Surgical treatment of thromboembolia in the heart right atrium in pregnant women

Two clinical cases of surgical treatment of cardiac right-chamber thromboembolism in pregnant women are described. Thromboembolism was diagnosed during a routine examination. In the first clinical case, considering the late pregnancy, a thromboembolectomy was performed under artificial circulation after surgical delivery.In the second case, thrombus removal from the right atrium was performed on a working heart, without interruption of pregnancy. The surgical and postsurgical period proceeded without any specific features and the patients were discharged from the hospital without any complications. These clinical cases show that it is possible to remove thrombus from the right heart chambers without the use of extracorporeal circulation, which is also safe for the mother and the fetus

Хирургическая эмболэктомия как перспективный метод лечения острой тромбоэмболии легочной артерии (несистематический обзор литературы)

Highlights. The article presents current literature data on the results of surgical treatment of acute pulmonary embolism.Abstract. The review article throws light on up to date approaches to the treatment of acute pulmonary embolism. The great variety of treatment methods and controversial results do not allow us to conclusively decide on which method to choose. Traditionally, pharmacological therapies have been favored over invasive methods because of the lower mortality rate. However, based on new studies, it can be established that interventional embolectomy is an effective option, showing good immediate and long-term results. Undoubtedly, additional studies are needed in order that surgical embolectomy developed from a rescue therapy of acute pulmonary embolism into a first-line or priority treatment.Основные положения. Статья содержит актуальные литературные данные о результатах хирургического лечения острой тромбоэмболии легочной артерии.Резюме. В обзорной статье освещены современные подходы к методам лечения острой тромбоэмболии легочной артерии. Разнообразие методов лечения и противоречивые результаты хирургического и терапевтического подходов не позволяет однозначно выбрать тот или иной метод. Традиционно фармакологические методы лечения предпочтительнее из-за меньшей частоты риска летальности и смертности. Однако с учетом новых исследований можно утверждать, что хирургическая эмболэктомия служит эффективным альтернативным вариантом, демонстрирующим хорошие ближайшие и отдаленные результаты

Трансплантация сердца и коронавирусная инфекция (COVID-19) в раннем послеоперационном периоде у пациента с гипертрофической обструктивной кардиомиопатией: клинический случай

Hypertrophic cardiomyopathy (HCM) is a disease that is usually unresponsive to conservative pathogenetic therapy. It does not have clearly developed surgical correction algorithms. Heart transplantation (HTx) is the sole therapeutic option when drug therapy is ineffective and surgical reduction of hypertrophic myocardium is not feasible. There are only sporadic reports in the literature about HTx for HCM. The novel coronavirus disease 2019 (COVID-19) pandemic has significantly affected the work of cardiac surgical units and, in particular, organ transplantation activities. This paper presents a clinical case of an HCM patient who underwent HTx, complicated by COVID-19 infection in the early postoperative period.Гипертрофическая кардиомиопатия – это заболевание, в большинстве случаев трудно поддающееся консервативной патогенетической терапии и не обладающее четко разработанными алгоритмами хирургической коррекции. Конечным вариантом лечения при неэффективности медикаментозной терапии и невозможности проведения хирургической редукции гипертрофированного миокарда является трансплантация сердца, о которой в литературе имеются лишь единичные сообщения. Пандемия новой коронавирусной инфекции существенно повлияла на работу кардиохирургических подразделений и в особенности на работу по пересадке органов. В данной статье представлен клинический случай пациента с гипертрофической кардиомиопатией, которому произведена трансплантация сердца, осложнившаяся инфекцией COVID-19 в раннем послеоперационном периоде

The first experience of extracorporal membrane oxygenation application in severe primary graft failure following heart transplantation

Introduction. The number of surgically treated cases of heart failure by means of orthotopic heart transplantation is increasing every year. At the same time, there is a shortage of optimal donors for heart transplantation, being a factor that leads to a primary graft dysfunction in the intra- and immediate postoperative period. In order to reduce the risk of complications and increase patient survival rates in primary heart graft dysfunction, a number of transplant centers resort to the choice of the treatment by means of mechanical circulatory support, such as extracorporeal membrane oxygenation. Clinical case. In the early postoperative period after heart transplantation, the patient was diagnosed with developing primary graft dysfunction. The clinical response to medication support of hemodynamics was unsatisfactory. Venoarterial extracorporeal membrane oxygenation was performed. On the 4th day, the regional contractility of the left ventricle restored, the ejection fraction of both ventricles increased, their systolic function improved. The patient was discharged on the 21st day in a satisfactory condition. Conclusion. Mechanical circulatory support modalities, such as venoarterial extracorporeal membrane oxygenation, can compensate for the emerging primary myocardial dysfunction in recipients. The efficiency of the extracorporeal membrane oxygenation is achieved not only by knowledge of current clinical recommendations, but also depends on the implementation of other clinics' experience as well as technical readiness of the center and medical personnel' qualification

Role of miRNA in the development of atrial fibrillation in patients with valvular heart disease

Atrial fibrillation (AF) is a common type of arrhythmia that is frequently observed in clinical practice. In patients admitted to the cardiac surgery department, AF most often develops due to valvular heart disease, as well as in the postoperative period. Modern surgical techniques for valvular defects make it possible to get rid of AF. However, there are still unresolved issues of treatment tactics, the selection of procedure and the correct selection of patients for surgery. In order to find answers to these questions, the influence of microribonucleic acids (miRNAs) on the development and course of AF is being studied. The article presents an analytical review on the influence of miRNA on the occurrence, regulation and course of AF in patients with valvular heart disease before surgery and in the postoperative period