The purpose of this study was to create an integrated diagnostic methodology to predict and prevent the development of complications (restenosis, thrombosis) in the late postoperative period after ‘KemAngioprotez’ femoropopliteal biological prosthesis implantation. Group I (n=52) included patients with a poor outcome (restenosis in the prosthesis in 35 patients accompanied by thrombosis) and group II (n=59) consisted of patients with functioning and intact prosthesse. Almost all known clinical and several metabolic parameters were assessed. According to the multivariate analysis, four factors were significant in the development of restenosis and thrombosis, i.e. patient’s age, atherogenic index (AI), lipid profile, platelet hypoor hyperaggregation and the technique for bioprosthetic further modification. Based on the obtained data the mathematical model was developed, which allows to predict and prevent the development of complications in the long term period after «KemAngioprotez» femoropopliteal bioprosthesis implantation.

Рurpose. To perform a retrospective comparison analysis of clinical use of xenoaortic prosthesis «PeriCor» and xenopericardial prosthesis «UniLine» in the immediate postoperative period.

Materials and methods. The analysis of surgical treatment of 88 patients with mitral valve disease was conducted. Bioprostheses «PeriCor» was implanted in 48 patients (Group I) and «UniLine» in 40 patients (Group II). The average age in Group 1 was 58,6±6,65 years, whereas in Group 2 – 65,1±7,1 years. Patients in both groups were characterized by severe initial clinical condition. The follow-up period in Group 1 was 127,3 patient-years, in Group II – 101,2 patient-years.

Results. One patient died in the in-hospital period in Group 1. The in-hospital mortality was 12,5 % in Group 2. There were no prosthesis-related complications found in both groups. In a 4-year follow up period 5 reoperations were performed in Group 1 due to causes of prosthetic valve dysfunction. There were no reoperations in Group 2.

Conclusion. The implantation of xenoaortic and xenopericardial bioprostheses in the mitral position allows to manage adequately intracardiac hemodynamic disorders in patients with acquired heart disease. Bioprostheses «PeriCor» and «UniLine» have the same hemodynamic characteristics in the immediate postoperative period.

Results of mathematical modeling of behaviour when loading of a new aortic bioprosthesis TiAra mounted at single-loop stent of nitinol wire are shown. The first clinical experience of TiAra prosthesis implantation in the aortic position is demonstrated. The prosthesis is implanted by one-row suture in subcoronary supraannular position. The implantation was held in two patients aged 71 and 75 with good clinical outcome. According to the control echocardiography the peak transprosthesis gradients at rest were 9-15 mm Hg. According to the results of clinical trial the prosthesis can be recommended for introduction into clinical practice.

Purpose. Assess the impact of the sutures and unfractionated heparin on biomaterial calcification in an experiment.

Materials and methods. Porcine aortic valve cusps, preserved in glutardialdehyde and ethylene glycol diglycidyl ether, were used. The test models were sutured with polypropylene, polydioxanone and nitinol (TiNi) threads. The sutured cusps were modified with unfractionated heparin. The model of accelerated calcification was used to study the impact of suture material and heparin on biological tissue mineralization by implanting the test models into male rats for 2 months.

Results. Two months after the implantation all the test models had calcium deposits in the peri-suture region; the amount of calcium in the biomaterial with polypropylene threads was 31-fold higher (р=0,0009), with TiNi threads it was 14-fold higher (р=0,001) and with polydioxanone threads it was 9-fold higher (р=0,0049) as compared to the controls. The modification with unfractionated heparin significantly decreased the amount of calcium in the biomaterial. The maximum effect was observed in the test models containing TiNi: the amount of calcium was 14,5-fold lower (р=0,0013), which was comparable with non-implanted models.

Conclusion. Cardiovascular bioprosthetic heart valves calcification can be initiated by the suture material due to inflammation in the peri-suture region. The amount of calcium in the biomaterial depends on the quality of the latter. Polypropylene threads precipitated the calcification of epoxy-treated xenocusps in the experiment. The modification with unfractionated heparin can effectively inhibit biological tissue calcification.

Purpose. To evaluate the local angiogenesis stimulation by polycaprolactone (PCL) scaffolds with VEGF in vivo.

