Ukrainian Journal of Cardiovascular Surgery

Forecasting risks in the development of life in dangerous countries

Vasyl V. Lazoryshynets — Thu, 25 Sep 2025 00:00:00 +0300

Forecasting risks in the development of life in dangerous countries

Risk Factor Associated Coronary Artery Calcium Score in Diabetes Patients

Riffatiyani Arsyad, Khalid Saleh, Andi Makbul Aman, Andi Alfian Zainuddin — Thu, 25 Sep 2025 00:00:00 +0300

Background. Diabetes mellitus (DM) is associated with an increased risk of coronary artery disease (CAD) and vascular calcification, although the mechanism of action remains complex. Coronary artery calcium (CAC) scoring is non-invasive method to assess subclinical atherosclerosis in this high-risk population.

Aim. To analyze the association between cardiovascular risk factors and CAC scores among diabetic patients.

Materials and methods. This cross-sectional study included 52 diabetic patients recruited from the Cardiology Clinic of Wahidin Sudirohusodo General Hospital, Indonesia. Data on demographic characteristics, body mass index (BMI), blood pressure, dyslipidemia, family history of CAD, and HbA1c levels were collected. CAC scoring was performed using non-contrast ECG-gated CT, and results were categorized using the Agatston method. Statistical analyses included Spearman correlation, Mann–Whitney U test, and multivariate regression tests.

Results. The majority of patients were male (65.4 %) and under 60 years (82.7 %). High CAC scores (>400) were observed in 61.5 % of patients. A significant positive correlation was observed between HbA1c and total CAC score (r = 0.317; p = 0.022). In multivariate analysis, HbA1c remained an independent predictor of elevated CAC scores (p < 0.05), while hypertension was also significant in partial models. Other factors, including BMI, dyslipidemia, age, and family history of CAD, were not significantly associated with CAC scores.

Conclusions. Coronary artery calcification is highly prevalent among diabetic patients, including younger and non-obese individuals. HbA1c and hypertension were key predictors of CAC burden. These findings underscore the need for optimal glycaemic and blood pressure control, along with consideration of CAC screening for early cardiovascular risk stratification in diabetic populations.

Efficacy of Losartan within a Multicomponent Secondary Prevention Strategy for Cardiovascular Events in Post-Ischemic Stroke Patients

Viktoriya-Svitlana M. Halich, Nazarii M. Kobyliak, Alina O. Pletenetska — Thu, 25 Sep 2025 00:00:00 +0300

Aim. To assess the efficacy of adding losartan to standard therapy in patients with ischemic heart disease (IHD) and polyvascular atherosclerosis following ischemic stroke as part of a multicomponent secondary prevention strategy over a 4-month treatment period.

Materials and Methods. A prospective study enrolled 60 patients who were randomly assigned to two equal groups: standard therapy (including antiplatelet agents, statins, antihypertensive medications, and risk factor management) and standard therapy plus losartan. All patients underwent assessment of lipid profiles, as well as serum levels of the matrix metalloproteinases MMP-2 and MMP-9, interleukin-1β (IL-1β), plasminogen activator inhibitor-1 (PAI-1), thrombin-activatable fibrinolysis inhibitor (TAFI), and tumor necrosis factor-alpha (TNF-α), both at baseline and after 4 months of therapy.

Results. After 4 months of therapy, a significant reduction in the serum levels of lipids (TC, TG, LDL-C, HDL-C), MMP-2, MMP-9, IL-1β, PAI-1, TAFI, and TNF-α (p<0.05) was observed in both groups. However, compared with the standard therapy group, the addition of losartan was associated with a significant reduction in MMP-2 (p = 0.008) and TAFI (p = 0.011) in the intergroup ANCOVA analysis.

Conclusions. The addition of losartan to standard therapy in patients with IHD and polyvascular atherosclerosis following ischemic stroke over a 4-month period was associated with improved clinical outcomes, attenuation of inflammatory and proteolytic cascade activation, and enhanced hemodynamic parameters.

Lipoprotein(a) as an Independent Risk Factor and Prognostic Marker of Obstructive Coronary Artery Atherosclerosis in Young Patients: A Literature

Mariia B. Heneha, Yevhen Yu. Marushko, Georgii B. Mankovskyi — Thu, 25 Sep 2025 00:00:00 +0300

Introduction. Lipoprotein(a) (Lp(a)) is a genetically determined, independent risk factor for premature coronary artery atherosclerosis, exhibiting atherogenic, prothrombotic, and pro-inflammatory properties.

Aim. To summarize current evidence on the pathophysiology, epidemiology, and clinical significance of Lp(a) in young patients with obstructive coronary artery atherosclerosis, and to review emerging therapeutic strategies for its reduction.

Results. Elevated Lp(a) levels (>125 nmol/L) are found in 20-30 % of the general population and up to 40% of young patients with premature coronary artery disease, including those without traditional risk factors. High Lp(a) levels correlate with disease severity (SYNTAX and Gensini scores) and increase the risk of reinfarction and restenosis after percutaneous interventions. Current therapeutic options are limited; the most promising are targeted genetic therapies (pelacarsen, olpasiran, SLN360), which can achieve 80-95 % reductions in Lp(a) levels.

Conclusions. Lp(a) measurement should be included in routine screening for high-risk groups. Incorporation of novel therapeutic strategies into clinical practice may significantly improve the prognosis of young patients with premature atherosclerosis.

Perioperative Features in Patients with Acute Myocardial Infarction

Olena K. Gogayeva, Mykola L. Rudenko, Oleksandr O. Nudchenko — Thu, 25 Sep 2025 00:00:00 +0300

Surgical myocardial revascularization in the setting of acute myocardial infarction (MI) remains one of the most challenging areas of coronary surgery. Timely restoration of coronary blood flow in the infarct-related artery is a key determinant of patient prognosis. However, the presence of multivessel coronary artery disease, as well as mechanical and thrombotic complications of MI, limits the feasibility of endovascular interventions and often necessitates open cardiac surgery, which is performed in only 1.2–5 % of MI patients. At present, retrospective data analysis remains the primary method to assess the role of coronary artery bypass grafting (CABG) in MI, as initiating large prospective studies is unlikely to gain support from the majority of cardiologists and cardiac surgeons.

