Surgical Treatment of Aortic Valve Papillary Fibroelastoma in Combination With Coronary Artery Bypass Grafting

Objective: To describe a rare case of surgical treatment of aortic valve papillary fibroelastoma in combination with coronary artery bypass grafting.   Clinical case: The patient was hospitalized with a suspected mass on the left coronary cusp of the aortic valve and complained of retrosternal pain that appeared during moderate exertion and brisk walking and went away with rest. The patient history revealed that these clinical manifestations began in February 2022 and were treated by coronary stenting. Since May 2022 the patient noticed symptoms of recurrent angina. Transthoracic echocardiogram dated June 14, 2022 revealed a 13 × 12 mm additional mobile mass on the left coronary cusp. On June 30, 2022 the patient had an open surgery: mass removal, coronary artery bypass grafting of the anterior descending artery, and coronary artery bypass grafting of the circumflex artery. During the aortic valve exploration, the mass was visualized on the left coronary cusp on the side of the left ventricle. The mass was removed by precision marginal excision.   Conclusions: To timely examine patients, refer them for surgical treatment, preserve and prolong their life, and improve its quality, clinical practitioners should know clinical manifestations and challenges in screening for aortic valve papillary fibroelastoma

The Effect of Reducing Irradiation Temperature on the Structure and Radiation Embrittlement Mechanism of RPV Steels

A complex research of RPV 15Kh2NMFA class 1 steel in different states was performed: in the initial state and after irradiatiion at different temperatures (50-300∘C). Low temperature (50-140∘C) irradiation was shown to cause the formation of dislocation loops of ultrahigh density. At the same time radiation-induced precipitates, being the main radiation-induced hardening phase at irradiation temperature of VVER reactors (∼300∘C), were absent. This leads to a higher radiation embrittlement rate after low-temperature irradiation as compared with irradiation at operating temperatures of VVER-1000. The radiation embrittlement coefficient values are 8.7 and 1.45 for (120-140)∘C and (290-315)∘C irradiation temperature, respectively

Our experience with mitral valve repair using an autologous pericardium for recurrent mitral regurgitation

Objective: To present outcomes of mitral valve reinterventions for recurrent degenerative mitral regurgitation.Materials and methods: From May 2017 to February 2021 3 male patients aged 43, 50, and 54 years and an 18-year-old female patient underwent mitral valve reinterventions with an autopericardial strip at Scientific Research Institute – Specialized Cardiac Surgery Clinical Hospital named after Academician B.A. Korolev. Three patients had primary mitral valve annuloplasty using a support ring and 1 patient using an autopericardial strip. In this patient group recurrent mitral regurgitation developed within 6-33 months between the primary repair and reintervention (20 ± 13.5 months on average).Results: No hospital mortality was reported. Cardiopulmonary bypass duration averaged 109.8 ± 19.7 minutes, and myocardial ischemia lasted 77.5 ± 10.1 minutes. Two patients had an adjunctive repeat radiofrequency Maze procedure, with the supraventricular rhythm restored in 1 patient. Echocardiography demonstrated that mitral regurgitation did not exceed grade 1 at discharge. Reintervention using an autopericardial strip for recurrent mitral regurgitation significantly reduces sizes of the left atrium and left ventricle. Ejection fraction did not change after the intervention. Mitral valve peak gradient in all cases did not exceed 9 mm Hg.Conclusions: The key to a successful mitral valve reintervention is a qualitative analysis of the recurrence causes and use of various techniques and materials for intervention on the mitral valvular complex. Mitral valve reinterventions, especially in young patients, are justified if certain safety conditions are met and have similar outcomes to primary interventions

HIGLY STABLE NITROXIDE SPIN LABELS FOR BIOPHYSICAL RESEARCH

This work was supported by the RSF, project # 19-13-000235 and Ministry of Science and Higher Education of the Russian Federation (grant No. 14. W03.31.0034)

СРАВНИТЕЛЬНАЯ ОЦЕНКА КЛИНИЧЕСКИХ И ГЕМОДИНАМИЧЕСКИХ РЕЗУЛЬТАТОВ ИМПЛАНТАЦИИ КСЕНОАОРТАЛЬНЫХ И КСЕНОПЕРИКАРДИАЛЬНЫХ БИОЛОГИЧЕСКИХ ПРОТЕЗОВ ПРИ КОРРЕКЦИИ ДЕГЕНЕРАТИВНЫХ ПОРОКОВ АОРТАЛЬНОГО КЛАПАНА