Materials and methods. PCL scaffolds were fabricated using electrospinning method. For the encapsulation of VEGF into PCL scaffold a two phase electrospinning was used. The scaffolds structure was examined by scanning electron microscopy. Growth factor release dynamic was assessed by ELISA. For evaluation of biological properties, the PCL and PCL+VEGF scaffolds were implanted in Wistar rat abdominal wall (n=60) for 2, 3 and 4 monthsT. he explanted samples were examined by histological and immunoishtochemical analyses.

Results. The study showed that PCL fiber diameters in the scaffolds have changed after VEGF encapsulation. Moreover, long-term controlled release of growth factor was demonstrated. In addition, we have also shown the preservation of PCL+VEGF scaffolds biological activity; this was evidenced by increase of the number of capillaries on scaffolds with VEGF compared to control samples after implantation in rats.

Conclusion. This study showed that the PCL scaffold with VEGF has pro-angiogenic potential in comparison with pure scaffolds and can potentially be used for the tissue engineering in vivo.

Purpose. To analyze the outcomes of aortic arch reconstruction in neonates with coarctation of the aorta (CoA) and hypoplastic arch.

Materials and methods. 14 neonates with CoA and hypoplastic arch underwent surgical repair from January, 2011 to July 2013. The age group of patients was from 2 day to 28 days (16±8 days). The average weight was 3245±667 grams. The average body surface, calculated using the Dubois formula, was 0,20±0,03 m². Preductal CoA with hypoplastic arch were diagnosed in 13 (92 %) patients. The descending and ascending aorta as well as the segments of the arch were measured with echocardiography and MSCT. Additionally to the “segmental” approach in diagnosis of aortic arch hypoplasia, the Z-score was used to assess the degree of hypoplasia; the degree of stenosis was calculated by the ratio of aortic segment diameters, the deviation from the standard values. All patients underwent median sternotomy. The site of arterial cannulation depended on the diameter of the ascending aorta. 7 (50 %) patients underwent xenopericardium patch augmentation of tubular hypoplasia of the aorta, other 50 % – underwent aortic arch reconstruction with their own aortic tissue segments (method of McKenzie E.D.).

Results. The in-hospital mortality was 21%. 6 (42 %) patients had no complications in the postoperative period. The patients received cardiotonic drugs in therapeutic doses. 7 patients received high doses of cardiotonics to treat biventricular heart failure, all of them had concomitant CHD with subsequent delayed sternal closure. There was no significant pressure gradient across the reconstructed area in all the patients in the early postoperative period (a direct method of measurement based on the difference of radial and femoral artery pressure). The pressure gradient across the area of plasty, measured with echocardiography before the discharge, was from 3 to 12,5 mm Hg (the average value – 8,5±1,2 mm Hg). There were no CNS complications. The average follow-up period was 10±2,5 months. The monitoring visits in the outpatient department did not reveal any significant gradient across the area of the intervention. Echocardiography and MSCT with segemental assessment were performed to evaluate the aortic arch reconstruction in 10 months. 7 out of 11 patients reported normal development of the aortic arch.

Conclusions. 1. Cardiopulmonary bypass with antegrade cerebral perfusion allows to push down safely the edge of the ascending aorta during the main stage and to place an adequate end-to-side anastomosis or to perform patch augmentation of the aortic arch. 2. Hypoplastic arch is commonly complicated by other CHDs, that allows to perform single-stage or palliative repair of associated anomalies.

Purpose. Analysis of the own experience with multislice computed tomography (MSCT) in the diagnosis of congenital heart disease (CHD) in children in the first years of life and determine the effectiveness of this technique.

Materials and methods. We analyzed MSCT data of patients with CHD (n = 156, mean age 3,5 (2; 9,7 mo), which was conducted on a 64-slice CT scanner with a bolus of X-ray contrast.

Results. We found excellent information content of MSCT in morphometry of coarctation of the aorta, ductus arteriosus in patients before and after surgical intervention. Possibilities of the method have been presented for patients with tetralogy of Fallot and anomalous pulmonary venous drainage. Pathological changes in the bronchopulmonary system were revealed in 55 patients with CHD by MSCT.

Conclusion. The use of MSCT in the diagnosis of CHD in children during the first years of life to get accurate morphometric data of the anatomy of CHD and assessment of concomitant noncardial pathology for determining treatment strategy, planning, operational correction and control of the results of surgery.

Purpose. Description of a rare case of diagnosis and treatment of arteriovenous malformations of the lower lobe of the left lung in the infant.