Aim. To study the features of the perioperative period for patients with acute myocardial infarction (MI).

Materials and Methods. A retrospective analysis was performed on 26 randomly selected cardiac surgery patients with acute MI who underwent surgery and were subsequently discharged from the GF “Amosov National Institute of Cardiovascular Surgery NAMS of Ukraine”. All patients received standard clinical and laboratory evaluations, including ECG, echocardiography, coronary angiography, and cardiac surgical intervention.

Results. The average age of the patients was 60.6 ± 9.3 years [range 39-80 years], Charlson index – 5.53 ± 1.57, EuroSCORE II – 13.9 % [range 5.01-68.2 %]. MI of up to 3 hours’ duration was registered in 4 (15.4 %) patients, MI of 6 hours’ duration – in 3 (11.5 %), MI of 12-24 hours’ duration – in 4 (15.4 %), MI of 2-5 days’ duration – in 5 (19.2 %), MI of 6-8 days’ duration – in 4 (15.4 %), MI of 10-20 days’ duration – in 6 (23.07 %). Q-MI was detected in 13 (50 %) patients, and non-Q MI was diagnosed in 13 (50 %) cases. Surgery was performed on the beating heart in 19 (73.07 %) cases. Two patients with cardiogenic shock on the 2nd day of Q-MI underwent coronary bypass grafting on-pump with intraaortic balloon counterpulsation. In complicated forms of CAD, operations were performed on-pump and coronary bypass grafting was supplemented with resection of left ventricular aneurysm (n=4), ventricular septal rupture repair (n=2), thrombectomy of left ventricular aneurysm (n=2), and mitral valve replacement (n=1). The average duration of stay in the intensive care unit was 4.4 ± 3.6 days [range 2-15 days], and patients were discharged on average 10.6 ± 5.6 days after surgery.

Conclusions. The key to successful surgical myocardial revascularization is the optimization of operative timing and an individualized approach. Most patients (61.5 %) with non-Q MI underwent cardiac surgery on the 1st day after MI onset, whereas in patients with Q-MI, 69.2 % underwent surgery between the 8th and 20th day. Patients with transmural MI complicated by cardiogenic shock should undergo emergency on-pump CABG with preventive IABP. In cases of mechanical complications of MI, daily echocardiographic monitoring is necessary for dynamic assessment of the size of the VSR, the thickness of the left ventricular wall in postinfarction aneurysms, and the mobility of thrombotic masses.

Determinants of Revascularization Success in STEMI Patients

Serhii S. Shpak, Sergii V. Salo, Valentyn O. Shumakov, Anastasia Kiriluk — Thu, 25 Sep 2025 00:00:00 +0300

Background. Immediate angiographic outcomes after stenting of the infarct-related artery in STEMI patients are important predictors of long-term outcomes such as survival, risk of severe heart failure, or left ventricular aneurysm formation. These outcomes can be assessed using the Thrombolysis in Myocardial Infarction (TIMI) flow grade. The lower the score, the higher the associated mortality rate. Understanding the factors that may influence the outcome of revascularization is crucial.

Aim. To demonstrate the determinants influencing the success of PCI.

Materials and Methods. Between 2022 and 2024, the study included 160 STEMI patients who underwent PCI. Specific correlation tests were applied for statistical analysis.

Results. Time to hospital admission emerged as one of the most critical determinants of successful PCI. Among all identified correlations, the most significant were the following: elderly patients had a higher likelihood of multivessel coronary artery disease; patients with diabetes mellitus were more likely to experience prolonged acute ischemia and had a higher incidence of cardiogenic shock.

Conclusions. Patients with prolonged acute ischemia more often present with subocclusion rather than total occlusion. Diabetic patients tend to seek medical care later, often presenting with myocardial infarction complications, and are more likely to develop cardiogenic shock. Thromboaspiration and predilatation are associated with impaired TIMI flow in PCI of the infarct-related artery.

Comparative Analysis of Left Ventricular Reverse Remodeling After Aortic Valve Replacement: Median Sternotomy, Minimally Invasive Approach, and TAVI

Oleksandra V. Telehuzova, Glib I. Yemets, Nadiya M. Rudenko — Thu, 25 Sep 2025 00:00:00 +0300

Aim. To evaluate and compare the effectiveness of left ventricular reverse remodeling (LVRR) after three distinct types of aortic valve replacement (AVR): surgical aortic valve replacement via median sternotomy (SAVR), minimally invasive aortic valve replacement (MIAVR), and transcatheter aortic valve implantation (TAVI).

Materials and Methods. This prospective observational study included 214 patients diagnosed with severe aortic stenosis who underwent valve replacement using one of the three approaches. Patients were allocated into groups based on the intervention method (TAVI: n=78, MIAVR: n=63, SAVR: n=73). A comprehensive evaluation of left ventricular morphology and function was performed using echocardiography at baseline, 1, 6, and 12 months post-intervention. Parameters assessed included left ventricular mass index (LVMI), volumes (LVEDV, LVESV), ejection fraction (LVEF), global longitudinal strain (GLS), and NT-proBNP levels. Functional capacity was evaluated using the NYHA classification.

Results. All three methods contributed to LVRR, as evidenced by progressive reductions in LVMI and LV volumes, along with improvements in LVEF and GLS. The TAVI and MIAVR groups demonstrated earlier and more pronounced reverse remodeling, particularly during the first 6 months, while SAVR showed a more gradual yet steady improvement. NT-proBNP levels significantly decreased across all groups, reflecting improved hemodynamics. TAVI was associated with the most rapid early recovery, whereas MIAVR demonstrated the most balanced and sustained benefits over the 12-month follow-up.

