There is no consensus regarding an optimal method of cerebral protection during aortic arch surgery. Achieving such an expert consensus seems to be an important condition for the further development of aortic arch surgery without risk for the patient. An overview of the current strategies for organ protection and a comparison of the results of single- and multicenter studies are presented.

Infectious endocarditis (IE) is a relatively rare disease and was previously most often caused by viridans group streptococci. Due to the slow development of these microorganisms, the condition was termed “subacute bacterial endocarditis”, reflecting its prolonged clinical course ranging from weeks to months for most patients. However, there has been a significant shift in the microbiology of IE in recent years, with an increasing frequency of staphylococci being identified as the predominant pathogens. For IE caused by Staphylococcus aureus, an acute clinical course is characteristic, often accompanied by the development of sepsis. Furthermore, there is an increase in cases of IE caused by enterococci, leading to treatment complexities and unfavorable outcomes. Unlike other infectious and cardiovascular diseases, the high mortality rate associated with IE has not changed over the past decades. Even in specialized medical centers, surgeries performed for IE continue to have the highest mortality rate among all heart valve diseases. Late diagnosis of the disease, prolonged ineffective conservative therapy, irreversible destructive changes, and myocardial reserve depletion primarily contribute to unsatisfactory outcomes of surgical treatment for IE. This review focuses on the main causative agents of IE and their impact on the speed of heart valve destruction.

Transcatheter aortic valve implantation (TAVI) is a technology that allows effective surgical treatment for aortic valve stenosis. One of the causes of aortic stenosis is a congenital pathology characterized by a bicuspidal structure of the aortic valve. This condition has long been considered an absolute contraindication to TAVI, however, the emergence of new generations of prostheses, surgical experience, as well as a deep understanding of the anatomy of bicuspid valves allows to perform TAVI in such patients. This article discusses the existing classifications of bicuspid aortic valves, the features of preoperative preparation, and also presents the results of existing studies of TAVI in patients with bicuspid morphology.

The management of patients with aortic and aortic valve pathology is an extremely relevant task. The main problem of this pathology is the absence of obvious symptoms before the onset of a life–threatening condition, dissection or rupture of the aorta. Early timely diagnosis becomes the most relevant in this situation, and imaging research methods play a leading role in this regard. However, the main limiting factor is the speed and quality of image evaluation. Therefore, an actual task is to develop an AI-based physician assistant for image mining (Computer vision, CV). This article provides an overview of modern neural network methods for effective analysis of diagnostic images (MSCT and MRI) relevant for the study of diseases of the cardiovascular system in general and the aorta in particular. One of the main focuses of this analysis is the study of the applicability of modern neural network methods based on the Transformer architecture or the Attention Mechanism, which show high accuracy rates in solving a wide range of tasks in other subject areas, and have a high potential of applicability for qualitative analysis of diagnostic images. An overview of two fundamental problems of image mining is given: classification (ResNet architecture, ViT architect, Swin Transformer architect) and semantic segmentation (2D approaches – U-Net, TransUNet, Swin-Unet, Segmenter and 3D approaches – 3D-Unet, Swin UNETR, VT-UNET). The described methods, with proper fine tuning and the right approach to their training, will effectively automate the process of diagnosing aortic and aortic valve pathology. For the successful implementation of AI development projects, a number of limitations should be taken into account: a high-quality data set, server graphics stations with powerful graphics cards, an interdisciplinary expert group, prepared scenarios for testing in conditions close to real ones.

One of the most common complications of ischemic heart disease is ischemic mitral regurgitation (IMR). About 20% of patients with coronary artery disease suffer from the onset and progression of IMR. It is more often observed in patients who have suffered a myocardial infarction of the inferior wall of the left ventricle (LV). It is known that the presence of mitral regurgitation (MR) reduces patient survival regardless of the presence of ischemic heart disease. The accumulated experience in the field of diagnosis and tactics of surgical treatment of IMR is currently ambiguous, despite many studies being conducted. In particular, such important problems as determining predictors and risk factors for recurrent IMR after surgical treatment, as well as indications for mitral valve intervention and the choice of surgical technique for correcting moderate and borderline IMR remain unresolved. Determining the risk factors for an unfavorable outcome of each specific method of surgical treatment of borderline IMR will help the specialists make the right decision regarding the treatment of this pathology. This literature review shows the full range of modern surgical methods for the treatment of borderline ischemic mitral dysfunction, evaluates the results of the most common isolated and combined operations, analyzes the risk factors for unfavorable outcome in the long-term period after their implementation, and also offers original approaches to the tactics of surgical treatment of IMR.

