory support. Discussion The low-volume lung ventilation during the CPB is beneficial for oxygenating function of the lungs in comparison with CPAP respiratory support.

Introduction Among all cardiovascular complications, new onset postoperative atrial fibrillation (POAF) is one of the most common complications, occurring in 30% to 50% of patients after cardiac surgery. (1) One of the possible mechanisms for the development of AF may be myocardial reperfusion after aortic unclamping (reperfusion arrhythmia). In this regard, the use of agents reducing the severity of reperfusion syndrome may reduce the frequency of POAF. One such remedy is exogenous phosphocreatine The aim of our investigation evaluation efficacy of exogenous phosphocreatine for prevention of new-onset POAF in cardiac patients. Methods After Institutional Ethics Committee approval, 56 patients posted for elective GABG surgery were randomly divided into two groups (n = 28 each). In study group (Pcr) patients received 2 g of exogenous phosphocreatine iv before aortic unclamping followed by continuous infusion at a dose of 1g per hour during 3 hours after aortic unclamping; In control group (C) patients received placebo The baseline and intraoperative characteristics of the patients were similar in both groups. Continuous ECG monitoring for arrhythmias was performed at 48 hours in all patients after CABG. The diagnostic hallmarks of AF on ECG included the loss of P-waves and the presence of irregular ventricular beats. The primary point was to determine the frequency of AF within 48 hours after surgery. Secondary points were frequency of cardioversion use the frequency (paroxysms of AF lasting 5-10 minutes with adverse effects),. Chi-square/Fisher's exact/Mid P exact test and Student's t-tests were applied for categorical and continuous data. Results Incidence of postoperative atrial fibrillation (POAF) in group Pcr was 26% vs. 37% in group C;(p = 0.47), a difference that was not signficant. The frequency of episodes of of ventricular tachyarrhythmias requiring cardioversion in group Pcr was significantly lesser than in the control group (n-5/17,8% and n-10/35%, respectively) In the group C 11 (38%) patients developed adverse effects, mostly hypotension, compared with only 4 patient (12,3%) in group Pcr (p = 0.04). The length of ainotropic support in early postoperative period was significantly lower in group Pcr compared with control group (175±37 vs 290±89 minutes). Discussion Prophylactic perioperative infusion exogenous phosphocreatine in patients undergoing CABG surgery reduces the incidence of cardioversion, adverse effects and the length postoperative of inotropic support

In aortic valve disease cases, prosthetic valves have been used for valve replacement, however, these prostheses have inherent problems, and their quality in some countries is lower comparing to new-generation models, causing shorter durability. Aortic valve neocuspidization (AVNeo) has emerged as an option, which can be applied to a wide spectrum of these diseases. Despite the promising results, this procedure is not widely spread among cardiac surgeons yet. We developed a surgical technique combining Bentall and Ozaki procedures to treat patients with concomitant ascending aorta replacement and AVNeo and we describe it in this paper. The Russian conduit – combination of Bentall and Ozaki procedures.

Big Data Analytics with Advanced Data Visualization of Medical information system qMS records is presented. The inpatients with Diabetes Mellitus type 1 were chosen for analysis. The various methods of analysis and visualization were implemented: Gray reflected binary code (Java), Cluster analysis (iPython), Graph analysis (iPython, Gephi), 3D Visualization (Java), as well as supercomputer "Uran" was used. The connected pathogenetic Continuum of Diabetes Mellitus type 1 was built. The Continuum of Diabetes Mellitus type 1 progression allows assume that Parathyroid hormone-related protein (PTHrP) plays the critical role in multi-organ pathogenetic cascade in this disease, including the development of Lung cancer. Based on our study we suggest considering PTHrP in terms of pharmacological treatment. Big Data Analytics including Cluster and Graph Analysis of Medical information system's data flow can be used to study pathogenesis of the disease and for new drugs creation proposal.

In cases of aortic valve disease, prosthetic valves have been increasingly used for valve replacement, however, there are inherent problems with prostheses, and their quality in the so-called Third World countries is lower in comparison to new-generation models, which leads to shorter durability. Recently, transcatheter aortic valve replacement has been explored as a less invasive option for patients with high-risk surgical profile. In this scenario, aortic valve neocuspidization (AVNeo) has emerged as another option, which can be applied to a wide spectrum of aortic valve diseases. Despite the promising results, this procedure is not widely spread among cardiac surgeons yet. Spurred on by the last publications, we went on to write an overview of the current practice of state-of-the-art AVNeo and its results.