Conclusions. AVR, regardless of approach, promotes reverse remodeling of the left ventricle in patients with severe aortic stenosis. However, the rate and extent of remodeling vary by method. These findings highlight the need for an individualized approach in selecting the most appropriate valve replacement strategy, considering patient risk profiles, anatomical factors, and expected recovery trajectory.

Long-Term Outcomes of Tetralogy of Fallot Repair with Pulmonary Valve Preservation and with Transannular Patch

Olga S. Borodinova, Anzhelika O. Mykhailovska — Thu, 25 Sep 2025 00:00:00 +0300

Introduction. Tetralogy of Fallot (ToF) is a prevalent cyanotic congenital heart defect, with surgical repair strategies focused on relieving right ventricular outflow tract obstruction (RVOTO). The choice between a transannular patch (TAP) and a valve-sparing non-transannular patch (NTAP) remains controversial due to the trade-off between pulmonary regurgitation and the risk of residual RVOTO.

Aim. To evaluate the predictive value of intraoperative echocardiographic parameters – particularly the RVOT z-score – for identifying severe residual RVOTO in children with ToF and to analyse their long-term outcomes after ToF repair.

Materials and Methods. This retrospective single-center study included 132 patients who underwent complete ToF repair. Intraoperative transesophageal echocardiography (ITEE) was used to assess RVOT anatomy and hemodynamics. The study assessed baseline characteristics and perioperative measurements of pulmonary valve (PV) and RVOT dimensions, pressure gradients, and long-term echocardiographic parameters. The primary endpoint was reoperation due to significant RVOTO. Statistical analysis included ROC curves, AUC calculation, threshold determination, sensitivity, and specificity. Group comparisons were performed using Student’s t-test or the Mann–Whitney U test, as appropriate.

Results. NTAP was performed in 82.6 % and TAP in 17.4 % of patients. Patients in the TAP group had a significantly higher rate of RVOT-related reoperations (36.3 % vs 11.1 %; p = 0.0029), mainly due to severe pulmonary valve insufficiency and the need for RV–PA conduit implantation. The most accurate predictor of significant RVOTO requiring reintervention was an intraoperative RVOT z-score <-3.2, assessed by ITEE (AUC = 0.925; sensitivity 85.0 %, specificity 90.1 %). Other parameters, such as the Prv/Plv ratio, RV–PA gradients, and PV z-score, showed lower predictive accuracy.

Conclusions. Reoperations on the RVOT were more common after TAP than NTAP (36.3 % vs 11.1 %, p = 0.0029), mainly due to residual RVOTO and PV insufficiency. An intraoperative RVOT z-score < -3.2 was the strongest predictor of significant RVOTO. Assessing RVOT and PV z-scores during surgery may help reduce reinterventions, support valve-sparing approaches, and lower the risk of late surgeries for PV insufficiency.

Bidirectional Cavopulmonary Anastomosis as a Stage in the Hemodynamic Correction of Double Outlet Right Ventricle

Thu, 25 Sep 2025 00:00:00 +0300

Double outlet right ventricle (DORV) is a complex congenital heart defect with an abnormal ventriculoarterial connection, in which the pulmonary artery and aorta arise predominantly from the right ventricle. This condition encompasses a wide range of anatomical variants and associated malformations. A subset of patients with DORV requires a univentricular approach to defect correction due to the impossibility of performing anatomical repair with a bidirectional cavopulmonary anastomosis. This cohort of patients presents specific perioperative management challenges, which are the focus of this article.

Aim. To evaluate the preoperative characteristics, immediate and long-term results after performing a bidirectional cavopulmonary anastomosis as a stage of hemodynamic correction in patients with double abduction of the great vessels from the right ventricle.

Materials and Methods. In the period from 1996 to 2024, 483 patients with double branching of the great vessels from the right ventricle were surgically corrected at the State Institution “NIACC named after M.M. Amosov of the National Academy of Medical Sciences of Ukraine”. Radical correction of the defect was performed in 446 (92.4 %) patients, in 5 (1 %) patients a one-and-a-half-ventricle repair, and in the remaining 32 (6.6 %) patients, hemodynamic correction was chosen due to the hemodynamic characteristics typical of the physiology of a single ventricle heart, so they underwent bidirectional cavopulmonary anastomosis as a stage of the single ventricle approach. On echocardiography, among the study group of patients (n=32) who underwent bidirectional cavopulmonary anastomosis, 24 (75 %) had transposition of the great arteries, in 4 (12.5 %) a tetralogy type, and 4 (12.5 %) patients had a type of interventricular septal defect.

Results. Hospital mortality was 3.1 % (n=1). Uncomplicated course in the early postoperative period was observed in 26 (81.2 %) patients. At discharge, 12 patients with II functional class of heart failure transitioned to I functional class, among the other 20 patients with III functional class, 15 transitioned to I and 5 to II. An increase in oxygen saturation from 74 [50; 92] % to 86 [77; 92] % was also noted after the intervention. Patient survival was 96.7 % (n=30) at 6 months and 93.5 % (n=29) at 1 year and remained stable until the final stage of hemodynamic correction. The next, or final, stage of hemodynamic correction in the form of total cavopulmonary connection was performed in 22 (71 %) patients who were discharged from the hospital (n=31). An assessment of all operated patients (n=32) shows that the final stage of hemodynamic correction, or the Fontan procedure, was achieved in 68.7 % of patients.

Conclusions. Double outlet right ventricle is a complex congenital heart disease that includes a wide range of anatomical variants and requires a careful approach to choosing the tactics of surgical treatment. Bidirectional cavapulmonary anastomosis as a stage of hemodynamic demonstrates favorable immediate and long-term outcomes in patients who cannot undergo radical correction.

Development of an Arrhythmogenic Cardiomyopathy Model Using CRISPR-Cas9 and Homology-Directed Repair

Thu, 25 Sep 2025 00:00:00 +0300

Arrhythmogenic cardiomyopathy (ACM) frequently results from loss-of-function variants in PKP2, leading to desmosomal failure, electrical instability, and fibrofatty remodeling.

