Selective transcatheter thrombolysis (STT) in patients with pulmonary embolism (PE) with an intermediatehigh risk of 30-day mortality is an option for rapid lung reperfusion with a decrease in right ventricular (RV) afterload, which largely determines the prognosis of patients. Objective . Comparison of the efficacy of STT using reduced doses of alteplase and routine conservative treatment of patients with PE with an intermediate-high risk of 30-day mortality using a retrospective analysis of the data from Almazov National Medical Research Centre. Design and methods . The retrospective single-center study included 45 patients (18 men (40 %) and 27 women (60 %)) admitted to the anaesthesiology and resuscitation department of the Almazov National Medical Research Centre from January 1, 2021 to May 1, 2022 with the confirmed diagnosis of acute PE. Intermediate-high risk patients (22 people (57,9 %)) were divided into two groups according to the treatment strategy: the group receiving standard anticoagulant therapy (n = 15 (68,2 %)) and the group with STT by alteplase at a total dose of 50 mg (n = 7 (31,8 %)). In order to assess the effectiveness of treatment, the main laboratory and instrumental indicators were compared based on data from the medical information system. Results . Baseline clinical characteristics of the compared groups did not differ. Systolic pressure in the pulmonary artery (SPPA) in the transcatheter treatment group decreased from 59 [50; 82] to 35 [30; 65] mmHg; in the conservative treatment group: from 65 [50; 70] to 52 [40; 59] mmHg. In the selective thrombolysis group, there was a significant trend for a greater decrease SPPA compared to the anticoagulant therapy group: –25 [–29; –3] versus — 10 [–23; –6] mmHg, р = 0,047. There was a significant change in the level of leukocytes and platelets in the group of transcatheter treatment versus anticoagulant therapy: –5,0 [6,1; 4,1] × 10 9 /l vs –2,8 [4,3; 1,8] × 10 9 /l (p = 0,017) and 130 [32; 181] × 10 12 /l vs 31 [2; 56] × 10 12 /l (р = 0,044). There were no significant differences in the change in the RV size between the groups. The groups did not differ in the total number of hemorrhagic complications. When bleeding was divided by severity (according to the TIMI classification), moderate bleeding was more common in the selective thrombolysis group (2 cases versus 0 with a conservative approach, p = 0,014). There were no differences in the duration of treatment in the anaesthesiology and resuscitation department and the terms of inpatient treatment. Conclusions . A single center retrospective study demonstrated the high quality of approaches to the diagnosis and treatment of PE in terms of current guidelines. The STT with reduced doses of alteplase was associated with a more significant decrease SPPA and normalization of hemogram parameters when compared to the standard treatment approach. At the same time, selective thrombolysis was associated with a higher risk of hemorrhagic complications. A prospective study of the efficacy and safety of prolonged STT with the selection of the dose of thrombolytic in patients with PE with an intermediate-high risk of 30-day mortality is needed.

Мананников Д.А., Горбатых А.В., Сойнов И.А., Прохорихин А.А., Зубарев Д.Д., Аверкин И.И., Иванилова А.А., Чернявский М.А.. Эндоваскулярное лечение ребёнка раннего возраста с конкурентным легочным кровотоком. Детские болезни сердца и сосудов. 2023; 20 (1): 39–44. DOI: 10.24022/1810-0686-2023-20-1-39-44 HTML

Aim. To demonstrate the TAVISCORE program designed to stratify the risk of complications after aortic valve (AV) interventions in patients with reduced ejection fraction.Material and methods. For the period from 2015-2022 at the Almazov Federal North-West Medical Research Center, 128 interventions on AV were performed for aortic stenosis in patients with reduced ejection fraction as follows: 61 — surgical AV replacement (SAVR), 67 — transcatheter aortic valve implantation (TAVI). To create an interactive calculator TAVISCORE (link for free download: https://drive.google.com/file/d/1a3s2MK6Tpk0cIQ_aMB7xe63upEwJsJOh/view?usp=sharing) all patients were combined into one group. For each factor present in the patient, the prognostic coefficient, its contribution to the likelihood of an event in the long-term follow-up period (death, myocardial infarction, stroke), was calculated. The next step, based on the calculations obtained and using the Python 3.10.6 language, was the creation of the TAVISCORE program.Results. The TAVISCORE was created for the personalized choice of tactics for the treatment of patients with aortic stenosis. It contains 54 risk factors and makes it possible to determine probability of cardiac or non-cardiac events in the long-term follow-up period after SAVR and TAVI. Thus, a tactic with lower probability of a complication can be chosen as optimal in this particular case. Retrospective use of the TAVISCORE after surgery can identify patients at high risk of complications, which will allow them to be selected for more thorough management and more frequent screening.Conclusion. The TAVISCORE can be used by a multidisciplinary consensus to select the treatment tactics and stratify the risk of complications after different AV replacement variants in patients with a reduced ejection fraction. Further prospective testing of this program is required.