Highlights • Aortic valve reconstruction with autologous pericardium has shown good results. • The infective endocarditis incidence data after Ozaki procedure are rare. • Homograft is an optimal replacement option for this patient cohort. • This is the first case of homograft use after previous Ozaki procedure., Introduction and importance The infective endocarditis incidence data for patients undergoing aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium (Ozaki procedure) are rare, and the optimal surgical treatment strategy remains unclear. Case presentation This is the first case report of surgical treatment of infective endocarditis of aortic valve with cryopreserved homograft in an athlete with previously performed Ozaki procedure. Clinical discussion The choice of homograft was dictated by the young age of the patient; professional activity as an athlete; refusal of anticoagulants and the need for wide excision of compromised tissues to mitigate potential risk of spread of infection as well as its recurrence. Conclusion The use of the aortic homograft allowed us to radically remove the infected tissues and achieve hemodynamic characteristics similar to the native valve. This is probably the first case report of use of homograft to treat aortic valve endocarditis following Ozaki procedure.

Surgical revascularization of the carotid basin in the acutest period of ischaemic stroke, i.e., within 72 hours, will make it possible to prevent the development of recurrent stroke by removing an embologenically dangerous atherosclerotic plaque of the symptomatic carotid artery and to improve cerebral blood supply, having eliminated haemodynamic stenosis of the carotid artery. However, the problem of safety of carotid endarterectomy in patients during the acutest period of ischaemic stroke still remains debatable.To comparatively analyse safety of eversion carotid endarterectomy performed in the acutest (0-72 hours) and acute (4-14 days) periods of minor ischaemic stroke.Between January 2015 and December 2019, specialists of the Department of Vascular Surgery of Municipal Clinical Hospital # 7 of Kazan performed a total of 80 eversion carotid reconstructions in the period of minor ischaemic stroke within 14 days. The patients were divided into 2 groups depending on the terms of performing carotid endarterectomy. The first group comprised 32 (40.0%) patients operated on in the acutest period of ischaemic stroke, i.e., within 72 hours from the onset of first symptoms of neurological deficit. The second group included 48 (60.0%) patients subjected to carotid endarterectomy within 4 to 14 days from the onset of first signs of neurological deficit.According to the obtained findings, haemorrhagic transformation in the early postoperative period occured in 2 Group Two patients, with one lethal outcome on POD 3. Cerebral ischaemia increased in one patient of each group without enlargement of the ischaemic zone according to brain computed tomography, with residual neurological deficit in Group I in remote period (Rankin scale score 1) and complete restoration in Group II (Rankin scale score 0). Recurrent minor ischaemic stroke on POD 1 developed in Group II with formation of a new lacunar region of ischaemia of the brain in the operated carotid basin and was verified by the findings of cerebral MRI with persisting neurological deficit for 6 months (Rankin scale score 2). The comparative assessment of severity of stroke on the day of operation and at discharge, as well as that of neurological symptomatology during the 1st and 6th months of follow up in both groups proved positive. No events of acute coronary syndrome, recurrent strokes or lethal outcomes were observed during the follow-up period.According to the findings of our study, patients with acute cerebral circulation impairment caused by embologenically dangerous lesions of internal carotid arteries should be operated on within the first 72 hours, if there are no accompanying changes requiring time for correction thereof.Хирургическая реваскуляризация каротидного бассейна в острейший период ишемического инсульта, т. е. в сроке до 72 часов, позволит предупредить развитие повторного инсульта путем удаления эмболоопасной атеросклеротической бляшки симптомной сонной артерии и улучшить кровоснабжение мозга, устранив гемодинамический стеноз сонной артерии. Однако вопрос о безопасности каротидной эндартерэктомии у пациентов в острейшем периоде ишемического инсульта до сих пор остается дискутабельным. Цель настоящего исследования – сравнительный анализ безопасности выполнения эверсионной каротидной эндартерэктомии в острейший (0–72 часа) и острый (4–14 дней) периоды малого ишемического инсульта. Материалы и методы. За период с января 2015 по декабрь 2019 гг. в отделении сосудистой хирургии Городской клинической больницы # 7 г. Казани выполнено 80 каротидных реконструкций по эверсионному методу в период малого ишемического инсульта в сроке до 14 дней. Пациенты были разделены на 2 группы в зависимости от сроков проведения каротидной эндартерэктомии. Первую группу составили 32 человека (40,0%), оперированных в острейший период ишемического инсульта, т. е. в сроке до 72 часов с момента появления первых симптомов неврологического дефицита. Вторую группу составили 48 человек (60,0%), которым каротидная эндартерэктомия была выполнена в сроке с 4 по 14 день с момента возникновения первых признаков неврологического дефицита. Результаты. Согласно полученным данным геморрагическая трансформация в раннем послеоперационном периоде проявилась у двух пациентов в исследуемой группе II с одним летальным исходом на 3 день после операции. Нарастание церебральной ишемии наблюдалось по одному случаю в исследуемых группах I и II без увеличения зоны ишемии по данным компьютерной томографии головного мозга с остаточным неврологическим дефицитом в группе I на отдаленных сроках (шкала Рэнкина 1 балл) и полным восстановлением в группе II (шкала Рэнкина 0 баллов). Повторный малый ишемический инсульт на 1 сутки после операции развился в группе II с формированием нового лакунарного участка ишемии головного мозга в оперированном каротидном бассейне и верифицированный по данным магнитно-резонансной томографии головного мозга с сохранением неврологического дефицита в течение 6 мес. (шкала Рэнкина 2 балла). Сравнительная оценка тяжести инсульта в день операции и при выписке, а также неврологической симптоматики на протяжении 1 и 6 мес. наблюдения в двух группах носит положительный характер. Случаев развития острого коронарного синдрома, повторных инсультов, летальных исходов за период наблюдения зафиксировано не было. Заключение. По результатам нашего исследования при остром нарушении мозгового кровотока, вызванного эмбологенно опасными поражениями внутренних сонных артерий, пациенты должны быть оперированы в первые 72 часа, если нет сопутствующих изменений, требующих времени для их коррекции.