Aim: To create a human cellular ACM model by CRISPR–Cas9 knock-in of PKP2 c.2011delC in control induced pluripotent stem cells (iPSCs) and to evaluate allele-specific correction by homology-directed repair (HDR) in patient-derived iPSCs.

Methods: Two complementary iPSC systems were engineered: (i) pathogenic PKP2 c.2011delC knock-in (exon 10; p.Lys672Argfs*12) in control iPSCs and (ii) CRISPR HDR correction in patient iPSCs. Clonal edits were confirmed by Sanger/TIDE and long-range PCR (~2 kb); karyotypes were normal and off-targeting was below method thresholds (TIDE ≈2%, amplicon-seq ≤1%). iPSC-derived cardiomyocytes were assessed for PKP2 expression/localization (IF/Western), desmosomal organization (PKP2/DSP/Cx43), electrophysiology (whole-cell patch clamp: APD90, arrhythmic events), Ca²⁺ handling (Fluo-4; unit of analysis = differentiation; 5 cells × 3 differentiations/group), and fibrofatty remodeling (Oil Red O, Picrosirius Red). From patient edits, 12 single-cell clones were isolated; 9 were fully corrected, 6 advanced to functional testing.

Results: Mutant cardiomyocytes recapitulated ACM: PKP2 protein ~34.2% of control; desmosomal score 0.83±0.27 (vs 2.91±0.17), prolonged APD90 275±18 ms (vs 224±15 ms), and arrhythmias in 78% (Healthy 5%). Ca²⁺ transients showed reduced ΔF/F₀ 0.704±0.034 (vs 1.000±0.039) and frequency shifts (Healthy 1.009±0.024 Hz, ACM 0.964±0.120 Hz, corrected 1.401±0.069 Hz; ANOVA p=0.0167). CRISPR correction restored PKP2 to 92.1% of control, improved desmosomal organization to 2.68±0.19, shortened APD90 to 225±13 ms, reduced arrhythmias to 12%, increased Ca²⁺ amplitude to 1.161±0.023, and normalized collagen (4.8±0.6%) and lipid (8.2±1.2%) burdens.

Conclusions: Dual-direction editing–pathogenic knock-in for modeling and isogenic HDR correction for rescue – provides a robust human platform for ACM. Correction of PKP2 c.2011delC reverses desmosomal, electrical, Ca²⁺-handling, and fibrofatty defects, supporting translational development of gene-editing therapies for ACM.

Structural-Functional Patterns of Lesions of the Main Arteries of the Head in Patients with Headache

Thu, 25 Sep 2025 00:00:00 +0300

Aim. To study the structural and functional features of the main arteries of the head (MAH) in patients with migraine (M), tension-type headache (TTH), and cervicogenic headache (CH).

Materials and Methods. A total of 456 patients (18–44 years old; 203 men, 255 women) with various types of headaches were studied, including M – 124 people, TTH – 186, and CH – 146 people. Using the duplex scanning method, the structure of the MAH, systolic linear blood flow velocity (Vs), and resistance indices (RI) in the common carotid (CCA), external carotid (ECA), internal carotid (ICA), and vertebral arteries (VA) in V2 segments were assessed.

Results. Extravasal compression of the vertebral arteries was significantly more prevalent in patients with CH (43.1%) and M (29.0%), while hypoplasia of the vertebral arteries was found equally in these groups. In all types of headaches, a decrease in velocity indicators and an increase in resistance index values in the VA were noted. In patients with migraine with aura (MA), extravasal compression and hypoplasia of the vertebral arteries predominated, and Vs indicators in this group were significantly reduced. Signs of extravasal compression and the associated decrease in VA hemodynamics were observed in all variants of TTH. Furthermore, signs of extravasal compression of the VA were detected in a significant proportion of patients with CH, especially those with cervicocranialgia (CCrA) and Barré-Liéou syndrome (BLS). In BLS, signs of pathological tortuosity and hypoplasia of the VA predominated. Velocity indices in extracranial segments of the VA were reduced in patients with CCrA and BLS, and a significant increase in RI values was also observed in the BLS group (0.87 ± 0.05; CG – 0.65 ± 0.06; p < 0.05).

Conclusions.

Patients with M were characterized by the presence of extravasal compressions and a decrease in Vs in the VA.
Hypoplasia of the VA was more common in the group of patients with MA than in M without aura.
Patients with TTH had a tendency towards reduced velocity indices in extracranial segments of the VA.
Patients with CH manifested extravasal compression of the vertebral arteries.
Tortuosity and hypoplasia of the VA, in combination with an increase in RI indices, were characteristic of patients with BLS

Comparative Analysis of the Treatment of Patients with Lower Limb Artery Thrombosis and Outflow Artery Injury Using Recombinant Tissue Plasminogen Activator as a Thrombolytic Agent

Dmytro A. Makivchuk, Yurii M. Hupalo — Thu, 25 Sep 2025 00:00:00 +0300

Aim. To evaluate the effectiveness of recombinant tissue plasminogen activator (rtPA) in the treatment of patients with lower limb arterial thrombosis and outflow artery injury, and to conduct a comparative analysis of treatment following catheter-directed thrombolysis (CDT).

Materials and Methods. The study analyzed the treatment outcomes of 64 patients who underwent CDT using rtPA. During the postoperative period and at the outpatient stage of treatment, patients received anticoagulant therapy according to the VOYAGER PAD protocol and underwent regular duplex ultrasound (DUS) vascular monitoring.

Results. Most patients demonstrated marked regression of ischemia, reduction of pain syndrome, and absence of critical hemorrhagic complications. Limb preservation was achieved in 93.3 % of patients within 2 months after CDT. The use of CDT allowed achieving a high rate of revascularization and reduced the risk of recurrent thrombosis.

