[Right ventricle free wall rupture during transcatheter occluder implantation in a patient with postinfarction rupture of the interventricular septum and COVID-19-associated myocarditis. Case report].

Intraventricular septum rupture is a rare mechanic complication of myocardial infarction associated with high mortality. This case describes STEMI in recovered patient after COVID 19 associated pneumonia, which was complicated by ventricular septum rupture followed by cardiogenic shock. It was managed by percutaneous occluder implantation. The procedure was complicated by right ventricular wall rupture. Postmortem examination of myocardium showed the signs of inflammation infiltrate and myocyte necrosis, according to histopathological Dallas criteria diagnosis of COVID-19 associated myocarditis was established. The COVID-19 pandemic has contributed to increasing cardiovascular mortality. This is typically attributed to diminishing resources for timely and appropriate medical care, and patients' late presentations for fear of contracting the infection. Cardiovascular complication of COVID-19 may be another contributing factor. Further research is needed to improve our understanding of the mechanisms and long-term sequelae of myocardium damage in COVID-19, to optimize treatment strategy and subsequent follow-up in such patients.

[Patent foramen ovale as the cause of recurrent embolic strokes. Case report].

А clinical case of a young patient with recurrent ischemic strokes is presented. The problems of diagnostic embolic strokes are discussed. We set out the algorithm for identifying patients, in whom patent foramen ovale is the most probable cause of embolic stroke. Detailed consideration of imaging diagnostic methods possibility is included. Hypothesis of probable source of cardioembolism from patent foramen ovale is presented. Recommendations for the secondary prevention of recurrent ischemic stroke, associated with patent foramen ovale, are provided. We also considered the issues of antithrombotic treatment.

[Analysis of the causes of repeat stenosis of the coronary arteries after elective stenting in patients with stable angina pectoris].

AIM: Coronary stenting is the evidence-based treatment approach of stable angina. The objective was to determine the incidence of restenosis or atherosclerosis progression which led to the need for coronary angiography according to a single center registry data. MATERIALS AND METHODS: The procedure and clinical data of 3732 (2897 males) consecutive stable coronary artery disease patients undergoing coronary stenting, over five years between March 2010 and September 2014, were subject of this study. Over the next 4 years, 1487 (1173 males) patients were re-evaluated due to angina reoccurrence. 699 patients demonstrated the indications for coronary angiography. RESULTS: The restenosis of the previously stented segment was detected in 84 (12%) cases, the progression of coronary atherosclerosis in 306 (44%), the combination of restenosis and atherosclerosis progression in 63 (9%), and the absence of these complications in 245 (35%) cases. The progression of coronary atherosclerosis was the leading indication for the repeat angiography and revascularization (44 and 58%, respectively); p0.05. The basal level of hsCRP2 mg/l had a prognostic significance for the development of combined event (the restenosis and atherosclerosis progression): AUC 0.65 (0.500.75), OR 3.0 (1.17.9), p0.05. CONCLUSION: The progression of coronary atherosclerosis was the leading indication for the repeat angiography and repeat revascularization during 2 years after coronary stenting. The hsCRP level 2 mg/l at baseline had a prognostic significance for the development of restenosis in previously stented segment and coronary atherosclerosis progression.

Computed Tomography Myocardial Perfusion Imaging With Transesophageal Atrial Pacing Stress Test in Patients With Borderline Stenoses in the Coronary Arteries: a Comparison With Fractional Flow Reserve.

Aim      To evaluate the diagnostic accuracy of cardiac perfusion computed tomography (PCT) with transesophageal electrocardiostimulation (TE ECS) for detection of ischemia in patients with borderline coronary stenosis (50-75 %) compared to measurements of fractional flow reserve (FFR).Material and methods  The study included 25 patients with borderline (50-75 %) coronary stenosis as per data of computed tomography angiography (CTA) or coronary angiography (CAG). Later the patients underwent invasive measurement of FFR and cardiac PCT on a 320-row detector tomograph in combination with the TE ECS stress test.  FFR values <0.8 indicated the hemodynamic significance of stenosis. Myocardial perfusion was evaluated visually based on consensus of two experts.Results All patients completed the study protocol. Cardiac pacing duration was 6 min for all patients. Four patients required intravenous administration of atropine sulphate. PCT with TE ECS detected significant for FFR stenoses with sensitivity, specificity, and predictive value of a positive result and predictive value for a negative result of 47, 90, 87, and 53 %, respectively.Conclusion      PCT with TE ECS in combination with CTA can be considered as an informative method for simultaneous evaluation of the condition of coronary arteries and detection of myocardial ischemia. This method is particularly relevant for assessing the hemodynamic significance of borderline coronary stenoses.

