Objective. To evaluate the effectiveness of epicardial bipolar radiofrequency ablation (RFA) of pulmonary vein ostia (PV) in comparison with its being combined with amiodarone administration for post-CABG atrial fibrillation (AF) prevention.Methods. A single-centre, prospective randomized study (PULVAB), including 96 CAD patients with no history of AF, was conducted between January 2015 and December 2018. Group 1 (control; n=34) had standard CABG alone. Group 2 (n=29) received RFA of PV as an adjunct to CABG for prevention of postoperative AF (POAF). Group 3 patients (n=33) had RFA at the time of CABG and were given amiodarone. Allocation was concealed using sequentiallynumbered opaque envelopes. The efficacy and safety of RFA concomitant with CABG were assessed, as both performed independently and combined with amiodarone administration, as well as intra-and postoperative course.Results. No differences were seen in operation length (p=0.937), cardiopulmonary bypass (CPB) or the aorta clamping times (р=0.377 and p=0.072, respectively). The study groups (CABG, CABG-RFA, CABG-RFA-amiodarone) did not differ statistically in the number of shunts placed - 3.17±0.61, 3.10±0.51 and 2.94±0,6 (p=0,121). No significant difference was noted in RFA duration between Groups 2 and 3 - 11.7±3.7 and 11.4±6.3 min, respectively (p=0,834).AF was found to occur most commonly at postoperative days two or four. The isolated CABG surgery group patients developed POAF most often of all (32,4%). The incidence of POAF was lower after RFA concomitant to CABG - 20.7% (р=0,29). A significant difference was identified in POAF incidence between Groups 1 and 3- 32.4% and 6.1%, respectively (p = 0.0065). Differences between Groups 2 and 3 proved not to be statistically significant (р= 0,086). Sinus rhythm in most of those who had developed arrhythmias was restored by pharmacological cardioversion except for three patients (one in each group). At discharge, 97.1% , 96.7% and 97% of the subjects in Groups 1, 2 and 3, respectively, exhibited sinus rhythm (p>0,05).There was no in-hospital mortality in any of the groups. Neither were there any wound complications, reoperations, perioperative myocardial infarction or cerebral circulatory disorders observed. No difference was revealed in the severity and frequency of renal or respiratory failure. The mechanical lung ventilation time and duration of stay in the ICU in the isolated CABG group were shown to be increased as compared with the CABG-RFA and CABG-RFA-amiodarone groups (p<0.05).Conclusion. The evidence from the pilot study (PULVAB) suggests that bipolar ablation of PV does not significantly complicate CABG, while being combined with amiodarone administration for prevention of rhythm disorders it significantly reduces the incidence of POAF. The in-hospital incidence of POAF tended to decrease, which was not statistically significant, though. Evaluating the efficacy of RFA concomitant with CABG, as performed independently, invites further investigation with more data analysis.

An analysis of the immune status in 53 patients that underwent coronary artery bypass grafting under cardiopulmonary bypass was carried out in the preoperative period and on day 1 and 7 after the surgical intervention. Significant changes in innate and adaptive immunity were revealed. In the first case, they were expressed as an inflammatory process developed throughout the postoperative period; it was confirmed with an increase in leukocytes, total and stab granulocytes, monocytes, oxidative stress of phagocytes, CD64+ and CD40+ granulocytes, endogenous intoxication with the developed significant deficiency in CD4+ monocytes, and regulatory NK cells; while immediately after the surgery, it was confirmed by IgG and IgM levels.Some changes in adaptive immunity manifested through its activation, confirmed by an increased CD4+, CD11b+, HLA-DR+, and CD4+CD25+lymphocyte content, together with a deficiency noted in total lymphocytes and CD8+ lymphocytes.

We present here a case of successful staged treatment of a patient with para-aortic abscess that arose 5 years after thoracic endovascular aortic repair because of thoracic aortic aneurysm. After stabilization of the patient's condition by intensive antibiotic therapy we performed left-subclavian extra-thoracic debranching as the first stage of the surgical treatment. In 2 weeks via median sternotomy and on-pump we removed the infected endograft and performed extraanatomical ascending-to-descending aortic bypass with good postoperative result.

Presented herein is a review of publications of foreign authors on the problem of infectious complications after endoprosthetic repair of the thoracic aorta. The problem discussed is of current importance, however in the Russian literature it is covered insufficiently. The article contains the data on frequency, terms and possible causes of the development of complications, also discussing the problems of diagnosis. The authors demonstrate extreme danger of infection of an aortic stent graft, difficulty of early diagnosis and mostly unsatisfactory therapeutic outcomes. Also noted are possible ways of prevention of complications and aimed at improving the results of this extremely severe patient cohort.

