Relevance. In recent years, concepts for assessing the quality of life have been developed. According to the WHO definition, quality of life is a person's perception of his position in life, culture and value system, it is associated with his goals, expectations, standards and concerns. Approximately three people out of every thousand have pulmonary hypertension for various reasons. This can lead to decreased exercise tolerance, quality of life, increased hospital admissions, and early death. An objective assessment of the quality of life of such patients will help achieve better clinical outcomes for patients and develop new treatments. Purpose of the study is to assessment of changes in the quality of life of patients with mitral valve disease associated with atrial fibrillation and high pulmonary hypertension (systolic blood pressure over 40 mmHg) during the first 24 months after radiofrequency denervation of the pulmonary arteries according to the SF-36 and MLHFQ questionnaires. Materials and Methods. The general population of patients (n = 202) with mitral heart disease, concomitant atrial fibrillation and high pulmonary hypertension was divided into several groups according to the complexity of surgical treatment: patients of the 1st group (n = 62) underwent only surgical correction of the mitral valve pathology (repair or replacement); patients of the 2nd group (n = 89) – surgical correction of the mitral valve pathology, as well as the Maze IV procedure using the AtriCure© bipolar ablator; patients of the 3rd group (n = 51) received complex surgical treatment by correcting mitral valvular pathology, performing the Maze IV procedure, as well as using radiofrequency denervation of the pulmonary arteries. The quality of life was assessed over several periods: initially, 6 months later, 1 and 2 years after surgical treatment. The scores were also converted to physical health component scores and mental health component scores. Results. The initial data of patients from different subgroups according to the criteria of the SF-36 questionnaire were comparable with each other. The indicators of the physical component and the psychological component of SF-36 characterize the 3rd group of patients with a lower level of quality of life in terms of the physical component, although no significant intergroup differences were found. Quality of life indicators after 6 months show positive changes in patients of all study groups without significant intergroup differences. Based on the results of 12 months, the greatest dynamics of the parameters of the questionnaire in terms of physical and mental components was observed in the 3rd group of patients. After 24 months, there is a significant advantage in changes in the indicators of patients of the 3rd group for all categories of the questionnaire. The target level after 6 months in the 3rd group was 100%, in the 2nd and 1st – 85.3% and 40.7%, respectively, maintaining differences up to 24 months. Conclusions. The use of a circular radiofrequency pulmonary artery denervation procedure is associated with a significant improvement in health status in assessing the quality of life of patients who have not undergone correction of pulmonary hypertension.