Coronary heart disease (CHD) remains the primary cause of death among the adult population of Russian Federation. An effective pathogenetic method for treating this pathology is revascularization of coronary arteries, performed endovascularly or surgically. The combination of surgical radicalism and low traumatism has made stenting of the coronary arteries the leading method of CHD treating: today in Russia the number of percutaneous coronary intervention (PCI) operations is approximately 6 times higher than the number of coronary artery bypass grafting (CABG) operations. However, PCI showed comparatively lower long-term effectiveness than CABG and thus needs to be improved. Considering the number of PCIs performed, any significant increase in the effectiveness of this method can provide a significant reduction in mortality from coronary artery disease and, accordingly, mortality in general. One of the most promising ways to increase the effectiveness of PCI today is the use of modern intravascular imaging technologies.

Introduction. Aortic insufficiency caused by ascending aortic aneurysm with concomitant dilation of the sino-tubular junction requires combined surgery. To date there is a lack of relevant papers.

Aim: To analyze early and mid-term outcomes in patients undergoing ascending aortic replacement with sino-tubular junction stabilization for aortic insufficiency.

Methods. The retrospective study included 57 patients with ascending aortic aneurysm and aortic insufficiency who underwent aortic replacement from December 2011 to January 2024. All patients were stratified into 2 groups according to aortic regurgitation (AR) grade: 1st group included patients with 1 grade, 2d group - patients with 2 grade. We analyzed clinical early and mid-term outcomes.

Results. There were no significant differences in neurological, pulmonary, renal complications as well as bleeding and mortality in the early postoperative period. Mid-term survival was 100% and 87.4% in the AR 1 grade and AR 2 grade, respectively. In both groups, the volumetric parameters of the left ventricle and size of the aorta at all levels studied were decreased in the postoperative period. There were no patients with recurrent or increased aortic insufficiency. No patient required proximal aortic reoperation.

Conclusion. Ascending aortic replacement with concomitant sino-tubular junction stabilization without additional aortic cusp repair and/or aortic root surgery is a safe and durable procedure providing reduce the aortic insufficiency regurgitation grade.

Introduction. Surgical treatment of infective and prosthetic endocarditis using homografts shows good results. Aortic homograft implantation is a common technique, whereas tricuspid and mitral valve replacement with mitral homograft is rare. Multiple valve malformations in infective endocarditis pose a surgical challenge because these patients are usually critically ill and surgical outcomes are often unsatisfactory. In this article, we describe our experience with successful surgical treatment of patients who underwent implantation of cryopreserved homografts

Aim: To study the long-term results of cryopreserved homograft implantation, freedom from reoperation, long-term survival, and to demonstrate new technical aspects of homograft implantation.

Material and Methods. This is a retrospective analysis of 24 patients operated in our clinic (UKB No. 1 of Sechenov University) between 2015 and 2021. Aortic homograft (AH) in orthotopic position was implanted in 6 patients with active IE. Pulmonary homograft (PH) was implanted in 13 patients: in orthotopic position (n = 10) and in heterotopic position (in the aortic root) (n = 3). Mitral homograft was implanted in 4 patients, with only 1 of them in the orthotopic position, whereas 3 were implanted in the TC position (Table 1). In 1 patient with AK and MC IE extended to the mitral-aortic contact, the use of an aorto-mitral monobloc was requested.

Results. In the midterm period, we had available data from all surviving patients. The mean gradient on AC after implantation of aortic homograft and pulmonary homograft in the position of the aortic root was 4.6 ± 1.96 mm Hg, significant regurgitation was absent in all patients, and no cases of reoperation were noted. After orthotopic implantation of pulmonary homografts, the mean gradient was 3.2 ± 1.4 mm Hg, significant regurgitation was absent in all cases. After MG implantation in TC position according to ECHO data all patients have 0–1 degree of regurgitation on the prosthesis, mean pressure gradient was 2,5 ± 0,6 mm Hg. MG was implanted in orthopic position in one case – a 52 years old woman with Bechterew’s disease, mean gradient on IC was 4 mm Hg, regurgitation 0–1 degree.

Conclusion. Valve homografts may have more advanced indications than IE. Techniques such as implantation of MG in tricuspidal or orthotopic position and the use of combined homografts show promising results, but require further clinical recruitment and evaluation of the distant period.

Aim: To assess the hemodynamic results of using the xenopericardial biological prosthesis “MedEng-BIO” with the “easy change” system in the aortic position in the mid-term period.

