Background Sepsis is associated with dysregulation of procoagulant, anticoagulant, and fibrinolytic pathways. Aims To compare the measurements of coagulation activation, clot formation, stabilization, and lysis between rotational thromboelastometry (ROTEM) and standard coagulation tests (SCTs) on patients with early sepsis (SP) and healthy controls (HC). Methods This observational study included 30 SP and 30 HC. At study inclusion, SCTs and ROTEM analyses were conducted. A modified ROTEM with exogenous tPA was used to investigate fibrinolysis resistance. Results SP had longer prothrombin time, higher fibrinogen levels and lower platelet count compared to HC. On ROTEM, clotting initiation was longer in SP than in HC but median clotting time maintained within reference ranges. SP had higher maximum velocity of clot formation, clot firmness, elasticity, and platelet component than HC. Clot lysis indices (CLI) were higher in EXTEM and APTEM (without and with added tPA) in SP compared to HC. The difference in CLI between APTEM and EXTEM was lower for both native and tPA-spiked samples in SP compared with HC. Conclusions While SCTs suggest SP are hypocoagulable, VET revealed normal coagulation initiation in more than 80% of SP. Compared to HC, SP had increased clot propagation, firmness and elasticity, and decreased platelet-mediated clot retraction and lysis. In sepsis, VET provide more comprehensive information about hemostatic changes than SCTs.

Objective: To identify risk factors for unfavorable outcome in newborns operated on for congenital pathology of the aortic arch. Materials and methods of research: Data from the results of treatment of 79 patients with congenital pathology of the aortic arch were analyzed and the effectiveness of the therapy was assessed. All patients underwent an examination with the study of obstetric and gynecological history, life history and illness, with an assessment of existing complaints after birth and their changes over time. The obtained clinical, echocardiographic and laboratory parameters were analyzed and compared. The following surgical methods were used for surgical correction of congenital pathology of the aortic arch: resectionof coarctation with plastic surgery of the aortic arch with native tissues, resection of aortic coarctation with the imposition of an extended end-to-end anastomosis, hybrid version. The results of the performed operations and complications were evaluated. Results: Factors such as the development of small ejection syndrome before surgery, the emergency nature of the intervention, and reduced left ventricular ejection fraction (less than 35%), increased heart rate, had a significant association with an unfavorable outcome. Signs of moderate significance that were associated with an unfavorable outcome of surgical treatment were the following clinical and hemodynamic preoperative parameters: increased respiratory rate, reduction of diastolic pressure in the lower extremities and reduction LV EDC. Anthropometric data and reduction of systolic pressure in the lower extremities had a weak connection with mortality. Conclusions: The most significant factors of unfavorable outcome before surgery in newborns with congenital pathology of the aortic arch, those operated with the use of artificial blood circulation are: increased heart rate, decreased LV EF. Low anthropometric indicators of the child (weight, height, body surface area) are also have an impact on the outcome. Index of the end-diastolic size of the left ventricle as a factor reflecting his anatomically determined ability to produce a systemic blood flow it is important when choosing an option for surgical.

