Objectives:To evaluate the effectiveness of hemofiltration during longstanding cardiopulmonary bypass (CPB) in patients with comorbidities. Materials and Methods:Prospective randomized clinical trial included 38 male patients with ex-pecting duration of CPB >120 minutes due to comorbid pathology. Standard anesthesia protocol was carried out. Study includes two groups: first group (controlled, n=20) included standard CPB, 2 nd group (analyzed, n=18) included perfusion with high-volume hemofiltration using polyionic buffered solution 80 mL/min during all CPB time. Hemofiltration has been also supported by ultra-filtration for hydro-balance maintenance at the level of 8-10 mL/kg. Laboratory tests, respiratory and renal complications, drainage blood loss, hemostasis disorders, requiring hemostatics and blood transfusion, intensive care unit (ICU) and in-hospital were evaluated. Nonparametric methods-Mann-Whitney U test for independent samples and Wilcoxon signed-rank test for dependent samples were used.Results: IL-6 level in 2 nd group was significantly lower (p=0.0017) and did not exceed 7.4 pg/mL. C-RP, metalloproteinase and procalcitonin levels were lower too, but not statistically significant. Lactate level in analyzed group was in reference range, while in control group after perfusion it in-creased to 8.3±4.2 mmol/L. Renal dysfunction, requiring dialysis, was diagnosed in six (20,7%) patients from controlled group vs two patients (6.1%) from analyzed group. Respiratory insufficiency Abstract Research ArticleAddress for Correspondence: Vladimir Chagirev, A.V.

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.

Primary tumors of the heart are a rare pathology with a frequency of occurrence of 0.0017% to 0.28% according to autopsies, while 75% of them are benign in nature, 25% are malignant. Secondary tumors of the heart occur 20–40 times more often than primary tumors. Due to the rapid development of radiology diagnostic methods, the chances of early detection of heart tumors have improved significantly at present. Recently, large cardiology centers have accumulated a lot of experience in the diagnosis and treatment of these lesions. However, early detection in primary malignant lesions of the heart is still a problem, since the clinical symptoms appear when tumors reach a large size. Modern methods of treatment of the heart malignant tumors include radical surgery, and in case of impossibility – cytoreductive surgery.We present literature review on the diagnostic methods and differential diagnosis of the heart lesions. The types of cardiac tumors are described; its morphological features, differential diagnostic imaging features and hemodynamic characteristics of the lesions are presented; the diagnostic effectiveness of modern imaging methods is analyzed.

The mitral valve prolapse is characterized by the degeneration of the valve leaflets, accompanied by their thickening, increasing surface area and flexibility. The mitral valves leaflets bulge (prolapse) beyond the plane of the atrioventricular ring into the left atrium during ventricular systole and lose the ability to close tightly, leading to the mitral regurgitation. Acute chord rupture of the mitral valve posterior leaflet is a rare but important cause of severe mitral regurgitation and the development of acute or progressive chronic heart failure. Acute mitral insufficiency, accompanied by hemodynamic disorders, requires an urgent valve plastic surgery or valve prosthetics. The mitral valve plastic surgery gives a number of undeniable advantages over prosthetics, providing the best hemodynamic parameters, saving the patient from lifelong receiving of anticoagulant drugs. Detailed qualified echocardiographic evaluation of all structures of the mitral valve (fibrous ring, MV leaflets by segments, overlapping structures, structure of the chordal apparatus, papillary muscles) provides the necessary information for the mitral valve reconstructive plastic surgery with the choice of the method that is most optimal for a certain patient at the preoperative stage. We report herein a clinical observation of the patient with a diagnosis: acquired heart disease, the mitral valve posterior leaflet prolapse with mitral insufficiency Grade 3. Chronic heart failure IIA. II FC. Atrial fibrillation. The patient underwent multicomponent mitral valve reconstruction with the creation of a neochord and the fibrous ring plastic on the duplicate of a PTFE strip (soft support ring), pairwise isolation of the pulmonary vein entrance and right cavotricuspid isthmus.

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