Pulmonary hypertension (PH) affects about 1 % of the world’s population, with a three-year survival rate of 70 %. The pathogenetic causes of death are the remodeling of the pulmonary arteries (PA) and the development of right ventricular heart failure (HF), therefore, the main goal of the treatment of pulmonary arterial hypertension (PAH) is to relieve the right chambers of the heart by reducing the pressure in the PA. For this purpose, it is possible to prescribe specific drug therapy to the patient, and in severe cases, surgical intervention — lung transplantation or cardiopulmonary organ complex. However, recently, due to the development and improvement of endovascular methods of treatment of PH, palliative endovascular interventions on the atrial septum are increasingly used, which have undergone significant changes over the past decades. This article presents a literature review of all currently available palliative X-ray endovascular methods for the treatment of PAH, as well as PH developed in patients with left ventricular HF. Objective. The purpose of the review is to assess the role of X-ray endovascular intervention in the treatment of PH.

Pulmonary embolism (PE) associated with malignant neoplasms is a frequent complication of the oncological process and leads to a decrease in survival and quality of life of these patients. In some cases, pulmonary embolism can become the debut of a current active oncological disease, which requires increased cancer alertness in patients with PE without clear predisposing factors, especially in cancer risk groups. The article demonstrates a clinical case of an individualized approach to choosing an interventional strategy in a comorbid patient with high-risk PE. The tactics of active oncological screening made it possible to confirm a pulmonary embolism against the background of current prostate cancer.

Aortic stenosis is one of the most common valvular heart defects that occurs in patients with oncology after radiation therapy and requires surgical treatment. However, this group of patients has a higher risk of intra- and postoperative complications, and therefore the most optimal method of surgical treatment of aortic stenosis in such a cohort of patients is transcatheter aortic valve implan­tation (TAVI). Brief description . Forty-six-year old woman entered the Almazov National Medi­cal Research Center with a clinical picture of severe aortic stenosis. At a young age, the patient was diagnosed with lymphogranulomatosis, or Hodgkin’s disease, for which radiation therapy was performed, which was complicated in the long term by valvular pathology. After a thorough examination, a high intraoperative risk for the patient was determined by the cardiac team and endovascular treatment of severe aortic stenosis was performed. The postoperative period was complicated by the development of complete atrioventricular block, which caused the implantation of a permanent dual-chamber pacemaker. Discussion . The presented case is an example of successful surgical treatment of aortic stenosis associated with previous radiation therapy for Hodgkin’s disease in a patient. Conclusion . Endovascular aortic valve implantation is a promising approach to the treatment of patients with post-radiation aortic stenosis, since it is associated with unfavorable anatomical and clinical risk factors for surgical valve replacement. Despite their younger age, these patients represent a category of higher surgical risk. Therefore, additional attention should be paid to the planning of the procedure and the prevention of the main TAVI risks.

Background. Diagnosis of acute myocardial infarction (AMI) in pubertal patients is a diagnostic challenge, as individuals of such a young age usually do not have traditional risk factors for coronary heart disease (CHD) and, as a result, are at increased risk of misdiagnosis. Objective. To describe a clinical case of AMI in a 16-yearold patient against the background of complete well-being. Design and methods. A 16-year-old patient, against the background of complete well-being, developed pressing pains in the chest, which stopped on their own after a few hours. During hospitalization, in addition to an increase in the level of troponin, the results of other laboratory and instrumental studies did not confirm the version of AMI, as a result of which other cardiac and non-cardiac causes of the development of chest pain formed the basis of the diagnostic search. This was the reason for the delayed diagnosis and endovascular treatment of thrombotic occlusion of the right coronary artery, and, as a result, the formation of an area of persistent hypokinesia of the lower parts of the left ventricle. Further search for possible causes of AMI, including the analysis of genetically associated conditions, did not yield results. Results. This publication describes a case of acute inferior myocardial infarction with ST segment elevation and thrombotic occlusion of the right coronary artery in a 16-year-old adolescent and the impact of an irrational diagnostic process on long-term prognosis. Conclusion. The presented clinical case demonstrates the importance of including the diagnosis of AMI in the process of differential diagnosis of acute chest pain, even in adolescent patients.

