Myectomy versus alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy

OBJECTIVES: There is very little evidence comparing the safety and efficacy of alcohol septal ablation versus septal myectomy for a septal reduction in patients with hypertrophic obstructive cardiomyopathy. This study aimed to compare the immediate and long-term outcomes of these procedures. METHODS: Following propensity score matching, we retrospectively analysed outcomes in 105 patients who underwent myectomy and 105 who underwent septal ablation between 2011 and 2017 at 2 reference centres. RESULTS: The mean age was 51.9 ± 14.3 and 52.2 ± 14.3 years in the myectomy and ablation groups, respectively (P = 0.855), and postoperative left ventricular outflow tract gradients were 13 (10-19) mmHg vs 16 (12-26) mmHg; P = 0.025. The 1-year prevalence of the New York Heart Association class III-IV was higher in the ablation group (none vs 6.4%; P = 0.041). The 5-year overall survival rate [96.8% (86.3-99.3) after myectomy and 93.5% (85.9-97.1) after ablation; P = 0.103] and cumulative incidence of sudden cardiac death [0% and 1.9% (0.5-7.5), respectively P = 0.797] did not differ between the groups. The cumulative reoperation rate within 5 years was lower after myectomy than after ablation [2.0% (0.5-7.6) vs 14.6% (8.6-24.1); P = 0.003]. Ablation was associated with a higher reoperation risk (subdistributional hazard ratio = 5.9; 95% confidence interval 1.3-26.3, P = 0.020). At follow-up, left ventricular outflow tract gradient [16 (11-20) vs 23 (15-59) mmHg; P < 0.001] and prevalence of 2+ mitral regurgitation (1.1% vs 10.6%; P = 0.016) were lower after myectomy than after ablation. CONCLUSIONS: Both procedures improved functional capacity; however, myectomy better-resolved classes III-IV of heart failure. Septal ablation was associated with higher reoperation rates. Myectomy demonstrated benefits in gradient relief and mitral regurgitation elimination. The results suggest that decreasing rates of myectomy procedures need to be investigated and reconsidered. © The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved

Endometrial morphology in women of reproductive age with PCOS

Background. Polycystic ovary syndrome is the most common endocrine disease in women, affecting various aspects of health. The results of several studies indicate an increased prevalence of hyperplasia or endometrial cancer in women with PCOS, but there are no clinical recommendations on the need for assessing the endometrial condition in PCOS and approaches to predictions. Aim: to determine the frequency and structure of endometrial pathology among reproductive-aged patients with PCOS. Materials and methods. In a cross-sectional survey, we examined 1200 women who are subject to annual preventive examination. The research period was May - December 2017. The diagnosis of PCOS was made according to the consensus criteria adopted in May 2003 in Rotterdam. Participants signed informed consent for the survey. Results. We found 102 women with a verified diagnosis of PCOS. 56 of them completed their participation in the study; the median age was 32.19 ± 5.67 years. All patients underwent a biopsy of the endometrium with immunohistochemical examination. Features of the structure of the endometrium: a normal endometrial characteristic in 24 women (42.9 %), chronic endometritis -18 specimens (58.1 %), abnormal hypoplastic endometrium - 6 (19.4 %), simple endometrial hyperplasia -1 (3.2 %) adenocarcinoma -1 (3.2 %), proliferative endometrium with disorders - 7(22.6 %). Conclusions. In the examined women with PCOS there was a high incidence of histologically confirmed endometrial pathology, in the structure of which chronic endometritis predominates. The foregoing necessitates new research and development of clinical protocols for the timely detection of endometrial pathology in PCOS

A central fragment of ribosomal protein S26 containing the eukaryote-specific motif YxxPKxYxK is a key component of the ribosomal binding site of mRNA region 5′ of the E site codon

