Ukrainian Journal of Cardiovascular Surgery

Achievements and challenges of 2024

Vasyl V. Lazoryshynets — Tue, 25 Mar 2025 00:00:00 +0200

On the 70th anniversary of Anatoliy V. Rudenko

Tue, 25 Mar 2025 00:00:00 +0200

Coronary-Cameral Fistula as a Cause of Post-Infarction Left Ventricular Aneurysm: Current State of the Problem and Diagnostic Search

Olena K. Gogayeva, Oleksandr O. Nudchenko — Tue, 25 Mar 2025 00:00:00 +0200

Coronary artery disease (CAD) is predominantly develops due to atherosclerotic stenosis of the arterial lumen but a special place hold coronary arteries anomalies, among which distinguish coronary artery fistulas (CAF). While 90% of CAFs are congenital, the remaining cases are acquired. Most CAFs remain asymptomatic, but in some cases, they can lead to heart failure, arrhythmias, shortness of breath, angina pectoris, or infective endocarditis. The pathogenetic mechanism of ischemia in the absence of coronary artery stenosis is the phenomenon of coronary steal. CAFs of medium and large size are typically symptomatic. Fistula connections from the distal coronary artery are more frequently aneurysmal and are associated with a high risk of thrombosis and myocardial infarction. In patients with symptoms of CAD or heart failure, closure of the CAF is recommended.

Case description. A 45-year-old male patient was hospitalized at the Institute with symptoms of unstable angina and heart failure. His medical history included a Q-wave myocardial infarction two years prior. ECG revealed post-infarction cardiosclerosis of the anterior-septal-apical region of the left ventricle (LV) with septal ischemia. Echocardiography demonstrated dilatation of the heart chambers, a dyskinetic LV aneurysm, and significantly reduced contractility (LV ejection fraction: 22–24%). Color Doppler imaging identified a coronary-cameral fistula originating from the distal segment of the left anterior descending artery (LAD) and draining into the right ventricle. Coronary angiography confirmed the presence of a coronary-cameral fistula from the distal LAD. Based on the findings, on-pump surgical intervention was recommended for the patient.

Conclusions
1. A coronary-cameral fistula from the LAD to the right ventricle can lead to Q-wave myocardial infarction with subsequent development of a left ventricular aneurysm.
2. A distally located CAF is associated with a progressive and symptomatic disease course.
3. Clinical manifestations of CAF include angina pectoris, shortness of breath, paroxysmal ventricular tachycardia, and heart failure. To alleviate anginal symptoms, long-acting nitrates are recommended.
4. The presence of a coronary-cameral fistula can be suspected auscultatory (systolic-diastolic murmur), detected by echocardiography with color Doppler, and confirmed angiographically.

The Prognostic Value of the Coronary Calcium Score for Detecting Significant Coronary Artery Stenosis Based on CT Coronary Angiography in Patients with Coronary Artery Disease

Mykhailo S. Ishchenko, Olha R. Romaniuk — Tue, 25 Mar 2025 00:00:00 +0200

Coronary artery disease (CAD) is a leading cause of mortality and disability worldwide. CT coronary angiography is a fast and non-invasive method for diagnosing coronary artery pathology. To standardize the assessment of CT coronary angiography results, the CAD-RADS (Coronary Artery Disease – Reporting and Data System) was developed, which is based on determining the degree of coronary artery stenosis. According to recent studies, in addition to CT coronary angiography, an important tool for cardiovascular risk stratification in asymptomatic patients is the assessment of coronary calcium score using the Agatston scale (CAC Score).

Aim. To assess the relationship and degree of correlation between the CAC Score and the presence of significant coronary artery stenosis when combining CAC Score and CT coronary angiography.

Materials and Methods. The data of 464 patients from the National Institute of Cardiovascular Surgery were analyzed. These patients presented with typical or atypical angina symptoms and had a low or moderate risk of coronary artery disease between September 1, 2024, and January 15, 2025. All patients underwent clinical examination, risk factor assessment, CAC Score evaluation, and CT coronary angiography. Patients with atherosclerosis were divided into two groups: those with non-significant stenosis and those with significant stenosis (≥50% in the left main coronary artery or ≥70% in the major epicardial coronary arteries).

