[Removal of ascending aortic dissection and residual blood flow after transcatheter isolation of descending aortic dissection]. / Ustranenie rassloeniia voskhodiashchei aorty i rezidual'nogo krovotoka posle transkateternoi izoliatsii rassloeniia niskhodiashchei aorty.

Presented herein is a clinical case report concerning successful simultaneous surgical treatment of a female patient with a complication after transcatheter treatment for chronic dissection of the descending portion of the thoracic aorta. The woman was subjected to elective transcatheter isolation of chronic dissection of the descending thoracic aorta using a stent graft with complete coverage of the zone of the origin of the left subclavian artery. Repeat control imaging studies several months after the intervention revealed residual blood flow through the false channel, directed retrogradely from the distal edge of the stent graft to the left subclavian artery. Besides, the patient was also found to have local dissection of the distal part of the ascending aorta (zone 0). An operative intervention was performed: sternotomy, prosthetic repair of the ascending portion of the aorta and part of the aortic arch, as well as transposition of the left subclavian artery to the left common carotid artery. The control imaging studies confirmed radical removal of the false aneurysm of the ascending aorta and the presence of total thrombosis of the false channel at the level of the stent graft.

[The Case of Fulminant Myocarditis].

Fulminant myocarditis (FM) is a severe form of inflammatory myocardial injury rapidly developing as acute heart failure, cardiogenic shock, or life-threatening disturbances of cardiac rhythm. FM requires intensive treatment including drug therapy, mechanical circulatory support, and in some cases - heart transplantation. Echocardiography can be used as a screening method of diagnostics. Magnetic resonance imaging of the heart often cannot be performed because of hemodynamic instability of a patient, therefore endomyocardial biopsy with histological and immunohistochemical studies as well as molecular-genetic analysis of obtained samples is required for final diagnosis. Prognosis of the disease is determined by histological picture. In most cases, after cessation of acute stage of the inflammatory process, FM has a favorable long-term prognosis. In this article we present a clinical case of FM and review of current literature on diagnosis and treatment of this disease.

[Results of a single-centre study of open and endovascular operations of prosthetic repair of abdominal aortic aneurysms]. / Rezul'taty odnotsentrovogo issledovaniia otkrytykh i éndovaskuliarnykh operatsii protezirovaniia anevrizm briushnogo otdela aorty.

OBJECTIVE: The purpose of the study was to assess surgical outcomes in patients suffering from an infrarenal abdominal aortic aneurysm and treated at the Department of Cardiovascular Surgery #2 of the National Medical Research Centre named after V.A. Almazov. PATIENTS AND METHODS: We carried out a non-randomized retrospective study including a total of 209 patients presenting with an infrarenal abdominal aortic aneurysm. Of these, 160 (76%) patients were subjected to open surgical interventions (Group One) and 49 (24%) patients underwent endovascular isolation of the abdominal aortic aneurysm (Group Two). The check examination was performed in the early postoperative period and at 30 postoperative days. The mean age of the patients amounted to 65±3.4 and 69±6.2 years in Group One and Two, respectively, with the mean diameter of the infrarenal portion of the aorta amounting to 6.5±0.8 and 6.7±0.9 cm, respectively. RESULTS: 30-day mortality amounted to 2.5 and 2.05% in Group One and Two, respectively (OR 1.231; 95% CI 0.134-11.277). Repeat interventions were more often performed in Group One patients compared with Group Two patients (13.7 vs 2.05%) (OR 6.085; 95% CI 0.791-46.799). Postoperative complications were observed more often in Group One patients than in Group Two patients (OR 9.916; 95% CI 2.143-39.457). Complications encountered in Group One and not observed in Group Two were as follows: nosocomial pneumonia - in 3.75% of cases, acute impairment of cerebral circulation (AICC) and acute myocardial infarction - in 1.25% of cases each, cardiac arrhythmia and acute renal failure - in 1.88% of cases each. Local postoperative wound-related complications were encountered in 18.11% of cases in Group One versus 4.1% in Group Two (OR 5.202; 95% CI 1.195-22.652). CONCLUSIONS: The retrospective analysis of open and endovascular methods of treatment of abdominal aortic aneurysms demonstrated that, given the multifocal nature of an atherosclerotic lesion in the cohort of patients involved, it is appropriate in the preoperative period to perform coronarography in all patients in order to rule out significant damage of the coronary bed. It is also appropriate to regard a cohort over 60 years and patients found to have significant concomitant pathology as candidates for endovascular treatment. A differentiated approach to careful selection will make it possible to improve the results of treatment of abdominal aortic aneurysms.