In recent decades, the multidisciplinary development of medicine has led to an improved understanding of the molecular mechanisms of the development of oncological diseases. The idea of malignant neoplasms as heterogeneous objects containing cells with different genetic backgrounds made it possible to explain the selective effectiveness of one type of treatment for a certain part of the tumor cells in a patient. Numerous targeted therapies have formed the cornerstone in the treatment of various malignancies, alone or in combination with other treatments such as chemotherapy, radiation therapy, surgery and interventional radiology.Interventional oncology covers both diagnostics and treatment. Its methods are minimally invasive and highly specific to the patient. Currently, personalized procedures are actively develop and allow to detect cancer cells, selectively contact and treat them. Another important problems is to evaluate drug delivery and uptake in order to make adjustments to the treatment based on the received data from the procedures and, ultimately, to predict the response. Here we will consider such interventional oncological procedures and innovative methods that are under development as transarterial chemoembolization (TACE), oily transarterial chemoembolization (cTACE), catheter intra-arterial delivery of nanoparticles etc. Thus, interventional oncology has unique opportunities for selective impact on tumor lesions not only for diagnostic purposes, but also for a wide range of minimally invasive percutaneous treatments.

Горбатых А.В., Мананников Д.А., Аверкин И.И., Зубарев Д.Д., Махсудов З.Ж., Морозов А.А., Чернявский М.А. Клинический случай успешного паллиативного эндоваскулярного лечения пациента с единственным желудочком сердца, атрезией митрального клапана, интактной межпредсердной перегородкой и персистирующей кардинальной веной. Детские болезни сердца и сосудов. 2022; 19 (4): 346–53. DOI: 10.24022/ 1810-0686-2022-19-4-346-353 HTML

We described a case report of transcatheter aortic valve replacement in conditions when the aortic stenosis anatomy does not make it possible to perform retrograde left ventricular catheterization, and the patient’s condition severity does not allow performing transapical or surgical aortic valve replacement. The presented technique of interatrial septal puncture with antegrade passage of the guidewire through the mitral and aortic valves and the venoarterial looping demonstrates an elegant way to solve this clinical situation, and can be adopted by specialists performing transcatheter interventions in severe aortic stenosis.

We report the successful endovascular correction of the migration of a transcatheter aortic valve prosthesis in the left ventricle outflow tract (LVOT). A 72-old man was underwent transcatheter aortic valve implantation (TAVI) at Almazov National Medical Research Centre for severe aortic stenosis. During the procedure, the self-expanding prosthesis dislocated 10–12 mm into the LVOT. The frame was optimised with the use of a balloon catheter, and aortic regurgitation I-II degree was achieved. However, on day 17 of hospitalisation, acute heart failure with episodes of asystole occurred as a result of severe paravalvular regurgitation; cardiopulmonary resuscitation was necessary. The prosthesis malpositioning was corrected by traction with endovascular snare devices. The patient was stable during the postprocedural period and discharged on day 31. Dislocation of self-expanding prostheses into the LVOT is a complication specific to TAVI that may quickly aggravate a patient’s condition; therefore, correction of valve malpositioning should be performed as soon as possible. The case reported here in an illustration of successful endovascular correction of dislocation performed with the snare traction technique. This bail-out approach can be used by interventional cardiologists in similar situations. Received 27 May 2021. Revised 29 July 2021. Accepted 30 July 2021. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsLiterature review: A.D. Gorovaya, D.D. Zubarev, A.A. ProkhorikhinDrafting the article: A.D. Gorovaya, V.S. Krasnov, A.A. ProkhorikhinCritical revision of the article: A.D. Gorovaya, M.A. Chernyavskiy, A.A. ProkhorikhinSurgical treatment: D.D. Zubarev, V.S. Krasnov, A.A. ProkhorikhinFinal approval of the version to be published: A.D. Gorovaya, D.D. Zubarev, V.S. Krasnov, M.A. Chernyavskiy, A.A. Prokhorikhin

This review presents an analysis of recent publications on the principles of diagnosis and management of patients with chronic thromboembolic pulmonary hypertension (CTEPH). The authors emphasize the importance of patient's operability assessment regarding the possibility of performing pulmonary thrombendarterectomy - a radical treatment option due to complete post-thrombotic material removal from the branches of the pulmonary artery. In the case of an inoperable type of CTEPH, such a method of transcatheter treatment as step-by-step balloon angioplasty of the pulmonary artery (BPA) is proposed. The article clearly outlines the principles of selection, patient training and techniques for BPA. The authors demonstrated their own patented method of the peripheral vascular bed visualization in the case of recanalization of chronic occlusions, which increases the safety of this intervention. Particular attention is paid to hybrid approaches using a soluble guanylate cyclase stimulator, riociguate in combination with BPA for high risk CTEPH patients. The review presents the data of the post hoc analysis of the CHEST-1 study and the data of real clinical practice of the use of riociguat in combination with the endovascular method of treatment on the example of the leading expert groups in Europe, who demonstrated in their studies the positive effect of riociguat on the hemodynamic parameters and the frequency of perioperative complications.