Цель. Создание анатомической модели сердца человека с реалистичной топографией магистральных сосудистых структур для отработки технологии эндоваскулярной и «открытой» хирургической процедуры циркулярной денервации ствола и устьев легочных артерий (pulmonary artery denervation – PADN). Материалы и методы. 3D-модели сердца могут использоваться для создания пространственного представления о топографии структур сердца и отработки хирургических манипуляций сердечно-сосудистыми хирургами и интервенционными кардиологами. Авторами разработан симулятор сердца и магистральных венозных сосудов человека. Модель создавалась по данным, полученным с помощью компьютерной томографии сердца пациента с гипертрофической кардиомиопатией и легочной гипертензией (ЛГ). С помощью симулятора была смоделирована операция PADN. Топографическое расположение ствола и бифуркации легочной артерии (ЛА), эластичные и прозрачные стенки сосудов позволили осуществить «открытую» процедуру денервации ЛА с применением зажима-аблятора. Эндоваскулярная технология выполнения PADN была отработана на симуляторе сердца в режиме флуороскопического контроля в условиях рентген-операционной. Радиочастотная абляция выполнялась в условиях погружения симулятора сердца в водно-солевой раствор, имитирующий естественную проводимость крови и тканей организма человека, точность и длительность аппликаций радиочастотного воздействия контролировалась навигационным модулем системы Carto и отображалась соответственно на анатомической карте ЛА в режиме реального времени. Результаты. Создана 3D-модель сердца, позволяющая отрабатывать процедуру PADN как открытым способом, так и эндоваскулярно. В результате обучения хирургической операции PADN на симуляторе время ее выполнения сократилось с 12,2±2,5 мин. до 5,5±1,5 мин. Благодаря отработке эндоваскулярного метода на анатомической модели, время выполнения процедуры под контролем флуороскопии сократилось с 37,2±6,7 мин. до 18,1±1,8 мин. Время выполнения процедуры в условиях навигационного картирования сократилось с 28,3±2,2 мин. до 15,5±3,0 мин. Заключение. Предложенная авторами анатомическая модель сердца CorView позволила отработать как хирургический, так и эндоваскулярный способы проведения PADN. Последний выполнялся как под визуальным, так и под флуороскопическим контролем. Исследование показало, что даже однократное выполнение манипуляции на модели сердца приводило к снижению затрачиваемого на выполнение процедуры времени, что в совокупности демонстрирует эффективность данного симулятора для обучения операции PADN. Purpose. To develop an anatomic heart model with realistic major vessels’ topography for practicing of endovascular and "open" surgical procedures for circular denervation of the trunk and orifices pulmonary arteries (Pulmonary artery denervation – PADN). Materials and methods. 3D heart models can be used by cardiac surgeons and interventional cardiologists to create a spatial representation of heart structures’ topography and practice surgical manipulations. The authors have developed a human heart and major vessels simulator. The model was created based on data obtained using computed tomography of the heart of a patient with hypertrophic cardiomyopathy and pulmonary hypertension. PADN procedure was performed with the help of the simulator. The topographic location of the trunk and bifurcation of the pulmonary artery, elastic and transparent vessel walls made it possible to carry out an "open" surgical PADN using an ablator clamp. Endovascular PADN was worked out with the help of simulator with the fluoroscopic control in an x-ray operation rooms. Radiofrequency ablation was performed in a water-salt solution simulating the natural conductivity of blood and tissues of the human body. The accuracy and duration of applications of radiofrequency exposure was controlled by the navigation module of the "Carto" system and displayed accordingly on the anatomical map of the pulmonary artery in real time. Results. A 3D model of the heart has been created. It allows practicing the PADN procedure both in an open way and endovascular way. As a result of PADN surgical operation training on a simulator, its execution time was reduced from 12.2±2.5 min to 5.5±1.5 min. The time of the endovascular PADN procedure under the control of fluoroscopy was reduced from 37.2±6.7 minutes to 18.1±1.8 minutes due to training with the heart model. The procedure execution time in the conditions of navigation mapping decreased from 28.3±2.2 min. to 15.5±3.0 min. Conclusion. The anatomical heart model CorView makes it possible to work out both surgical and endovascular methods of PADN. The latter was performed under both visual and fluoroscopic control. The study has shown, that even a single PADN training on a heart model has led to a decrease in the time spent on the procedure, which demonstrates the effectiveness of this simulator for teaching PADN procedure.

The aim of the study. To assess the influence of radiofrequency circumferential exposure modes on the morphological parameters of the pulmonary artery tissues in animal experiment (pigs).Material and methods. In the experiments, we used outbred pigs divided into 3 groups (4 animals in each). The first experimental group included 188 histological samples of the pulmonary arteries (PA) after radiofrequency circumferential exposure on the PA using an ablator clamp. Two lines of exposure on the PA and two lines of exposure on each PA mouth were performed. Ablation was performed until the target level of tissue impedance between the ablator branches corresponding to the values at transmural damage was reached. The second experimental group included 162 histological samples of the PA after circumferential denervation of pulmonary trunk and both PA mouths. Ablation was completed upon reaching 50 % impedance level relative to the impedance values at transmural damage. The third group (control) included 55 histological samples of PA without radiofrequency exposure. The material obtained was studied using light microscopy, hematoxylin and eosin and van Gieson’s staining, and also by impregnation with silver salts according to S. Ramón y Cajal.Conclusions. Morphological criteria for irreversible destruction of nerve fibers and ganglia of the pulmonary trunk adventitial layer and for PA bifurcation were obtained when using two studied ablation modes. Circumferential PA denervation using subthreshold power of radiofrequency exposure made it possible to avoid irreversible damage to the nerve endings and ganglia of the PA intimal layer and thus to preserve physiological neuroreflectory regulation of the PA and the entire pulmonary circulation. Turning off the cascade of pathological reflexes eliminates the factor of the progression of pulmonary hypertension associated with an increase in peripheral resistance of the pulmonary arterioles precapillary link.