Material and Methods. In the cardiac surgery department No. 1 of Cardiology Research Institute, Tomsk NRMC, from October 2016 to January 2024, 341 patients (155 women and 186 men) underwent aortic valve replacement surgery using an innovative “MedEng-BIO” bioprosthesis with the “easy change” system. The average age of the patients was 67.6 ± 6.6 years. The study included 190 patients (88 women and 102 men) who underwent aortic valve replacement using the innovative “MedEng-BIO” bioprosthesis with the “easy change” system in the period from January 2017 to January 2022. The average age of the patients was 67.6 ± 6.6 years. The average pressure gradient on the aortic valve before surgery was 48.2 ± 13.5 mmHg. The effective area of the aortic valve opening averaged (EАO) – 0.72 ± 0.2 cm2 . Control echocardiographic studies of left ventricular (LV) function and aortic bioprosthesis after surgery were performed on the 10th–14th day after surgery and 3–5 years after discharge using Vivid 7, GE and IE 33 (Philips) devices.

Results. Control echocardiographic studies conducted in the mid-term period allowed us to establish that the hemodynamic characteristics of “MedEng-BIO” aortic prostheses in the aortic position remain satisfactory. The average pressure gradient on the “MedEng-BIO” prostheses of 21 sizes was 22.6 mmHg, 23 with a size of – 15.1 mmHg and 25 with a size of 10.3 mmHg.

Conclusion. Based on the data obtained, it can be concluded that xenopericardial “MedEng-BIO” bioprostheses with the “easy change” system correct intracardiac hemodynamics well over a follow-up period of more than 3 years and show no signs of degeneration.

Cardiac surgery research shows that isolated aortic valve (AV) procedures account for 9% of all cardiac surgeries, with a surgery mortality rate of 2.3% and the predominance of bioprosthese use. Despite the widespread use of these methods, there is a high rate of patient-prosthesis mismatch affecting long-term survival. In this context, new technologies are emerging, such as Tiara bioprostheses and Ozaki neocuspidization of AV, but their comparative analysis is currently lacking.

Aim: to compare short-term outcomes of the Tiara bioprosthesis implantation and the Ozaki procedure.

Methodology and Research Methods. Retrospective analysis of 387 patients who underwent Ozaki procedure or the Tiara bioprosthesis implantation was performed. Inclusion criteria are patient age 18 years or older, Ozaki procedure performed or the Tiara bioprosthesis implantation. Exclusion criteria are use of a mini-access, the presence of infective endocarditis and repeated cardiac surgery. Ultimately, 352 patients were selected. Given the statistically significant differences in clinical and demographic characteristics between the groups, a propensity score matching was used in a 1 : 1 ratio. As a result two balanced groups of 58 patients each were formed.

Results. In the group, where the Tiara bioprosthesis was implanted, the average age was 69 ± 5 years. In the group, where the Ozaki procedure was performed, the average age was 68 ± 6 years (p = 0.3). There were 14 men and 44 women in the Tiara group and 21 men and 37 women in the Ozaki group (p = 0.1). The median diameter of the annulus in the Tiara group was 20 (20–22) mm, while in the Ozaki group it was 21 (20–22) mm (p = 0.2). Statistically significant differences were noted in the duration of the surgery, cardiopulmonary bypass and cross-clamp time, which were statistically less in the Tiara group compared to the Ozaki group: surgery duration – 160 (145–199) minutes versus 250 (220–295) minutes (p < 0.001 ), cardiopulmonary bypass time – 72 (60–97) minutes versus 112 (92–133) minutes (p < 0.001), cross-clamp time – 55 (46–70) minutes versus 81 (71–100) minutes (p < 0.001). There was no statistically significant difference between the groups in terms of postoperative complications and hospital mortality. In-hospital mortality was 0% versus 2 (3.4%) cases (p = 0.4). Resternotomy due to bleeding was performed in 1 patient (1.7%) in the Tiara group and in 4 patients (6.9%) in the Ozaki group (p = 0.3). Pacemaker implantation was required in 2 patients (3.4%) in the Tiara group, whereas such a need did not arise in the Ozaki group (p = 0.4). Stroke occurred in 4 patients (6.9%) in the Tiara group and in 1 patient (1.7%) in the Ozaki group (p = 0.3). Acute kidney injury was recorded only in 1 patient in the Ozaki group (1.7%) (p = 1). Both groups had similar rates of patient-prosthesis mismatch; moderate discrepancy was noted in only one patient (1.7%) in the Tiara group; no such cases were recorded in the Ozaki group. However, significant differences were found in peak and mean gradients on AV. In the Tiara group, the peak gradient was 32 ± 12 mmHg, and the average was 17 (11–20) mmHg. In comparison, in the Ozaki group the average values were significantly lower: peak gradient – 11 ± 5 mmHg, average – 5 (3–8) mmHg. (p < 0.001 for both comparisons).