Aim. To assess clinical and hemodynamic outcomes of aortic valve replacement with xenoaortic biological prosthesis “Aspire Vascutek” and xenopericardial biological prosthesis “UniLine”. Methods. 130 patients who underwent aortic valve replacement with bioprostheses in the period from October 2012 to March 2016 were included in the study. All patients were enrolled into two groups according to the model of the implanted device. 65 recipients of xenoaortic bioprostheses “Aspire Vascutek” were included in Group 1, whereas patients (n = 65) xenopericardial bioprostheses “UniLine” were assigned in Group 2. Males prevailed in Group 1 (63%, the mean age - 66.4±5.5 years). 85% of Group 1 patients had heart failure Strazhesko-Vasilenko IIA grade and 94% of patients had chronic heart failure NYHA III. Similarly, male patients (58%) prevailed in Group 2. The mean age of Group 2 patients was 66.5±3.65 years. All patients in Group 2 II had heart failure Strazhesko-Vasilenko IIA grade and chronic heart failure NYHA III. Results Two patients in Group 1 died in the early postoperative period (the overall mortality was 1.5%). All patients had chronic heart failure NYHA I-II at discharge. Peak transvalvular pressure gradient significantly decreased in the in-hospital period, particularly in Group 2 patients (82,3±22,7 mm Hg vs. 28.8±7.6 mm Hg). 88% of Group 1 patients underwent the 60-month follow-up, and 96% of Group 2 patients - the 48-month follow-up. Transvalvular pressure gradients decreased progressively in both study groups within 60 months follow-up. This decrease was more pronounced in recipients of xenopericardial biological prostheses. Conclusion. Aortic valve replacement with xenopericardial bioprostheses “UniLine” and xenoaortic bioprostheses “Aspire Vascutek” for aortic valvular disease allows treating intracardiac hemodynamic derangements and achieving good clinical and hemodynamic outcomes.Цель. Исследование клинических и гемодинамических результатов имплантации ксеноаортального биологического протеза (БП) «Aspire» (Vascutek Terumo, Великобритания) и ксеноперикардиального биологического протеза «ЮниЛайн» (НеоКор, Кемерово, РФ) для коррекции пороков аортального клапана. Материалы и методы В проводимое исследование включено 130 пациентов, которым в период с октября 2012 г. по март 2016 г. для коррекция порока аортального клапана были использованы различные модели БП. При этом, в зависимости от типа имплантируемого БП выделено две группы пациентов. В группу I вошли 65 пациентов, которым для коррекции аортального порока использовался ксеноаортальный БП «Aspire». Группу 2 составили 65 человек, которым имплантирован каркасный ксеноперикардиальный БП «ЮниЛайн». В группе I преобладали мужчины (63%, средний возраст - 66,4±5,5 лет). 85% пациентов в группе I имели НК IIA по Стражеско – Василенко и 94% пациентов находились в III ФК по NYHA. Среди пациентов в группе II так же преобладали мужчины – 58%. Средний возраст составил 66,5±3,65 лет. Все наблюдаемые пациенты в группе II имели НК II A по классификации Стражеско – Василенко и находились в III ФК по NYHA. Результаты. В раннем послеоперационном периоде умерло двое пациентов в группе I (летальность в общей группе составила 1,5%). К моменту выписки из стационара все пациенты переведены в I – II ФК недостаточности кровообращения по NYHA. На госпитальном этапе отмечалось достоверное снижение трансклапанных пиковых градиентов давления, наиболее выраженное у пациентов в группе II: с 82,3±22,7 мм рт. ст. до 28,8±7,6 мм рт. ст. В сроки до 60 мес. после операции наблюдением было охвачено 88% пациентов в группе I; в сроки до 48 мес. под наблюдением находилось 96% пациентов в группе II. При оценке трансклапанных градиентов давления в сроки до 60 мес. отмечено проградиентное снижение в обеих наблюдаемых подгруппах пациентов, наиболее выраженное при имплантации ксеноперикардиальных биологических протезов. Заключение. Имплантация ксеноперикардиального БП «ЮниЛайн», так и ксеноаортального БП «Aspire Vascultek» при пороках АК различного генеза позволяет адекватно корригировать нарушения внутрисердечной гемодинамики и достигать хороших клинических и гемодинамических результатов

Феноменология инерциальной кинематики в структуре формирования двигательных адаптаций