ЦЕЛЬ ИССЛЕДОВАНИЯ Описать случаи COVID-19-ассоциированного миокардиального повреждения, проанализировать его патогенез, подходы к диагностике и лечению. МАТЕРИАЛ И МЕТОДЫ Все пациенты в приведенных клинических примерах миокардита при новой коронавирусной инфекции имели жизнеугрожающие нарушения ритма, в том числе в виде фибрилляции желудочков с клинической смертью и последующими реанимационными мероприятиями, синкопальных состояний на фоне брадиаритмии в двух случаях, а также фибрилляции предсердий с тромбозом ушка правого предсердия. РЕЗУЛЬТАТЫ Во всех случаях специализированная медицинская помощь позволила спасти жизнь пациентам, а соответствующее медикаментозное лечение — восстановить синусовый ритм и компенсировать явления сердечной недостаточности. Стоит указать, что нарушения ритма у представленных пациентов имели преходящий характер и полностью нивелировались при контрольном осмотре через 3 мес. Специфическую медикаментозную терапию проводили согласно общепринятым подходам, и лишь в 1 случае было принято решение об имплантации кардиовертера-дефибриллятора — пациентке с внезапно развившейся фибрилляцией желудочков — с последующими успешными реанимационными мероприятиями. ВЫВОД Миокардит при новой коронавирусной инфекции может сопровождаться жизнеугрожающими нарушениями ритма с возможным летальным исходом в отсутствие соответствующей медицинской помощи. Особенностями миокардита, ассоциированного с инфекцией SARS-CoV-2, могут быть отсроченный характер клинических проявлений или молниеносное течение с резким развитием острой сердечной недостаточности, аритмий, а также преходящий характер повреждения со сравнительно быстрым восстановлением на фоне лечения. Необходимы дальнейшее динамическое наблюдение за пациентами с перенесенными воспалительными поражениями миокарда, анализ других случаев миокардита при COVID-19, формирование полноценной выборки для последующего детального анализа.

Среди всех заболеваний сердечно-сосудистой системы тромбоэмболия легочной артерии (ТЭЛА) признана одной из наиболее распространенных патологий, диагностируемой у 0,5—2 человек на 1000 населения. Частота ТЭЛА среди лиц старше 75 лет достигает 10 случаев на 1000 населения в год. В статье описано успешное комбинированное хирургическое лечение массивной ТЭЛА высокого риска, включавшее открытую тромбэмболэктомию и радиочастотную циркулярную денервацию ствола и устьев легочных артерий. Описанный случай комплексного лечения показывает его высокую эффективность в уменьшении степени легочной гипертензии, ремоделирования правых отделов сердца, а также нивелирования явлений сердечной недостаточности.

Aim To study the effectiveness of nebulized surfactant therapy as a part of a multimodality treatment of severe and extremely severe COVID-19 viral pneumonia with concomitant cardiovascular diseases (CVDs).Material and methods This retrospective controlled study analyzed a multimodality treatment of 38 patients with severe and extremely severe COVID-19 viral pneumonia and concomitant CVDs who were administered nebulized surfactant for correction of acute respiratory distress syndrome (ARDS). The control group consisted of 105 patients with severe and extremely severe novel coronavirus infection with concomitant CVDs who were not administered surfactant as a part of the multimodality therapy.Results Administration of nebulized surfactant as a part of the multimodality treatment in patients with COVID-19 allowed alleviating the severity of respiratory insufficiency (р<0.001), which decreased the death rate of patients with severe and extremely severe COVID-19 and undoubtedly demonstrated the effectiveness of this medicine. The timely multimodality therapy, including nebulized surfactant, improves the course of the disease. Thus, the absence of a possibility for administering nebulized surfactant for more than 4 days was associated with fatal outcomes (р=0.045).Conclusion Administration of nebulized surfactant as a part of the multimodality treatment of severe and extremely severe COVID-19 and concomitant CVDs increases the survival (р<0.001) and reduces the mortality by 46 %. The risk factors of an unfavorable outcome of this disease include an age older than 65 (р=0.020), a positive polymerase chain reaction test (р=0.037), a ferritin concentration at baseline >600 mg /ml (р<0.001), and a surfactant treatment duration < 4 days (р=0.045). Further study of the efficacy of nebulized surfactants as a part of the multimodality therapy is required and should include randomized clinical trials with a large number of patients and the development of distinct criteria for the treatment of ARDS.