[The prognostic value of high-sensitivity C-reactive protein blood level after coronary stenting for the development of stent restenosis].

Aim      To analyze the relationship between serum concentrations of high-sensitivity C-reactive protein (hsCRP) in dynamics and development of restenosis at 12 months following elective coronary stent placement (CSP).Material and methods  The key role in atherogenesis, neointimal proliferation and restenosis belongs to inflammation. This study included 91 patients (median age, 60 [56; 66] years) with stable exertional angina after an elective CSP using second-generation stents. Follow-up coronarography was performed for 60 patients at 12 months. Concentration of hsCRP was measured immediately prior to CSP and at 1, 3, 6, and 12 months after CSP. Restenosis of the stented segment (50% or more narrowing of the stented segment or a 5-mm vessel segment proximally or distally adjacent to the stented segment) was observed in 8 patients.Results According to results of the ROC analysis, the increase in hsCRP concentration >0.9 mg/l (>25%) at one month after CSP had the highest predictive significance with respect of restenosis (area under the ROC curve, 0.89 at 95 % confidence interval (CI) from 0.79 to 0.99; sensitivity, 87.5 %; specificity, 82.8 %; р=0.0005), which was superior to the absolute value of hsCRP concentration >3.0 mg/l (area under the ROC curve, 0.82 at 95 % CI from 0.68 to 0.96; р=0.0007).Conclusion      Increased concentration of hsCRP ≥0.9 mg /l (≥25 %) at a month after CSP was associated with restenosis of the coronary artery stented segment.

[The Incidence and Possible Predictors of Coronary Restenosis].

OBJECTIVE: Assess time and possible predictors of restenosis after the implantation of first- and second-generation coronary stents and bare metal stents (BMSs) in patients with stable coronary artery disease after elective coronary stenting. MATERIALS AND METHODS: From 2010 to 2014, 3,732 (2,897 males, 60 [53; 68] years old) patients with stable exertional angina of functional class I-III underwent coronary stenting. From 2014 to 2017, 1,487 (1,173 males and 314 females) patients returned. Repeat coronary angiography was performed in 699 patients. RESULTS: A total of 644 first-generation stents, 5,321 second-generation stents, and 473 BMSs were implanted. During the control coronary angiography, contrasting was repeated for 193 first-generation stents, 899 second-generation stents, and 77 BMSs. Restenosis (stenosis of 50 % or more in the previously stented segment) was detected in 28 (14 % of angiographic control) first-generation drug-eluting stents, 94 (10 %) second-generation drug-eluting stents, and 21 (27 %) BMSs. Patients with BMS restenosis returned significantly earlier than patients with restenosis of the first- and second-generation drug-eluting stents (11 [6, 27] months vs. 32 [11; 48]) months and 24 [12; 42] months, respectively; p<0.05). The initial and repeat levels of high-sensitivity C-reactive protein (hs-CRP) were higher in patients with restenosis (2.2 [1.2, 5.0] mg / L vs. 2.1 [1.0, 4.6] mg / L, respectively; p> 0.05) than in patients without restenosis (2.0 [0.9, 4.2] mg / L vs. 1.9 [0.7, 3.5] mg / L respectively, p>0.05). Blood levels of hs-CRP ≥2 mg / L according to receiver operating characteristic curve (ROC) analysis at return visit were used as a predictor to identify restenosis of stents with a diameter <3 mm and a length >25 mm - area under the curve (AUC) 0.67 (95 % confidence interval (CI) 0.51-0.84), p <0.05, odds ratio 3.7 (95 % CI 1.1-12.1), p<0.05. Stent type had a significant effect on the time to restenosis in the survival analysis (p<0.0005). CONCLUSION: The time from coronary stenting to the return visit of patients presenting with restenosis after the implantation of first- and second-generation drug-eluting stents is consistent; median time of the return visit of patients with restenosis of the first-generation stents was 2-3 years after coronary stenting. Blood levels of hs-CRP ≥2 mg / L at the return visit is a predictor of restenosis of stents with a diameter <3 mm and a length >25 mm.