Purpose of the study: to evaluate the results of using a protocol for the prevention of bleeding in cardiac surgical patients with pathology of the aortic valve and aortic root to optimize tactics for preventing bleeding.Materials and methods: the first group included 185 cardiac surgical patients with pathology of the aortic valve and aortic root, who underwent surgery on the aortic valve, during the treatment of which a bleeding prevention protocol was applied. The second group consisted of 237 cardiac surgical patients with pathology of the aortic valve and aortic root who underwent surgery on the aortic valve, during whose treatment a bleeding prevention protocol was not used. Data were collected on the management tactics of the preoperative, intraoperative and postoperative periods, such as:– anamnestic data, results of echocardiographic examination, laboratory data: preoperative level of hemoglobin, fibrinogen;– intraoperative level of hemoglobin, fibrinogen, dose of transfused cryoprecipitate, thromboelastometry data, intraoperative blood loss;– drainage discharge during 1 day of the postoperative period, frequency of bleeding, resternotomy, and deaths.Study results: In the second group of patients, the number of cases of intraoperative hypofibrinogenemia was almost 5 times greater than in group 1; out of 237 patients, 62 (26.2%) had a critically low level of fibrinogen. Fibrinogen hemodilution coagulopathy (intraoperative hypofibrinogenemia) was associated with resternotomy: Х2 = 63.375, p = 0, df = 1, HR = 11.686, 95% CI: 5.61-24.33. Complications associated with bleeding were more common in the second group of patients – 44 (18,6%) cases out of 237 operated patients, Х2 = 10,6; р = 0,001, Х2Yates = 9,693; р = 0,002, RR = 2,453, 95% CI: 1,39-4,34. In the first group, there were only 14 (7,6%) cases of complications associated with bleeding out of 185 operated patients. Significant differences were also found in the frequency of resternotomies: in group 1 – 3 (1.6%) cases, in group 2 – 28 (11.8%) Х2 = 15,859; р = 0 (Х2Yates = 14,397, р = 0; р (F) = 0; RR = 7,286, 95% CI: 2,25-23,59). Of 185 operations in group 1, only 3 cases of resternotomy were observed, which corresponds to 1.6% of all patients in group 1. Upon repeated inspection of the surgical wound, surgical sources of bleeding were identified in all 3 cases. Of the 237 operations in group 2, there were 28 cases of repeated revision of the surgical wound. Of the 28 resternotomies, only in 15 cases a surgical source of bleeding was identified, therefore, the remaining 13 cases of bleeding occurred due to coagulopathy. In group 1, there were no cases of resternotomy performed due to hypocoagulable bleeding. A statistically significant association was found between preoperative anemia and resternotomy (x2, p = 0.039, RR = 2.03, 95% CI: 1-4).Conclusions:1) intraoperative hypofibrinogenemia increases the risk of resternotomy 11 times (x2 = 63.375, p = 0, df = 1, RR = 11.686, 95% CI: 5.61-24.33);2) preoperative anemia doubles the risk of resternotomy (p = 0,039, ОR = 2.03, 95% CI: 1-4);3) when using the bleeding prevention protocol, intraoperative hypofibrinogenemia occurs 5 times less often;4) when using the bleeding prevention protocol, complications associated with bleeding are 2.5 times less common: Х2 = 10,6; р = 0,001, Х2Yates = 9,693; р = 0,002, RR = 2,453, 95% CI: 1,39-4,34;5) when using a bleeding prevention protocol, the risk of resternotomy is reduced by 7 times: Х2 = 15,859; р = 0 (Х2Yates = 14,397, р = 0; р (F) = 0; RR = 7,286, 95% CI: 2,25-23,59).

The OBJECTIVE was to estimate the left ventricular stroke volume calculated using the Reuleaux triangle formula, and compare with the parameters obtained from measurements in the left ventricle outflow tract. METHODS AND MATERIALS. A prospective cross-sectional study of the dimensions of the left ventricular outflow tract (LVOT), the aortic valve, and the velocity-time integral (VTI) was carried out, followed by calculation of the left ventricular stroke volume in the LVOT and aortic valve in 36 patients receiving renal replacement therapy. RESULTS. The sizes of anatomical structures were determined in 36 patients. The average value of the LVOT area was calculated – 3.8 cm2, the average value of the area of the aortic valve (AV) opening was 2.8 cm2, the AV area according to the circle formula – 3.14 cm2, the AV area according to the Reuleaux triangle formula – 2.8 cm2. The mean value of the VTI in the LVOT was 21 cm; the VTI on the AV was 26.9 cm. The stroke volume (SV) in the LVOT was 70.85 ml, the SV on the AV by the area of the AV opening was 70.9 ml, the SV on the AV according to the circle formula – 76.5 ml, SV for AV according to the Reuleaux triangle formula – 68.72 ml. In a comparative analysis of the results of mathematical calculations, it was revealed that, in comparison with the SV in LVOT, the discrepancy between the results was more than 30 % when using the circle formula (χ2=4.1, p=0.04), in comparison with the Reuleaux triangle formula (13.8 % versus 4.1 %, respectively). CONCLUSION. Parameters of the left ventricular stroke volume calculated with the Reuleaux triangle formula matches to the reference values selected in the study, calculated for the left ventricular outflow tract.