Conclusion. The study showed that the surgery duration, cardiopulmonary bypass, and myocardial ischemia period was statistically significantly shorter in the Tiara group compared with the Ozaki group. Despite this, transvalvular gradients on the AV were smaller in the Ozaki group.

Introduction. Transcatheter pulmonary valve implantation is one of the most relevant issues in endovascular surgery for congenital heart defects. However, at present, there is no “ideal” valve for transcatheter implantation. Balloon-expandable pulmonary valves for transcatheter implantation have a rigid frame, which requires pre-stenting of the native right ventricular outflow tract or the valve-containing conduit to avoid perioperative complications. This tactic increases the procedure time, complicates the valve implantation technique, and raises the cost of the operation. Self-expanding valves, which are primarily aimed at addressing pulmonary regurgitation, present an alternative. Determining an adequate implantation zone for the valve is crucial for the successful treatment of a dilated native right ventricular outflow tract. This is why preoperative CT imaging protocol, with 3D reconstruction providing detailed anatomical structures at every level, plays a significant role.

Aims. To assess the properties of the transcatheter self-expanding frame of the pulmonary artery valve and to perform its in vitro implantation in a 3D model of a patient with right ventricular outflow tract dysfunction.

Material and Methods. We developed a model of a self-expanding nitinol frame for a transcatheter valve for implantation in the position of the pulmonary artery, based on the most commonly encountered anatomy of right ventricular outflow tract dysfunction. We conducted tests for radial forces of the frame and valve loading trials in the delivery system. Results. A 3D reconstruction of the right heart chambers with the inferior vena cava was performed, with detailed anatomical structure delineation at each level. A 3D model was printed on an SLA 3D printer, Formlabs Form 3B+, using Elastic 50A photopolymer (Formlabs Inc., USA). Under fluoroscopic guidance, a test implantation of the pulmonary artery valve frame was carried out.

Conclusion. By optimizing the design of the supporting frame, we were able to improve the transcatheter valve frame model based on the analysis of the most common right ventricular outflow tract dysfunctions. 3D-printed constructs enable the safe testing of developing transcatheter valve models and help identify and timely address any existing deficiencies.

Introduction. Aortic root surgery continues to improve. Both linear valve-containing and anatomic (so-called Valsalva grafts) conduits are used for aortic root replacement. However, there is no clear opinion about the importance of using anatomical valve-containing conduits. The answer to this question can be obtained by comparing the transvalvular hemodynamics of a linear conduit with the transvalvular hemodynamics of the native aortic root. Research in this area will help to find the characteristics that a new valve-containing conduit should possess to provide optimal hemodynamics.

Objective. To demonstrate the method of aortic root structures prosthetics with imitation of its natural geometry, to report on the advantages of such intervention from the position of transvalvular hemodynamics.

Material and Methods. An experimental study of transvalvular hemodynamics in the prosthesis “Russian Conduit I” of linear design with autopericardial flaps sewn into it was performed. The results were compared with the reference hemodynamics in the native aortic root with sewn-in flaps of the same shape as in the studied conduit. The results of the study showed that the natural geometry of the aortic root significantly affects transvalvular hemodynamics, which is expressed in smaller transvalvular gradients, lower energy losses at the opening and closing of the flaps, and larger opening area.

Results. We extrapolated the experimental data to the clinical results of similar operations in comparable groups. We studied the results of the operation with the use of the Russian Conduit prosthesis. The operation with the aortic root preservation was symmetrical neocuspidization. According to the results of the study it was demonstrated that preservation of native aortic root gives better transvalvular hemodynamics, which significantly affects the reverse remodeling of the left ventricle in the mid-term period. With this in mind, it is concluded that it is necessary to preserve the geometry of the aortic root during interventions for its prosthesis with a valve-containing conduit. This paper presents a clinical case of a new aortic root prosthesis “Russian Conduit II”. It was used for aortic root reconstruction with restoration of the locking function of the native aortic valve. The description of the surgical technique, immediate results, and the possibilities of similar surgical intervention are described in detail.

Conclusion. There are reasons to believe that the use of the developed prosthesis in aortic root surgeries can give hemodynamic results comparable with native valve, and the operation itself has a potential for high reproducibility and standardization of surgical technique, which will expand its application.

The main complications in the long-term period in children after the elimination of obstructive pathology of the aortic arch are arterial hypertension and recoarctation of the aorta. It is possible that persistent arterial hypertension is associated with the architectonics of the aortic arch and the nature of blood flow in it.

Aim: To evaluate the immediate and long-term results after reconstruction of the aortic arch in conditions of artificial circulation by two methods: aortoplasty by “ascending sliding” (technique with native tissues) and aortoplasty using a patch of pulmonary homograft (technique using foreign material).