Surgical policy in treatment of patients suffering from concomitant valvular pathology and ischaemic heart disease is an extremely important problem of contemporary cardiac surgery. With the advent of advanced techniques and due to the improvement of old ones, there have over the last decades appeared new approaches to treatment of this cohort of patients. Presented in the article is a review of current publications regarding the problem of surgical treatment of patients with a combination of pronounced valvular pathology requiring surgical correction and ischaemic heart disease necessitating the need for myocardial revascularization. This is followed by providing the data concerning contemporary strategies of treatment of patients with concomitant pathology, as well as the comparison of various approaches and the effect of the chosen technique on the outcome.Хирургическая тактика при лечении больных с сочетанной клапанной патологией и ишемической болезнью сердца – актуальный вопрос современной кардиохирургии. За последние десятилетия с внедрением передовых методик и за счет совершенствования старых появляются новые подходы лечения данной когорты больных. В статье представлен обзор современных публикаций по проблеме хирургического лечения больных с сочетанием выраженной клапанной патологии, требующей хирургической коррекции, и ишемической болезнью сердца, нуждающейся в реваскуляризации миокарда. Приведены данные о современных стратегиях лечения больных с сочетанной патологией и сравнение различных подходов, влияние выбранной методики на результат.

We report 3 patients with coronary artery disease and kidney cancer followed by thrombosis of inferior vena cava and right cardiac chambers undergoing simultaneous surgery.Представлен опыт успешного одномоментного хирургического лечения 3 больных в условиях искусственного кровообращения в случаях, когда рак почки с опухолевым тромбозом нижней полой вены и правых отделов сердца сочетался с поражением коронарного русла.

Complete revascularization in patients with multiple-vessel coronary artery disease and partial or complete absence of the grafts is still actual problem for cardiac surgeons. The main causes of the absence of conduits for coronary artery bypass surgery are aging of population, increased incidence of repeated coronary artery bypass surgery and prevalence of varicose vein disease of the lower extremities. The most perspective approaches characterized by acceptable early and long-term postoperative outcomes are bilateral internal mammary artery grafting, sequential bypass including autoarterial grafts, as well as hybrid revascularization methods. However, treatment strategy is individualized in each patient.Проблема полной реваскуляризации пациентов с многососудистым поражением коронарных артерий и частичным или полным отсутствием трансплантатов для их шунтирования остается актуальным в повседневной практике кардиохирурга. Основными причинами недостатка трансплантатов для коронарного шунтирования является увеличение мировой популяции пожилого населения, увеличение частоты повторных операций коронарного шунтирования, распространенность варикозной болезни вен нижних конечностей. Наиболее перспективными направлениями, характеризующимися приемлемыми показателями функционирования, как в раннем, так и отдаленном послеоперационных периодах, являются бимаммарная методика, секвенциальное шунтирование, в том числе и аутоартериальными графтами, а также гибридные методы реваскуляризации. Тем не менее выбор тактики лечения носит сугубо индивидуальный характер у каждого пациента.

The article describes the case of a 42-year-old young woman with Löffler's endomyocarditis (fibroplastic endomyocarditis with eosinophilic syndrome). Pathomorphological (macroscopic and histological) criteria for the diagnosis of this rare form of restrictive cardiomyopathy are presented.В статье описан случай заболевания молодой женщины 42 лет эндомиокардитом Лёффлера (фибропластическим эндомиокардитом с эозинофильным синдромом). Представлены патоморфологические (макроскопические и гистологические) критерии диагностики этой редкой формы рестриктивной кардиомиопатии.