The aim of the study was to develop a methodology for assessing the state of motor adaptation at the level of the main joint elements of the locomotor system when performing postural deviations with inertial components in a group of healthy volunteers (n=24). To conduct the study we used the “Teslasuit” smart suit as a technology with a system of inertial measuring units. A virtual skeletal model of the subject’s body was reconstructed on the obtained quaternions for each direction of spatial displacement. Parameters of inertial kinematic were calculated by the Fast Fourier Transform in the frequency bands of 0.1–5, 6–10, and 11–15 Hz. To assess motor adaptive reactions, we developed the following tests: ventrodorsal displacement test; laterolateral displacement test; linear displacement test in vertical direction; axial rotation test around vertical. All test tasks were performed using biofeedback as a virtual reality environment. The study revealed the presence of universal motor adaptation mechanisms with activation of the components of axial rotation of the trunk and axial rotation and flexion of the leading shoulder joint. At the same time, a dynamic phase of postural regulation during axial rotations and tilts of the body leads to the activation of motor adaptation mechanisms from the leading hip, knee, and ankle joints, while axial movements form a picture of the kinematic stabilization of these locomotor system elements.Целью исследования являлась разработка методики оценки состояния двигательной адаптации на уровне основных суставных элементов локомоторной системы при выполнении постуральных девиаций с инерциальными компонентами в группе здоровых добровольцев (n=24). Для проведения исследования использовалась технология «умного» костюма «Teslasuit» с системой инерциальных измерительных сенсоров. На основе полученных кватернионов выполнялась реконструкция виртуальной скелетной модели тела испытуемого с последующим расчетом угловых ускорений для каждого направления пространственного перемещения с последующим частотным преобразованием и выделением показателей инерциальной кинематики в частотных полосах 0,1–5, 6–10 и 11–15 Гц. Для оценки двигательных адаптивных реакций были разработаны тестовые задания: тест латеро-латеральных девиаций, тест вентро-дорзальных девиаций, тест аксиальных ротаций вокруг вертикали, тест линейных перемещений по вертикали. Все тестовые задания выполнялись с применением биологически-обратной связи. Проведенное исследование выявило наличие универсальных механизмов регуляции двигательной адаптации с активацией компонентов осевых ротаций туловища и осевых ротаций и сгибаний ведущего плечевого сустава. Вместе с этим обеспечение динамической фазы постуральной регуляции при осевых ротациях и наклонах туловища приводит к активации механизмов двигательной адаптации со стороны ведущего тазобедренного, коленного и голеностопного суставов, при этом аксиальные перемещения формируют картину кинематической стабилизации данных элементов локомоторной системы

ИНТИМАЛЬНАЯ САРКОМА ЛЕГОЧНОЙ АРТЕРИИ, ПРОТЕКАЮЩАЯ ПОД МАСКОЙ ТРОМБОЭМБОЛИИ ЛЕГОЧНОЙ АРТЕРИИ: РЕЗУЛЬТАТЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ

HighlightsThe article describes a rare case of surgical treatment of pulmonary artery intimal sarcoma. The authors analyzed the causes for incorrect diagnosis of pulmonary embolism in detail, and proposed alternative options for distinguishing the diseases under consideration. Moreover, the authors analyzed different surgical treatment modalities of intracardial sarcomas, and demonstrated the prospect of using molecular hydrogen as a component of an anesthetics during surgical interventions with cardiopulmonary bypass. AbstractThe article describes a rare clinical case of a patient with pulmonary artery sarcoma. The absence of specific symptoms of sarcoma, as well as features of developing cardiovascular and respiratory failure, characteristic of pulmonary embolism, contributed to the incorrect diagnosis. The article analyzes the main problems of primary diagnostics, and proposes new parameters for evaluating manifesting symptoms and the results of additional examination, which should improve the results of surgical treatment of malignant tumors.Основные положенияВ статье представлен редкий случай хирургического лечения интимальной саркомы легочной артерии. Детально проанализированы причины гипердиагностики тромбоэмболии легочной артерии, а также предложены альтернативные варианты дифференциальной верификации рассматриваемых заболеваний. Рассмотрены возможные варианты хирургического лечения сарком внутрикардиальной локализации. Кроме этого, продемонстрирована перспектива применения молекулярного водорода в качестве компонента анестезиологического пособия при выполнении оперативных вмешательств в условиях искусственного кровообращения. РезюмеВ статье описано редкое клиническое наблюдение пациентки с саркомой легочной артерии. Отсутствие специфических симптомов саркомы, а также особенности развивающейся сердечно-сосудистой и дыхательной недостаточности, характерные для тромбоэмболии легочной артерии, способствовали постановке неправильного диагноза. В работе проанализированы основные проблемы первичной диагностики, а также предложены параметры оценки манифестирующих симптомокомплексов и результатов объективных методов обследования, что в свете повышенной онкологической настороженности позволит улучшить результаты хирургического лечения злокачественных заболеваний сердца