[Complications of the Catheter Treatment of Atrial Fibrillation: Stenosis of All Pulmonary Veins after Radiofrequency Ablation].

Radiofrequency ablation is the "gold standard" in atrial fibrillation treatment. The frequency of complications is about 3.5-3.9 %. The symptomatic pulmonary vein stenosis is one of the most severe complications. In this report we present a clinical case of stenosis of all four pulmonary veins after redo catheter ablation of atrial fibrillation in 61year-old patient, and discussion of possible causes, specific features of diagnosis, and possible approaches to treatment of this complication.

Rate of Complications at Early Removal of Compression Bandage After Transradial Coronary Angiography.

PURPOSE: to compare rates of access site complications at early (after 4 hours) and traditional (after 24 hours) removal of a compression bandage after diagnostic transradial (TR) coronary angiography (CA) in patients not receiving anticoagulants. MATERIALS AND METHODS: We included into this study 392 patients (mean age 63±8.7 years, 62.8% men) who underwent transradial coronary angiography. Patients were divided into 2 groups. In group 1 patients (n=221) compression bandage was removed from puncture site in 4 hours after procedure with subsequent control of radial artery patency using presence of pulse metric curve during ulnar artery compression (the reverse Barbeau test with pulse oximeter). In patients of group 2 (n=171) compression band was removed after 24 hours. In both groups control of radial artery patency was carried out after 24 hours using the reverse Barbeau test. Upon detection of radial artery occlusion (RAO) ultrasound imaging of the forearm arteries was performed. RESULTS: No RAO was detected in group 1 while in group 2 number of detected RAO was 15 (8.8%) (р<0.05). Rates of hematomas at puncture site were not significantly different. Puncture site bleeding after band removal requiring repeated banding occurred in 1 patient of group one (0.6%); no such cases were registered in group 2 (p>0.05). CONCLUSION: Compared with traditional method early removal of compression bandage after TR CA was associated with lower rate of RAO.

[Endovascular closure of a ventricular septal defect from Takotsubo Syndrome].

Takotsubo Syndrome is a transient condition characterized by left ventricular systolic dysfunction. Although the prognosis is excellent in most cases, rare cases of serious complications can occur. We present a case of a 81-year - old woman with Takotsubo Syndrome complicated by ventricular septal rupture that was successfully closed with an occluder Occlutech with good immediate and long - term outcomes.

[Giant Aneurysms in Coronary Arteries of a Young Woman].

Coronary arteries aneurysms with their thrombotic occlusion are known to be detected in young patients who have suffered Kawasaki disease in childhood. The other vascular beds are usually not involved. In the literature one can find not enough information regarding diagnostics of this pathology, as well as no specific treatment algorithm. We present here a clinical case of re-emergence of giant aneurysms of coronary arteries in the young female patient with subsequent immuno-histological confirmation of previous Kawasaki disease.

[Clinical case of using manual thrombus aspiration during percutaneous coronary intervention in a patient with ST-segment elevation myocardial infarction type 2].

The paper describes a patient admitted to the Emergency Cardiology Department, A.L. Myasnikov Institute of Clinical Cardiology, for diagnosed ST-segment elevation acute coronary syndrome. At the prehospital stage, the patient received ineffective thrombolytic therapy; percutaneous coronary intervention was made at the Department of X-ray Endovascular Diagnostic and Treatment Methods of the Institute 3.5 hours after disease onset. Repeated thrombus aspirations from the infarction-related artery were carried out, which could have a good angiographic pattern. His medical record shows that the patient has been suffering from persistent atrial fibrillation for a long time. There is also evidence for transient ischemic attacks in 2010 and 2011. The fact that there are no coronary artery stenoses after thrombus removal could suspect the thromboembolic genesis of myocardial infarction.

[No-reflow phenomenon in the practice of an endovascular surgeon].

No-reflow phenomenon is a complication of percutaneous coronary intervention and is the absence of distal coronary bed filling. The main cause of this phenomenon is distal embolism of the coronary artery by atheromatous and thrombotic masses. The paper gives different classifications for evaluation of myocardial and coronary reperfusion. The use of aspiration catheters, glycoprotein IIb/IIIa receptor inhibitors and other drugs that affect prognosis in patients with this phenomenon is also touched upon.

[Transradial approach during percutaneous coronary interventions. Part 1. Evidence base for applying a transradial approach].