Materials and Methods. In the presented single-center, pilot, prospective randomized study, the results of surgical treatment of coarctation with hypoplasia of the aortic arch in conditions of artificial circulation were assessed. According to the study design, depending on the method of correction of aortic coarctation, all patients were divided into two groups: aortoplasty by the “ascending sliding” method (30 patients); aortoplasty with a patch from a pulmonary homograph (30 patients).

Results. There was no lethality in the hospital period. In the early postoperative period, the compression of the bronchi or trachea in the “ascending sliding” group was 20% versus 0% in the aortoplasty group using a patch from a pulmonary homograph. Recoarctation of the aorta in the aortoplasty group using a patch from a pulmonary homograph was 30%, while in the “ascending sliding” group there was no recoarctation. Arterial hypertension in the “ascending sliding” group was 13.3%, and in the aortoplasty group, using a patch from a pulmonary homograph was 56.6%.

Conclusion. Patients after “ascending sliding” correction have a higher chance of bronchial and tracheal compression in the early postoperative period, while patients after correction by aortoplasty with a patch from a pulmonary homograph had a higher incidence of hypertension and aortic recoartcation.

Relevance. The psychological status and emotional state of patients suffering from heart rhythm disorders play an important role in the course of the pre- and postoperative period, whereby psychological effects of the fast-track approach in cardiac surgery, in contrast to clinical effects, are insufficiently studied.

Aim: To investigate the dynamics of patients’ emotional state (severity of anxiety, depression and stress symptoms) in the perioperative period during fast track radiofrequency ablation (RFA), as well as to compare it with the normative values.

Material and Methods. The sample consisted of 77 patients with heart rhythm disorders (mean age 57.09 ± 13.606; 44.2% male) hospitalised for RFA; psychodiagnostic questionnaires DASS-21 and PSS-10 were used.

Results. It was found that preoperative anxiety (from moderate to very high) was observed in 57.9% of patients, symptoms of emotional distress – in 34.2%, symptoms of depression – in 18.4%; at the same time symptoms of anxiety and stress before RFA significantly exceeded the normative values (p ≤ 0.001). After RFA, pronounced symptoms of anxiety are observed in 44.7% of patients, stress – in 26.9%, depression – in 13.5% of patients; postoperative anxiety and stress symptoms also exceed the normative values (p ≤ 0.001). No statistically significant dynamics of unfavourable emotional indicators after RFA was revealed, only a decrease in emotional stress was noted, at the level of statistical trend (p < 0.1).

Conclusion. It is expedient to carry out a more differentiated study of the emotional state of patients undergoing RFA on an expanded sample. Psychological interventions aimed at providing support are recommended for patients with heart rhythm disorders in the perioperative period due to the high stressfulness of the surgical intervention and patients’ emotional instability.

Aim: To assess erythrocyte membranes β-adrenoreactivity and heart rate variability (HRV) in children with supraventricular arrhythmias initially and in the early period after radiofrequency ablation (RFA).

Study method. The study included 43 patients 13 [10; 15] years with supraventricular arrhythmias and indications for interventional treatment. The patients were divided into groups depending on the electrophysiological variant of the arrhythmias: manifest Wolf-Parkinson-White (WPW) phenomenon – 15 patients; latent and manifest WPW syndrome – 13 patients; atrioventricular nodal reentry tachycardia (AVNRT) – 10 patients; atrial ectopic tachycardia – 5 patients. The control group consisted of 11 practically healthy children 14 [12; 16] years. The patients underwent RFA. Initially and in 3–5 days after RFA, the following was performed: HRV time analysis according to Holter monitoring ECG; determination of erythrocyte membranes β-adrenoreactivity in blood samples.

Results. In all groups, initially and in 3–5 days after RFA, the median level of erythrocyte membranes β-adrenoreactivity remained within the normal range; no statistically significant changes in the indicator were detected, including when compared with the control group. Analyzing HRV in patients with the WPW phenomenon and syndrome, pNN50 and rMSSD values decreased statistically significantly after RFA, p = 0.004, p = 0.047, respectively. In patients with AVNRT, the level of SDANNi increased statistically significantly, p = 0.007. The changes indicate a decrease in the influence of the vagus nerve and an increase in sympathetic influences, which is regarded as a decrease in HRV.

Conclusion. Supraventricular arrhythmias in children with structurally normal hearts are not accompanied by dysfunction of the autonomic nervous system (ANS) according to the analysis of erythrocyte membranes β-adrenoreactivity and HRV, which indicates the absence of a significant contribution of the ANS to the pathogenesis of these arrhythmias. In the early postoperative period after RFA, a decrease in HRV was noted, associated with manifestations of operational stress. The lack of dynamics in the erythrocyte membranes β-adrenoreactivity level after RFA indicates that in this category of patients HRV indicators respond faster. The study results suggest the value of HRV assessment in patients with supraventricular arrhythmias, while the use of erythrocyte membranes β-adrenoreactivity is more promising in patients with ventricular arrhythmias in whom HRV analysis is limited.

