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Objective: We aimed to define the relationship of preoperative NT pro-BNP testing in routine practice of cardiac surgery with clinical, perioperative variables, surgical outcomes and complications in pediatric and adult cardiac surgery patients. In addition, we assessed relationship of NT pro-BNP with EuroSCORE II in adult patients undergoing cardiac surgery.   Methods: A total of 48 patients who underwent cardiac surgery in our institution were enrolled into study. According to age aspects pediatric (PG, n=20) and adult (AG, n=28) group of patients were separately evaluated. Each group further was categorized into two subgroups (group 1 and 2) on the basis of cut-off points of NT pro-BNP level (430 and 250pg/ml in adults and children, respectively). Preoperative NT-pro BNP was obtained from patients. Statistical tests were conducted to reveal differences in clinical and perioperative variables among NT-pro-BNP groups and relationship of the assay with baseline clinical and operative parameters, as well as postoperative outcomes. Results: In adults undergoing cardiac surgery, statistically significant differences  were found between groups with low and high levels of NT pro-BNP by NYHA classes (I to III, p˂0.001), body mass index (BMI) values (31.7(3.15) vs 25.9 (3.8) kg/cm2, p=0.017), estimated glomerular filtration rate (GFRe) (111.4(26.4) vs 77.9(22.4) ml/min/1.73m2 p=0.036), moderately impaired renal function (20% vs 72.7%, p=0.049), need for inotropes (28.6% vs 86.7%, p=0.006), and mean EuroSCORE II (0.81 (0.19) vs 1.7 (0.5), p=0.008).  There was the positive significant correlation of NT pro-BNP levels with EuroSCORE II, NYHA class, need for inotropes, renal function and left ventricular (LV) function categories, while its negative correlation was found with BMI, LV ejection fraction and GFRe parameters. In PG – NT pro-BNP was negatively correlated with age, body surface area, LV end-diastolic and end-systolic dimensions.  Conclusion: In adult patients undergoing cardiac surgery, preoperative NT-pro-BNP level correlated well with several baseline and clinical-operative parameters, including BMI, renal and LV function, NYHA class, need for inotropes support, and EuroSCORE II.   Further studies are needed to define its exact diagnostic and prognostic significance in pediatric patients.

Objective:We present the case of possible reverse type of TCM in a female patient presented with progressive left ventricular dysfunction and its rupture in pericardium.Methods:The detailed history, physical examination, laboratory tests, electrocardiography, serial echocardiography, coronary angiography with left ventriculography were performed to diagnose possible Takotsubo cardiomyopathy in 63-year old woman admitted to our center with complaints of dyspnea, lightheadedness, weakness and signs of hypotension and history of inferior myocardial infarction, acute left ventricular aneurysm, and effusive pericarditis and pleuritis, developed after emotional stress 5 months ago.Results:Clinical evaluation revealed unremarkable laboratory tests, normal troponin values, signs of old inferior myocardial infarction on electrocardiogram, and left ventricular (LV) dilatation and dysfunction, akinesia of LV infero-lateral wall with thinning and its rupture and blood shunting in pericardium. Her coronary angiography revealed normal coronary arteries. The diagnosis of pheochromocytoma was excluded. The patient underwent surgery under cardiopulmonary bypass with removal of LV pseudoaneurysm. The patient was discharged from hospital with improvement in NYHA class and LV function.Conclusion:Thus, in female postmenopausal patients presenting with acute myocardial infarction signs complicated by pericarditis, intact coronary arteries and LV dysfunction with emotional stress as triggering factor, reverse type of TCM should be considered and proper management applied to prevent development of life-threatening complications like LV rupture.

Objective: The aim of this paper is to understand the structure of congenital heart diseases (CHD) and the age of the first diagnosis in a population referred to specialized cardiac surgery center from different regions of Kyrgyz Republic. Methods: In 2017, 7213 people of different ages, from Kyrgyz Republic were examined by using transthoracic echocardiogram at cardiac surgery center aimed to detection of congenital heart disease Results: In total, 478 new patients with primary diagnosis of CHD were identified; 413 (86%) patients had a delayed diagnosis. The total detectability was 6.75%. The structure of congenital heart disease has a large difference depending on the age group. The proportion of complex heart defects predominates in newborn children and significantly decreases with age. Conclusion: A study of the prevalence and structure of heart defects in the country will help to find the right decision in planned care for patients with CHD, in cases of limited resources.

Objectives: to evaluate the advantage of preserving the subvalvular structures of the mitral valve from both leaflets compared with the preservation of the subvalvular structures only from the posterior valve during mitral valve replacement surgery (MVR). Methods: A retrospective analysis of case histories of 41 patients with isolated rheumatic lesions of the mitral valve who underwent MVR, which were divided into 2 groups: with complete preservation of subvalvular structures (n = 24) and preservation of only the posterior leaflet (n = 17), was performed. Results: In the group with complete preservation of the chordal-papillary apparatus, there was a significant decrease in the end-systolic volume (p<0.05) and a slight increase in the ejection fraction of the left ventricle in the immediate postoperative period compared with the group with the preservation of the chordal-papillary apparatus only from the posterior cusp, where end-systolic volume decreased slightly (p&qt;0.05) and the ejection fraction of the left ventricle remained at the same levels. Conclusion: Our preliminary results of the study indicate better remodeling and optimization of the geometry of the left ventricle when assessing the closest postoperative parameters in a group of patients with preservation of chordo-papillary structures of both leaflets, both the anterior and the posterior leaflets.