Metabolic disorders represent a serious medical and social problem and are risk factors for the development of thromboembolic complications. Disturbances of both carbohydrate and fat metabolism contribute to an increase in blood viscosity, creating prothrombotic conditions, which are not always objectively assessed even by specialists. In addition, multiple comorbid conditions usually significantly complicate the prognosis. The article presents a clinical case of recurrent thrombosis of the right atrium and the orifices of the superior and inferior vena cava in a 39-year-old patient with type 2 diabetes mellitus, obesity, arterial hypertension, and varicose vein disease.

Chronic thromboembolic pulmonary hypertension is a long-term consequence of acute pulmonary embolism. Gradual obstruction of the pulmonary arteries and secondary changes in the pulmonary microcirculation over time cause progressive increases in pulmonary vascular resistance and pulmonary artery pressure that can result in severe right heart failure. This article provides an overview of pulmonary embolism and chronic thromboembolic pulmonary hypertension scientific literature and national guidelines. We focus on disease and recurrence risk factors and outline future directions of research to improve short- and long-term patient outcomes.Received 17 January 2021. Revised 1 March 2021. Accepted 19 April 2021.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflicts of interests.Contribution of the authorsConception and study design: A.M. Chernyavskiy, A.G. Edemskiy, D.S. Grankin, E.N. KliverDrafting the article: O.Ya. VasiltsevaCritical revision of the article: E.N. KliverFinal approval of the version to be published: O.Ya. Vasiltseva, A.G. Edemskiy, D.S. Grankin, E.N. Kliver, A.M. Chernyavskiy

Presented herein is a clinical case report regarding hybrid surgical treatment for a saccular aneurysm of the aortic arch in a female patient. While undergoing a routine medical check-up she had been found to have fluorographic evidence strongly suggesting dilatation of the aortic thoracic portion. Based on the findings of further examination we determined the indications for surgical treatment of the thoracic portion of the aorta. The woman was subjected to reconstruction of the arch and the descending portion of the thoracic aorta according to the frozen elephant trunk technique.

Presented herein is the remote (more than 15-year follow up) result of successful surgical treatment of aortic coarctation complicated by septic aortitis and a false aneurysm of the anastomosis between the graft and the aortic arch. In 2002, after correction of aortic coarctation the woman was admitted to our Clinic with an incompetent proximal anastomosis and an infected aortic pseudoaneurysm. Taking into consideration the general and local septic process, repeat reconstruction of the thoracic aorta was impossible due to the risk for generalization of the infectious process and fatal complications. Therefore, the woman was subjected to extra-anatomical bypass grafting of the thoracic aorta with a synthetic graft from the ascending aorta to the infrarenal portion of the abdominal aorta in order to isolate the infection focus to be followed by removal thereof. The postoperative period turned out uneventful, with no complications. After 15 years, the woman was examined again, with her condition being stable. The findings of contrast-enhanced magnetic resonance imaging demonstrated complete patency of the extra-anatomical bypass graft. The carotid-subclavian anastomosis functioned well, without narrowed portions. No infectious complications after the carried out operations were observed. Using extra-anatomical bypass grafting with exclusion from circulation and removal of the infected portion of the aorta along with the graft is one of reliable variants of treatment for such a severe complication as an infected false aneurysm.

The article looks at a clinical case of a 31-year-old female with signs of paroxysmal ventricular tachycardia and Morgagni–Adams–Stokes syndrome. In April 2014, electrophysiological examination revealed a source of ventricular tachycardia localized in the apices of the right and left ventricles of the patient. The sources were then subjected to RF ablation followed by cardioverter-defibrillator implantation. Subsequent antiarrhythmic therapy failed to improve her state. In September 2016 the patient was re-examined and underwent RF ablation of the apical region of the right ventricle. Later on, taking into account continuously recurrent life-threatening cardiac rhythm disorders, as well as unpromising strategies for further conservative treatment, she was put on the waiting list and then underwent orthotopic cardiac transplantation. Histological examination and immunohistochemistry assay showed leiomyosarcoma in the source of ventricular tachycardia previously found in the apex of the right ventricle. This clinical case demonstrates a diversity of clinical manifestations of primary malignant tumors of the heart that pose a challenge for intravital diagnostics and interpretation of a clinical picture.