Introduction. According to ECG-synchronized myocardial perfusion imaging (MPI) mechanical dyssynchrony (MD) is a sensitive marker of impaired myocardial perfusion. However, its direct comparison with indicators of myocardial blood flow reserve (MFR) according to single-photon emission computed tomography (SPECT) was not carried out. Traditional MPI protocols imply a long gap between stress test and image acquisition, during which stress-induced changes may pass. It is potentially possible to reduce the time interval down to 5 minutes.

Aim: To investigate the relationship between early and delayed MD indices and the data of MFR by means of SPECT.

Material and Methods. The study included 20 patients with suspected coronary heart disease, preserved left ventricular ejection fraction (> 55%) and without obstructive coronary artery lesions (< 50%) according to multislice computed coronary angiography. All patients underwent dynamic SPECT (dSPECT) according to a two-day rest/stress protocol. Gated MPI was performed 60 minutes after radiopharmaceutical administration. Myocardial blood flow and reserve, as well as phase histogram standard deviation (PSD, degree) and phase histogram bandwidth (HBW, degree) from 5 minutes after radiopharmaceutical administration were obtained from the dSPECT data by postprocessing. Perfusion data as well as MD indices (PSD, HBW) were obtained from delayed images. Based on dSPECT data, patients were divided into 2 groups: with preserved (MFR ≥ 2.0) and reduced (MFR < 2.0) myocardial blood flow reserve.

Results. Correlation analysis showed that MD indices on stress test in early scan had a stronger association with MFR (PSD ρ = –0.68, p < 0.001; HBW ρ = –0.68, p = 0.001) compared to those in delayed scan (PSD ρ = –0.38, p = 0.019; HBW ρ = –0.44, p = 0.005). According to multivariate regression analysis, PSD on stress test at early scan was the only independent predictor of reduced MFR (OR 1.29 (1.1; 1.53)). Stress PSD > 22° obtained at early scanning had a sensitivity of 81% and specificity of 87% (AUC = 0.86, p < 0.001) in predicting of reduced MFR.

Conclusion. Left ventricular mechanical dyssynchrony indices obtained by early post-stress gated MPI have a stronger association with myocardial blood flow reserve indices.

Arterial hypertension (AH) refers to socially significant diseases which cause a high level of primary disability and mortality. Identification of this pathology predictors, such as free circulating DNA (fc-DNA) level in blood, can provide early disease diagnostics, effective treatment, and, finally, a relatively favorable prognosis.

Aim: To study fc-DNA level and nucleotide profile in blood plasm in patients with hypertension.

Material and Methods. Study included 60 persons: 20 patients with stage II hypertension (group Hypertension II), 20 patients with stage III hypertension (group Hypertension III) and 20 healthy people (Control group). For fc-DNA isolation diaGene kit had been used. Obtained DNA samples were analyzed by liquid chromatography using FPLS® System (Sweden). Results. All samples (groups II, III and Control) involved not only fc-DNA, but also acid-soluble nucleotides. In patients with hypertension II and hypertension III fc-DNA content significantly increased compared to practically healthy individuals, regardless of disease stage (p < 0.05). The study also revealed a decrease in the level of adenosine and guanosine diphosphate (GDP) in the blood plasma in patients with hypertension, which was statistically significant in group III.

Conclusion. The obtained data show new possibilities for cf-DNA and acid-soluble nucleotides using in blood plasma in patients with hypertension and determine further research of these indicators correlation with clinical features and prognosis of hypertension.

Background. Detailed study of the histopathological events and mechanisms accompanying the infectious process in native heart valves and their biological prostheses is very important due to the variability of clinical manifestation of infective endocarditis (IE).

Aim: To study cellular infiltration of aortic heart valves (AVs) and bioprosthetic heart valves (BPs) affected by infection, as well as to search for common patterns or differences of native and BPs characterized by degenerative changes in the leaflet apparatus.

Material and Methods. We studied the leaflets of AVs affected IE (n = 10) or calcific aortic stenosis (CAS) (n = 11), as well as the leaflets of BPs affected by IE (n = 5) or structural valve degeneration (SVD) (n = 10) and removed from the mitral position during re-prosthetics surgery. Histological sections were prepared using a cryostat microtome. Cell typing was performed by staining with antibodies to the CD45, CD68 CD3, CD19, myeloperoxidase (MPO) and CD31 markers using immunohistochemical analysis. Bacteria were visualized by Gram staining of histological sections. The expression of MPO in the studied samples was determined by Western blotting.

