Clinical observations of COVID-19 infection in patients with chronic thromboembolic pulmonary hypertension.

Aim    To present clinical observations of the novel coronavirus infection (COVID-19) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) after a surgical intervention in the form of thromobendarterectomy from pulmonary artery branches.Material and methods    The Acad. E.N. Meshalkin National Medical Research Center performed 127 open surgical interventions for CTEPH in the form of thromobendarterectomy from 2016 through 2020. The present study enrolled 113 patients included into the follow-up care group and into the Center Registry who were followed up for more than 6 months after the surgery. Clinical and functional features of COVID-19 were evaluated in the studied group.Results    In the follow-up care group, 5 (4.4%) postoperative CTEPH patients had COVID-19. One patient had asymptomatic disease, and others had typical clinical symptoms and bilateral polysegmental pneumonia. There were no cases requiring artificial ventilation and no lethal outcomes. All patients with COVID-19 received anticoagulants as a basis therapy for CTEPH, and two patients who had residual pulmonary arterial hypertension (PAH) additionally received a PAH-specific therapy. During the treatment of COVID-19, no adjustment of the anticoagulant or PAH-specific therapy was required.Conclusion    The group of patients with CTEPH is a unique pathophysiological model for studying the effect of COVID-19 under the conditions of compromised pulmonary circulation. In the studied follow-up care group, the COVID-19 morbidity was 4.4 % without fatal outcomes. Evaluation of the role of chronic anticoagulant and PAH-specific therapy in COVID-19 postoperative patients as well as evaluation of the role of COVID-19 in CTEPH progression merit further investigation.

[Predictors of neurological complications during surgical treatment of the ascending aorta and aortic arch chronic dissection]. / Prediktory nevrologicheskikh oslozhnenii pri khirurgicheskoi korrektsii khronicheskogo rassloeniia voskhodiashchego otdela i dugi aorty.

AIM: To evaluate the prognostic significance of oxygen supply to the brain in the risk of neurological complications in the early post operative period of surgical treatment of the ascending aorta and aortic arch. MATERIAL AND METHODS: The level of oxygenation (rSO2) in the right and left hemispheres was measured in 68 patients with ascending aorta and aortic arch chronic dissection. Before and in the nearest period after surgery, the patients underwent a clinical/instrumental neurological study. RESULTS: The incidence of ischemic stroke in the early post operative period was 5.9%, cognitive impairment was recorded in 22% of patients. Among the parameters of oxygen supply to the brain, the dynamics of rSO2 during circulatory arrest had a significant impact on the post operative neurological status. The risk of cognitive impairment, besides the association with the oxygen status of the brain, increased with the age of patients and comorbid pathology. CONCLUSION: The decrease in rSO2 by ≥30% during surgical treatment of ascending aorta and aortic arch dissection increases the risk of ischemic stroke and cognitive impairment in the early post operative period.

[Predictors of cerebral complications during carotid endarterectomy]. / Prediktory tserebral'nykh oslozhnenii karotidnoi éndarteréktomii.

AIM: To evaluate the prognostic value of parameters of cerebral oxygenation in estimation of the risk of ischemic stroke (IS) in perioperative and early postoperative phase of carotid endarterectomy (CEE). MATERIAL AND METHODS: Four hundred and sixty-six patients with hemodynamically significant atherosclerotic lesion of arteries of the brachiocephalic system, who underwent CEE with bilateral monitoring of cerebral oxygenation (rSO2), were enrolled. The end-point of the study was cerebral complications in perioperative and early postoperative phase. RESULTS: The perioperative level of rSO2 <50% (AUC 0.85 (0.73-0.96), p<0.05) and the reduction in rSO2 in the operated side during the temporary occlusion of the inner carotid artery (ICA) by ≥20% (AUC 0.74 (0.51-0.97) p<0.05) were the best predictors of the risk of IS. The risk group with the reduction in rSO2 by ≥20% at the main stage of CEE included patients with collateral stenosis and ICA occlusion, occlusion of the circle of Willis and the history of myocardial infarction. CONCLUSION: The reduction in rSO2 in the stage of ICA occlusion by ≥20% increased the risk of IS by >10 times, the perioperative level of rSO2 <50% increased the risk of IS in perioperative and early postoperative phase of CEE by 6 times.

Anatomical variants of transposition of the main vessels and their relationship with the content of chemical elements in heart ventricles.

Cardiometrical characteristics of anatomical variants of the main vessels transposition are determined by different functional load of heart compartments and are associated with metabolic processes of different intensity, which is confirmed by the content of chemical elements in the right- and left-ventricular myocardium. It was shown that the content of chemicals was virtually the same in both cardiac ventricles in case of main vessels transposition and isolated atrial septal defect. Positive correlations between the degree of left-ventricular hypertrophy and content of S, K, Fe, and Sr in it and a negative correlation between this hypertrophy and Cu content were revealed. Transposition of the main vessels and defects of atrial and ventricular septa were associated with different levels of chemical elements in both ventricles, particularly of Zn, Mn, Fe, and Ca.