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.

The single ventricle is a group of congenital heart defects, which even today remains the most difficult for surgical treatment and further patient care. The survival rate of patients with this defect remains relatively low despite a number of staged surgical interventions. A large percentage of mortality is observed in the interstage period due to the development of heart failure, the treatment of which is an urgent problem because standard therapy does not meet expectations. This article reviews the world literature on the application of an innovative method of heart failure correction – stem cell therapy. The main types of stem cells, their sources, mechanism of action, methods of their delivery to myocardium are also considered.

Cardiac surgery of the aortic valve in pediatric patients is an urgent problem. Performing an open aortic commissurotomy and planar resection of the valves during the newborn period allows to obtain suboptimal results and postpone subsequent interventions indefinitely. With an unsatisfactory result of open aortic commissurotomy in children of the first years of life, the need to search for optimal surgical tactics arises. The presented article describes the technique of replacing the aortic root with a decellularized valve-containing allograft in a child of 14 months of life. A good immediate result of the operation is associated with the ability of the allograft to provide physiological hemodynamics in the aortic position. The advantages of the described technique are the reduction in the time and complexity of surgical intervention, the possibility of preserving own pulmonary valve, the probability of recellularization and the possibility of graft growth with the growth of the child. That is precisely why the presented technique should be considered as an alternative to Ross surgery, especially if there are anatomical contraindications to it.

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

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. Улучшить результаты кардиохирургических операций у новорожденных и детей раннего возраста путем выявления наиболее значимых факторов риска развития острого повреждения почек (ОПП), а также разработки и внедрения алгоритма его профилактики в послеоперационном периоде.

Цель. Исследовать течение интра- и послеоперационного периода у новорожденных и детей раннего возраста после кардиохирургических операций с применением модифицированной методики комбинированной кристаллоидно-кровяной холодовой кардиоплегии и системы доставки с уменьшенным объемом заполнения.