Results. Colonies of gram-positive cocci and gram-negative rod-shaped bacteria were registered into native AKs affected by IE. BPs affected by SVD are characterized by the presence of mixed colonies of gram-positive cocci and gram-negative rod-shaped bacteria. Immunophenotyping demonstrated leukocyte infiltration (CD45+) in all studied heart valves. AVs and BPs with infectious lesions and BPs affected by SVD were characterized by inflammatory infiltrates included macrophages (CD68+), neutrophils (MPO+) and single T-lymphocytes (CD3+). In calcified AVs, we found no neutrophils; the clusters of immune cells were represented by macrophages and single T-lymphocytes. In both groups of AVs, single cells positive for the vascular endothelial marker CD31 were noted in the fibrous layer. The highest expression of MPO was observed in AVs affected by IE in comparison to other studied valves.

Conclusion. AVs affected by infection compared to native heart valves affected by CAS are characterized by aggressive infiltration by neutrophils. Neutrophils and bacterial agents were also detected in BPs regardless of the diagnosed IE. These results indicate the involvement of bacterial invasion in the development of SVD of the biological element of BPs and indicate the necessarily for a detailed study of this phenomenon.

Background. The average lifespan of a bioprosthetic heart valves (BHVs) is limited to 10–15 years due to structural valve degeneration (SVD). One of the causes of SVD is the infiltration of immune cells. Inflammation like this usually develops several years after valve replacement, the cause of it remains unknown. Presumably, the main stimulus of the immune response is an asymptomatic colonization by bacterial agents.

Aim: To study bacterial invasion of BHVs explanted due to SVD, and to identify patterns in microorganism and cellular infiltrate localization.

Material and Methods. 23 BHVs excised during replacement due to SVD were included in the study. The identification of bacteria in the samples was carried out by Gram staining and PCR analysis. Immunohistochemical staining with antibodies to markers CD45 (pan-leukocyte marker), CD68 (macrophage marker), CD3 (T-lymphocyte marker) and neutrophil elastase (ELA2) were used for phenotyping of immune cells. The composition of BHVs tissues was studied using Russell-Movat pentachrome staining.

Results. All BHVs showed traditional signs of SVD (perforations and large calcifications at the base and dome of the leaflets, ruptures in the commissural zone), but had no signs of prosthetic valve endocarditis (no vegetation, blood culture and swab results were negative). Using the histological method, we detected bacterial cells in 19 of the 23 studied valves (82.6%), whereas PCR data indicated the presence of bacteria in 11 (47,8%) valves (Streptococcus ssp. and Staphylococcus ssp. without species identification). Moreover, we identified the co-localization of colonies of microorganisms and inflammatory infiltrates composed of macrophages (CD45+, CD68+) and neutrophils (CD45+, ELA2+).

Conclusion. Bacteria commonly cause asymptomatic colonization of BHVs which is strongly associated with inflammatory cell infiltration.

Objective. The presence of marked asymmetric septal hypertrophy in patients with aortic stenosis may lead to dynamic obstruction of the left ventricular outflow tract in addition to fixed obstruction at the level of the aortic valve. The persistence of an increased subvalvular gradient may worsen both early and long-term results. At the same time, surgical tactics in combination of two pathologies is currently undefined.

Aim: To analyze the early and mid-term results of concomitant Ozaki procedure and septal myectomy.

Patients and Methods. This case series included 13 patients with severe aortic stenosis and asymmetric septal hypertrophy who underwent aortic valve reconstruction according to the Ozaki technique and septal myectomy according to Morrow. The mean age was 68 years [from 50 to 79]. In 12 of 13 patients, the aortic valve annulus was less than 21 mm. Early and mid-term (29.5 months) clinical results, complications specific for septal myectomy, hemodynamic parameters at the aortic valve and left ventricular outflow tract were evaluated.

Results. 1 patient died at the hospitalization stage. There were no cases of repeated aortic clamping for aortic valve prosthesis, additional resection of interventricular septum, acute defect of interventricular septum. One patient required permanent pacing due to complete transverse heart block. There were no lethal outcomes during the follow-up. Good hemodynamic results were achieved in all patients: mean aortic valve area 2.2 cm2 (from 1.4 to 3.0 cm2 ); mean transvalvular gradient 11 mmHg (from 6 to 15 mmHg); basal interventricular septum thickness 11.2 mm, left ventricular outflow tract gradient 3.9 mmHg.