Methods. Anamnestic, clinical, laboratory, ultrasound, multislice computed tomography (MSCT), aortography , X-ray-edovaskular coiling.

Results. Clinical manifestations of vascular malformations are varied depending on the location, amount of education, presence of hemodynamic disturbances. Due to the rarity of the disease, the difficulty of diagnosis in the perinatal period, give their own observation of the rare cases of diagnosis and treatment of arteriovenous malformations of the lower lobe of the left lung in the infant.

Conclusion. The reason for dilatation and heart failure may be vascular malformation as aorto-pulmonary malformations very different localization. This pathology may be suspected prenatally and confirmed by modern diagnostic methods. The correction of vascular malformations is possible in the present at any age by X-ray-endovaskular procedures.

Purpose. Studying of efficiency of new organizational approaches to providing the medical care (MC) to newborns with critical congenital heart diseases (СHD) in for 2007–2012.

Materials and methods. The analysis of providing MС by the newborn with СHD during 2007–2010 (119 children) and 2011–2012 (113 children) was carried out. Clinical and anamnestic data, indicators of an echocardiography prenatal and post-natal, an electrocardiography, laboratory researches, intensive conservative therapy, and hospitalization outcomes were studied.

Results. With the organization of regional perinatal center (RPC) organization the providing MC newborn with CHD was based by the principles: a) the second stage of prenatal ultrasonic screening was guided by RPC; b) dynamic supervision of pregnant women with suspicion of CHD of fetus at a stage of prenatal hospitalization in RPC; c) joint approach in definition of tactics of maintaining the newborn patient with CHD (the organization of an interdisciplinary neonatal cardiological consultation); d) widespread introduction and availability of hi-tech methods of diagnostics and treatment, including surgeries on early terms in the Kuzbass cardiocenter. Productivity of prenatal diagnostics increased. During 2007–2010 39,5 % of hospitalizations ended with transfer to expeditious treatment. In 2011–2012 already 61,9 % of children are transferred to cardiac hospitals (р=0,001). The lethality in the first group made 21,0 %, in the second – 7,1 % (р=0,002).

Conclusion. Introduction of new organizational approaches in providing MC newborn with CHD allowed to improve diagnostics of critical conditions, to provide timeliness of cardiac correction and to lower a lethality at a presurgical stage.

Purpose. The purpose of the study was to assess the intensity of endogenous intoxication and oxidative stress in the coronary sinus and peripheral blood of coronary artery disease patients undergoing coronary artery bypass surgery.

Materials and methods. The study involved 30 patients with coronary artery disease. Serum concentrations of lipid peroxidation products, total antioxidant activity and endogenous intoxication parameters, i.e. substances of low and medium molecular weight, medium molecular weight peptides, were assessed in coronary sinus and peripheral blood.

Results. Long-existing cardiac ischemia certainly accompanied by a significant accumulation in the blood of patients with lipid peroxidation products and the products of endogenous intoxication. In peripheral blood total antioxidant activity is reduced by 2 times unlike sinus. In the study of indices of lipid peroxidation in the reperfusion period there was a reduction of primary and secondary lipid peroxidation products – diene conjugates and malondialdehyde, and later during reperfusion is increasing lipid peroxidation products.

Conclusions. Coronary artery bypass surgery in coronary artery disease patients is accompanied, on one hand, by the increase in the activity of lipid peroxidation processes and decreased antioxidant protection, and, on the other hand, by increased levels of endogenous intoxication products.

Introduction. The prognostic and diagnostic value of measuring concentrations of acute phase reactants in the postoperative period in patients undergoing cardiac valve replacement surgery during cardiopulmonary bypass is not clear now.

Materials аnd metods. Serum levels of inflammatory markers (procalcitonin (PCT), tumor necrosis factor α (TNFα), interleukin-1β (IL-1β), interleukin-6 (IL-6)) were measured quantitatively by ELISA. Blood samples from 71 patients with a diagnosis of infective endocarditis undergoing cardiac valve replacement surgery during cardiopulmonary bypass were taken preoperatively, on the first and seventh day after surgery. Were measured serum concentration and correlated to postoperative clinical course.

