BackgroundPatients with atrial fibrillation (AF) routinely undergo different imaging modalities for the evaluation of the left atrial (LA) appendage to rule out thrombus prior to the AF ablation procedure. Recently, uninterrupted novel oral anticoagulants were introduced for patients undergoing atrial fibrillation (AF) ablation to minimize the peri-procedural thromboembolism risk. We performed a retrospective analysis to evaluate the safety of uninterrupted rivaroxaban and whether transesophageal (TEE) or intracardiac echocardiography (ICE) is necessary for patients undergoing AF ablation.MethodsData from 332 consecutive patients (42% females, aged 64 ± 11 years) with AF undergoing either TEE (n = 115) prior to catheter ablation or ICE (n = 217) for the detection of LA thrombus were analyzed. All patients were on uninterrupted rivaroxaban during, and for at least, 4 weeks before the procedure. Heparin bolus was administered in all patients before transseptal puncture to maintain a target activated clotting time of >350 s.ResultsA total of 277 patients (80.4%) had paroxysmal AF. The average CHA2DS2­VASc score was 2.11 ± 0.91 in the TEE group and 2.46 ± 0.61 in the ICE group. The CHA2DS2­VASc score was ≥2 in 64 (55.7%) and 214 (98.6%) patients in the TEE and ICE groups, respectively. The left atrial appendage was adequately visualized in all cases. None of the patients have an identifiable LA thrombus either in the TEE group or the ICE group. One (0.3%) thromboembolic periprocedural stroke occurred in a patient with long-standing persistent AF in the TEE group.ConclusionsThis study illustrates that performing AF ablation with ICE guidance on uninterrupted rivaroxaban for at least 4 weeks even without TEE is feasible and safe.

58Российский кардиологический журнал № 5 (121) | 2015 58 АНАТОМИЧЕСКИЕ И МОРФОЛОГИЧЕСКИЕ ПРИЗНАКИ ДИФФУЗНО-ГЕНЕРАЛИЗОВАННОЙ ФОРМЫ ГИПЕРТРОФИЧЕСКОЙ КАРДИОМИОПАТИИдземешкевич С. Л., Фролова Ю. в., Ким С. Ю., Федоров д. Н., Заклязьминская Е. в., Федулова С. в., Шапиева А. Н., маликова м. С., Луговой А. Н.Цель. На основании инструментальных, гистологических и генетических исследований показать роль и значение внутрисердечных аномалий и морфо-логических особенностей особой формы гипертрофической кардиомиопатии (ГКмП), которую авторы обозначают как диффузно-генерализованную. Материал и методы. Проведено клиническое, инструментальное, гистологи-ческое и молекулярно-генетическое обследование 16 пациентов с диффузно-генерализованной формой ГКмП, которым выполнены комплексные хирурги-ческие вмешательства: чрезаортальным доступом расширенная миоэктомия межжелудочковой перегородки и левопредсердным доступом париетальная резекция папиллярных мышц и универсальное хордосохраняющее протезиро-вание митрального клапана. Результаты. Госпитальной летальности не было. Отдаленные результаты, прослеженные до пяти лет, свидетельствуют о перемещении всех пациентов из III-IV в I-II ФК по NYHA. морфологическое исследование показало, что в основе увеличения массы миокарда при ГКмП лежит не гипертрофия, а гиперплазия кардиомиоцитов. У всех 16 пациентов обнаружены убедитель-ные гистологические знаки миксоматозной трасформации створок. Заключение. диффузно-генерализованная форма ГКмП обусловлена рас-пространенным гиперпластическим процессом в миокарде. Предложенная радикальная ремоделирующая операция устраняет внутрижелудочковые перепады давления и увеличивает диастолической объем левого желудочка, предупреждая развитие диастолической дисфункции. ANATOMIC AND MORPHOLOGICAL SIGNS OF A DIFFUSE-GENERALIZED HYPERTROPHIC CARDIOMYOPATHYDzemeshkevich S. L., Frolova Yu. V., Kim S. Yu., Fedorov D. N., Zaklyazminskaya E. V., Fedulova S. V., Shapiyeva A. N., Malikova M. S., Lugovoy A. N.Aim. based on the instrumental, histological and genetic studies to show the role and significance of intracardial anomalies and morphological specifics of the special form of hypertrophic cardiomyopathy (HCM), that the authors name as diffuse-generalized. Material and methods. A clinical, instrumental, histological and molecular-genetic study was conducted with 16 enrolled patients with diffuse-generalized form of HCM, who underwent complex surgical interventions: by transaortal approach the extended myoectomy of interventricular sept, and by intraatrial approach -parietal resection of papillary muscles, and universal chordal-sparing mitral valve replacement.Results. There was no in-hospital mortality. The long-term results for up to 5 years show that all patients moved from the IV-III NYHA to I-II NYHA functional classes. Morphological study showed that in the base of myocardial mass increase in HCM there is neither hypertrophy, but hyperplasia of cardiomyocytes. All 16 patients showed significant signs of myxomatous mitral valve degeneration. Conclusion.Diffuse-gener...