Left main coronary artery compression by pulmonary artery aneurism in patients with long standing pulmonary arterial hypertension.

This review focuses on a rare complication of pulmonary arterial hypertension (PAH), extravasation compression of the left coronary artery (LCA) dilated by the pulmonary artery. The review described clinical manifestations and methods for diagnostics of LCA compression, and advantages of the endovascular correction of this complication in patients with pulmonary hypertension. Selection of a device to be implanted during the endovascular intervention in these patients was discussed with due account for concomitant treatment with oral anticoagulants. As an illustration of the issue under discussion, a clinical case of acute coronary syndrome in a female patient from the PAH Registry of the V. A. Almazov National Medical Research Center was provided.

[Hybrid treatment of patients with aneurysms and dissections of the aortic arch and descending portion of the thoracic aorta]. / Gibridnoe lechenie bol'nykh s anevrizmami i rassloeniiami dugi i niskhodiashchego otdela grudnoi aorty.

The authors share herein their experience with hybrid surgical treatment of 21 patients presenting with lesions of the aortic arch and descending thoracic aorta. Aortic pathology included dissection of the thoracoabdominal aorta (n=15), a sacciform aneurysm of the aortic arch (n=5), and a spindle-shaped aneurysm of the distal portions of the aortic arch (n=1). The first stage consisted of the following operations: transposition of the left subclavian artery into the left common carotid artery (n=9; 42.8%), partial debranching (n=11; 52.5%), and total debranching (n=1; 4.7%). The second stage consisted in implantation of a stent graft: to the thoracic aorta in 18 (85.8%) cases, and to the thoracic and abdominal portions of the aorta in 3 (14.2%) cases. The most significant complications of the immediate postoperative period included acute cerebral circulation impairment (n=1) and local dissection of the ascending aorta (n=1). Type I endoleaks were observed in 4 (19%) patients, type II endoleaks in 1 (4.7%), and type III endoleaks in 1 (4.7%). The mean duration of the follow up after discharge from hospital amounted to 11.6±7.9 months. In 4 patients after 6 months the findings of the control MSCT angiography showed no significant changes of the endoleaks. 1-year patency of the shunted branches of the aortic arch amounted to 95.2%. The cumulative survival rate amounted to 95.2%.

[Successful two-stage surgical treatment of a thoracoabdominal aortic aneurysm: a case report]. / Sluchai uspeshnogo dvukhétapnogo khirurgicheskogo lecheniia torakoabdominal'noi anevrizmy aorty.

Presented herein is a clinical case report regarding hybrid or two-stage surgical treatment of a Crawford type II thoracoabdominal aortic aneurysm in an 87-year-old woman. For the first stage operation we performed open resection of the abdominal aortic aneurysm with aortofemoral bifurcation prosthetic repair and debranching of visceral and renal arteries. Several months thereafter, the second stage operation was performed, consisting in transcatheter exclusion of the thoracoabdominal aortic aneurysm with the help of two stent grafts. The postoperative period turned out uneventful, with no complications. The check-up contrast-enhanced multislice computed tomography (MSCT) carried out 8 months later showed neither endoleaks nor migration of the stent grafts, with the bypass shunts' patency preserved.

[Autoimmunity and Prognosis of Patients With Morphologically Documented Myocarditis].

