Aim: To analyze the experience of treatment of congenital heart disease. Identify the proportions and ratios of surgical and endovascular treatments. Development of diagnostic service. To determine the impact of industry funding mechanisms on the development of endovascular surgery for congenital heart disease. Materials and methods: The tendencies of cardiac surgery development of congenital heart defects on the basis of the analysis of endovascular and surgical methods of treatment are considered. Own results of 10 years of experience in the treatment of congenital heart disease are presented. Results: An increase in the proportion of endovascular methods and a decrease in surgical treatments. The obtained data show a rapid increase in the share of medical procedures (from 48.9% to 89.4%) and a sharp decline in the share of diagnostic procedures (from 51.1% to 10.6%) in endovascular surgery. Early mortality after cardiac surgery in children is <5%, mortality after edovascular interventions - <1%. Ultrasound examination (ultrasound) of the heart - allows to detect 95% of all congenital heart defects and is shown to every citizen as a screening method. The influence of industry financing mechanisms on the development of endovascular surgery of congenital heart defects is shown. Expensive equipment began to be purchased at public expense, the number of equipment representatives on the market increased and, as a result, the number of endovascular procedures increased. Over the past 5 years, public funding for the needs of the industry has increased from 16 to 75%. Conclusions: Today, pediatric cardiology and cardiac surgery are reaping the fruits of the golden age in medical science. With the development of cardiac surgery, the number of operated patients increases every year. The successful outcome of treatment of patients with CHD depends on a comprehensive multidisciplinary team (Heart Team). New evidence-based approaches in resuscitation management allow to recover as soon as possible after the intervention. We see further development of the industry in the development of multidisciplinary teams to help patients with the CHD. Finally, we expect an increase in the regulatory burden and the cost of developing new treatments and diagnostics. Key words: congenital heart defects, endovascular methods, open heart operations, minimally invasive interventions, critical heart defects.

The aim. To assess the effectiveness and safety of transcatheter closure of a secondary atrial septal defect (ASD) using an occluder in symptomatic children weighing ≤10 kg. Materials and methods. In the period from November 2014 to June 2021, on the basis of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, closure of secondary ASD using an occluder was performed in 18 patients, among them 13 women (72.2%) and 5 men (27.8%). Th e mean age of the patients was 18.94±9.44 months (the youngest patient was 12 months, the oldest was 4 years). The mean weight was 9.294±1.170 kg (6.4 kg to 10 kg), the mean Z-score was -1.7±1.5 (-4.6 to 0.46), the mean height was 80 cm (71 cm to 88 cm). According to the measurements by transesophageal echocardiography (TEE), the average size of the defects was 13.7 mm±3.6mm (the largest 18.0 mm, the smallest 6.0 mm). Results and discussion. In our publication, the effectiveness of the method was 100% (18/18), while the world statistics show 94-95%. Th e frequency of complications was 5.6% (n=1). We suggest that this is associated with the use of a sizing balloon and careful selection of the device. When choosing treatment tactics for symptomatic children weighing ≤10 kg, the decisive factor was the determination of the presence of edges and the size of the defect. Defects were considered suitable for closure, according to TEE data, when all margins of the defect were ≥4 mm, except for the aortic margin. Although the total length of the interatrial membrane was taken into account, it was not of decisive importance, since for most occluders with the presence of all edges, the fields of the implant could not interfere with the work of the anatomical structures of the heart. To determine the real size of the defect, we recommend a measuring balloon under TEE control. The following devices were used to close the defect: MemoPart ASD occluder, Amplatzer Septal Occluder, LifeTech HeartR Occluder, LifeTech HeartR Multi-Fenestrated Atrial Septal Defect (MF-ASD) Occluder.   Conclusion. After the study, we are convinced that the endovascular method of closing a hemodynamically significant secondary ASD for the treatment of children with a body weight of ≤10 kg has proven to be an effective method, with successful implantation of the occluder in 100% of cases.