Conclusions. Recombinant tissue plasminogen activator (rtPA) is an effective thrombolytic agent for CDT in the treatment of patients with acute lower limb arterial thrombosis (ALLAT) and concomitant outflow artery injury. The results of this study suggest that endovascular methods with additional angiographic control of distal blood flow are a recommended treatment option for patients with ALLAT and run-off arterial lesions. These methods demonstrated a high success rate in revascularizing the affected arteries and improving the degree of lower-limb ischemia, as evidenced by regression according to the Rutherford classification. The combination of CDT with secondary angioplasty proved beneficial in certain patients with hemodynamically significant steno-occlusions that may have contributed to run-off arterial thrombosis.

Regional Anesthesia Methods Under Ultrasound Guidance for Endovenous Laser Ablation and Miniphlebectomy

Vitalii S. Myrona, Volodymyr I. Cherniy — Thu, 25 Sep 2025 00:00:00 +0300

Comparative effectiveness of the combination of n. femoralis and n. ischiadicus fossa poplitea block with n. femoralis and n. saphenus block under ultrasound control in endovenous laser ablations and mini-phlebectomy.

Aim. To conduct a comprehensive comparison of two regional anesthesia techniques regarding their effectiveness, safety, and clinical feasibility in the minimally invasive treatment of lower extremity varicose veins.

Materials and Methods. A prospective randomized study was conducted involving 50 patients, divided into two groups: Group A (femoral and sciatic nerve block in the popliteal fossa, n = 25) and Group B (femoral and saphenous nerve block, n = 25). All procedures were performed under ultrasound guidance using 300 mg of 1 % lidocaine hydrochloride solution. Intraoperative pain (VAS scale), hemodynamic parameters, duration of motor block, and perioperative cortisol level dynamics were assessed.

Results. Group A demonstrated a significantly longer duration of anesthesia and motor block — 300.0 (180.0) minutes — and provided better analgesia of the posterior lower leg. In contrast, Group B was associated with a shorter duration of motor block — 220.0 (200.0–240.0) minutes. The level of intraoperative pain (VAS) showed no statistically significant differences between the groups. However, to achieve adequate analgesia, patients in Group B required higher doses of fentanyl compared to those in Group A.

Conclusions. Both methods are effective and safe options for anesthesia during EVLA and miniphlebectomy. The combination of femoral and saphenous nerve blocks is optimal for routine procedures due to its technical simplicity and shorter execution time. The combination of femoral and sciatic nerve blocks in the popliteal fossa is recommended for complex cases requiring prolonged analgesia. Ultrasound guidance ensures a high level of safety for both techniques.

Early and Mid-Term Outcomes of Pulsed Field Ablation in Patients with Atrial Fibrillation

Olexandr V. Doronin, Maryna S. Meshkova — Thu, 25 Sep 2025 00:00:00 +0300

Introduction. Pulsed field ablation (PFA) is emerging as a safe and effective non-thermal approach for catheter-based treatment of atrial fibrillation (AF). It selectively targets cardiac tissue while reducing the risk of collateral damage. In Ukraine, this technology was introduced in 2024.

Aim. To evaluate the early and mid-term outcomes of PFA in patients with different forms of AF treated at a single Ukrainian center.

Materials and Methods. A total of 48 patients underwent PFA between March 2024 and February 2025 using the FARAPULSE™ catheter. Remote follow-up data were obtained for 42 patients (33 with paroxysmal AF and 9 with persistent AF). All procedures were performed under general anesthesia following a standardized ablation protocol. For persistent AF, additional posterior wall isolation was performed. Key procedural metrics and rhythm outcomes were documented.

Results. The mean follow-up duration was 6.6 ± 3.4 months. Sinus rhythm was maintained in 78.7 % of patients with paroxysmal AF and in 66.7 % of those with persistent AF. Among the latter, 67.1 % continued antiarrhythmic therapy. No procedural complications were reported. Overall symptomatic improvement was noted in 81.0 % of patients. The efficacy rate aligns with international multicenter trials, such as PULSED-AF and INSPIRE.

Conclusions. Initial experience with pulsed field ablation in Ukraine demonstrates promising results for both paroxysmal and persistent AF. The procedure proved to be safe and effective, even during the operator’s learning curve. Continued research with extended follow-up and larger cohorts is warranted to validate long-term efficacy.

Autonomous Effects of Catheter Radiofrequency Pulmonary Vein Isolation Ablation Using a High-Power and Short-Duration Technique

Eugene O. Perepeka — Thu, 25 Sep 2025 00:00:00 +0300

Introduction. Catheter-based pulmonary vein ablation (PVA) is the gold standard for the treatment of symptomatic, drug-refractory atrial fibrillation (AF). The effect of catheter ablation on the autonomic nervous system, particularly the parasympathetic system–referred to as the “cardioneuroeffect” – represents an important side effect that may contribute to more stable outcomes of the procedure.

Aim. To investigate the intraoperative autonomic effects of high-power, short-duration pulmonary vein isolation.

Materials and Methods. For this retrospective study, 49 patients with paroxysmal and persistent forms of AF were selected, in whom long-term outcomes regarding arrhythmia recurrence could be tracked. All patients underwent catheter-based radiofrequency ablation at the State Institution “National Institute of Cardiovascular Surgery named after M. M. Amosov of the National Academy of Medical Sciences of Ukraine” between May 2022 and December 2024.

Results. Over a mean observation period of 19.87 ± 7.56 months (range 8-34), recurrences occurred in 19 out of 49 patients (38 %). In patients without recurrence, there was a pronounced decrease in the R-R interval during the intervention (889.33 ± 157.48 vs. 762.92 ± 133.81 ms, p=0.003) and a significant increase in heart rate (69 ± 11.96 vs. 80.67 ± 15.53 bpm, p=0.003). In patients with recurrence, changes in the R-R interval and heart rate were not statistically significant (p=0.09 and p=0.117), indicating smaller autonomic modulation. At the end of the procedure, the R-R interval and heart rate were significantly higher and lower, respectively, in the recurrence group (874.25 ± 137.06 ms vs. 762.92 ± 133.81 ms, p=0.029; 69.75 ± 11.85 vs. 80.67 ± 15.53 bpm, p=0.022). Patients with recurrence had a higher mean degree of left atrial fibrosis according to voltage mapping (1.64 ± 1.21 vs. 0.84 ± 0.72), but this difference did not reach statistical significance (p=0.11). Absence of reconnection during the intervention was observed in 62.5 % of patients without recurrence, compared to only 30.8 % in the recurrence group. Reconnection in two veins occurred exclusively in the recurrence group (54 % of cases), which was not observed in any patient without recurrence. This difference was statistically significant (p=0.003).

