Aim. To study the in-hospital outcomes of patients with residual shunt (RS) through the occluder and identify predictors of its formation after endovascular patent foramen ovale (PFO) closure.Material and methods. We analyzed the data of 276 patients who underwent endovascular PFO closure for the period 2018-2023 at the Chazov National Medical Research Center. All patients underwent a scope of examinations that complied with clinical recommendations. RS in the postoperative period was assessed based on Transesophageal echocardiogram bubble study. Univariate regression analysis revealed RS predictors.Results. RS in the postoperative period was visualized in 50 patients, who, in terms of the incidence of in-hospital complications, were comparable to 226 patients without RS (p>0,05). Univariate regression analysis revealed the following indicators associated with postoperative RS: implantation of the Amplatzer PFO or Figulla Flex UNI occluder (odds ratio (OR) 8,87; 95% confidence interval (CI): 3,09-25,49), Chiari network (OR 8,26; 95% CI: 1,91-35,81), Olivares-Reyes class >3 interatrial septum aneurysm (OR 2,37; 95% CI: 1,27-4,43), as well as LAVi ≥34 ml/m2 (OR 4,01; 95% CI: 1,33-12,09) (p<0,05).Conclusion. The use of Amplatzer PFO or Figulla Flex UNI occluders, the presence of a Chiari network, signs of left atrium dilatation, and Olivares-Reyes class >3 aneurysm were significant RS predictors.

One of the known potential complications associated with endovascular closure of the patent foramen ovale (PFO) is de novo atrial fibrillation (AF).Aim. To assess the risk factors and incidence of de novo AF in patients who underwent endovascular PFO closure.Material and methods. The data of 276 patients who underwent endovascular PFO closure for the period from 2020 to 2023 at the Chazov National Medical Research Center of Cardiology were analyzed. All patients underwent examinations in accordance with clinical guidelines. De novo AF in the postoperative period was assessed by Holter monitoring, while 1, 6 and 12 months after the intervention — by electrocardiographic recording. Based on univariate regression analysis, risk factors associated with de novo AF were identified.Results. De novo AF in the postoperative period was registered in 2 patients. One month after the intervention, AF episodes were diagnosed in 6 patients. After 6 months, AF detected earlier persisted in 3 patients,and there were 3 new cases. Twelve months after the intervention, AF was recorded in 2 patients. According to regression analysis, the following parameters were associated with de novo AF: age ≥52,0 years (hazard ratio (HR) 6,22; 95% confidence interval (CI): 1,51-25,56), body mass index ≥28,07 kg/m2 (HR 8,48; 95% CI: 1,72-41,73), CHARGE-AF score ≥0,56 (HR 4,59; 95% CI: 1,12-18,82), left atrial size ≥4,00 cm (HR 19,56; 95% CI: 2,10-181,88), LAVi ≥34 ml/m2 (HR 45,67; 95% CI: 5,46-381,83) according to echocardiography.Conclusion. Echocardiographic signs of left atrial and left ventricular dilation were significantly associated with a high risk of de novo AF in the immediate and longterm periods after endovascular PFO closure.