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<p><strong>Aim.</strong> The study is aimed at presenting the protocol of intraoperative organ protection, analyzing its effectiveness during aortic arch surgery and evaluating the rate of postoperative complications in this group of patients. <br /><strong>Methods.</strong> The study included 141 patients. In the first group (n=70) patients underwent aortic arch surgery with hypothermic circulatory arrest (target core temperature 26 °C) and antegrade cerebral perfusion. Patients of the second group (n=71) underwent ascending aortic replacement using cardiopulmonary bypass with moderate hypothermia (target core temperature 32 °C). Cerebral and tissue oxygenation monitoring was performed in all the cases. In the first group transcranial Doppler monitoring was also performed. 33 patients in the first group and 34 patients in the second group underwent testing before and after surgery in order to evaluate cognitive function. Patients’ condition was evaluated during the in-hospital period that was about 15.97±20.54 days. <br /><strong>Results.</strong> In-hospital mortality rate was 4,2 % in the first group and 0% in the second one (p=0.12). Stroke was observed in 1.4 and 0 % of cases respectively. The rate of encephalopathy (as the leading symptom) was 7.1 and 5.6 % in 1st and 2nd groups respectively. Multimodal monitoring enabled to dynamically adjust the flow rate of antegrade cerebral perfusion. As a result, cerebral SctO2 and linear velocity were maintained within the acceptable range.<br /><strong>Conclusion.</strong> The presented protocol proved to be effective, it allows to perform aortic arch surgery with the same postoperative neurological complications’ rate as after ascending aortic replacement. We recommend performing reconstructive aortic arch surgery by using moderate hypothermic circulatory arrest (26-28 °С) and selective antegrade cerebral perfusion. In this modality, it is important to perform the distal anastomosis quickly and start patient’s rewarming (this will significantly shorten the duration of cardiopulmonary bypass and, as a result, decrease the rate of postoperative complications) and to carry out both precise intraoperative monitoring of the brain condition (by using cerebral oxymetry and transcranial Doppler) and central core temperature.</p><p>Received 21 June 2016. Accepted 21 October 2016.</p><p><strong>Funding:</strong> The study had no sponsorship.<br /><strong>Conflict of interest:</strong> The authors declare no conflict of interest.<br /><strong>Author contributions</strong><br />Conceptualization and study design: Belov Yu.V., Charchyan E.R., Akselrod B.A.<br />Material acquisition and analysis: Khachatryan Z.R., Oystrakh A.S., Medvedeva L.A., Guskov D.A., Fedulova S.V.<br />Statistical data processing: Khachatryan Z.R., Guskov D.A., Skvortsov A.A.<br />Article writing: Akselrod B.A., Khachatryan Z.R., Skvortsov A.A. <br />Review &amp; editing: Charchyan E.R., Akselrod B.A., Eremenko A.A., Belov Yu.V.</p>