Conclusions. During catheter radiofrequency isolation of the pulmonary veins in patients with paroxysmal and persistent AF, a more pronounced effect of cardioneuromodulation was associated with a reduction in arrhythmia recurrences during the postoperative period.

Tilt Test as a Primary Non-Invasive Method for Testing Cardiac Autonomic Nervous System Function in Patients with Vasovagal Syncope

Dmytro A. Tymoshenko, Mykola V. Derkach, Alina V. Topchii — Thu, 25 Sep 2025 00:00:00 +0300

Introduction

Syncope is a sudden, brief loss of consciousness with rapid spontaneous recovery, caused by transient global cerebral hypoperfusion. Among various causes of syncope, the most common are reflex mechanisms, particularly vasovagal syncope (VVS) [1]. At present, the tilt test is the most widely used non-invasive method for testing the cardiac autonomic nervous system. Tilt test results are verified using the modern VASIS classification, which distinguishes three types of vasovagal syncope.

Aim

The aim of this study was to determine the role of the tilt test in assessing the cardiac autonomic nervous system and its influence on the selection of treatment strategies for patients with vasovagal syncope.

Materials and Methods

A retrospective analysis was conducted on data from 40 patients who presented to the Amosov National Institute of Cardiovascular Surgery with recurrent syncope and had a positive tilt test result. Among those examined were 30 men and 10 women, with a mean age of 37.8 ± 11.6 years (with an age range of 15-69 years). The tilt test was performed according to the classical Italian protocol. Following the test and confirmation of vasovagal syncope, each patient was assigned an appropriate treatment strategy – ranging from conservative management to invasive interventions.

Results.

All 40 patients had a positive tilt test result, confirming the vasovagal origin of syncope. This high rate of positive responses likely reflects careful preselection of candidates for potential invasive treatment. Syncope occurred in 36 patients (90 %) during the nitroglycerin provocation phase and in 4 patients (10 %) during the passive tilt phase. The mean time to syncope in the passive tilt phase was 10.8 ± 2.1 minutes (range: 8-15 minutes), while in the nitroglycerin phase it was 4.2 ± 2.3 minutes (range: 1-13 minutes). A cardioinhibitory type was identified in 24 patients (60 %), a mixed type in 11 (28 %), and a vasodepressor type in 5 (12 %).

Treatment strategies were determined jointly with the patients. Fourteen individuals with recurrent syncope and a pronounced vagal component underwent catheter ablation of parasympathetic ganglionated plexi, with no procedural complications and complete resolution of vagally mediated sinus node dysfunction. Another 10 with the cardioinhibitory type opted for conservative therapy. Among those with the mixed type, six underwent cardioneuroablation, while the remaining five were managed conservatively. Invasive interventions for the vasodepressor type remain uncommon [10,12], and these patients were treated conservatively.

Conclusions

The tilt test plays a crucial role in diagnosing vasovagal syncope by assessing the cardiac autonomic nervous system. Accurate classification of the vasovagal syncope type using the VASIS classification directly influences subsequent treatment decisions. According to numerous contemporary studies, invasive treatments demonstrate the greatest effectiveness in patients with the cardioinhibitory type of vasovagal syncope.

Features of Diagnosis and Surgical Treatment of Fragment Embolism of the Right Ventricle in Mine-Blast Injuries

Thu, 25 Sep 2025 00:00:00 +0300

Among the many types of combat injuries, particular attention is drawn to fragmentary injuries of the heart and blood vessels. In such cases, the damaging agent can be located in various parts of the heart, including both its chambers and walls. A separate category of such injuries is fragment embolism of the heart and vessels, a rare consequence of ballistic trauma. This condition involves the traumatic penetration of a foreign body (usually a bullet or fragment) into a blood vessel, which then continues to migrate along the vessel to another part of the body. The rarity and high variability of clinical manifestations of such injuries have led to a lack of established treatment or management strategies.

Aim. To determine the features of the course, diagnosis and treatment of right heart fragment embolism in patients with mine-explosive injuries and to provide recommendations for surgery in such conditions.

Materials and Methods. Our experience includes 72 cases of mine-blast injuries. Almost all cases involved injuries to the organs of the thoracic cavity, namely the lungs, heart, or mediastinal organs. Direct heart injuries were observed in 33 patients. Localization of fragments in the right ventricular cavity was diagnosed in 14 patients. Fragment embolism of the right ventricular cavity was observed in 4 cases, accounting for 5.8 % of the total number of patients with mine-blast injuries. All were men aged 24, 29, 43, and 44 years. The leading diagnostic method that enabled detection of the fragment was contrast-enhanced CT with synchronization.

Results. As a result of mine-blast fragment injuries, all 4 patients were wounded in the upper or lower limbs and inguinal region. No breaches of the chest cavity or diaphragm were observed. In all cases, fragments were found in the right ventricular cavity. Diagnosis of cardiac fragment presence was made at different times after injury, ranging from 1 day to 4 months. All patients underwent surgery using cardiopulmonary bypass via a trans-tricuspid approach. In all cases, there were no signs of pericardial injury, inflammation, hemopericardium, or damage to the cardiac walls. A neodymium magnet was used during each operation.

Conclusions. The entry of fragments into the venous vessels of the upper and lower limbs may be accompanied by migration to the right heart chambers, with potential fixation to the trabeculae of the right ventricle and risk of entry into the pulmonary artery basin. Contrast-enhanced CT allows for precise localization of the fragment and aids in planning the treatment strategy. In our opinion, to prevent fragment migration into the pulmonary artery system, priority should be given to the removal of fragments located in the RV cavity.