Results. Postoperative changes in serum levels PCT, IL-1β and IL-6 significantly increased in patients from groups without postoperative severe SIRS. The serum IL-1β concentrations stay in the preoperatively level at all time points in patients from groups with postoperative severe SIRS. Postoperative IL-6 values on the first day after surgery were significantly lower in patients from groups with postoperative severe SIRS than those in the other group. The serum TNF-α levels significantly increased in patients from all groups at first day after surgery.

Conclusion. The low postoperative levels of IL-1β and IL-6 expected to be the best predictive markers in order to monitor the systemic inflammatory response occurring after cardiac surgery with cardiopulmonary bypass.

Purpose. To assess the impact of cardiac risk factors on the treatment strategy for patients with multiple atherosclerotic lesions.

Materials and methods. The study presented the results of the treatment of 97 patients with aortoiliac lesions and coronary artery disease. 51 patients had infrarenal aortic aneurysm and 46 patients were diagnosed with chronic lower limb ischemia. All the patients had ECG, echocardiography and coronary angiography performed. The additional studies performed were Holter and blood pressure monitoring, stress echo and thallium myocardial perfusion scintigraphy.

Results. Open-heart myocardial revascularization as the first stage procedure was done in 10 aneurysm patients and 8 lower limb ischemia patients, transluminal balloon angioplasty (PTCA) with stenting was done in 12 and 11 patients, respectively. Aortoiliac lesions were treated during the second-stage procedure. After the interventions for aortic lesions there was one death in the abdominal aortic aneurysm group; the lower limb ischemia group had no fatal outcomes.

Conclusions. 1.Most patients with abdominal aortic aneurysms and chronic ischemia have significant cardiac risk factors with coronary artery lesions being the leading one. 2. Coronary angiography remains the most accurate technique for coronary lesion assessment. 3. Patients with severe coronary lesions require myocardial revascularization (coronary artery bypass surgery, stenting) as the first-stage procedure. 4. In patients at a high risk of cardiac complications the surgery for abdominal aortic aneurysms or chronic lower limb ischemia can be performed only if there exist life-saving indications.

Purpose. To compare and evaluate the nature of events after different revascularization strategies in patients with infrarenal aortic aneurysm and concomitant ischemic heart disease and, based on the analysis of the obtained data, to choose the safest revascularization strategy in this category of patients.

Material and methods. The treatment results were assessed in the two groups of patients. Group 1 included 79 (40,1 %) patients, who underwent an open surgery for abdominal aortic aneurysm with pharmacological treatment of the concomitant coronary disease, and Group 2 consisted of 118 (59,9 %) patients, who first underwent surgical and/or endovascular coronary revascularization and then an open surgery for abdominal aortic aneurysm.

Results. Group 2 was found to have significantly less cardiovascular events and less cardiovascular mortality, which was due to the approach consisting in all the abdominal aortic aneurysm patients undergoing coronary angiography and, in case there was a stenotic coronary lesion, coronary revascularization was performed first with a surgery for abdominal aortic aneurysm being done afterwards.

Conclusion. Coronary angiography in patients with infrarenal aortic aneurysm can help identify the group of patients who would benefit from first-stage coronary revascularization, which could lead to less cardiac events and less surgical mortality when abdominal aortic aneurysm is treated.

In the first part of this review article the evolution of ventricular arrhythmia concepts, which is classified nowadays to be idiopathic, are highlighted. The questions about the benign nature and ‘idiopathy’ of ventricular arrhythmias in patients without any structural heart diseases are discussed.

The second part of this review article covers indications for catheter ablation in idiopathic focal ventricular arrhythmias. The questions of mapping, characteristic features of ablation in different sites and the issue of early and late recurrent conditions are discussed.

Purpose. Study echocardiographic aspects of the remodeling of the left ventricle in patients with coronary artery disease and different types of left ventricular aneurysms in functional pharmacological test with nitroglycerin before and after surgery.

Materials and methods. We will recruit 96 patients with coronary artery disease and postinfarction cardiosclerosis. All patients performed echocardiography rest and with nitroglycerin before and after, only rest, surgery.

Results. Before surgery patients with 1 type of left ventricular aneurysm change the volume of the left ventricular and ejection fraction. Patients with 3 type of left ventricular aneurysm had not change echocardiographic parameters of the left ventricular in the early postoperative period.

Conclusion. viable myocardium diagnosis can from the basis prognosis hemodynamic successful coronary bypass surgery.