Results. The study included 464 patients, predominantly male (55.6%), with a mean age of 59 ± 10.22 years. Atherosclerotic coronary artery disease was detected in 273 patients (58.8%). Based on the CAD-RADS, 24.54% of patients had CAD-RADS 1, 31.14% had CAD-RADS 2, 16.12% had CAD-RADS 3, 20.88% had CAD-RADS 4A, 5.49% had CAD-RADS 4B, and 1.83% had CAD-RADS 5. In the first group (non-significant stenosis), there were 196 patients (71.8%), while the second group (significant stenosis) included 77 patients (28.2%). The median CAC Score in the first group was 24.5 (1–103.25), while in the second group, it was 271.5 (88–666.5), p<0.001. A moderately strong positive correlation was found between the CAC Score and the presence of significant coronary artery stenosis (ρ=0.635, p<0.001). ROC curve analysis shows that the optimal cutoff value of the CAC Score for detecting significant stenosis was 282, with a sensitivity of 48.7%, specificity of 88.8%, and an AUC of 0.819.

Conclusions. The study identified a statistically significant correlation between the level of coronary calcification and the presence of significant stenosis. The CAC Score is a reliable prognostic marker for significant coronary artery stenosis in patients with suspected coronary artery disease.

Long-Term Outcomes of Coronary Artery Bypass Grafting in Patients with Reduced Left Ventricular Myocardial Contractility: Single-Center Experience

Yurii V. Kashchenko, Khrystyna O. Chekh, Anatoliy V. Rudenko — Tue, 25 Mar 2025 00:00:00 +0200

Coronary artery bypass grafting (CABG) is one of the most effective methods for treating ischemic heart disease (IHD) in patients with multivessel coronary artery disease and significantly reduced left ventricular ejection fraction (LVEF ≤ 35%). Patients with low LVEF are considered high-risk due to an increased likelihood of cardiac complications and the limited effectiveness of alternative treatments, such as medical therapy or stenting. CABG not only reduces the risk of heart failure but also significantly improves quality of life and long-term survival, which is particularly important for this patient category. Due to its ability to fully restore myocardial blood supply even in complex clinical cases, CABG remains the standard of care for patients with severe forms of IHD. Additional findings indicate that CABG improves cardiac function and reduces the incidence of heart failure symptoms, leading to enhanced patient quality of life.

Aim. To evaluate early and long-term outcomes of CABG in patients with reduced left ventricular myocardial contractility.

Materials and methods. The study included 210 patients with LVEF ≤ 35%, who underwent CABG at the National Institute of Cardiovascular Surgery named after M.M. Amosov, National Academy of Medical Sciences of Ukraine, from January 1, 2015, to December 31, 2021. Patients were divided into three groups according to their LVEF: 35–У ре30%, 29–25%, and ≤ 24%. An analysis was conducted on the changes in ejection fraction, end-diastolic volume, and clinical symptoms at the time of hospitalization, discharge, and one year after surgery.

Results. The study results showed that CABG in patients with LVEF ≤ 35% was associated with significant improvement in left ventricular ejection fraction and reduction of clinical symptoms. The most significant improvement was observed in the group of patients with LVEF ≤ 24%.

Conclusions. Coronary artery bypass grafting in patients with low ejection fraction (≤35%) significantly reduces clinical symptoms (chest pain, dyspnea, edema), improves cardiac function with an increase in ejection fraction, prevents further EF reduction, and substantially decreases end-diastolic index in patients with initial EDI >100 ml/m², demonstrating a positive effect on left ventricular remodeling.