CLINICAL AND FUNCTIONAL ASSESSMENT OF THE BIOLOGICAL PROSTHESIS “ASPIRE” FOR SURGICAL CORRECTION OF MITRAL VALVE DISEASE

Aim: To assess clinical and functional efficacy of implanted biological prosthesis “ASPIRE” (manufactured by Vascutek) for correction of mitral valve disease.Materials and methods: From October 2008 to December 2013, biological prostheses “ASPIRE” (Vascutek) were implanted to 34 patients with mitral valve disease (mean age 63.59 ± 4.96 years, 79.4% female). From these, 24 patients had mitral stenosis and 10 patients had mitral insufficiency. 73.5% of all patients had heart failure Strazhesko-Vasilenko IIA grade and 85.3% of patients had chronic heart failure NYHA III. Isolated mitral valve replacement was performed only in 8 (23.5%) of patients. In 22 (64.7%) of cases mitral valve replacement was combined with tricuspid valvuloplasty in various modifications. Duration of cardiopulmonary bypass and of aortic clamping was 88.09 ± 25.95 and 65.68 ± 25.51 minutes, respectively. Before and after surgery all patients underwent echocardiographic assessment and clinical assessment of their general status.Results: In-hospital mortality was 5.88% (n = 2) and was related to multiorgan failure in the early postoperative period. All 32 (94.12%) surviving patients improved with decrease or complete disappearance of heart failure. Postoperative complications were typical for cardiac surgery. There were no episodes of embolism, structural dysfunction, thrombosis of the prosthesis and endocarditis of the prosthesis in the early postoperative period. Pressure gradients across prosthetic valves were not high and corresponded to good clinical and hemodynamic results in the early postoperative period.Conclusion: Taking into account good immediate results of mitral valve replacement, as well as no need in lifelong anticoagulation in patients with multiple concomitant disorders, implantation of the biological prosthesis “ASPIRE” (Vascutek) could become a procedure of choice for correction of valve abnormalities in patients above 65 years. For more comprehensive assessment of the implanted prosthesis, it is necessary to further assess long-term results of valve replacement

ORIGINAL METHODOLOGY OF ANNULOPLASTY OF THE MITRAL VALVE WITH A STABILIZED AUTOPERICARDIUM IN DEGENERATIVE HEART DISEASES

Introduction: We have evaluated the results of using stabilized autopericardium for the correction of the mitral valve (MV) defects in patients with degenerative heart diseases. Methods: For the period from 2017-2019, MV plasty was performed in 51patients with a strip of autopericardium according to the original method. Among the patients who underwent surgery, men prevailed 64.7% (33). The average age is 55.6 (36 to 78) years. A strip 12x0.5mm in size was cut from the patient’s pericardium. Autopericardium stabilization was carried out by treatment with a 0.6% glutaraldehyde solution for 10 minutes. Processing of the autopericardium with glutaraldehyde allows preserving the positive properties of the autopericardium to eliminate the inconvenience of manipulating the autopericardial strip, increase its strength, reduce the cellular response from the body and prevent denaturation of the collagen fibers. Our proposed technique allows us to determine the optimal length of the strip, individually for each patient. Correction was considered adequate if, after surgery, regurgitation on MV did not exceed I degree. Results: No mortality was observed at the hospital stage. In one case, an early relapse of MV failure occurred, but the degree of mitral regurgitation did not exceed II degree and the patient was under observation. Conclusions: The use of a stabilized autopericardium as a material for the reconstruction of MV with an individual selection of the strip length allows increasing the strength of the fibrous ring and achieving optimal MV functioning and significantly improving tissue-specific biocompatibility of the autoimplant. The clinical results obtained using the original MV annuloplasty technique demonstrated high efficiency, low mortality and improved results of the correction of degenerative heart diseases and could be recommended for extensive clinical use in cardiac surgery

Comparative Outcomes of Mitral Valve Annuloplasty With Support Rings and Autopericardial Strip in Patients With Degenerative Diseases

Objective: To compare the outcomes of mitral valve annuloplasty with support rings and that of the current technique employing an autopericardial strip in patients with degenerative diseases (patent RU2774033C1, June 14, 2022).Materials and methods: The study included 105 patients with degenerative mitral valve disease who underwent surgery in our clinic from May 2010 to January 2020. Depending on the conduit type, the patients were divided into two groups. Group I included 53 patients who underwent mitral valve annuloplasty with an autopericardial strip. Group II included 52 patients who underwent annuloplasty with a support ring. Male patients predominated in both groups: 59.6% and 57.7%, respectively. The mean age of patients was 54.9 ± 9.5 years (36–78 years) in group I and 54.8 ± 10.05 years (32–70 years) in group II. In most cases, tri- and quadrangular resections of the P2 segment were performed, and in some cases, neochords were implanted to the A2 segment.Results: There was 1 death in group II as a result of progressive cardiovascular and multiple organ failure while in group I no hospital mortality was reported. At the discharge, 81.1% of patients in group I and 59.6% of patients in group II had no mitral regurgitation.Conclusions: The current technique of mitral valve annuloplasty with an autopericardial strip in patients with degenerative diseases allows for adequate stabilization of the annulus fibrosus and improves the surgical outcomes in selected patients. With our proposed method of mitral valve annuloplasty, the suitable strip length can be chosen for each patient