Association of Cardiovascular Surgeons of Russia Russian Society of Cardiology (RSC) Association of Pediatric Cardiologists of Russia Russian Scientific Society of Specialists in X-Ray Endovascular Diagnostics and Treatment All-Russian Public Organization for the Promotion of Radiation Diagnostics and Therapy "Russian Society of Radiologists and Radiologists". Task Force members declared no financial support/conflicts of interest. If conflicts of interest were reported, the member(s) of the working group was (were) excluded from the discussion of the sections related to the area of conflict of interest.

OBJECTIVES:The objective of this work was to develop technology to create 'soft' patient-specific models of semilunar heart valves, the aortic valve in particular, suitable for training and simulation of surgical and endovascular interventions.METHODS:Data obtained during routine cardiac contrast-enhanced multislice computed tomography were used to create 3-dimensional models of the aortic root. Three-dimensional models were used to create soft silicone models of the aortic root made by casting silicone into a negative mould printed with stereolithography. A comparison between the constructed models and the size of the aortic root was performed. We quantified how much time was needed for production of each model.RESULTS:Four patient-specific soft models of the aortic root were produced. Data from patients of different ages and body surface areas were used as prototypes. All models had minimum size errors. During development of this technology, production time per model was reduced from 63 to 39 h.CONCLUSIONS:We have demonstrated the feasibility of making soft patient-specific 3-dimensional aortic root models using currently available technology. These models can be used both for training physicians in a variety of open surgical and endovascular interventions and for the study of complex aortic root geometry.

The study centered on the possibility of surgery on the atrial septum (AS) without aortic clamping and cardiac arrest. We compared two groups of patients who underwent intervention on AS as the major or concomitant stage of surgical treatment. Nineteen patients were assigned to the main group; they were operated under CPB without aortic clamping and cardioplegia. The control group consisted of 20 patients, whose AS was surgically treated by using a standard technique with aortic occlusion. The groups were comparable by age and disease. The patients of both groups withstood the surgical interventions satisfactorily, with no mortality. The mean CBP time in the patients operated without aortic clamping was shorter than that in the control group patients (operated with aortic clamping) by about 18-20 minutes. The major surgical stage time did not differ between the groups. The technique of atrial septal defect closure or its dissection on the beating heart without cardioplegia is safe, comfortable for a surgeon and allows saving time required for the recovery period. Besides, it does not cause myocardial lesion associated with cardioplegia.

ВОЗМОЖНОСТИ ТЕХНОЛОГИИ 3D-ПЕЧАТИ В ПРЕДОПЕРАЦИОННОЙ ОЦЕНКЕ ОСОБЕННОСТЕЙ АНАТОМИИ ДЕФЕКТА МЕЖЖЕЛУДОЧКОВОЙ ПЕРЕГОРОДКИ И АНОМАЛИИ РАЗВИТИЯ ПРАВОГО ЖЕЛУДОЧКАЗавадовский К.В. 1 , Кривощеков Е.В. 2 , Бразовский К.С. 3 , Лежнев А.А. 2 , Мочула А.В. 1 , Шмакова Н

Calcineurin pathway plays the critical role in the cardiac remodeling of various origin, development of chambers dilatation and progression of heart failure. Components of calcineurin pathway are involved in myocardium hypertrophy regulation, angiogenesis and apoptosis. Results of quantitative expression profiling study of main calcineurin pathway genes PPP3CA, PPP3R1, PPP3CB, GATA4 and NFATC4 in myocardium of right atrium auricle of patients with a coronary heart disease, exposed to various types of surgical treatments depending on weight of a clinical finding (surgical reconstruction of the geometry of left ventricle (LV) (postinfarction aneurysm) or coronary artery bypass grafting in case of unaltered morphology of LV) are presented. In patients with sizable postinfarction LV dilatation (n = 21) expression level of calcineurin catalytic subunit genes PPP3CA and PPP3CB was 1.3 and 1.6 times lower (p = 0.018 and 0.023, accordingly) compared to patients with unaltered shape of the heart (n = 34). Expression level of PPP3R1 gene encoding calcineurin regulatory subunit B and GATA4 and NFATC4 genes for transcription factors did not differ in studied subgroups of patients. Thus, lower expression of PPP3CA and PPP3CB genes in atrium myocardium can be related to expressed postinfarction LV remodeling. Further studies of relation quantitative expression profiling of calcineurin pathway genes with the level of damage of myocardium is essential what may have important outcome for the prevention of adverse events of cardiosurgical treatments in patients with postinfarction remodeling.