A Differentiated Approach to the Assessment of Biomarkers Depending on the Phenotype of Heart Failure

Nadiia M. Kulaiets — Tue, 25 Mar 2025 00:00:00 +0200

Heart failure (HF) remains a major cause of hospitalization and mortality globally. Current evidence suggests significant differences in cardiovascular outcomes based on ejection fraction (EF) phenotypes, including HF with reduced (HFrEF), mildly reduced (HFmrEF), and preserved (HFpEF) EF. Biomarkers such as NT-proBNP, BNP, ST2, and Galectin-3 provide valuable insight into myocardial remodeling and inflammation. However, the prognostic role of their ratios across different HF phenotypes remains unclear.

Aim. To determine the prognostic value of NT-proBNP, BNP, ST2, Galectin-3, and their ratios in patients with HF categorized by EF (HFrEF, HFmrEF, and HFpEF), regarding rehospitalization and one-year mortality risk.

Materials and Methods. A prospective study including 398 patients (aged 45–65 years) hospitalized for decompensated HF. Patients were classified into three groups: HFrEF (≤40%, n=167), HFmrEF (41–49%, n=133), and HFpEF (≥50%, n=98). Biomarker levels were measured via enzyme-linked immunosorbent assay (ELISA), and the primary outcomes were HF-related rehospitalization and one-year mortality.

Results. Patients with HFrEF had a significantly higher frequency of NYHA class IV (21.0%, p=0.0001), atrial fibrillation (70.1%, p=0.0001), and one-year mortality (12.0%, p=0.0001) compared to those with HFmrEF or HFpEF. HFrEF patients also had higher NT-proBNP levels (+16.2%, p=0.015) and ST2 levels (43.0 [38.3–47.3] ng/mL, p=0.004). Rehospitalization risk in HFrEF increased with NT-proBNP >843.0 pg/mL (OR=1.82, 95% CI: 1.37–2.41, p<0.0001) and NT-proBNP/ST2 >21.61 (p<0.0001). Among HFmrEF and HFpEF patients, elevated BNP (≥86.18 pg/mL, p=0.019) and Galectin-3 (>2.15 ng/mL, p=0.0047) were significant predictors of rehospitalization. In patients with HF and atrial fibrillation (AF) (n=226), compared to those with sinus rhythm (n=172), there were more cases of advanced NYHA class (III–IV) and higher mortality. Additionally, AF was associated with elevated NT-proBNP, ST-2 and galectin-3, suggesting a more severe clinical course and worse prognosis.

Conclusions. Different HF phenotypes exhibit distinct biomarker profiles associated with rehospitalization and mortality risk. NT-proBNP/ST2 and NT-proBNP/BNP ratios have high prognostic value in HFrEF, whereas BNP and Galectin-3 are more predictive in HFmrEF and HFpEF. These findings highlight the importance of phenotype-specific biomarker assessment for personalized HF management.

Algorithm for the Management of Patients with Ischemic Heart Disease and Cardio-Renal-Metabolic Syndrome

Yevhen Yu. Marushko, Georgii B. Mankovskyi — Tue, 25 Mar 2025 00:00:00 +0200

Cardiorenal-metabolic syndrome (CRMS) is the most dangerous combination of heart failure, chronic kidney disease, and type 2 diabetes mellitus, as it combines comorbidities, each of which is a powerful proatherogenic factor.

Aim. To assess the prognostic impact of using a new algorithm for managing patients with CAD and CRMS over a 5-year follow-up period.

Materials and methods. In a prospective study, we included 377 patients with coronary artery disease and cardiorenal-metabolic syndrome. Patients underwent invasive coronary angiography. In case of insignificant coronary lesions, CFRi was determined to establish microvascular angina, which was treated with medication. In the case of a single-vessel stenotic coronary lesion, PCI was performed. In the case of a two- or three-vessel lesion, PCI or CABG/MCS was performed depending on the Syntax Score. Patients were followed for 5 years from the moment of initial hospitalization.

Results. The total number of endpoints achieved in the entire cohort of patients with CHD and CRMS (cardiovascular death, myocardial infarction, need for repeated revascularization) was 104 (30.3%) of the 343 patients who completed the study. Interestingly, 79 (76.0%) of them reached the endpoint due to the formation of new stenosis in the coronary arteries. At the same time, the use of the algorithm for selecting revascularization tactics in patients with CAD and CRMS resulted in the need for repeated intervention due to restenosis of previously installed stents in only 3 (2.7%) of 111 PCI cases.