The paper describes the experience of percutaneous transapical access (PTA) usage for performing transcatheter structural interventions in 7 patients. Four patients had paravalvular insufficiency of the prosthetic mitral valve, one patient had a reshunt of ventricular septal defect and a pseudoaneurysm in the area of fibrous mitral-aortic continuity. Two patients underwent PTA for diagnostic examination. The visualization methods, planning algorithm, and technique of the procedure have been described. The overall efficiency was 100%, the degree of paravalvular leak was reduced in all treatment procedures. The main reported complication was hemothorax in two cases. In one case, the occluder migrated from the paravalvular fistula channel into the left atrial cavity with subsequent endovascular extraction. The aim. This study was designed to evaluate modern outlooks about the use of PTA during interventions, enhance the available data and extrapolate the authors’ own experience with the development of their own conclusions and recommendations. Materials and methods. To differentiate structural pathology, the initial selection of patients was performed according to the findings of transthoracic and transesophageal ultrasound. The next step in planning of PTA is analysis of computed tomography (CT) data with 3D reconstruction. PTA and subsequent interventions were performed in the hybrid catheterization laboratory after evaluation of CT data, guided by transesophageal echocardiography (TEE), and with the establishment of optimal angles of the angiograph arc for the best fluoroscopic imaging. Besides, in order to avoid trauma of left anterior descending coronary artery, selective angiography was performed. Surgical team support was essential in all cases. Results. The overall efficiency was 100%, reduction of the degree of paravalvular leak was achieved in all treatment procedures. The main reported complication was hemothorax in two cases. In one case, the occluder migrated from the paravalvular fistula channel into the left atrial cavity with subsequent endovascular extraction. Discussion. The subject of our research was PTA for structural interventions. Available data of the world literature shows that this technology has been developed since the end of the last century. The main complications that can be encountered during the intervention by PTA were: hemothorax; hemopericardium/tamponade; rupture of the coronary artery; pneumothorax; arrhythmia; death. In four out of five cases, we used a Lifetech HeartR PDA occluder to close the puncture site of the left ventricular apex. In the fifth case, LifeTech mVSD occluder was used. Conclusions. Correction of structural pathology by routine use of PTA requires a comprehensive approach to the diagnosis of this pathology using transthoracic and transesophageal echocardiography, contrast-enhanced CT and 3D reconstruction. Support of a multidisciplinary team to provide transition to conventional cardiac surgery access in case of periprocedural complications is mandatory. Due to the emergence of specialized implants, as well as the development of imaging techniques, PTA requires attention and further study.

The aim. To analyze the results of the use of endovascular treatments for pulmonary artery atresia (PAA). Materials and methods. Treatment of this heart defect at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine with application of endovascular methods began in 2006. Since then, 138 patients were operated, 57 of them female (41.3%) and 81 (58.6%) were male. Endovascular methods were used in 23 patients, and 115 patients underwent open-heart surgery. The mean length of hospital stay was 25±16.3 days. Of 115 patients who underwent open-heart surgery, 62 (54%) were male and 53 (46%) were female. On the day of surgery, the mean age of these patients was 607.8±1023.7 days, mean weight was 8.8±8.1 kg. The average length of hospital stay was 26±18.6 (maximum 215, minimum 5). Of 23 patients who underwent endovascular surgery, 18 (77%) were male and 5 (23%) were female. The mean age on the day of surgery was 220.5±650.2 days, mean weight was 5.0±4.4 kg. The mean length of hospital stay was 22±5.7 days (maximum 34, minimum 4). In the treatment of PAA, a stepwise procedure is used, correcting part of the defect at each stage and thereby reducing the traumaticity of the operation. In our case, correction of the defect was performed on the open heart and using endovascular methods of treatment. After endovascular interventions, no fatal effects were observed. Open-heart surgery was performed in case if endovascular interventions could not be performed. The condition of such patients was usually more severe. It should also be noted that the open-heart surgery itself is a serious trauma to the body. Due to the above, postoperative period in this group of patients more often proceeded with complications. Due to more severe preoperative condition of the patients and surgical trauma, in some cases of open-heart interventions, some patients did not recover after surgery. As a result, the total mortality in the group of patients who underwent open-heart surgery was 13.0%. In addition, in 7 cases, such surgery was supplemented by the Rashkind procedure. In case of recurrent surgery after 6 months, stenting of patent ductus arteriosus was performed. Repeated surgical interventions were accompanied by the improvement of the condition and the patients were discharged from the clinic in satisfactory condition. Conclusions. PAA is one of the most complex congenital pathologies of the heart and main vessels, and therefore preservation of such a newborn depends on the preservation of patent ductus arteriosus. Endovascular surgery for PAA is the operation of choice that allows to prepare the patient for the next stage of treatment, including open-heart surgery. Endovascular interventions in PAA are minimally invasive, which increases the chances of patients with complicated anatomy to survive despite their serious condition on admission to the hospital.