Scimitar syndrome (SS) is an extremely rare congenital heart disease (CHD). There are two main clinical forms of the disorder: adult and infant. The usual course of the infantile form is characterized by an unfavorable prognosis. According to some reports the mortality could reach 100% without surgical treatment. The results of surgical treatment in this age group are currently unsatisfactory. Authors represent a clinical case of SS in a 4.5 months old male patient, who was in moderate and relatively stable condition upon admission. The severity of the patient’s condition was mainly caused by the progressive cardiac and respiratory failure. The diagnoses of CHD, SS were established during the clinical and instrumental examination: partial anomalous drainage of the right pulmonary veins into the inferior vena cava, hypoplasia of the right branch of the pulmonary artery, hypoplasia of the right lung, sequestration of the right lung, dextrocardia, secondary atrial septal defect (ASD), therefore, the indications for surgical correction were also identified. Ligation of the systemic pulmonary anastomoses, reimplantation of the right pulmonary vein collector into the left atrium, suturing of ASD under cardiopulmonary bypass and hypothermic circulatory arrest had been performed. The postoperative period was difficult: the patient was supported with an artificial lung ventilation for long time. He was transferred to the general somatic department on the 28th day after the surgical intervention, which was then followed by a favorable long-term result. Conclusion: Authors represent a successful case of radical surgical treatment of a child aged 4.5 months old with a rare CHD using the non-standard technique for reimplantation of the pulmonary vein collector as well as the features of intraoperative support.

Цель. Определить вероятность возникновения абдоминальных осложнений после операций с искусственным кровообращением (ИК) при развитии системной гипоперфузии в раннем послеоперационном периоде и определить возможности повышения безопасности проведения кардиохирургических операций.

BACKGROUND:In sepsis, fibrinolysis resistance correlates with worse outcomes. Practically, rotational thromboelastometry (ROTEM) is used to report residual clot amplitude relative to maximum amplitude at specified times after clot formation clot lysis indices (CLIs). However, healthy individuals can exhibit similar CLIs, thus making it challenging to solely diagnose the low fibrinolytic state. Furthermore, CLI does not include the kinetics of clot formation, which can affect overall fibrinolysis. Therefore, a more nuanced analysis, such as time to attain maximal clot amplitude after reaching maximal clot formation velocity (t-AUCi), is needed to better identify fibrinolysis resistance in sepsis. OBJECTIVES:To evaluate the correlation between the degree of fibrinolytic activation and t-AUCi in healthy or septic individuals. METHODS:Whole blood (n = 60) from septic or healthy donors was analyzed using tissue factor-activated (EXTEM) and nonactivated (NATEM) ROTEM assays. Lysis was initiated with tissue-type plasminogen activator, and CLI and t-AUCi were calculated. Standard coagulation tests and plasma fibrinolysis markers (D-dimer, plasmin-α2-antiplasmin complex, plasminogen activator inhibitor type 1, and plasminogen) were also measured. RESULTS:t-AUCi values decreased with increasing fibrinolytic activity and correlated positively with CLI for different degrees of clot lysis both in EXTEM and NATEM. t-AUCi cutoff value of 1962.0 seconds in EXTEM predicted low fibrinolytic activity with 81.8% sensitivity and 83.7% specificity. In addition, t-AUCi is not influenced by clot retraction. CONCLUSION:Whole-blood point-of-care ROTEM analyses with t-AUCi offers a more rapid and parametric evaluation of fibrinolytic potential compared with CLI, which can be used for a more rapid and accurate diagnosis of fibrinolysis resistance in sepsis.

Cirrhotic cardiomyopathy (CCM) is defined as cardiac dysfunction in patients with liver cirrhosis without preexisting cardiac disease. According to the definition established by the World Congress of Gasteroenterology in 2005, the diagnosis of CCM includes criteria reflecting systolic dysfunction, impaired diastolic relaxation, and electrophysiological disturbances. Because of minimal or even absent clinical symptoms and echocardiographic signs at rest according to the 2005 criteria, CCM diagnosis is often missed or delayed in most clinically stable cirrhotic patients. However, cardiac dysfunction progresses in time and contributes to the pathogenesis of hepatorenal syndrome and increased morbidity and mortality after liver transplantation, surgery, or other invasive procedures in cirrhotic patients. Therefore, a comprehensive cardiovascular assessment using newer techniques for echocardiographic evaluation of systolic and diastolic function, allowing the diagnosis of CCM in the early stage of subclinical cardiovascular dysfunction, should be included in the screening process of liver transplant candidates and patients with cirrhosis in general. The present review aims to summarize the most important pathophysiological aspects of CCM, the usefulness of contemporary cardiovascular imaging techniques and parameters in the diagnosis of CCM, the current therapeutic options, and the importance of early diagnosis of cardiovascular impairment in cirrhotic patients.