Conclusions. In patients with cardiorenal-metabolic syndrome, the cause of coronary artery disease in 17.5% of cases is microvascular angina, while in 82.5% – stenosing atherosclerosis of coronary vessels. The risk of angina recurrence in patients with coronary artery disease and CRMS within 5 years after primary treatment is 30.3%, of which – in 76.0% of cases due to the formation of new coronary artery lesions. The use of the proposed algorithm for myocardial revascularization tactics in patients with CAD and CRMS allows achieving a frequency of significant restenosis of previously installed coronary stents in only 2.7% of cases during a 5-year follow-up.

Effectiveness of Glucocorticoids in the No-Reflow Phenomenon in STEMI Patients

Maksim Y. Sokolov, Sergii V. Salo, Valentyn O. Shumakov, Serhii S. Shpak — Tue, 25 Mar 2025 00:00:00 +0200

Relevance. The driving force behind the pathogenesis of no-reflow, as a component of ischemic-reperfusion injury, is myocardial edema, which provokes extravascular compression of the infarct-related artery (IRA), making it impossible to restore antegrade blood flow. Targeting edema is a promising approach in the treatment of this condition.

Aim. To analyze different strategies for managing no-reflow and to present data on the intracoronary single-dose administration of glucocorticoids in terms of their ability to improve blood flow gradation according to the TIMI scale during primary PCI in STEMI patients.

Materials and methods. During the period 2022–2024, 26 STEMI patients with no-reflow (TIMI 0/1 after stent implantation) were selected and divided into two groups of 13 patients each. The main group received a single intracoronary selective injection of methylprednisolone (250 mg) via a microcatheter into the IRA. The control group did not receive intracoronary pharmacotherapy for no-reflow, only hemodynamic support in case of hemodynamic deterioration.

Results. The most significant risk factor for the occurrence of no-reflow was found to be a prolonged period of acute myocardial ischemia, which, in our study, lasted 18 hours from the onset of symptoms. Regarding the effect of glucocorticoids, it was observed that when using methylprednisolone, administered according to the approved methodology, an increase in blood flow from TIMI 0 to TIMI 3 was achieved in 61.5% of cases. Compared with the control group, the angiographic effectiveness of this new treatment for the no-reflow phenomenon reached 53.8%. In-hospital mortality did not differ significantly between the two groups (38.46% vs. 53.85%).

Conclusions. The duration of acute myocardial infarction symptoms is a crucial risk factor for the no-reflow phenomenon during primary PCI. This study demonstrates that the use of glucocorticoids can help restore blood flow in no-reflow cases. Achieving TIMI 3 blood flow following a single intracoronary injection of methylprednisolone occurred in 61.5% of patients in the treatment group. Compared with the control group, the effectiveness of this new method reached 53.8%. Despite the improvement in TIMI flow, it was not possible to reduce in-hospital mortality in patients receiving hormone therapy.

Interventions in CHD Patients with Combined Left Main Stenosis and Chronic Coronary Artery Occlusion

Sergii M. Furkalo — Tue, 25 Mar 2025 00:00:00 +0200

Combined left main coronary artery (LMCA) lesion and chronic coronary artery occlusion (CTO) significantly worsens the clinical course of patients with CHD, affecting the prognosis and complicating interventional treatment of this category of patients.

Aim. To analyze the effectiveness and technical features of interventional procedures in patients with ischemic heart disease and left coronary artery lesion combined with CTO of one of the coronary arteries.

Materials and methods. We included 30 patients with combined LMCA stenotic lesion and CTO of one of the main coronary arteries in the study. The average age of the patients was 62.4±9.7 years, 90% were men. Clinical manifestations were characterized by anginal syndrome of varying severity: 25 (83.3%) patients had CCS III, 23.3% of patients had diabetes mellitus, 19 (63.3%) patients had a history of MI in the area of the occluded artery, and the ejection fraction (EF) was 52.8±11.3%.