Below is a case report of treatment of a patient with persistent tachysystolic atrial fibrillation (AF), chronic heart failure (CHF) with a moderately reduced left ventricular ejection fraction (EF) and patent foramen ovale (PFO) with an atrial septal aneurysm. A 58-year-old man (with body mass index of 27.8 kg/m2) with tachysystolic persistent AF (duration 3 months) was hospitalized due to an increase in CHF symptoms (CHF functional class according to NYHA is II-III). The patient had been constantly receiving therapy in accordance with current recommendations (angiotensin receptor blockers, diuretics, beta-blockers, amiodorone and rivaroxaban). Transthoracic echocardiography showed a moderate decrease in ejection fraction (EF) (41%), an increase in the left (47 mm) and right (51x74 mm) atria. The patient underwent AF radiofrequency catheter ablation (RFA) in the left atrium, which identified PFO. The final stage of RFA was performed by external electrical cardioversion with successful restoration of sinus rhythm. Four months after RFA, despite a stable sinus rhythm, the patient maintained a moderately reduced LV EF (44%) and dilatation of the left (44 mm) and right (43x65 mm) atria. Transesophageal echocardiography revealed an aneurysmally altered atrial septum and a positive bubble test with a large number of bubbles. In accordance with current recommendations, the patient had indications for primary prevention of stroke - endovascular occlusion of the PFO, which was performed. Three months after PFO closure, the patient discontinued diuretics, amiodarone, and rivaroxaban. Combined therapy in a patient with persistent AF, with a moderately reduced EF and verified PFO, which included pathogenetic therapy for CHF, prescription of antiarrhythmic drugs, RFA of the AF substrate, and interventional closure of the PFO, made it possible to effectively control sinus rhythm, significantly reduce the manifestations of CHF and provide primary prevention of embolic disorders.

The literature review is devoted to the pathophysiology and clinical picture of migraine, targets of therapy and drugs used, and the connection between the pathogenesis of migraine with aura and patent foramen ovale is discussed. The results of clinical studies show a positive effect of endovascular patent foramen ovale closure on the course of migraine in the form of a decrease in the intensity, frequency of attacks and the number of headache-free days, as well as in some cases complete relief of the disease. Further study of the topic is promising, but requires careful study design and long-term follow-up of patients.

Aim. To study the effect of endovascular closure of patent foramen ovale (PFO) on the severity of symptoms of migraine attacks in patients with migraine with a history of aura.Materials and Methods. We analyzed the data of 74 patients with migraine with a history of aura who underwent endovascular closure of the PFO for the period from 2018 to 2022 at the E.I. Chazov National Medical Research Center of Cardiology. All patients underwent examinations that complied with clinical recommendations. The presence of a history of migraine with aura was determined through a patient interview, previous hospital history, and was confirmed by a neurologist. The severity of migraine symptoms was assessed using the MIDAS (Migraine Disability Assessment) scale before occluder implantation and after 36,9 [22,7; 50,8] months the intervention as part of a telephone contact.Results. 49 patients before the intervention had pain syndrome assessed on the MIDAS scale <11 points, in 25 patients the MIDAS score was ≥11 points. The technical success of the intervention was 100%. In the long–term period, the average MIDAS score in the group of patients with baseline MIDAS <11 was 0.00 [0.00; 5.00] points, and in the group with baseline MIDAS ≥11 was 15.00 [14.00; 15.00] points (p<0,0001). After 36,9 [22,7; 50,8] months occluder implantation, the average MIDAS score decreased by 75.0% in both groups (p<0,0001). The number of patients in the group with an initial MIDAS ≥11 points decreased by 80.0% compared to baseline values (p<0,0001).Conclusion. Endovascular closure of the PFO in patients with migraine with a history of aura promotes significant regression of the pain syndrome.

Aim. To study 12-month dynamics of residual shunt (RS) closure after endovascular patent foramen ovale (PFO) closure.Material and methods. We analyzed the data of 80 patients who underwent endovascular PFO closure at the Chazov National Medical Research Center for Cardiovascular Diseases in the period 2018-2023. All patients underwent a full range of examinations in accordance with current clinical guidelines. The severity of RS immediately after occluder implantation, as well as after 1, 6 and 12 months post-intervention assessment was based on transesophageal echocardiogram bubble study at the control visit.Results. In the postoperative period, RS was visualized in 17,5% (n=14) of patients. Discharge was significant in 7,5% (n=6) of patients. One month after the intervention, residual significant discharge persisted in 10,0% (n=8) of patients. After 6 months, RS was visualized in 2,5% (n=2) of patients, and after 12 months, only in one patient (1,3%). The proportion of patients with RS 1 month after the intervention decreased to 42,9%, after 6 months to 85,7%, and after 12 months to 92,9% (p<0,05).Conclusion. Most patients with RS after endovascular intervention for PFO are characterized by complete endocardialization of the occluder and PFO closure within the first year.