Наумов А.Б., Хубулава Г.Г., Марченко С.П., Кулемин Е.С., Фогт П.Р., Купатадзе Д.Д., Терешенко О.Ю., Пилюгов Н.Г., Селиверстова А.А., Черномордова А.В., Андреев М.С., Марютина Т.А., Невмержицкая О.В., Чупаева О.Ю., Азарова И.Н., Кальной П.С., Сазонов А.Б., Волков А.М. Механическая дисперсия и деформация миокарда: эхокардиографические предикторы послеоперационной острой сердечной недостаточности у пациентов первого года жизни в аспекте сравнения вариантов кардиоплегии. Детские болезни сердца и сосудов. 2021; 18 (1): 33–44. DOI: 10.24022/1810-0686-2021-18-1-33-44 HTML

Lidocaine may be beneficial when added in solutions for the preservation of vascular grafts or solid organs as it has anti-inflammatory, endothelial protective, and antithrombotic effects. However, the mechanisms of lidocaine-induced changes in hemostasis were not elucidated until now. The aim of the study was to examine the effect of increasing concentrations of lidocaine on coagulation parameters and blood-clotting kinetics using velocity curves of clot formation assessed by rotational thromboelastometry. Ex-vivo blood coagulation using whole blood from healthy volunteers was studied with rotational thromboelastometry. For each volunteer, four assays were performed: saline control and samples with lidocaine end blood concentrations of 0.3, 0.6, and 0.9%. In this in-vitro study, whole blood from 15 healthy volunteers was used. Lidocaine concentration of 0.3% prolonged the initiation phase of clotting without significant differences in the propagation phase or clot stability and inhibited clot lysis compared with the control group. Higher lidocaine concentrations (0.6 and 0.9%) resulted in prolongation of both initiation and propagation phases and decreased clot firmness compared with the control group. Lysis was significantly increased only in the 0.6% lidocaine group compared with control. Although lidocaine concentration of 0.3% only delays coagulation initiation, the 0.6% concentration inhibits all phases of hemostasis and increases clot lysis compared with control. Higher lidocaine concentration results in very weak clot formation with very low lysis visible on thromboelastometry. More research is needed to explain the effects of lidocaine on clotting kinetics.

Objective. To assess the correlation between the hemodynamic characteristics of the left ventricle and geometric features of the aortic arch in the fetus.Methods. The study involved 31 fetuses from 29 to 34 weeks of gestation by echocardiography. The scientists assessed the morphogeometric characteristics of the left ventricle andaortic arch. They studied the following parameters: end-diastolic volume ofthe left ventricle (LVEDV), stroke volume of the leftventricle (LVSV), velocity-time integral of the flow through aortic valve (VTI AV), diameter of the aortic valve ring (AV), diameterof the aortic arch segment between brachiocephalic trunk and left carotid artery (dС). Results. The average gestational age was 31,9±1,4weeks (95% CI: 31,4–32,4 weeks). Average body weight 1899±377 g (95% CI: 1762–2038 g). LVEDV = 1,57±0,64 ml (95% CI: 1,3–1,8). LVSV = 1,3±0,45 ml (95% CI: 1,1–1,4 ml). AV 0,4±0,07 cm (95% CI: 0,39–0,44 cm). C segment of the aorticarc is 0,37±0,07 cm (95% CI: 0,035–0,040 cm). There was direct correlation between the variables used to calculate dC (Pearson correlation coefficient: LVEDV = 0,51; p=0,002; LVSV = 0,46; p=0,005; AV = 0,52, p=0,001). The diameter of the C segment of the aortic arch can be calculated using the following equations: dС= 0,76· LVSV +2,8 (95% CI LVSV 0,2–1,3 95% CI for constant2,1–3,6; Fisher’s criterion 7,6 р=0,01). dС= 0,59· LVEDV +2,8 (95% CI LVEDV 0,2–0,98; 95% CI for constant 2,2–3,5; Fisher’s criterion 10 р=0,004). dС= 0,59·AV+1,3 (95% CI AV 0,22–0,95; 95% CI for constant – 0,23–2,9; Fisher’s criterion 10,7;р=0,003).Conclusion. 1)hemodynamic characteristics of the left ventricle allow predicting the sizeof the aortic arch in fetuses from 29 to 34 weeks of gestation; 2)morphogeometric characteristics of the aortic arch are determined by the characteristics of the left ventricular stroke volume, end-diastolicvolume of the leftventricleand the sizeof the fibrous ring of the aortic valve.

