[Case of successful prevention of multiple organ dysfunctions in 74 years old patient with sepsis after Crawford surgery complicated with pleural empyema, chest wall tissues infection and osteomyelitis of ribs].

The article deals with a clinical case demonstrating that patient's elderly age is not an absolute contraindication for complex surgery in spite of high risk of postoperative complications. Early diagnostics, target treatment of the infection cite with vacuum-assisted therapy for wounds and the treatment of infectious complications based on individual characteristics of elderly patient with sepsis as an outcome of prosthetic thoracoabdominal aortic repair allowed avoiding multiple organ dysfunctions in the patient.

[Renovascular hypertension prevalence aetiology, pathogenesis. Pharmacotherapy (review of the literature)].

Presented herein is a review of literature on the problem concerning renovascular hypertension. The article considers the prevalence rate of the pathology concerned, causes of its origin and pathogenesis of development of renovascular hypertension. In the light of peculiarities of the pathogenesis of development presented are the principles of and indications for drug therapy. Underlined is the necessity of performing a timely surgical intervention aimed at restoring the renal blood flow.

[Surgical treatment of aneurysm and kinking of the internal carotid artery].

The authors describe herein a case report of a female patient with an aneurysm and kinking of the internal carotid artery, located 35 cm above the bifurcation,and accompanied by the focal neurological symptomatology. The successfully carried out surgical management consisted in excision of the aneurysm together with the kinking of the internal carotid artery and formation of an <> anastomosis. Both the aneurysm and kinking were caused by fibromuscular dysplasia.

Strategy and tactics of instrumental examination of patients with thoracic and thoracoabdominal aortic aneurysm.

The paper gives a detailed characterization and describes the importance of instrumental methods for examination of patients in the diagnosis of thoracic and thoracoabdominal aortic aneurysms. Provides a differentiated protocol of the examination of patients as dependent on the clinical course, disease stage and nemodynamic stability of the patient's status. Delineates the tactics of the examination of patients with acute and chronic dissection of the proximal and distal segments of the aorta as dependent on hemodynamic stability. Emphasis is laid on the key role of computed tomography and magnetic resonance tomography in the diagnosis of aortic aneurysms.

[Aneurysm of the ascending aorta in its coarctation]. / Anevrizma voskhodiashchei aorty pri ee koarktatsii.

In long-term period after resection of aorta coarctation, 9-14% patients developed aortic aneurysms, one third of them localized in the ascending aorta. From 146 patients operated on for aneurysm of the ascending aorta, 3 had aortic coarctation. In 2 patients aneurysms of the ascending aorta formed late after resection of the coarctation, the third patient was hospitalized with clinical picture of cardiac insufficiency at terminal stage due to coarctation of the aorta and a giant aneurysm of the ascending aorta with significant aortic insufficiency. The patients underwent successful surgeries: 1) ascending aorta grafting; 2) aortic valve and ascending aorta grafting by Bentallo de Bono method; 3) aortic valve and ascending aorta grafting by Bentallo de Bono method with bypass of descending aorta from the conduit. Cystic medianecrosis and two-volume aortic valve were revealed in all the patients. It is concluded that patients after surgery for coarctation of the aorta require long-term follow-up to defect cardiovascular complications early.

[Myocardial bridge - congenital anomaly of coronary vasculature.]. / Miokardial'nyi mostik - vrozhdennaia anomaliia koronarnogo rusla.

Coronary artery lumen compression during systole by a myocardial bridge can cause myocardial ischemia and even necrosis. Myocardial bridges represent a variant of norm or congenital anomaly of coronary vasculature. They belong to relatively frequent autopsy findings (5.4-85.7%) and are most often located over left anterior descending artery. Main angiographic sign of myocardial bridging is effect of contrast medium pushing out during narrowing of intramural part of a coronary artery during systole. In most cases systolic coronary artery narrowing not associated with any symptoms and bridging is just accidentally found at angiography. However some bridges produce clinical manifestations such as angina pectoris or myocardial infarction which require drug treatment. Therapy failures are managed by stenting or surgery. Under certain conditions systolic coronary artery narrowing can cause sudden death therefore all patients with clinically overt myocardial bridges should be under continuous medical surveillance. A case of clinically successful open heart supracoronary myotomy in a patient with myocardial ischemia due to a bridge causing 80% systolic narrowing of the left anterior descending coronary artery is presented.