The use of the radial artery as an approach to percutaneous coronary interventions is becoming increasing popular now. The success of this approach depends on both the accumulated experience of an operator and a health care facility. The paper analyzes an investigation of the comparative characteristics of both a transradial approach and a transfemoral one and the impact of the former on the success of the procedure. It considers the role of the transradial approach in the present-day practice of X-ray endovascular diagnosis and treatment specialists and discusses the problems of education and choice of optimal clinical indications.

[Transradial approach during percutaneous coronary interventions. Part 2. Practical guidelines and the authors' data].

The paper describes the technical features of a transradial approach; indications and patient selection for this arterial approach; and stepwise patient preparation. It depicts the anatomic variants of the origin of the radial artery, which affect the success of this approach. The suitable instruments for this approach are described. The authors give their results of the performed study comparing different types of approaches.

[Embolization of mammary artery branches after mammary artery bypass surgery].

Even after performed mammary artery bypass surgery, some patients continued to have clinical manifestations of angina pectoris. This may be associated with the development of coronary stealing syndrome due to the fact that the native intrathoracic artery has large lateral branches. Current methods for embolization of arteries of different diameters make it possible to accomplish this task reasonably safely and in full measure. This paper describes a clinical case of reembolization of the lateral branch of a mammary artery shunt with an intravascular coil.

[Endovascular treatment for chronic coronary occlusions in patients with coronary heart disease].

OBJECTIVE: To analyze the angiographic results of endovascular treatment for chronic coronary occlusions in patients with coronary heart disease. MATERIAL AND METHODS: In 2009 to 2013 attempted endovascu-ar recanalization of chronic coronary occlusions in 854 patients with coronary heart disease. The patients' age ranged from3 6 to 68 years (mean 52 years). The estimated du-ation of occlusion was m1 onth to more than 3 years. There were 193 (22.6%) females and 661 (77.4%) males. 462 (54.1%) patients had a history of myocardial infarction. 738 (86.4%) and 116 (13.6%) patients had true (TIMI grade 0) and functional (TIMI grade i1 occlusions, respectively. Multi- and univascular lesions were found in 683 (79.9%) and 171 (20.1%) patients, respectively. Silent occlusions with preserved myocardial contractility were identified in 165 (19.3%) patients. RRESULTS:Blood flow could be successfully restored in 616 (72.1%) patients. Recanalization of chronic coronary occlusion failed in 238 (27.9%) patients. CCONCLUSION:Recanalization of chronic coronary occlusions is a highly effective and relatively safe technique. The efficiency of the procedure largely depends on the duration of occlusion, its X-ray morphological characteristics, and the experience of a physician.

[Coronary angioplasty and stenting in patients with ischemic cardiomyopathy].

Multiple coronary artery atherosclerotic lesions are a major cause of ischemic cardiomyopathy. Myocardial revascularization in patients with ischemic cardiomyopathy in the presence of the viable myocardium and/or ischemic areas leads to improved central hemodynamic parameters and as a consequence to better quality of life and prognosis as a whole. The paper describes a clinical case of successful coronary artery angioplasty and stenting in a patient with ischemic cardiomyopathy. Following 8 months, there was a considerable improvement in the patient's general condition, an increase in left ventricular ejection fraction, and a reduction in cardiac cavity sizes.

[Endovascular closure of the left atrial appendage in patients with atrial fibrillation: review of modern data and own experience of application].

Atrial fibrillation (AF) is the most often disturbance of cardiac rhythm met in clinical practice. Long term therapy with anticoagulants is used for prevention of thrombi formation in left atrial appendage and consequent thromboembolism. However some patients have contraindications to this therapy. This article contains consideration of various alternative methods of prevention of thromboembolic complications in particular those 2 which are most widely used at present - percutaneous transcatheter isolation of left atrial appendage with Amplatzer Cardiac Plug () or Watchman Device. We present also data on own experience of the use of the ACP device.

[The first experience with X-ray endovascular closure of the left atrial auricle using an Amplatzer Cardiac Plug in patients with atrial fibrillation].

Atrial fibrillation is the most common cardiac arrhythmia in clinical practice. Long-term anticoagulant therapy is used to prevent thrombosis in the left atrial (LA) auricle and, as a consequence, thrombolisms. However, some patients have contraindications to its use. The paper considers different alternative methods for preventing thromboembolic events and particularly one of the most common presently encountered ones - percutaneous transcatheter LA auricle excision, by applying the Amplatzer Cardiac Plug. There are also data on the authors' experience in using this device.