The calcineurin signaling pathway plays a crucial role in the heart remodeling of a different nature, in the development of left ventricular dilatation, and in the progression of heart failure. Components of the calcineurin pathway are involved in the regulation of cardiomyocyte hypertrophy, angiogenesis, and apoptosis. In this study, quantitative expression profiles were determined for major calcineurin pathway genes PPP3CA , PPP3R1 , PPP3CB , GATA4 , and NFATC4 in the myocardium of the right atrium auricle in patients with ischemic heart disease who underwent different types of surgery depending on the severity of clinical symptoms as follows: surgical reconstruction of left ventricle (LV) geometry (post-infarction aneurysm) or coronary artery bypass grafting (unaltered LV morphology). In patients with sizable post-infarction LV dilatation ( n = 21), the expression levels of calcineurin catalytic subunit genes PPP3CA and PPP3CB were 1.3 and 1.6 times lower ( p = 0.018 and 0.023, respectively) than in patients with unaltered heart shape ( n = 34). The differences in expression levels of PPP3R1 , which encodes calcineurin regulatory subunit B and levels of GATA4 and NFATC4 , which encode transcription factors, were not significant. Thus, decreased PPP3CA and PPP3CB expression in the atrial myocardium may be a marker of significant post-infarction LV remodeling. The further investigation of the relationship between expression levels of calcineurin pathway genes and the degree of myocardial damage may provide useful insights for predicting adverse events in cardiosurgical treatment of patients with post-infarction heart remodeling.

In this study, we genotyped polymorphism in GPX1 Pro198→Leu (C→T) rs 1050450 in four groups, i.e., patients with coronary artery disease, people who lived a long time (over 90 years), people who died early (before 55 years) from cardiovascular disease, and the Russian population as a control group. We have found a significant higher T-allele frequency in men with coronary artery disease, i.e., 34.84% (χ2 = 5.228, p = 0.022; OR =1.46), and in men who died early from cardiovascular diseases, 38.16% (χ2 = 6.461, p = 0.011; OR = 1.69) compared to men in the control group, 26.8%. Moreover, a significantly higher genotype TT frequency has been shown in patients with coronary artery disease and myocardial infarction before age 50, which is 19.44% compared to the control group, which was 7.28% (χ2 = 9.55, p = 0.002). The TT frequency in individuals who lived a long time (4.39%) was the lowest and differed significantly from the group with coronary artery disease, which was 12.79% (χ2 = 8.07, p = 0.0045), and from the subgroup with coronary artery disease with myocardial infarction before age 50, which was 19.44% (χ2 = 14.49, p = 0.0001). Thus, our results indicate that the TT allele (Leu) of GPX1 Pro198→Leu (C > T) polymorphism is unfavorable for successful aging; it leads to predisposition to coronary artery disease, early myocardial infarction (before age 50), and early death (before age 55).

The objective of the present study was to improve visualization of a surgical wound during intervention on the brachiocephalic arteries and limb blood vessels. The atraumatic wound retractor was developed at our institution. Patients with the vascular pathology of the great arteries were included in the study. Comparative analysis of the results of the surgical treatment in patients operated with or without the use of the new device was performed. Duration of the surgical and early postoperative treatment stages, volume of postoperative blood loss, and the criteria of the great vessels' accessibility were compared. Application of the new device provided better visualization of the wound without prolongation of treatment stages and did not increase frequency of surgical complications. The atraumatic wound retractor is more convenient to use during the main surgical stage. It reduces surgical risks allowing better visualization of a surgical intervention object

In this study we genotyped polymorphism Thr12Ser (rs1937) in TFAM gene in two groups: patients with coronary artery disease and control group (people from Tomsk population). For genotyping was used restriction fragment length polymorphism. We have found significant higher genotype CC frequency in men with coronary artery disease — 4.52% compared with control men — 0.45% (χ 2 = 6.315; р = 0.043; OR = 10.45). Thus genotype CC is associated with coronary artery disease in men fromTomsk population.