Surgical Outcomes in the Era of COVID-19: A Stratified Analysis Based on Infection Chronology

Dmytro M. Kosovan — Thu, 25 Sep 2025 00:00:00 +0300

Aim. To investigate the impact of COVID-19 infection timing on postoperative outcomes in patients undergoing surgical treatment for acquired valvular heart disease.

Materials and Methods. This single-center retrospective study included 96 patients with confirmed COVID-19 who underwent valvular heart surgery. Patients were stratified into two groups based on the timing of SARS-CoV-2 infection: those infected prior to hospital admission (preoperative COVID-19; n=69) and those infected during hospitalization after surgery (postoperative/hospital-acquired COVID-19; n=27). Clinical, laboratory, and perioperative data were analyzed, including length of hospitalization and ICU stay, duration of mechanical ventilation, use of inotropes/vasopressors, and mortality. Statistical analyses included t-tests, Mann–Whitney U tests, Pearson’s correlation, and chi-square tests.

Results. Postoperative COVID-19 infection was associated with significantly worse outcomes, including longer hospital and ICU stays, prolonged mechanical ventilation (169.7 ± 140.8 h vs. 18.1 ± 35.3 h; p<0.001), increased need for inotropic and vasopressor support (dobutamine use: r=0.84; norepinephrine use: r=0.76), and higher mortality. Laboratory findings revealed more profound thrombocytopenia, hyperglycemia, and renal dysfunction in the postoperative group. In contrast, patients with preoperative COVID-19 demonstrated more favorable outcomes, provided that a sufficient interval (≥6–7 weeks) had elapsed between infection and surgery. Strong correlations were observed between mortality and indicators of multiorgan dysfunction, particularly respiratory failure, cardiac decompensation, and pneumonia.

Conclusions. The timing of COVID-19 infection is a critical determinant of postoperative prognosis in patients undergoing valvular surgery. Hospital-acquired infection is an independent predictor of adverse outcomes. Elective surgery should be deferred for at least 6–7 weeks after COVID-19 recovery, with individualized risk assessment. Preventing early nosocomial infection in the postoperative period is essential to reduce mortality in cardiac surgery patients.

Search for Fundamental Patterns in the Behavior of Integral Parameters of Cardiopulmonary Bypass for Rapid Assessment of Oxygen Balance During Cardiac Surgery

Mykola V. Sup, Vitaliy B. Maksymenko — Thu, 25 Sep 2025 00:00:00 +0300

Disruption of the balance between oxygen delivery and consumption remains a key contributor to metabolic disturbances and potential perioperative complications. This study explores the feasibility of calculating and applying the oxygen mass transfer coefficient (KO₂) as a core indicator of the mass-exchange capacity of the microcirculatory membrane. The proposed approach is grounded in the theoretical linkage between critical parameters of cardiopulmonary bypass (CPB) and the fundamental Fick’s law, enabling a quantitative assessment of oxygen diffusion efficiency under artificial circulation conditions.

Objective. To improve the assessment of systemic oxygen balance during CPB by introducing an integral oxygen mass transfer coefficient (KO₂), which combines the main perfusion adequacy criteria based on Fick’s principle.

Materials and Methods. A total of 129 intraoperative observations were analyzed during cardiac surgical procedures involving cardiopulmonary bypass (CPB). These data served as the basis for all necessary calculations to determine the oxygen mass transfer coefficient (KO₂). CPB monitoring parameters included standard acid–base balance and blood gas variables consistent with the alpha-stat strategy, based on Astrup’s micromethod and the Siggaard–Andersen principles, using conventional blood gas analyzers. Additionally, physiological variables were taken into account, including hemodynamic indices, hematological status, anthropometric characteristics, as well as indicators of perfusion efficiency and metabolic balance.

Results. Within the framework of analytical validation, KO₂ dynamics demonstrated consistent behavior across both temperature groups and aligned with independent markers of tissue oxygenation status – specifically, increases in lactate levels and oxygen extraction, decreases in venous blood gas parameters, and shifts in acid–base balance. As these variables were not included in the clustering algorithm, their concordance supports the analytical independence and functional informativeness of KO₂. Furthermore, changes in KO₂ were often observed to precede alterations in metabolic parameters.

Conclusions. The construct validity of KO₂ demonstrated sensitivity to early alterations in oxygen balance and functional concordance with independent metabolic indicators, supporting its potential as a promising engineering parameter for automated assessment of oxygenation efficiency during cardiopulmonary bypass.

T1 Mapping in Cardiac MRI: Principles, Techniques, and Reference Values of Native Myocardial T1 and Extracellular Volume in Healthy Subjects

Thu, 25 Sep 2025 00:00:00 +0300

Background. Cardiovascular diseases remain the leading cause of morbidity and mortality worldwide. One of the key aspects of modern cardiac diagnostics is tissue characterization of the myocardium, which enables the identification of early and diffuse changes not detectable by conventional imaging modalities. T1 mapping by cardiac magnetic resonance (MRI) has emerged as a powerful quantitative technique for detecting and monitoring myocardial fibrosis, both focal and diffuse, in a non-invasive and reproducible manner.

Aim. The aim of this study was to establish reference values for native T1 and extracellular volume fraction (ECV) of the myocardium using 1.5T MRI in a healthy Ukrainian population, including both pediatric and adult patients, and to evaluate age-related changes in these parameters.

Materials and Methods. This prospective study included 312 participants (143 children and 169 adults) who underwent cardiac MRI between 2022 and 2024. All participants had normal echocardiographic findings and no history of cardiovascular or systemic diseases. Cardiac MRI was performed using a 1.5 Tesla scanner (Magnetom Avanto Fit, Siemens Healthineers) with a standardized protocol. Native T1 mapping was performed using a MOLLI sequence before contrast administration, and post-contrast T1 mapping was used to calculate ECV using hematocrit-adjusted formulae. T1 values were measured in the interventricular septum in short-axis slices. Data were stratified into pediatric subgroups: infants (0-1 years), early childhood (2-6 years), school-age children (7-12 years), and adolescents (12-18 years). Adults were further stratified by age: <50 years and ≥50 years. Statistical analyses included ANOVA, t-tests, and Pearson correlation.