Aim. The paper demonstrates the interim analysis of efficacy and safety after everolimus-eluting bioresorbable vascular scaffold (BVS) Absorb implantation in “real-world patients” with coronary artery disease.Methods. A cohort of 500 consecutive patients who underwent percutaneous coronary intervention for stable chest pain or acute coronary syndrome with implantation of at least one BVS (Absorb, Abbott Vascular) and followed up by telephone interview and review of medical charts were included in a singlecenter, prospective, all-comers, first in Russia registry. The primary endpoint, target vessel failure, defined as the combination of cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularization and secondary endpoints, MACCE (composite of cardiovascular death, myocardial infarction, coronary artery bypass surgery, target vessel revascularization, stroke) and stent thrombosis, were assessed during 6-month follow-up.Results. A total of 500 patients with coronary artery disease (CAD) (stable CAD 54.4%, acute coronary syndrome 45.6%) and different amount of affected vessels (1 vessel CAD 40.8%, n = 204; 2-vessel CAD 32.8%, n = 164; 3-vessel CAD 26.4%, n = 132) received 664 scaffolds and 55 stents in 603 stenoses. Procedure success, defined as a residual stenosis less than 30% and TIMI 3 flow in target vessel at the end of procedure, was observed in 98.51% (n = 594). At the moment of 6-month follow-up 4.2% (n = 24) of patients were lost to contact. After 6 months, incidence of target vessel failure and MACCE was 4.2% (n = 21) and 5% (n = 25). The cumulative rate of definite/probable scaffold thrombosis was 1.6% (n = 8).Conclusion. The interim analysis of Gabi-R: Russia registry, the largest trial of BVS Absorb implantation in routine clinical practice, showed high procedural success and low incidence of adverse events during follow-up. However, a tendency to high incidence of scaffold thrombosis compared to drug-eluting stents can be observed. Considering the long-term results of randomized trials retrospective registries, safety in terms of BVS routine use is of big concern. Longterm 24-month data regarding safety endpoints are required to test the afore-mentioned suggestion. Received 5 January 2019. Revised 28 March 2019. Accepted 29 March 2019.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.

This review article presents results of studies on adherence to drug therapy of patients after discharge from hospital. It contains analysis of the reasons for poor adherence, assessment of the impact of quality of adherence on the immediate and long-term results of surgical and medical treatment, structured methods of improvement of adherence to therapy; as well as economic aspects of the problem.

We present a case report of successful transcatheter implantation of a Russian-made cardiac valve prosthesis in a patient with dysfunction of biological mitral valve prosthesis (valve-in-valve). A patient aged 78 years with a high surgical risk and severe heart failure due to mitral valve bioprosthesis dysfunction is described. Fluoroscopyand transesophageal echocardiography-guided transapical implantation of a MedLab-CT prosthesis (23 mm) was made. When a heart rate of 180 beats per minute, a stent prosthesis was implanted. Transcatheter implant valve functioned properly after surgery. The patient was discharged in satisfactory condition.

Aim. Transcatheter aortic valve replacement in patients with high and extremely high risk has become a routine procedure in many cardiac surgery clinics. Until recently, there were no transcatheter prostheses produced within Russia. This article analyzes the results of applying the first domestic transcatheter aortic valve prosthesis MedLab­KT. Material and methods. In the period from June 2018 to October 2018, 7 operations of transcatheter aortic valve replacement were made using the MedLabKT prosthesis. In all cases, implantation was performed by transapical access. Results. We noted one death. In all cases, paraprosthetic regurgitation was not registrated or was not significant. There are no cases of dislocation of the prosthesis. There were no complications associated with access. In one case, implantation was complicated by myocardial infarction. Conclusion. The first experience of implantation demonstrated the efficacy and safety of using the MedLab­LT prosthesis for transcatheter aortic valve replacement. The analysis of long­term results is required.