Research objective. Evaluation of the influence of various modes of radiofrequency circular exposure on immunohistochemical parameters of pulmonary trunk tissues in the experiment on animals (pigs).Materials and methods. The experiments were made on outbred pigs - 12 animals. During the experiment 3 groups were formed, 4 animals in each. The first experimental group comprised 188 histological samples of pulmonary artery (PA) after circular radiofrequency exposure on PA using an ablator clamp. Two lines of ablation impact on the pulmonary trunk and two lines of impact on each mouth of PA were performed with the formation of 6 ablation lines. The ablation was performed until the target level of tissue impedance between the ablator jaws corresponding to the values for transmural damage was reached. The second experimental group comprised 162 histological samples of PA after circular denervation of the pulmonary trunk and mouths of both PAs according to the described method. The ablation was completed upon reaching 50% of the impedance level relative to the impedance values for transmural damage. The third group - control, without circular radiofrequency exposure (55 histological samples). The obtained material was studied by light microscopy, typical general pathological processes were recorded with the help of staining with hematoxylin and eosin. The changes in the connective tissue (fibrous, muscle) were found with the help of Van Gieson staining. The thermoablative effect degree was assessed using semi-quantitative analysis of pathological processes (Olpred stain intensity assessment). In order to assess the degree of impact on the nerve fibers of different layers of PA, an immunohistochemical study (IHC) of the samples was carried out in all three groups. The expression of S-100 protein and synaptophysin was evaluated.Conclusion. Average optic density of the samples of the ablation groups was significantly lower than in the control group (p <0.001). When calculating the specific area of the connective tissue disconnection, its greater value was determined in "the edge zones" of the sections in both experimental groups, which is due to mechanical compression of tissues, compaction of their structure and, as a result, an increase in capacitive characteristics as a current collector and conductor for radio frequency rate ( p = 0.056). IHC analysis of preparations made it possible to qualitatively assess the damage to the trunks and endings of peripheral nerve fibers in the adventitial and intimal layers of PA section after radiofrequency exposure in the experimental groups.In the first experimental group the active expression of synaptophysin and protein S-100 of sympathetic nerve fibers was absent in the adventitial and, as a rule, in the intimal layers. In the preparations obtained from PA of animals of the second experimental group, the activity of synaptophysin in synaptic fibers and expression of protein S-100 of endothelium vasa vasorum were also not determined in the adventitial layer. At the same time, the positive reaction of protein S-100 and synaptophysin was observed in the nerve endings and ganglia in the intimal layer of PA preparations of the second group. The circular denervation of PA using subthreshold rate of radiofrequency exposure corresponding to 50% of the impedance of PA tissues from the corresponding impedance values in case of transmural damage, made it possible to avoid irreversible damage to the nerve endings and ganglia of PA intimal layer, thereby preserving the physiological neuroreflex regulation of PA and entire pulmonary circulation. Thus, the cascade of pathological reflexes, factors of pulmonary hypertension advance connected with the spasm of precapillary mouth of the pulmonary arterioles is turned off.

The aim of the study was to perform a histological assessment of the effectiveness of radiofrequency exposure for circular denervation of the pulmonary artery in patients with secondary high pulmonary hypertension. Materials and Methods The study was carried out on the autopsy material derived from non-operated patients. Three groups were formed. The experimental group included the material (207 histological samples) from the patients with chronic high pulmonary hypertension arising on the background of mitral heart disease. The samples of this group were exposed to circular radiofrequency ablation. In the comparison group, we used autopsy material (24 samples) obtained from the patients with high pulmonary hypertension. The control group included material (35 samples) from the patients without pulmonary hypertension who died from causes not associated with cardiovascular diseases. The samples of the comparison and control groups were not exposed to radiofrequency. Visual evaluation of the damage to the vascular wall was performed after hematoxylin and eosin staining, according to Van Gieson. Damage to the nerve plexuses was evaluated after their impregnation by silver salts. To assess the degree of damage to the vascular wall on the stained sections, a scoring method of semi-quantitative analysis of the observed pathological processes (fibrinoid necrosis, metachromasia, karyorrhexis, karyolysis, fibrinoid and mucoid swelling, lipid presence) was used. Silver salt impregnation allowed visualizing damage to the reticular fibers, trunks and endings of peripheral nerve fibers. Results The mean optical density of the ablation group was statistically significantly lower than in the comparison and control groups (p<0.001). The mean specific area of tissue dissociation was higher in the “marginal zones” of the ablated sections, under pronounced mechanical compression in these areas. The difference in the mean areas of the argentophilic samples of the ablation and comparison and control groups was expressed in a lower percentage of argentophilic fibrous structures (p<0.05). At the same time, the highest concentration of argentophilic structures was observed in the comparison group, which points to a bigger content of nerve fiber structures in the patients with high pulmonary hypertension. Conclusion The results of the histological study demonstrated the feasibility of radiofrequency ablation of the pulmonary arteries in patients with high-grade secondary pulmonary hypertension. Radiofrequency denervation leads to the destruction of the sympathetic ganglia in the adventitial layer of the pulmonary arteries, which are responsible for the spasm of the precapillary bed of the pulmonary circulation, which promotes vasodilation, an increase in the vascular bed, and, as a result, a reduction in pulmonary hypertension.