Objective. To assess the correlation between the hemodynamic characteristics of the left ventricle and geometric features of the aortic arch in the fetus. Methods. The study involved 31 fetuses from 29 to 34 weeks of gestation by echocardiography. The scientists assessed the morphogeometric characteristics of the left ventricle andaortic arch. They studied the following parameters: end-diastolic volume ofthe left ventricle (LVEDV), stroke volume of the leftventricle (LVSV), velocity-time integral of the flow through aortic valve (VTI AV), diameter of the aortic valve ring (AV), diameterof the aortic arch segment between brachiocephalic trunk and left carotid artery (dС). Results. The average gestational age was 31,9±1,4weeks (95% CI: 31,4–32,4 weeks). Average body weight 1899±377 g (95% CI: 1762–2038 g). LVEDV = 1,57±0,64 ml (95% CI: 1,3–1,8). LVSV = 1,3±0,45 ml (95% CI: 1,1–1,4 ml). AV 0,4±0,07 cm (95% CI: 0,39–0,44 cm). C segment of the aorticarc is 0,37±0,07 cm (95% CI: 0,035–0,040 cm). There was direct correlation between the variables used to calculate dC (Pearson correlation coefficient: LVEDV = 0,51; p= 0,002; LVSV = 0,46; p= 0,005; AV = 0,52, p= 0,001). The diameter of the C segment of the aortic arch can be calculated using the following equations: dС= 0,76· LVSV +2,8 (95% CI LVSV 0,2–1,3 95% CI for constant2,1–3,6; Fisher’s criterion 7,6 р =0,01). dС= 0,59· LVEDV +2,8 (95% CI LVEDV 0,2–0,98; 95% CI for constant 2,2–3,5; Fisher’s criterion 10 р =0,004). dС= 0,59·AV+1,3 (95% CI AV 0,22–0,95; 95% CI for constant – 0,23–2,9; Fisher’s criterion 10,7; р =0,003). Conclusion. 1)hemodynamic characteristics of the left ventricle allow predicting the sizeof the aortic arch in fetuses from 29 to 34 weeks of gestation; 2)morphogeometric characteristics of the aortic arch are determined by the characteristics of the left ventricular stroke volume, end-diastolicvolume of the leftventricleand the sizeof the fibrous ring of the aortic valve.

Цель исследования. Сравнить отдаленные результаты транскатетерной и хирургической имплантации аортального клапана по уровню летальности, частоте и срокам развития осложнений.

Case series Patients: Female, 60-year-old . Male, 65-year-old . Male, 72-year-old Final Diagnosis: COVID-19 pneumonia . SARS-CoV-2 Symptoms: Dry coughing . dyspnoea . fever Medication: - Clinical Procedure: Hight-frequency percussion ventilation Specialty: Infectious Diseases Objective: Unusual clinical course Background: High-frequency percussive ventilation (HFPV) is a method that combines mechanical ventilation with high -frequency oscillatory ventilation. This report describes 3 cases of patients with severe COVID-19 pneumonia who received intermittent adjunctive treatment with HFPV at a single center without requiring admission to the Intensive Care Unit (ICU). Cases Reports: Case 1 was a 60-year-old woman admitted to the hospital 14 days after the onset of SARS-CoV-2 infection symptoms, and cases 2 and 3 were men aged 65 and 72 years who were admitted to the hospital 10 days after the onset of SARS-CoV-2 infection symptoms. All 3 patients presented with clinical deterioration accompanied by worsening lung lesions on computed tomography (CT) scans after 21 days from the onset of symptoms. SARS-CoV-2 infection was confirmed in all patients by real-time reverse transcription-polymerase chain reaction (RT-PCR) assay from nasal swabs. All 3 patients had impending respiratory failure when non-invasive intermittent HFPV therapy was initiated. After therapy, the patients had significant clinical improvement and visibly decreased lung lesions on followup CT scans performed 4-6 days later. Conclusions: The 3 cases described in this report showed that the use of intermittent adjunctive treatment with HFPV in patients with severe pneumonia due to infection with SARS-CoV-2 improved lung function and may have prevented clinical deterioration. However, recommendations on the use of intermittent HFPV as an adjunctive treatment in COVID-19 pneumonia requires large-scale controlled clinical studies. In the pandemic context, with a shortage of ICU beds, avoiding ICU admission by using adjunctive therapies on the ward is a useful option.