The eukaryotic ribosomal protein S26e (rpS26e) lacking eubacterial counterparts is a key component of the ribosomal binding site of mRNA region 5′ of the codon positioned at the exit site. Here, we determined the rpS26e oligopeptide neighboring mRNA on the human 80S ribosome using mRNA analogues bearing perfluorophenyl azide-derivatized nucleotides at designed locations. The protein was cross-linked to mRNA analogues in specific ribosomal complexes, in which the derivatized nucleotide was located at positions −3 to −9. Digestion of cross-linked rpS26e with various specific proteolytic agents followed by identification of the resulting modified oligopeptides made it possible to map the cross-links to fragment 60–71. This fragment contains the motif YxxPKxYxK conserved in eukaryotic but not in archaeal rpS26e. Analysis of X-ray structure of the Tetrahymena thermophila 40S subunit showed that this motif is not implicated in the intraribosomal interactions, implying its involvement in translation process in a eukaryote-specific manner. Comparison of the results obtained with data on positioning of ribosomal ligands on the 40S subunit lead us to suggest that this motif is involved in interaction with both the 5′-untranslated region of mRNA and the initiation factor eIF3 specific for eukaryotes, providing new insights into molecular mechanisms of translation in eukaryotes

Meshalkin National Medical Research Center

We present three cases of successful transatrial transcatheter valve-in-valve implantation in patients with bioprosthetic mitral valve dysfunction. Patients with a high surgical risk, with severe heart failure due to bioprosthetic mitral valve dysfunction, were implanted with transcatheter prostheses using the transatrial approach.Transesophageal echocardiography and fluoroscopy-guided transcatheter mitral prosthetic valve positioning was performed. With a cardiac pacing at 180 bpm, a transcatheter valve was implanted. The transcatheter valves functioned properly after surgery. The patients were discharged in satisfactory condition

The Leydig Steroid Cell Tumor in a Postmenopausal Woman with Clinical and Biochemical Hyperandrogenism: A Case Report

Leydig cell tumors (LCTs) refer to tumors of the stroma of the genital strand, which are found mainly in postmenopausal women. The diagnosis of LCTs in postmenopausal women is associated with specific difficulties and is based on the identification of hyperandrogenism with clinical manifestations of virilization, which has an erased picture in postmenopausal women. LCTs require differential diagnosis with other causes of hyperandrogenism. We present the clinical case of a 55-year-old Russian postmenopausal patient with LCTs of the right ovary, significantly increased levels of androgens, and rapidly progressive clinical signs of hyperandrogenism. The patient underwent laparoscopic bilateral salpingo-oophorectomy, and the androgen indices reached average values by the first and third month after surgery. This case demonstrates that LCTs are often benign with a good prognosis and normalization of the clinical and laboratory manifestations of hyperandrogenism after surgical treatment. The type of surgery performed (bilateral salpingo-oophorectomy rather than unilateral) is recommended as the treatment of choice for LCTs in postmenopausal patients

The first experience of implantation of the transcatheter aortal valve prosthesis “MedLab-KT”

Aim. Transcatheter aortic valve replacement in patients with high and extremely high risk has become a routine procedure in many cardiac surgery clinics. Until recently, there were no transcatheter prostheses produced within Russia. This article analyzes the results of applying the first domestic transcatheter aortic valve prosthesis MedLab­KT. Material and methods. In the period from June 2018 to October 2018, 7 operations of transcatheter aortic valve replacement were made using the MedLabKT prosthesis. In all cases, implantation was performed by transapical access.Results. We noted one death. In all cases, paraprosthetic regurgitation was not registrated or was not significant. There are no cases of dislocation of the prosthesis. There were no complications associated with access. In one case, implantation was complicated by myocardial infarction.Conclusion. The first experience of implantation demonstrated the efficacy and safety of using the MedLab­LT prosthesis for transcatheter aortic valve replacement. The analysis of long­term results is required