В статье проанализированы результаты наблюдения двух больных ревматическим митральным стенозом через 14 и 22 года после первичной катетерной баллонной митральной вальвулопалстики (КБМВ). В ходе вторичной госпитализации одному из них выполнено чрескожное коронарное вмешательство по поводу ишемической болезни сердца, второму повторная КБМВ в связи с развившимся рестенозом левого атриовентрикулярного отверстия. Приводится анализ литературных источников, относящихся к данным наблюдениям, с обсуждением показаний к малоинвазивному вмешательству и факторов, влияющих на его эффективность. У первого пациента в результате первичной КБМВ площадь митрального отверстия (МО) увеличилась с 1,4 до 4,2 см2. Поводом для повторных госпитализаций стала ишемическая болезнь сердца и необходимость эндоваскулярного вмешательства на коронарных артериях. При контрольном обследовании через 22 года после первичной КБМВ трансмитральный пиковый градиент давления 14 мм рт. ст., средний 4 мм рт. ст., площадь МО 1,9 см2. У второго пациента в результате первичной КБМВ митральное отверстие увеличилось от 0,68 см2 до 1,6 см2. Пациент повторно обследован через 14 лет. Диагностирован митральный рестеноз площадь МО 1,35 см2. Выполнена повторная КБМВ. Достигнуто увеличение МО до 2,51 см2 со снижением среднего градиента диастолического давления на МК с 12,29 до 2,9 мм рт. ст. При контрольной ЭхоКГ через 4 года после повторной КБМВ площадь МО 2,4 см2, средний градиент давления на МК 3,4 мм рт. ст., митральная регургитация I степени. Давление в легочной артерии 26 мм рт. ст. Показано, что в случае оптимального результата первичной КБМВ удовлетворительное состояние отверстия митрального клапана и подвижность створок могут сохраняться более 20 лет после чрескожного вмешательства. Катетерная баллонная митральная вальвулопалстика малоинвазивный и эффективный метод лечения митрального стеноза, позволяющий при правильной оценке анатомических изменений клапана получить у отдельных пациентов положительный результат, который может сохраняться более 20 лет. После КБМВ необходим ЭхоКГ контроль каждые 12 года для диагностики рестеноза и других осложнений и своевременного направления больного на повторное хирургическое вмешательство. При возникновении митрального рестеноза возможно повторное проведение КБМВ с хорошим результатом.

Presented herein is a clinical case report concerning successful surgical management of a rare variety of a primary tumour of the heart, i. e., a capillary haemangioma of the left atrium, simulating by the contours and localization a myxoma. The final diagnosis was verified only by histological examination. The authors describe difficulties of diagnosis of the disease involved, underlying the necessity of plastic correction for restoration of the normal anatomical configuration of the heart. This is followed by a review of the literature, reflecting a possible course of the disease, problems of diagnosis, and therapeutic policy.

Presented herein is a description of a rare complication, i.e. caecal volvulus, after heart surgery. This case report illustrates difficulty of diagnosis of abdominal organs complications after artificial circulation and necessity of active surgical policy.

Presented herein is a case report concerning tumorous thrombosis of the inferior vena cava and right atrium, which is rather an uncommon but severe complication of primary hepatic cancer. The purpose of the article is to demonstrate successful surgical management of locally disseminated hepatic carcinoma complicated by tumorous thrombosis of the inferior vena cava and portal vein, as well as thrombosis of the right atrium. The patient was subjected to dextral hemihepatectomy with thrombectomy from the right portal vein, resection of the right cupola of the diaphragm, marginal resection of the lower lobe of the right lung, thrombectomy from the inferior vena cava and right atrium. The outcome of our case report, as well as literature data suggest that in case of resectability of hepatic tumour complicated by thrombosis of major vessels and even the heart, surgical intervention is justified if there is a possibility to completely remove thrombotic masses along with the primary tumour.

A clinical case report is given of the successful surgical treatment of the right atrial thrombosis in a 43 year old male patient with chronic atrial fibrillation, in whom permanent pacemaker was implanted due to symptomatic pauses.

At the Department of Heart Surgery of the A. V. Vishnevsky Institute of Surgery in seven patients with limited physical abilities and having to ambulate on crutches for osteosynthesis of the sternum after cardiosurgical interventions we used Ti-Ni fixating cramps with self-regulating compression. This technique provided reliable fixation of the sternum even in the early postoperative period in patients with elevated loading on the shoulder gridle. On day 2-3 after the surgical intervention all patients began to observe the standard motor regimen, i.e., ambulation on crutches. The possibility of early activation in the initially severe cohort of patients with multifocal atherosclerosis and accompanying diseases was one of the factors of an uneventful course of the postoperative period and rapid rehabilitation. Neither sternal instability nor infectious complications during the in-hospital period were observed.

Sternal fixation with nickelide titanium staples with shape memory effect is considered to be a novel method of wound closure after cardiac operations. The study includes data of 140 patients and is devoted to the preliminary assessment of the use of the mentioned fixators with self-regulating compression. Osteosynthesis proved to be completely effective in 136 (97,1%) patients. The use of nitinol staples allows not only a secure sternal fixation with minimal risk of underlying structures' trauma, but decreases time of postoperative patients' rehabilitation after the major cardiac surgery.

The aim of the study was to assess the use of multispiral computed tomographic coronarography (MSCT-CG) in comparison with conventional coronary angiography. Overall 62 patients aged 45-72 years were examined, the MSCT-CG was conducted in 38 patients. The sensitivity of MSCT-CG was 92%, the specificity - 91,2%, in comparison with the CAG. The prognostic value of negative test was 95,7%, the prognostic value of positive test was 84%, overall accuracy was counted up to 91,5%. Though, the MSCT-CG showed certain overestimation in calculating the stenosis degree and, thus, false positive results, in cases with calcined atherosclerotic plaques. Main advantages of MSCT-CG were: non-invasiveness, possibility of vessel lumen, arterial wall and structure of the plaque assessment.

Presented herein is a case of successful repair of thoracic aortic aneurysm by endograft in a female patient 21 years after replacement of the descending aorta for coarctation. During scheduled examination the patient was found to have aneurysm of proximal anastomosis. Additional examination was followed by the stenting of the thoracic aorta using endograft manufactured by the "GORE" Company (USA). The immediate results were classified as good: aneurysm was not opacified, the patency of the vessels of the aortic arch was well preserved. According to the data of check examination carried out 5 months after operation, no graft dislocation was marked, aneurysm was not detectable. The given case demonstrates low-invasive endovascular intervention permitting the avoidance of complicated and traumatic open regrafting of the aorta and attainment of beneficial short- and long-term treatment results.