The volume of the left atrium is one of the key factors associated with both the development of primary atrial fibrillation and its progression. Open atrial communication is considered as a factor predisposing to dilation and remodeling of the heart cavities. We present a clinical case of endovascular closure of an open oval window in a patient with a persistent form of AF, a moderately reduced left ventricular ejection fraction, who had previously undergone radiofrequency ablation, and persistent manifestations of heart failure. A 58-year-old patient was hospitalized in November 2019 with clinical manifestations of increasing heart failure. History: persistent form of atrial fibrillation with pronounced ventricular tachysystole. In April 2019, the patient underwent radiofrequency ablation, during which signs of open oval window were revealed. The initial left ventricular ejection fraction is 41%, the anterior–posterior left atrium size is 47 mm, the NT-proBNP level is 912 pg/m. In the subsequent period, steady sine waves were recorded.

The purpose of this guide is to assist cardiologists in the management of patients with chronic heart failure (CHF) in accordance with the available modern evidence base. This manual contains data on the diagnosis, treatment, and rehabilitation of patients with chronic heart failure and data on acute decompensation of heart failure.

Purpose of the study. To study the effect of prophylactic antibiotic therapy on the course of the postoperative period in patients undergoing endovascular closure of patent foramen ovale (PFO). Material and methods. The study included 276 patients who were submitted to endovascular closure of PFO. The follow-up duration was 12 months. Depending on prophylactic antibiotic therapy the patients were divided into 2 groups - those who did not receive and those who received prophylactic antibiotic therapy (115 and 161 patients, respectively). Results. Cephalosporins were prescribed to patients as prophylactic antibiotic therapy, and in the presence of allergic reactions they were replaced by glycopeptides. In total, patients received 1 to 2 drugs per prophylaxis course. Postoperative complications were present in 37 (22.98 %) patients who received prophylactic antibiotic therapy and 12 (10.43 %) who did not receive prophylaxis (p = 0.007). Access site complications were the most identified, but they were not inflammatory in nature. An elevation of body temperature over 37.1 °C was observed in 19 (11.80 %) patients receiving prophylactic antibiotic therapy compared to 5 (4.35 %) who did not receive prophylaxis (p = 0.03). Meanwhile, marked leukocytosis was absent in both groups. The duration of body temperature elevation did not differ between the groups. They also had a longer duration of hospitalization, 7.00 [6.00; 8.00] bed days, compared to 6.00 [4.00; 7.00]. Discussion. It has been suggested that hyperthermia may be associated with prophylactic administration of antibacterial drugs causing death of persistent microflora. In patients who did not receive prophylactic antibiotic therapy, their concentration was lower, which did not lead to an increase in body temperature. Since there are no indications on the necessity of prophylactic antibiotic therapy before endovascular closure of PFO in clinical recommendations, it is suggested to evaluate its appropriateness for each patient individually.

Disclaimer The EAC/NSHFMD Guidelines represent the views of the EAC and NSHFMD, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC and NSHFMD is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC/NSHFMD Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC/NSHFMD Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC/NSHFMD Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC/NSHFMD Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.Members of the Working Group confirmed the lack of financial support/ conflict of interest. In the event of a conflict of interest being reported, the member (s) of the Working Group was (were) excluded from the discussion of sections related to the area of conflict of interest.E.B. Wataman professor, Dr. of Sci. (Med.) (Moldova); E.K. Kurlyanskaya, Cand. of Sci. (Med.) (Belarus); A.M. Noruzbaeva professor (Kyrgyzstan); V.A. Azizov professor (Azerbaijan); Zelveyan P.A., Dr. of Sci. (Med.) (Armenia)