Results. The lesion of the LCA was combined with the RCA CTO in 9 cases (30%). Occlusion of the CX and stenosis of the LM were recorded in 10 cases (33%). In 11 cases, combined lesion of the LCA and the LAD was recorded (37%). The technical success of CTO recanalization in the group was 86.6%. In 17 cases, stenting of the LM was performed before CTO intervention and stenting of the LM after CTO intervention in 10 cases. CTO recanalization without stenting of the LM was performed in 3 cases. The intervention beam time was 42.4±22.3 min, and the air rudder index was 1887.1±948.4 mGy. The main technique of CTO recanalization used in our series of patients was the AWE (antegrade wire escalation) technique. Retrograde access was used in 3 (10%) cases. No operative mortality was recorded. In one case, coronary artery perforation occurred.

Conclusions. In patients with combined lesions of the LCA and CTO, where CABG is of high risk or not feasible, interventional approach can be successfully used. The priority of performing the intervention on the LCA or CTO depends on the anatomy of the coronary artery lesions and clinical manifestations of the disease.

Tricuspid Valve Myxoma: Features of Anatomy, Clinical Course, and Surgical Treatment

Tue, 25 Mar 2025 00:00:00 +0200

Relevance. Myxomas originating from the tricuspid valve (TV) are extremely rare. The literature describes myxomas that most often affect one leaflet of the TV. For the first time in our extensive practice, we encountered a myxoma of the right heart, which incredibly affected all leaflets of the tricuspid valve, which left no chance for its preservation.

Aim. To present our experience in treating TV lesions in cardiac myxomas with a demonstration of a rare case of myxoma of probably congenital nature that affected all of its leaflets.

Materials and methods. Among 922 patients with cardiac myxomas (CM), 70 (7.6%) patients with heart valve lesions due to this tumor were identified. The article presents the experience in treating tricuspid valve lesions in CM and a case of diagnosis and surgical treatment of TV myxoma of unusual localization in a 71-year-old woman. Diagnosis based on the use of echocardiography, coronary angiography and laboratory methods.

Results. Isolated tricuspid valve insufficiency was observed in 30 patients. However, only 9 of these patients had a direct effect of myxoma on the function of the valve, which was located in the cavity of the right atrium (8) and right ventricle (1). In one case, a myxoma measuring 3.0×2.5 cm in a capsule with a smooth surface was found in the hole of the TV. The base of the tumor was located on the fibrous ring of the TV at the point of transition of the posterior leaflet into the septal with the involvement of all leaflets and all chords of this valve, which were included in the body of the tumor. The valve is significantly distorted with the inability to differentiate its leaflets. The tumor does not visually spread beyond the leaflets and fibrous ring. Given the very unusual location with an extremely unfavorable prognosis, the patient underwent surgery to remove the tumor and replacement the tricuspid valve.

Conclusions. Myxomas of the ventricular septum are very unusual tumors with a diverse and unpredictable pattern of lesions that can be detected after the onset of symptomatic ventricular septum obstruction and signs of right ventricular heart failure. Despite significant lesions of the ventricular septum by a tumor process of a likely congenital nature, there is a possibility of a long asymptomatic course of the disease. Surgical treatment of TV myxoma involves removing the tumor with a high probability of replacing the affected valve.

Antibiotic Resistance in Patients with Infective Endocarditis

Tue, 25 Mar 2025 00:00:00 +0200

The incidence of infective endocarditis (IE) is estimated at 3-7/100,000 cases. In international studies, infection was one of the most frequent provoking factors of acute heart failure, recorded in 18.7% of cases in patients with infective endocarditis. Due to the associated high morbidity and mortality, the prescription of appropriate antibiotic therapy and the study of antibiotic resistance remain the focus of research.

Аim. To analyze the dynamics of antibiotic resistance in patients with infective endocarditis.

Materials and methods. The study included clinical data from 150 patients undergoing cardiopulmonary bypass surgery for active IE from 01.01.2019 to 01.07.2020. Upon hospitalization, patients underwent diagnostic blood cultures with subsequent microbiological identification and antibacterial resistance.

