Aim. To evaluate the effect of angiotensin-neprilysin receptor inhibitors on myocardial remodeling in patients with chronic heart failure and atrial fibrillation. Materials and methods. We studied dynamics of the parameters of ultrasound structural and functional parameters of the left atrium and left ventricle of the heart was during 3-month therapy with sacubitryl-valsartan in a group of 15 patients with a combination of chronic heart failure due to dilated and paroxysmal paroxysmal forms of atrial fibrillation. Results. Showed a statistically significant positive effect of the use of angiotensin receptors and neprilysin inhibitors on the parameters of remodeling of the left atrium (according to transthoracic and transesophageal echocardiography), left ventricle, as well as levels of natriuretic peptides ANP and NT-pro-BNP. Conclusion. The use of ARNI may be promising in terms of treatment and prevention of AF in patients with heart failure.

Aim. In the issue we report first in Russia experience of transcatheter “valve-invalve” implantation (TVIV) for treatment of severe tricuspid stenosis due to the structural deterioration of surgical tricuspid bioprosthesis.Material and methods. TVIV was performed in 4 high-risk redo patients (1 to 3 previous sternotomies) of various ages across (18-68 years) with structural deterioration of surgical tricuspid bioprosthesis.Results. Technical success was achieved in 100% cases. Diastolic gradients on tricuspid valve markedly decreased in all patients. Peak transtricuspidal gradient decreased from 20,4 to 10 mmHg in average. Clinical improvement as assessed by 6-minute walk test after TVIV was observed in 3 patients with congestive heart failure. In 1 patient with asymptomatic right ventricle dysfunction TVIV resulted in the enhancement of echocardiographic parameters.Conclusion. TVIV is a mininvasive alternative to conventional surgical tricuspid valve redo replacement. Based on available data including own experience TVIV should be considered an effective and safe treatment option for failed TV bioprostheses in high-risk patients of different age. Further studies are needed to assess long-term results of the method.

А clinical case of a young patient with recurrent ischemic strokes is presented. The problems of diagnostic embolic strokes are discussed. We set out the algorithm for identifying patients, in whom patent foramen ovale is the most probable cause of embolic stroke. Detailed consideration of imaging diagnostic methods possibility is included. Hypothesis of probable source of cardioembolism from patent foramen ovale is presented. Recommendations for the secondary prevention of recurrent ischemic stroke, associated with patent foramen ovale, are provided. We also considered the issues of antithrombotic treatment.

Authors' contributions. All authors meet the ICMJE criteria for authorship, participated in the preparation of the article, the collection of material and its processing. Conflict of Interest.No conflict of interest to declare. Funding for the article. None.

A 63-year-old man with a history of hypertension, hyperlipidemia and severe COVID-19 3 months earlier presented with NYHA class III-IV heart failure (HF) and intermittent claudication. Three months before, patient noted increasing dyspnea. SARS-CoV2 was verified. CT scan showed pneumonia; the severity of disease required dexamethasone and tocilizumab. Atrial fibrillation (AF) and LV EF 30% were first detected. CT scan disclosed left atrial appendage (LAA) thrombosis. Despite anticoagulants, 3 weeks later the patient developed lower limbs ischemia. Ultrasound and CT scan showed multiple thrombosis in the abdominal aorta and lower limbs arteries (Figure A). Surgery for limb ischemia was not performed due to a further decrease of LV EF to 18%. At that point, diagnosis was SARSCoV2-induced myocarditis. Нe visited our hospital for second opinion. ECG showed AF with mean heart rate (HR) of 158/min (B). Careful history collection suggested a longer AF duration which was missed and untreated due to lockdown. CRP, troponin were normal. NT-proBNP was 9326 pg/ml. After strict rate control was achieved, LV EF became 23%. Cardiac MRI with delayed gadolinium contrast revealed no fibrosis or active myocarditis (C). Angiography showed stenosis >70% of the left anterior descending artery (D). After PCI, LV EF became 27%. The patient was discharged on guideline-recommended optimal medical therapy. Three months later LV EF became 30%, six months later - 47%. Thrombus in LAA was dissolved. Pulmonary vein isolation and cardioversion were performed. One week later LV EF was 60%. Currently, the patient has stable sinus rhythm and no signs of HF for > 6 months. Thus, COVID-19 could contribute to the progression of atherosclerosis, modify the substrate and aggravate the severity of AF, but it was not the only cause of a serious illness in the patient. COVID-19 also had an indirect negative impact - delay the detection of cardiac pathology and cause its underdiagnosis under the guise of "post-COVID".