The paper describes three clinical cases of ischemic stroke (IS) in the presence of patent foramen ovale (PFO) in young women. The first patient has experienced two episodes of focal neurological deficit related to physical exercise. A cerebellar stroke focus was visualized by brain magnetic resonance imaging (MRI). During emotional stress, the second patient having migraine with aura developed transient weakness in the right extremities, and a stroke focus was verified in the left parietal lobe. The third patient suddenly had facial asymmetry and left arm numbness after awakening in the morning. The patient underwent intravenous thrombolysis; control brain MRI revealed a right parietal lobe stroke. Standard examinations of all the patients established no cause of IS. Transcranial Doppler with a bubble test and subsequent transesophageal echocardiography revealed PFO that was regarded as clinically significant. Endovascular occlusion was successfully accomplished in all the patients. The paper discusses the problems of secondary prevention of PFO-related stroke and proposes an algorithm for the diagnosis and treatment of this disease.

Background Despite the enormous benefits of radial access, this route is associated with a risk of radial artery occlusion (RAO). Objective We compared the incidence of RAO in patients undergoing transradial coronary angiography and intervention after short versus prolonged hemostasis protocol. Also we assessed the efficacy of rescue 1-hour ipsilateral ulnar artery compression if RAO was observed after hemostasis. Material and Methods. Patients referred for elective transradial coronary procedures were eligible. After 6 F radial sheath removal, patients were randomized to short (3 hours) (n = 495) or prolonged (8 hours) (n = 503) hemostasis and a simple bandage was placed over the puncture site. After hemostasis was completed, oximetry plethysmography was used to assess the patency of the radial artery. Results One thousand patients were randomized. Baseline characteristics were similar between both groups with average age 61.4 ± 9.4 years (71% male) and PCI performed on half of the patients. The RAO rate immediately after hemostasis was 3.2% in the short hemostasis group and 10.1% in the prolonged group (p < 0.001). Rescue recanalization was successful only in the short group in 56.2% (11/19); at hospital discharge, RAO rates were 1.4% in the short group and 10.1% in the prolonged group (p < 0.001). Conclusion Shorter hemostasis was associated with significantly less RAO compared to prolonged hemostasis. Rescue radial artery recanalization was effective in > 50%, but only in the short hemostasis group.

Patent foramen ovale (PFO) is detectable in more than 25% of the adult population and is generally clinically insignificant. However, it can be a cause of paradoxical embolism in some cases. Randomized trials indicate that endovascular PFO closure in patients with a history of cryptogenic stroke is an effective method for the secondary prevention of catastrophic brain damage.Objective: to study the safety and efficiency of endovascular PFO closure in young patients with a history of cryptogenic stroke.Patients and methods. Sixty-two patients, including (22 males and 40 females) women, underwent percutaneous PFO closure in May 2018 to March 2020. The patients' mean age was 37.4±7.6 years. The inclusion criteria were a prior cryptogenic ischemic stroke lasting less than 12 months and PFO with a high risk for paradoxical embolism (PFO concurrent with atrial septal aneurysm or hypermobility; PFO, ≥2 mm size; the presence of the Chiari network and/or the Eustachian valve).Results and discussion. The technical success of the operation was achieved in all cases. In 50 (80.6%) patients, the right chamber of the heart was completely isolated from the left one in the first 3 months. During the first year, the atria were also completely isolated in 10 (16.1%) patients. A left-to-right shunt persisted in 2 (3.2%) patents 12 months later. Two patients were found to have main procedural complications: one had perioperative atrial fibrillation and the other had pseudoaneurysm formation at the puncture site.Conclusion. Endovascular PFO closure is a safe and effective operation for the secondary prevention of recurrent ischemic stroke. In our study, blood shunting through the PFO was stopped in 96.6% of patients at less than 6 months after surgery, which suggests that there is a rapid and effective reduction in the risk of paradoxical embolism.