Results. Among the positive results of bacteriological blood tests in the group of patients with IE, the frequency of gram-positive flora was 22% of cases, gram-negative flora was detected in 1.3% of cases. The rate of daptomycin-resistant strains was 42.9% in the group of patients without signs of acute heart failure (AHF) and 20.0% in the group with AHF. The level of antimicrobial resistance to linezolid was 40% in the group of patients with IE complicated by AHF and 14.3% in the group of patients without clinical manifestations of AHF at the stage of hospitalisation.

Conclusions. Our study revealed a high level of antibiotic resistance in patients with infective endocarditis. In particular, the analysis of antimicrobial resistance to amikacin showed 76.9% in the group of patients without clinical manifestations of acute heart failure. The proportion of strains resistant to daptomycin and teicoplanin was 42.9% and 40.5%, respectively. At the same time, the level of resistance to imipenem was relatively low-12.5% in the group without clinical manifestations of AHF. Effective treatment of infective endocarditis should be based on a combination of early cardiac surgery and rational etiotropic antibiotic therapy, taking into account current data on antibiotic resistance.

Retrograde Approach for Percutaneous Ventricular Septal Defect Closure: Is It Really Better Than Antegrade?

Tue, 25 Mar 2025 00:00:00 +0200

Introduction. This study was designed to compare the antegrade and retrograde approaches for percutaneous ventricular septal defect (VSD) closure, in light of ongoing debates regarding the advantages and disadvantages of each approach. To the best of our knowledge, there is currently no published literature comparing the immediate and longterm outcomes of these two techniques for transcatheter VSD closure.

Materials and methods. From August 2012 to January 2025, 254 patients underwent percutaneous ventricular septal defect closure using various devices. Of these, 103 patients were treated with the antegrade approach (Group 1), and 151 patients with the retrograde approach (Group 2). The mean follow-up period was 59.5 ± 35.5 months in Group 1 and 54.5 ± 21.4 months in Group 2 (p = 0.45).

Results. The procedure was successful in 97 patients (94.17%) in Group 1 and in 151 patients (100%) in Group 2. The number of major complications was approximately equal in both groups (p = 0.49). Two patients in Group 1 were referred to surgery due to the new onset of significant aortic or tricuspid insufficiency. One patient in Group 2 developed complete atrioventricular (A-V) block complicated by dilated cardiomyopathy two years after perimembranous ventricular septal defect closure. Four patients (3.88%) in Group 1 experienced hemodynamic collapse due to valve compromise from the arterio-venous loop, compared to zero patients in Group 2 (p = 0.014). The number of minor complications was similar in both groups (16 patients, 15.53%, in Group 1 vs 17 patients, 11.25%, in Group 2; p = 0.31).

The mean fluoroscopy time and mean procedure time were significantly lower in Group 2 compared to Group 1 (31.56 ± 23.7 vs 17.6 ± 16.2 minutes, p = 0.001; and 55.8 ± 32.9 vs 117.5 ± 57.8 minutes, p < 0.001).

Conclusions. The retrograde approach appeared to be technically simpler, requiring only one vessel puncture, and had zero complications associated with the creation of a transcardiac loop. The number of perioperative, medium-term, and long-term complications was similar in both groups. However, the antegrade approach can still be applied in patients with low weight and large defects, as well as in cases with a deficient rim to the aortic valve or defects requiring the implantation of asymmetric devices.

Experience in the Management of Patients with Acute Type A Aortic Dissection and Coronary Ostial Involvement Classified as Neri Type B

Tue, 25 Mar 2025 00:00:00 +0200

Introduction. Acute type A aortic dissection (ATAAD) is a life-threatening condition with a high mortality rate, particularly in the absence of surgical intervention. Coronary artery involvement in ATAAD occurs in 7–20.7% of patients and is associated with a poor prognosis. Despite various surgical approaches, the optimal treatment strategy remains controversial, especially in cases of type B coronary ostial dissection according to the Neri classification.