THREE-DIMENSIONAL MODEL OF LEFT CHAMBERS OF THE HEART BASED ON ECHOCARDIOGRAPHY DATA: AN INSTRUMENT FOR DEVELOPMENT OF TRANSCATHETER VALVES

Aim. Comparative analysis of the acquired with EchoCG method parameters of the left chambers of the heart and of mitral valve in normal state and in restrictive type of failure with further building up three-dimensional models of these variants of the fibrous anulus geometry, and of the left atrium, left ventricle and its outgoing tract.Material and methods. The study was done using 3D transthoracal and transesophageal EchoCG on Philips iE33 (Philips Healthcare, USA) in 30 patients with unchanged mitral valve (n=15) and in ischemic mitral regurgitation (n=15). Spatial configuration of the anulus fibrosus was investigated, and mitral valve, spatial and volumetric parameters of the left atrium and left ventricle. Data was processed in SciLab 4.1.2 software and exported to CATIA 5 modelling system, where the acquired curves were combined to 2 solid thin-wall models, and after linking of the surfaces — to a hard-bodied model with required thickness of the walls.Results. All studied parameters revealed significant differences (p&lt;0,001) in groups comparison. In restrictive type of insufficiency, sizes of fibrous anulus increase: intercomissural diameter by 22%, front-back — by 13%, perimeter — by 28%, surface — by 79%. End systolic and diastolic volumes of the LV increase more than 2 times, which is related with more prominent sphericity of the LV, than normally. Increase of LA more than 1,5 times also combines with its geometry change towards sphere. Three dimensional computer model of the left heart chambers changed as a result of ischemic mitral failure, is created. The model can be implemented in creation, analysis and prediction of medical devices for the position and/or realized as the full-sized mockups, test systems and phantoms for development and education.Conclusion. The investigation of mitral valve characteristics and of the left heart chambers by method of 3D transthoracal and transesophageal echocardiography makes it to obtain the baseline data necessary for creation of 3D computed models of the anatomic area normal and disordered. Such models can be implemented in the development of implanted devices constructions, preliminary tests of medical devices and in training

Имплантация in vitro первого отечественного транскатетерного протеза в нативный митральный клапан

Цель. Оценка in vitro опытного образца первого отечественного транскатетерного биопротеза для протезирования митрального клапана.Методы. В эксперименте in vitro проведено испытание опытного образца транскатетерного митрального биопротеза на самораскрывающемся нитиноловом каркасе «Солертис» при имплантации в позицию нативного митрального клапана изолированного свиного сердца с использованием трансатриального доступа. Результаты. Выявлены адекватная ориентация предсердных и желудочковых элементов биопротеза, надежный круговой охват и прилегание аннулярной части каркаса, обеспечивающие стабильную фиксацию протеза в позиции нативного митрального клапана без обструкции выходного отдела левого желудочка, полноценное функционирование створок, отсутствие парапротезной регургитации.Заключение. Опытный образец первого отечественного транскатетерного митрального биопротеза в эксперименте in vitro продемонстрировал эффективность при имплантации в позицию нативного митрального клапана. Результаты исследования позволяют перейти к следующему этапу доклинических испытаний протеза — эксперименту in vivo.Поступила в редакцию 5 декабря 2017 г. Принята к печати 20 декабря 2017 г. Опубликована онлайн 28 декабря 2017 г.ФинансированиеРабота выполнена при поддержке гранта Российского научного фонда (16-15-10315).Конфликт интересовАвторы заявляют об отсутствии конфликтов интересов.Вклад авторовКонцепция и дизайн исследования: И.Ю. Журавлева Сбор и анализ данных: Д.П. Демидов Написание статьи: Р.М. ШарифулинРедактирование статьи: А.В. Богачев-Прокофьев, А.М. Караськов Утверждение окончательного варианта статьи: А.В. Богачев-Прокофьев, И.Ю. Журавлева, Р.М. Шарифулин, Д.П. Демидов, А.М. Караськов</p