BackgroundAlthough remote ischaemic preconditioning (RIP) provides protection against myocardial ischaemia and reperfusion injury during cardiac surgery, it is not widely used. Systemic intermittent hypoxic–hyperoxic training (IHHT) may be a suitable alternative.MethodsThis is a prospective, single-centre, randomised controlled trial. 127 patients with ischaemic heart disease and indication for coronary artery bypass graft (CABG) surgery from the Cardiology Clinic IM Sechenov First Moscow State Medical University were randomly assigned to IHHT, IHHT-control or RIP. Primary endpoint was serum concentration of troponin I and lactate 2 and 24 hours after surgery.ResultsMedian value for troponin I 24 hours after surgery was 1.068 (0.388–1.397) ng/mL in the IHHT group and was significantly lower compared with IHHT-controls with 1.980 (1.068–3.239) ng/mL (p=0.012) and to the RIP group with 1.762 (1.288–2.186) ng/mL (p=0.029), while there was no significant difference between RIP and the IHHT-control. Serum lactate after surgery was 1.74 (1.23–2.04) mmol/L in the IHHT group and was also significantly lower compared with IHHT-controls with 2.10 (1.80–2.29) mmol/L (p=0.045) and RIP with 2.12 (1.91–2.33) mmol/L (p=0.032). No significant complications or serious adverse events were observed during IHHT. Intraoperative and early postoperative complications did not differ significantly between groups.ConclusionsThe results of this first trial using IHHT for myocardial protection against perioperative ischaemic myocardial injury in patients undergoing CABG surgery are promising and further larger trials should be done with adequate power to detect clinical rather than surrogate marker benefits.

Background Congestive heart failure (CHF), a common problem in adults, is associated with multiple hospitalizations, high mortality rates and high costs. Purpose To evaluate whether home care for homebound patients with CHF reduces healthcare service utilization and overall costs. Methods A retrospective study of healthcare utilization among homebound patients who received home care for CHF from 2012-1015. The outcome measures were number of hospital admissions per month, total number of hospitalization days and days for CHF only, emergency room visits, and overall costs. A comparison was conducted between the 6-month period prior to entry into home care and the time in home care. Results Over the study period 196 patients were treated by home care for CHF with a mean age of 79.4±9.5 years. 113 (57.7%) were women. Compared to the six months prior to home care, there were statistically significant decreases in hospitalizations (46.3%), in the number of total in-hospital days (28.7%), in the number of in-hospital days for CHF (66.7%), in emergency room visits (47%), and in overall costs (23.9%). Conclusion Home care for homebound adults with CHF can reduce healthcare utilization and healthcare costs.

Introduction The problem of postoperative cognitive dysfunction today remains extremely relevant. One way to protect the brain is to use drugs that increase tolerance to intraoperative ischemia. The aim of this study is compare protective effects on brain during endarterectomy in terms of intravenous (propofol) and inhalation (desflurane) anesthesia. Methods The study included patients over 65 with carotid atherosclerosis(Stenosis>70%) All patient were divided in two groups. Both groups underwent standard anesthesia induction with fentanyl (10 mcg/kg), propofol (2,0 mg/kg), and pancuronium bromide (0.1 mg/kg) In group D anesthesia was maintained on O2/air/ desflurane at concentrations up to 1.3 MAC and in group P by continuous infusion of propofol. Serum level of baseline protein S100B (the possibility of using S100b, as a marker and prognostic index for brain tissue damage during ischemic stroke has been proven [1,2] before surgery (T1), immediately after surgery (T2), and day after surgery(T3) was evaluated in all patients. All patients were continuously monitored for Heart rate, invasive blood pressure, SpO2, urine output, BIS index, capnography, brain dopplerography, nasopharyngeal temperature, and arterial blood gases. During the clamping of the carotid vessels, sympathomimetic support with norepinephrine was used to achieve MBP in the region of 100 mm Hg if required. Results The concentration of 100b in both groups did not differ at T1. The serum level of s100B at the T2 and T3 was significantly higher in group P (mediana 0,12 ng/l for group D vs 0,30 ng/l for group P in T2 (p = 0,002)); (mediana 0,15 ng/l for group D vs 0,44 ng/l for group P in T3 (p = 0,001)) Discussion The serum level of the S100b marker in the postoperative period was significantly higher when TIVA was performed. Probably desflurane has pharmacological protective properties on the brain, but it requires additional analysis.