Aim. To analyze the outcomes of coronary ostia repair in patients with acute type A aortic dissection (ATAAD) involving coronary artery ostia classified as type B by Neri.

Materials and methods. Between 2019 and 2023, 316 patients with ATAAD underwent surgery at the National Institute of Cardiovascular Surgery named after M.M. Amosov. Among them, 49 (15.5%) had coronary artery ostia involvement, and 21 patients (42.9%) were classified as Neri type B. Preoperative assessment was performed using CT and, in selected cases, coronary angiography, which was confirmed intraoperatively. The primary surgical approach involved supracoronary ascending aortic replacement with partial arch repair.

Results. Coronary ostia repair was performed in all patients in this cohort. In 14.3% of cases, extended patch repair using autopericardium was required. Supracoronary ascending aortic replacement was carried out in 90.5% of patients, while the Bentall procedure was necessary in 9.5%. The in-hospital mortality rate was 9.5%. Major postoperative complications included acute renal failure (9.5%), ischemic brain injury (9.5%), and spinal cord ischemia (4.8%).

Conclusions. Coronary ostia repair is an effective approach for treating coronary involvement in ATAAD patients with Neri type B dissection. However, the high rate of complications and mortality highlights the need for further refinement of surgical techniques and more accurate preoperative diagnostic methods.

Impact of Acute Complications on The Course and Outcome of Severe COVID-19: a Clinical Analysis and Determination of Mortality Predictors

Tetiana D. Danilevych, Lesia V. Rasputina — Tue, 25 Mar 2025 00:00:00 +0200

Aim. To establish the features of the clinical picture, the structure of acute complications and predictors of mortality in patients with a severe course of COVID-19.

Materials and methods. 221 patients who were in the intensive care unit (ICU) of City Clinical Hospital No. 1 in Vinnytsia, Ukraine were examined in the period 2020-2023. Among them, 133 (60.2%) patients survived and 88 (39.8%) of patients died as a result of a severe course of COVID-19 (p = 0.02).

Results. The mortality rate of patients with a severe course of COVID-19 was 39.8%. Among patients classified as categories 6 and 7 by the WHO, the highest mortality was observed, (p<0.001). In the group of deceased patients, there were significantly more patients with hypertension (73 (83.0%) vs. 90 (67.7%), p=0.008), coronary heart disease (CHD) (83 (94.3%) vs. 91 (68.4%)), p = 0.0001), a combination of CAD and hypertension (72 (81.8%) vs. 79 (59.4%), p < 0.001). In addition, acute/chronic kidney diseases (18 (20.5%) vs. 13 (9.8%), p = 0.022) and cancer were more common (12 (13.6%) vs. 8 (6.0%)), p = 0.046).

Among the acute complications that occurred during the stay of patients in the ICU, the deceased patients experienced significantly higher rates of the following conditions: stroke (10 (11.4%) vs. 3 (2.3%), p = 0.006), acute heart failure (9 (10.2%) vs. 4 (3.0%), p = 0.038), pulmonary embolism (9 (10.2%) vs. 3 (2.3%), p = 0.014), infectious toxic shock (10 (11.4%) vs. 1 (0.8%), p = 0.001), acute respiratory distress syndrome (78 (88.6%) vs. 6 (4.5%), p < 0.0001), endstage of renal failure (62 (80.5%) vs. 82 (62.1%), p = 0.006). Additionally, among rhythm disturbances, atrial fibrillation was more prevalent in deceased patients and was associated with a lower survival rate (31 (35.2%) vs. 19 (14.3%), p = 0.0001).

Conclusions. The study demonstrated that clinical factors associated with mortality in patients with a severe course of COVID-19 include patient age and с omorbidity such as hypertension, CAD, heart failure and rhythm disorders. Tachyarrhythmias and bradyarrhythmias were more often observed in deceased patients, in particular, they had more frequent AF, which emphasizes its role as a predictor of poor prognosis in patients with COVID-19.