Сhronic thromboembolic pulmonary hypertension (CTEPH) is a serious, under - diagnosed but potentially curable complication of pulmonary embolism (PE) due to medicine advancements. Lack of specific symptoms and signs makes its diagnosis challenging, requiring clinicians to be ready to suspect its presence in patients with dyspnea of unknown origin or persistent symptoms after the pulmonary embolism event. The success of the treatment of this disease depends entirely on early diagnosis. The complexity of the differential diagnosis is due to the problematic aspects including the lack of doctors' awareness of both the pathology itself and the possibilities of its modern treatment. Recently, in our country, the problem of the availability of expert centers with sufficient experience in providing highly specialized medical care to this rather difficult category of patients who need specific therapy has become very actual. The aim of this review is to provide contemporary information about epidemiology, pathophysiology, and clinical features of treating patients with CTEPH, and also, to increase awareness of potential PE→CTEPH transformation. In the article a 4-year - period of experience of the Meshalkin National Medical Research Center on management of CTEPH patients has been presented.

The article looks at a clinical case of a 31-year-old female with signs of paroxysmal ventricular tachycardia and Morgagni–Adams–Stokes syndrome. In April 2014, electrophysiological examination revealed a source of ventricular tachycardia localized in the apices of the right and left ventricles of the patient. The sources were then subjected to RF ablation followed by cardioverter-defibrillator implantation. Subsequent antiarrhythmic therapy failed to improve her state. In September 2016 the patient was re-examined and underwent RF ablation of the apical region of the right ventricle. Later on, taking into account continuously recurrent life-threatening cardiac rhythm disorders, as well as unpromising strategies for further conservative treatment, she was put on the waiting list and then underwent orthotopic cardiac transplantation. Histological examination and immunohistochemistry assay showed leiomyosarcoma in the source of ventricular tachycardia previously found in the apex of the right ventricle. This clinical case demonstrates a diversity of clinical manifestations of primary malignant tumors of the heart that pose a challenge for intravital diagnostics and interpretation of a clinical picture.

AIM:To evaluate 5-year results of surgical treatment of patients with chronic postembolic pulmonary hypertension.MATERIAL AND METHODS:170 patients with chronic postembolic pulmonary hypertension underwent pulmonary thrombendarterectomy. Mean age was 48±21.5 years. The operation was carried out using standard technique with hypothermia and circulatory arrest. We have analyzed clinical and functional status of 47 patients (23 males) prior to surgery and in long-term postoperative period (5-6 years). Distance of 6-minute walk test, mean pulmonary artery pressure and vascular resistance according to right heart catheterization, RV ejection fraction and volumes according to echocardiography, pulmonary artery diameter according to CT-angiography were analyzed.RESULTS:In remote postoperative period average distance of 6-minute walk test was increased by 2.8 times compared with initial values. Right heart catheterization revealed reduction of the average pulmonary pressure from 54.04±23.35 to 25.16±15.41 mmHg and vascular resistance from 539.66±120.59 dyn·sec·cm-5 to 101.39±89.20 dyn·sec·cm-5. Echocardiography showed increase of RV EF from 36±2.3 to 51.8±4.1% and decrease of RV end-diastolic volume from 109.4±39.2 to 39.1±6.8 ml. According CT-angiography there was decrease of pulmonary trunk diameter from 35.10±5.25 to 30.30±8.65 mm.CONCLUSION:Our 5-year data show that pulmonary thrombendarterectomy has high long-term effectiveness in patients with proximal form of chronic postembolic pulmonary hypertension.

Objectives. 3-year research data on transendocardial implantation of autologous bone marrow mononuclear cells (ABMMC) in CAD patients with a preserved systolic function of the left ventricle (LV) were analyzed. Methods. The study included 30 patients with post-infarction cardiosclerosis, with their LV EF varying from 50 % to 70 %. To administer an average 41 16 x 10 6 dose of ABMMC into the myocardial infarction borderline, the NOGA system was used. Results. Lethality at 36 months was 6.6 % (2 patients) and both cases were not related to the main pathology. Within 36 months of ABMMC implantation, the functional class of angina improved from с 2.80.1 to 2.1 01 (р<0.05) and NYHA functional class decreased from 2.80.1 to 2.30.1 (p<0.05). After 36 postoperative months, in most patients the cumulative myocardial perfusion observed at 12 months remained the same in the ABMMC segments. Transendocardial implantation is a safe intervention that improves patients hemodynamic parameters and quality of life.

: Presented herein are the results of successful surgical treatment by extraanatomic bypass grafting of coarctation of the aorta complicated by septic aortitis and a pseudoaneurysm of the anastomosis between the graft and aortic arch.