Results. Native T1 time demonstrated a statistically significant age-dependent increase in pediatric patients. Mean values were: 940±20 ms (0-1 year), 960±20 ms (2-6 years), 980±20 ms (7-12 years), and 1000±20 ms (12-18 years). Adults exhibited stable T1 values with a mean of 1000.2 ms, showing no significant correlation with age (p = 0.501) or sex (p = 0.848). T1 values in adolescents did not differ significantly from adults (p = 0.183), suggesting myocardial tissue maturation by the age of 12-18 years. Comparison between myocardial segments revealed that the interventricular septum had significantly higher T1 values than the lateral wall (p<0.001), supporting previous recommendations to prefer septal measurements for reproducibility. ECV values were calculated in 94 children and 134 adults. The mean ECV in adults was 24.9 % ±1.53, while in children it was 25.0 % ±1.72. Both groups had identical medians (25 %), though children exhibited a broader distribution (22–28 %) compared to adults (24–26 %). No statistically significant differences in ECV were found between age groups (p>0.05).

Conclusions. Our findings establish age-specific reference ranges for native T1 and ECV in a healthy Ukrainian cohort using 1.5T cardiac MRI. T1 values increase during childhood and plateau during adolescence, with no further age-related variation in adulthood. ECV remains consistent across age groups but exhibits wider variability in children. These normative values may support improved tissue characterization and diagnostic accuracy for pediatric and adult cardiac conditions. T1 mapping, with its ability to detect early diffuse fibrosis, holds promise as a clinical and research tool in longitudinal cardiac health assessment.

Case Report of Multidisciplinary Management of Peripartum Cardiomyopathy

Thu, 25 Sep 2025 00:00:00 +0300

Peripartum cardiomyopathy (PPCM) is a form of heart failure that occurs during pregnancy or in the postpartum period, characterized by reduced left ventricular systolic function [1]. Peripartum cardiomyopathy is one of the leading causes of maternal mortality and morbidity worldwide.

Aim. To demonstrate, through a clinical case, the importance of early diagnosis, timely risk factor identification, and optimized strategies for treatment, delivery, and postpartum care.

Case Report. Patient B, a 36-year-old woman, was urgently admitted to the hospital on the sixth day postpartum due to progressive symptoms of acute heart failure. Examination confirmed peripartum cardiomyopathy, acute heart failure (Killip III, pulmonary edema), severe mitral regurgitation, left atrial dilation, moderate tricuspid regurgitation, moderate pulmonary hypertension, and massive bilateral pleural effusion. The left ventricular ejection fraction (LVEF) was 36 %, with NYHA Functional Class IV. Bilateral thoracentesis was performed, and acute heart failure therapy was administered in the intensive care unit for five days, leading to clinical improvement and improved laboratory and instrumental findings. The patient received heart failure therapy, including bromocriptine, and was managed by a multidisciplinary team of cardiologists, obstetricians, cardiac surgeons, and intensivists. At discharge, the patient’s condition was stable. Echocardiography revealed reduced mitral regurgitation (from severe to moderate), decreased left atrial size, and an LVEF increase to 40 %. NT-proBNP was 533.2 pg/mL, with other laboratory parameters within normal limits. Long-term outcomes were assessed at 2, 6, and 14 months post-discharge. At 14-month follow-up, complete recovery of myocardial and mitral valve function was observed, with a stable clinical condition.

Conclusions. Peripartum cardiomyopathy remains a serious cause of maternal and perinatal morbidity and mortality. Timely diagnosis and management of this condition are possible only through close collaboration within a multidisciplinary team comprising obstetrician-gynecologists, cardiologists, cardiac surgeons, and anesthesiologist-intensivists. Coordinated actions of these specialists contribute to optimizing the management of pregnancy, delivery, and the postpartum period, as well as improving long-term outcomes for both mother and child.

Clinical Case of Surgical Correction of Infective Endocarditis of the Pulmonary Valve Associated with Infundibular Stenosis in an Adult

Thu, 25 Sep 2025 00:00:00 +0300

Background. Congenital heart defects, if not surgically corrected in a timely manner, are a predictor for the development of infective endocarditis, with the likelihood of its occurrence increasing with patient age.

Aim. To present a comprehensive approach to the surgical management of infective endocarditis during complete correction of congenital heart disease.

Case report. Patient M., 19 years old, was admitted to the Department of Cardiac Surgery of the Ternopil Regional Clinical Hospital (VKTOKL) on 30.12.2024 (case history No. 22656) with a diagnosis of infective endocarditis of the pulmonary artery valve (IEPAV), critical infundibular stenosis of the right ventricular outflow tract (RVOT), severe tricuspid valve (TV) insufficiency, circulatory failure of the III degree according to the New York Heart Association classification, concomitant bilateral infarct-pneumonia, and pulmonary failure of the II degree. On 03.01.2025, the patient underwent surgery, which included removal of vegetations, sanitation of the pulmonary artery valve, RVOT, and TV, resection of infundibular stenosis of the RVOT, prosthetic replacement of the pulmonary artery valve with a St. Jude Epic 23 bioprosthesis, and DeVega TV plasty under cardiopulmonary bypass. During the long-term follow-up, 4 months after surgery, the patient tolerated physical exertion well. Echocardiography revealed a gradient of 3 mm Hg in the RVOT, with no insufficiency of the TV or pulmonary artery valve, and a left ventricular ejection fraction (LVEF) of 65 %.

Conclusions. Timely surgical correction of congenital heart defects with restoration of anatomical structures in the heart eliminates the cause-and-effect relationship leading to the development of infective endocarditis.The implantation of a biological valve into the pulmonary artery represents the optimal and definitive procedure for restoring hemodynamics in the pulmonary arterial system.