Conclusion. In our case series of 13 patients with aortic stenosis and subvalvular left ventricular outflow tract obstruction, Ozaki procedure and septal myectomy resulted in good early and mid-term clinical and hemodynamic outcomes. Septal myectomy is a safe procedure without increasing the risk of complications. However, large prospective randomized comparative studies are needed to provide reliable evidence of the benefit of combined intervention and to develop optimal recommendations.

Acute ischemic mitral insufficiency is a serious and life-threatening complication of acute myocardial infarction (MI). The development of acute mitral insufficiency (AMI) severely limits the possibilities of conservative therapy and most often requires emergency surgical intervention. However, the timing and choice of surgical intervention in patients with AMI are debatable. We present a clinical case of AMI development in a 50-year-old patient with inferior MI with late medical care. Given the ineffectiveness of conservative treatment and the progress of acute heart failure, it was decided to perform mitral valve replacement under conditions of cardiopulmonary bypass on the 12th day of MI with the preliminary use of a circulatory assist device (ECMO) as a “bridge” therapy. The presented clinical case confirms that the use of auxiliary blood circulation devices allows expanding the possibilities of cardiac surgical treatment in the early post-infarction period in patients with mechanical ruptures of the heart and reduces the risk of fatal outcomes.

The article discusses aspects of the restoration of the psychoemotional sphere in patients suffering a stroke associated with an open foramen ovale, who underwent endovascular occlusion at the stationary stage. It was revealed that due to their negative social perceptions of the recovery of patients after a stroke, they are afraid to return to an active lifestyle after treatment. The possibility of introducing consultative conversations with psychoemotional correction to create a positive social way of life for patients after a stroke, which will contribute to the restoration of their psychoemotional sphere, is considered.

Introduction. In Tomsk Region specialized medical care for the patients with acute cerebrovascular disorders has been provided and coordinated since 2012 by the Regional Vascular Center of Tomsk Regional Clinical Hospital where more than three-quarters of all stroke patients in the region are admitted annually.

Aim: To study the dynamics of mortality rates in different nosological forms of stroke, gender and age characteristics of the patients who died from stroke, the example of the work of the Regional Vascular Center of Tomsk Regional Clinical Hospital being used, and to determine the directions for further improvement of medical care organization.

Materials and Methods. At the first stage, the assessment of the dynamics of mortality rates from different nosological forms of stroke in Tomsk Regional Clinical Hospital according to the Federal Statistical Observation Form No. 14 from 2018 to 2022 was performed. At the second stage of the study, based on data from registration form No. 066/u of the Regional Vascular Center, the structure of gender and age of the patients who died from stroke was analyzed, the average age of death of the patients with stroke, their gender and age characteristics, taking into account the form of stroke, were determined.

Results. Mortality rates from stroke in Tomsk Regional Clinical Hospital were relatively stable and quite high – 23.6–24.8%; the greatest fluctuations in mortality rates (36.0–59.6%) and (46.7–56.9%) were observed in hemorrhagic forms. The average age of death from stroke in men at the Regional Vascular Center was 12 years lower than in women – 67.0 (59.0–76.0) years. Distinct gender differences were revealed among deceased patients with a significant predominance of men – 73.0 and 68.6% in the age groups 18–44 years and 45–59 years.

Conclusion. Directions for further improvement of medical care organization have been identified: opening an additional vascular center, developing mechanisms for timely re-evacuation of patients, optimizing the system for managing stroke risk factors.

The strategy of scientific and technological development of the Russian Federation prioritizes the formation of new approaches to the treatment of tuberculosis, including forms with multidrug resistance. In modern conditions the fulfillment of this task is impossible without the intensive introduction of advanced digital and intelligent technologies, robotic systems and systems using artificial intelligence methods. This approach should start with an important component –the creation of a knowledge base.

Aim: To create a knowledge base of drug therapy based on the appropriate ontology, to assemble a prototype of a medical decision support system for managing the treatment of patients with pulmonary tuberculosis.

Material and Methods. Current scientific data and recommendations for the treatment of pulmonary tuberculosis in adults were used, according to clinical recommendations approved by the Ministry of Health of the Russian Federation in 2022. The IACPaaS platform is used to implement the intelligent service.

Results. A knowledge base has been created to manage the treatment of patients with pulmonary tuberculosis, which allows you to structure knowledge about drug therapy of tuberculosis, define concepts, relationships and axioms describing this process. Each element of the ontology includes a complexly structured block of conditions that allows you to describe in a formal presentation the necessary clinical criteria that determine the conditions for creating an intelligent assistant to a phthisiologist.

Conclusion. The generation of the knowledge base will make it possible to switch to personalized medicine through the rational use of anti-tuberculosis drugs, which will reduce the time and improve the effectiveness of tuberculosis treatment.