Background: In multi-vessel atherosclerotic coronary artery disease, coronary artery bypass grafting remains the method of choice and allows for the best possible revascularization and maximal continuity of the results. Conduit functioning to a large extent depends on the coronary artery (CA) diameter and on the severity of atheromatous involvement and anatomic abnormalities of its walls. However, there is no consensus on what minimal diameter and extent of CA lesions could provide robust long-term results of bypass surgery. Consequently, surgical strategy for bypass grafting in diffuse coronary involvement and small vessel diameters has not been clearly defned.Aim: To perform a comparative analysis of the bypass grafts functioning depending on CA anatomy and methods of revascularization.Materials and methods: The study included 98 patients, who, irrespective of their clinical condition, had a control coronary angiography (CAG) with shuntography (SHG) between 6 months to 5 years after they had undergone direct myocardial revascularization by coronary artery bypass grafting. In total, 215 anastomoses were assessed. The bypassed CAs were divided into two groups according to their diameters and into two subgroups depending on the severity of the coronary vasculature involvement. When bypassing an artery with diffuse involvement, angioplastic anastomoses were done in 52.5% of the cases. Long-term graft functioning was assessed by shuntography.Results: Conduit functioning after bypassing of CA >1.5 mm in diameter and with local CA narrowing did not depend on the graft type and was 95.1% for the internal thoracic artery (ITA) grafts and 90.1% for the great saphenous vein (GSV) grafts. With diffuse lesions, these values decreased to 68.4% for ITA and 69.1% for GSV (р < 0.05). Long-term revascularization results for coronary arteries with a diameter of ≤ 1.5 mm were signifcantly lower for all types of conduits: with local stenosis, 78.6% ITA and 68.4% GSV grafts were patent, whereas in diffuse coronary bed involvement, 50 and 33.3%, respectively (р < 0.05). After placement of an angioplastic anastomosis to the CA with diffuse lesions, 79.3% of the ITA and 69.2% of the GSV grafts were functioning, whereas after the use of the standard technique, such were 55.6 and 40%, respectively (р < 0.05).Conclusion: Bypass grafting of CA with local lesions and > 1.5 mm in diameter, the graft type has not signifcant impact on its long-term functioning. In diffuse CA involvement, angioplastic anastomoses should be used.

Background: In multi-vessel atherosclerotic coronary artery disease, coronary artery bypass grafting remains the method of choice and allows for the best possible revascularization and maximal continuity of the results. Conduit functioning to a large extent depends on the coronary artery (CA) diameter and on the severity of atheromatous involvement and anatomic abnormalities of its walls. However, there is no consensus on what minimal diameter and extent of CA lesions could provide robust long-term results of bypass surgery. Consequently, surgical strategy for bypass grafting in diffuse coronary involvement and small vessel diameters has not been clearly defned. Aim: To perform a comparative analysis of the bypass grafts functioning depending on CA anatomy and methods of revascularization. Materials and methods: The study included 98 patients, who, irrespective of their clinical condition, had a control coronary angiography (CAG) with shuntography (SHG) between 6 months to 5 years after they had undergone direct myocardial revascularization by coronary artery bypass grafting. In total, 215 anastomoses were assessed. The bypassed CAs were divided into two groups according to their diameters and into two subgroups depending on the severity of the coronary vasculature involvement. When bypassing an artery with diffuse involvement, angioplastic anastomoses were done in 52.5% of the cases. Long-term graft functioning was assessed by shuntography. Results: Conduit functioning after bypassing of CA >1.5 mm in diameter and with local CA narrowing did not depend on the graft type and was 95.1% for the internal thoracic artery (ITA) grafts and 90.1% for the great saphenous vein (GSV) grafts. With diffuse lesions, these values decreased to 68.4% for ITA and 69.1% for GSV (р 1.5 mm in diameter, the graft type has not signifcant impact on its long-term functioning. In diffuse CA involvement, angioplastic anastomoses should be used.

Aortocoronary bypass grafting is a reliable and effective method of treatment for ischemic heart disease. Despite a well-defined spectrum of the used grafts, many tactic issues of aortocoronary bypass grafting remain unsolved. There is a lack of a unified classification of lesions in the native coronary vasculature; this prevents from establishing objective indications to direct myocardial revascularization and excludes any further improvement of surgical results. The strategy to bypass the maximal number of occluded coronary arteries irrespective on the patient’s age and the degree of coronary pathology could not be considered the most optimal in the absence of objective methods of post-operative diagnosis.