The aim of the study was to develop a method of drainage tube placement for efficient fluid drainage from anterior mediastinum, pericardial and pleural cavities in children after cardiac surgery with or without bypass. From January 2008 to December 2010, a total of 158 children underwent cardiac surgery at the Institute for Cardiology of the Siberian Branch under the Russian Academy of Medical Sciences. Patients were divided into two groups. The first group consisted of 83 children with an average age of 4±2 months (from 10 days to 5 years of age) and an average weight of 4.9±2.5 kg (from 2 to 18 kg). In this group, the drainage tubes were inserted by the newly developed method. The second group included patients (n=75) with an average age of 5±2.3 months (from 18 days to 6 years of age) and an average weight of 5.6±2.4 kg (from 2.5 to 20 kg). In this group, the drainage tubes were placed by a standard method (4 drain tubes in patients with open pleural cavity and 2 drain tubes in cases when pleural space remained intact). The groups did not significantly differ by age, weight, disease severity, duration of major surgery stages, and postoperative blood loss. The developed method allowed to decrease the number of the drainage tubes in patients with both open pleural cavity (2 vs. 4 tubes) and intact pleural cavity (1 vs. 2 tubes). There were no serious, life threatening, complications in the early postoperative period. No patients in either group developed complications during the drainage tube removal; no inadequate fluid drainage events were documented. The study showed that the developed method of drainage tube insertion was efficient and reduced the number of the tubes twice without increasing the risk of early postoperative complications.

In this study we genotyped polymorphism Thr12Ser (rs1937) in TFAM gene in two groups: patients with coronary artery disease and control group (people from Tomsk population). For genotyping was used restriction fragment length polymorphism. We have found significant higher genotype CC frequency in men with coronary artery disease — 4.52% compared with control men — 0.45% (χ2 = 6.315; р = 0.043; OR = 10.45). Thus genotype CC is associated with coronary artery disease in men fromTomsk population.

1.1 Background Coronary artery disease takes a leading role in the etiology of chronic heart insufficiency in 60% of the cases (Belenkov et al., 2002; Kalon et al., 1993; Oganov & Maslennikova, 2000; Simonsen, 2003). According to the data of different authors patients with coronary artery disease experience development of ischemic cariomyopathy preconditioned by diffuse, significantly pronounced atherosclerosis of coronary arteries manifesting as cardiomegaly termed as “heart remodeling” and symptoms of congestive heart failure in 10-35% of the cases (Belenkov et al., 2002; Mareev, 2002). Postinfarction left ventricular remodeling is one of the most urgent challenges of modern cardiology and cardiac surgery. The heart remodeling process is a combination of changes in cavities’ form and volume and in mass of postinfarction heart myocardium in response to significant inadequate hemodynamic conditions of its functioning not connected with sarcomeres elongation caused by their prior overstretching (Jackson, 2002; Maisch, 1996; Rosenberg & Nepomnyashchih, 2003). Among the patients with different cardiomyopathies these are the ones with ischemic cardiomyopathy who have the most unfavorable prognosis, which makes the problem of ischemic heart failure much more significant (Bellenger, 2000; Buckberg, 2005; Frazier, 2000). Quite frequently the surgical intervention becomes the only treatment method for the patients with chronic heart insufficiency basing on deep changes of functional myocardium morphology. Different approaches to surgical ventricular reconstruction aimed at mechanical changes of the heart cavities sizes in combination with coronary artery bypass grafting (CABG) take the leading place in the complex treatment of this pathology. Nevertheless their outcomes show that in the late postoperative period repeated heart remodeling and CHF progressing i.e. return to the initial preoperative values of the heart cavities sizes and functional capacity of the heart takes place in a part of the operated patients (Batista, 1996; Dickstein, 1997; Dor, 1985; Gradinac, 1998; Menicanti & Di Donato,

Functional morphology of LV myocardium and RA appendage in 48 patients with ICMP was studied based on intraoperative biopsies analysis. In the early postoperative period (1 year) all the patients were divided into 2 groups. Group one was comprised of the patients with positive dynamics of EDI and LV EF, group two with negative ones. Retrospective analysis of echocardiographical values did not let to reveal predictors of postoperative remodeling of heart in both patients groups. On the contrary, drawing clinical-morphological parallels of negative dynamics in the early postoperative period showed that the presence of diffuse lymphocytic- macrophage inflammatory infiltration of myocardial stroma in combination with pronounced fibrosis, low values of trophic index (TI) (<0,015) and specific volume (SV) of atrial natriuretic peptide granules in atrial cardiomyocytes as well as high values of pericappilar diffusion zone (PDZ) (>1000 mcm) and Kernogan index (KI) (>1,6) of LV myocardium are morphological predictors of postoperative heart remodeling.