The article presents a clinical case of treatment of a patient with acute massive pulmonary embolism. A 70-year-old patient was urgently admitted to the intensive care unit with complaints of sudden onset of chest pain for the first time, severe shortness of breath and two episodes of syncope in the last 4 hours. When the patient was admitted to the hospital, the heart rate was 131 beats / min, blood pressure was 80/50 mm Hg, SpO2 was 88 %, and PO2 was 76 mm Hg. Echocardiographically revealed dilated right atrium and right ventricle, hyperechogenic «floating» formation of the right atrium; moderate tricuspid regurgitation and pronounced pulmonary hypertension with systolic pressure in the pulmonary artery ~ 63 mm Hg were observed, and preserved systolic function of the left ventricle; inferior vena cava 20 mm, on the udder did not fall. It was urgently decided to carry out thrombolytic therapy to the patient in connection with unstable hemodynamics. The patient was started administration of alteplase according to the accelerated scheme: 10 mg of tissue plasminogen activator as an intravenous bolus for 1 minute of administration, then – intravenous infusion of alteplase 90  mg for the next 2 hours until the maximum total dose of 100 mg. Three hours after thrombolytic therapy – hemodynamic parameters of the patient had a positive dynamics: blood pressure – 125/80 mm Hg, pulse – 76/min, SaO2 – 98 %, PO2 – 90 mm Hg. On transthoracic echocardiography – no thrombus in the right atrium and right ventricle, as well as a small tricuspid regurgitation, with slight pulmonary hypertension (PsystRV – 36 mm Hg). This clinical case demonstrates thrombolysis with alteplase – «rescue therapy» and a fairly effective treatment option for patients with unstable hemodynamics, acute massive pulmonary embolism, complicated by thrombosis of the right atrium and/or right ventricle and existing hypertensive.

Аbnormal coronary artery origins can occur both in isolation and in combination with congenital heart defects. In the vast majority of cases, such anomalies can affect the deterioration of coronary blood flow with ischemic manifestations. The report describes effort angina in an adult patient who in the childhood underwent operation for the congenital heart defect because of inter-arterial compression of the left anterior descending artery originating with a separate mouth from the right sinus of Valsalva. The purpose of this study is to evaluate the outcome of surgical treatment of coronary heart disease in a patient with abnormal origin of the left anterior descending artery, bicuspid aortic valve and aortic root dilatation. Materials and methods. The paper presents the result of surgical treatment of a patient with abnormal origin of the left anterior descending artery, bicuspid aortic valve and aortic root dilatation, surgical myocardial revascularization in coronary heart disease. It describes the results of instrumental methods, the choice of treatment and control remote results of the operation. Results and discussion. A 43-year-old patient with complaints of angina pectoris underwent instrumental studies such as coronary angiography, bicycle ergometry, computer coronary angiography with comparison of their results. A surgical way of correction of impaired coronary blood flow on the left anterior descending artery was chosen by performing mammary coronary bypass surgery on a beating heart. During the re-examination after 3 months, the patient had no complaints of chest pain, and repeated bicycle ergometry revealed no data on myocardial ischemia. Conclusion. Thus, this clinical case clearly demonstrates the necessity of understanding congenital heart defects, their pathological anatomy and comparison with findings of all clinical and instrumental examinations in the diagnosis and treatment of coronary heart disease in patients with congenital heart defects and abnormal coronary artery origin. Only a comprehensive approach to such patients will provide an opportunity for rapid and correct diagnosis, accordingly, for the choice of adequate treatment.

The aim – to analyze of the complex treatment of a patient with coronary artery disease and subclavian-vertebral robbery syndrome, diagnostic methods of examination, observation and treatment.Materials and methods. The patient with coronary artery disease and occlusion of the left subclavian artery. Physical assessment methods were used? Such as: examination of the patient, anamnesis; laboratory and instrumental investigations – general blood analysis, biochemical blood analysis, electrocardiogram, echocardiography, coronary angiography of the carotid and subclavian arteries.Results and discussion. This complex interventional method of treating the patient had rather good angiographic result. The implantation of the stent system into the area of ​​critical lesion of the main left coronary artery and stent system in the occlusion of the left subclavian artery led to avoid the open surgical operation in the patient and to reduce the period of rehabilitation with a low postoperative risk.Conclusion. According to the international experience, in cases of planned phased treatment of coronary and peripheral arteries that require surgical intervention, it is better to give preference to the endovascular technique in patients with hemodynamically significant lesions. Percutaneous transluminal angioplasty and stenting should be the first therapeutic method for eliminating the problem of symptomatic lesions of the coronary and peripheral arteries.