The modified Blalock-Taussig shunt is the palliative treatment of choice for tetralogy of Fallot. Shunt thrombosis is a potential complication, requiring high-risk reoperation. The use of percutaneous rheolytic devices for thrombus removal in such occluded shunts has not been previously reported. We describe a case in which use of a rheolytic catheter resulted in significant thrombus removal and rapid reversal of cyanosis and dyspnea in a 5-year-old patient. The patient remains free of symptoms at 30-day follow-up.

Aim. To determine the algorithm of in vivo diagnosis and surgical treatment of cardiac myxomas. Methods. Summarized was the experience of diagnosis and surgical treatment of 65 cases of cardiac myxomas. Examination of patients included electrocardiography, phonocardiography, radiography, angiocardiography, selective coronary angiography, two-dimensional transthoracic echocardiography, transesophageal echocardiography, computed tomography and magnetic resonance imaging with contrast, a biopsy, and a morphological study. Results. Among the examined patients (mean age 42.4±1.5 years) cardiac myxomas were diagnosed, which were localized in the left and/or right chambers of the heart. All patients underwent surgery. The tactics of surgical treatment were dependant on the tumor size, its mobility, involvement of the valve apparatus and conduction pathways of the heart into the pathological process, and concomitant diseases. The prognosis of the natural course of cardiac myxomas is unfavorable. In the diagnosis of space-occupying lesions (myxomas) of the heart chambers, which are often combined with valvular pathology, the most informative are echocardiography, computed tomography and magnetic resonance imaging. The final verification of the diagnosis should be made using emergency and routine pathological studies. Conclusion. Timely surgical removal of the myxomas with simultaneous correction of the concomitant cardiac pathology makes it possible to restore the intracardiac haemodynamics and to prevent thromboembolic complications.

No abstract

Objective. To evaluate the effectiveness of epicardial bipolar radiofrequency ablation (RFA) of pulmonary vein ostia (PV) in comparison with its being combined with amiodarone administration for post-CABG atrial fibrillation (AF) prevention.Methods. A single-centre, prospective randomized study (PULVAB), including 96 CAD patients with no history of AF, was conducted between January 2015 and December 2018. Group 1 (control; n=34) had standard CABG alone. Group 2 (n=29) received RFA of PV as an adjunct to CABG for prevention of postoperative AF (POAF). Group 3 patients (n=33) had RFA at the time of CABG and were given amiodarone. Allocation was concealed using sequentiallynumbered opaque envelopes. The efficacy and safety of RFA concomitant with CABG were assessed, as both performed independently and combined with amiodarone administration, as well as intra-and postoperative course.Results. No differences were seen in operation length (p=0.937), cardiopulmonary bypass (CPB) or the aorta clamping times (р=0.377 and p=0.072, respectively). The study groups (CABG, CABG-RFA, CABG-RFA-amiodarone) did not differ statistically in the number of shunts placed - 3.17±0.61, 3.10±0.51 and 2.94±0,6 (p=0,121). No significant difference was noted in RFA duration between Groups 2 and 3 - 11.7±3.7 and 11.4±6.3 min, respectively (p=0,834).AF was found to occur most commonly at postoperative days two or four. The isolated CABG surgery group patients developed POAF most often of all (32,4%). The incidence of POAF was lower after RFA concomitant to CABG - 20.7% (р=0,29). A significant difference was identified in POAF incidence between Groups 1 and 3- 32.4% and 6.1%, respectively (p = 0.0065). Differences between Groups 2 and 3 proved not to be statistically significant (р= 0,086). Sinus rhythm in most of those who had developed arrhythmias was restored by pharmacological cardioversion except for three patients (one in each group). At discharge, 97.1% , 96.7% and 97% of the subjects in Groups 1, 2 and 3, respectively, exhibited sinus rhythm (p>0,05).There was no in-hospital mortality in any of the groups. Neither were there any wound complications, reoperations, perioperative myocardial infarction or cerebral circulatory disorders observed. No difference was revealed in the severity and frequency of renal or respiratory failure. The mechanical lung ventilation time and duration of stay in the ICU in the isolated CABG group were shown to be increased as compared with the CABG-RFA and CABG-RFA-amiodarone groups (p<0.05).Conclusion. The evidence from the pilot study (PULVAB) suggests that bipolar ablation of PV does not significantly complicate CABG, while being combined with amiodarone administration for prevention of rhythm disorders it significantly reduces the incidence of POAF. The in-hospital incidence of POAF tended to decrease, which was not statistically significant, though. Evaluating the efficacy of RFA concomitant with CABG, as performed independently, invites further investigation with more data analysis.

An analysis of the immune status in 53 patients that underwent coronary artery bypass grafting under cardiopulmonary bypass was carried out in the preoperative period and on day 1 and 7 after the surgical intervention. Significant changes in innate and adaptive immunity were revealed. In the first case, they were expressed as an inflammatory process developed throughout the postoperative period; it was confirmed with an increase in leukocytes, total and stab granulocytes, monocytes, oxidative stress of phagocytes, CD64+ and CD40+ granulocytes, endogenous intoxication with the developed significant deficiency in CD4+ monocytes, and regulatory NK cells; while immediately after the surgery, it was confirmed by IgG and IgM levels.Some changes in adaptive immunity manifested through its activation, confirmed by an increased CD4+, CD11b+, HLA-DR+, and CD4+CD25+lymphocyte content, together with a deficiency noted in total lymphocytes and CD8+ lymphocytes.