AIM: to assess clinical and prognostic value of circulating cardiospecific autoantibodies (AAB) and CD4+ T-regulatory cells in patients with myocarditis. MATERIAL AND METHODS: We included into this study 47 patients with lymphocytic myocarditis verified by analysis of histological and immunohistochemical data. Comparison group consisted of 30 practically healthy persons. Content of marker cardiotropic AAT were measured with the help of standardized immune enzyme test-systems. Number of circulating CD4+CD25+ and CD4+CD25+FoxP3+ T-lymphocytes were evaluated by flow cytometry. RESULTS: Among factors determining prognosis of patients with lymphocytic myocarditis factors of key significance were the presence of clinically overt heart failure at the disease debut, and degree of reduction of left ventricular ejection fraction. Distinctive feature of active myocarditis was elevation of titer of AABs to sarcomeric, cytoskeleton, and cytoplasmic proteins of cardiomyocytes, as well as elevated level of AABs to various epitopes of adenine nucleotide translocator. Elevated level of AAB to 1-adrenoreceptors was an independent predictor of unfavorable outcome in patients with lymphocytic myocarditis. Increased population of circulating CD4+CD25+ T-regulatory cells was as sociated with elevated concentration of of natriuretic peptide. CONCLUSION: Abnormalities in the system of autoimmunity play key role not only in pathogenesis but also in prognosis of inflammatory myocardial diseases. Changes of profile of circulating cardiospecific AABs and T-regulatory cells can bear a protective function.

[Comparative analysis of the serum level of autoantibodies as a diagnostic tool of myocardial inflammatory diseases].

AIM: To assess whether the serum levels of autoantibodies (auto-Abs) interacting with myocardial and vascular wall antigens might be used for the differential diagnosis of myocardial inflammatory diseases. Subjects and methods. Seventeen patients with morphologically documented myocarditis were examined. A comparison group comprised 9 patients with acute myocardial infarction (AMI). A control group included 18 apparently healthy individuals and 8 patients with chronic erosive gastritis (CEG). Serum auto-Abs levels were estimated by the ELI test systems standardized for enzyme immunoassay. RESULTS: The individual profiles that reflect relative changes in the levels of 16 study auto-Abs and characterize the integral autoreactivity of a patient have clear intergroup differences. Using the profiles of auto-Abs could confirm the diagnosis of myocarditis in 94% of cases or assign the patient to a group of apparently healthy individuals. The informative value of the method in patients with AMI and CEG was 81.8 and 87.5%, respectively. CONCLUSION: The proposed method may be used for the noninvasive screening diagnosis of myocardial inflammatory diseases.

[The first experience with heart transplantation in the Federal Center of the Heart, Blood and Endocrinology named after V. A. Almazov].

At the present time heart transplantation is considered to be the operation of choice in treatment of patients with terminal stage of chronic heart failure. Results of the first 5 heart transplantations made in the Federal Center of the heart, blood and endocrinology named after V. A. Almazov are assessed. There were no perioperational lethality and complications at the hospital stage. An analysis of the long-term results has shown effectiveness of heart transplantations in treatment of severe heart pathology.

[Laboratory diagnosis of myocardial microlesions during coronary balloon angioplasty with stenting].

Fifty patients with stable angina who had undergone elective coronary angioplasty with stenting were examined. Myocardial microlesions diagnosed from the elevated levels of troponin (Tn) I and creatine phosphate kinase MB (CPK-MB) were detected in 48-54% of the patients; however, the content of Tn I exceeded the high reference level only in 18%. Tn I is a more specific method than CPK-MB in detecting myocardial microlesions during intracoronary intervention. The signs of myocardial microlesions were most commonly detected during intervention into the arteries with types B and C stenoses in case of complicated or technically difficult stent implantation.

[Hemodynamics and activation of mechanoreceptors in the human carotid sinus]. / Dinamika pokazatelei krovoobrashcheniia pri aktivatsii mekhanoretseptorov sinokarotidnoi zony u cheloveka.

Investigation into consequences of the carotid sinus stimulation has revealed that the stimulation elicited a considerable decrease in arterial blood pressure because of a decrease in the cardiac output (often) or in peripheral vascular resistance (less frequently). The type of the response to the stimulation was found to depend on haemodynamic characteristics at rest.