Autologous Mesenchymal Stem Cell Transplantation for the Treatment of Chronic Heart Failure in Dilated Cardiomyopathy: A Clinical Case

Tue, 25 Mar 2025 00:00:00 +0200

Dilated cardiomyopathy (DCMP) occupies a significant place among non-coronary heart diseases leading to chronic heart failure (CHF). Due to the high mortality rate associated with DCMP, there is a continuous search for alternative heart-preserving treatment methods as “bridges” to heart transplantation. One of the promising approaches is stem cell therapy.

Aim. To describe our own successful case of intravenous transplantation of autologous mesenchymal stem cells (MSCs) as a palliative treatment for CHF associated with DCMP.

Clinica case. A 48-year-old man with DCMP underwent specialized medical treatment for CHF (stage C) in the cardiology department of the Kharkiv Regional Cardiology Centre. The treatment was supplemented by a double intravenous administration of autologous MSCs, with a one-month interval between the two procedures. The first injection, performed against the background of acute left ventricular failure (ALVF), contained 6 million MSCs, while the second administration involved 4 million MSCs. To assess the patient’s clinical status and heart function, physical examination, electrocardiography, and echocardiography were performed at the time of each injection and one month after each procedure. No adverse reactions or side effects were observed following either procedure.

Discussion. Instrumental evaluation demonstrated that the double intravenous administration of MSCs led to a gradual improvement in overall left ventricular contractility, a progressive reduction in both systolic and diastolic left ventricular volumes, a decrease in left atrial volume, and regression of mitral regurgitation severity from grade II to grade I. Additionally, it contributed to the complete elimination of persistent ventricular extrasystole.

These functional improvements alleviated CHF symptoms (from stage C to stage B), prevented further episodes of ALVF, reduced the need for diuretics, and increased the patient’s tolerance to physical exertion. Positive dynamics in the patient’s clinical condition and echocardiographic parameters were observed as early as one month after each MSC administration.

Conclusions. The intravenous administration of autologous MSCs improves the systolic function of the affected heart muscle and can be considered a promising palliative therapy as part of the comprehensive treatment of CHF associated with DCMP. However, the methodology of its clinical application requires further investigation.

Emergency Mitral Valve Replacement in Blunt Cardiac Injury

Tue, 25 Mar 2025 00:00:00 +0200

Blunt Cardiac Injury (BCI) is a collective term that includes cardiac contusion, myocardial contusion, cardiac rupture, pericardial rupture, heart luxation, intracardiac structure injuries, coronary artery injuries, and injuries of the main vessels. Mitral valve injury due to blunt thoracic trauma is a very rare condition, accounting for only 0.01% of BCI cases. The clinical picture of hemodynamic instability in cases of mitral valve injury leads to pulmonary oedema (wheezing over the lung fields during auscultation) and progressive heart failure. Fluid overload increases the risk of death. Additional injuries can obscure the true cause of hemodynamic instability and shock. In the largest review of 82 patients who underwent surgery for mitral valve injury, only 15 patients (18%) were operated on within 24 hours.

Aim. To present and analyze the case of emergency mitral valve replacement in first 24 hours in blunt chest trauma.

Case report. In this study, we report the successful outcome of a blunt cardiac injury with mitral valve replacement performed within the first 24 hours. A 27-year-old male, a restrained driver, presented to the hospital in a state of shock. Hemorrhage as a cause of shock was excluded. Pulmonary oedema and worsening of the clinical picture despite resuscitation led to the diagnosis of an intracardiac injury as the cause of refractory shock. Urgent surgery with mitral valve replacement was performed within 24 hours of admission. The postoperative period was complicated by sepsis and ischemic stroke. The patient was discharged on the 44th day with mild rightsided hemiparesis. At the 24-month follow-up, clinical examination revealed no mitral insufficiency on cardiac echocardiography, and the patient had returned to his everyday activities.

Conclusions. Surgical repair of mitral valve injuries is indicated when therapeutic or conservative treatment is unsuccessful. In other words, these patients have no chance of survival if surgery is not performed under such critical circumstances.