In-hospital mortality in patients with acute myocardial infarction (AMI) is 5% 8% and has not decreased in recent years. One of the reasons for high mortality is reperfusion cardiac injury. It is quite obvious that there is an urgent need to develop drugs that can effectively reduce mortality in AMI. Opioids could become such drugs. The activation of peripheral µ2-, δ2-, κ1-opioid receptors (ORs) reduces the size of the infarction and improves contractility in reperfusion. Peripheral µ1-, δ1-, κ2ORs is not involved in the regulation of cardiac tolerance to reperfusion injury. PI3-kinase (phosphoinositide 3-kinase), ERK1/2 (extracellular signal-regulated kinase-1/2), Akt-kinase, epidermal growth factor receptor (EGRF) and soluble guanylyl cyclase (sGC) are involved in the cardioprotective effect of opioid postconditioning. Inhibition of GSK-3β (glycogen synthase kinase3β) and JNK (c-jun NH2 amino-terminal kinase) is involved in opioid postconditioning in contrast to Janus kinase-2 (JAK2) and protein kinase A (PKA). There is evidence that hemeoxygenase-1 (HO-1) and NO synthase (NOS) are also involved in opioidinduced postconditioning. Peptide and non-peptide µ2-, δ2-, κ1-OR agonists may become drugs for the treatment of AMI. Aim is to analyze signaling mechanisms of the cardioprotective effect of peptide and non-peptide opioid receptor agonists during cardiac reperfusion. A literature search was carried out in the PubMed database with queries “opioid receptors”, “opioid receptor agonists”, “cardioprotective effect of opioid receptor agonists”.

Erectile dysfunction (ED) is one of the most frequently developing and significantly reducing quality of life complications of radical prostatectomy (RPE). According to the number of studies, ED is diagnosed in 60-75% of patients after the RPE. The use of nerve-sparing surgical techniques has reduced the incidence of ED after RPE, but has not completely solved this problem. In addition, it is not always possible to preserve the vascular-nerve bundles for the reason of oncological radicalism. All of the above factors make the issue of restoring erectile function one of the priority areas of medical rehabilitation of patients after the radical surgery for prostate cancer (PC). The development of new strategies for the treatment of ED after NS RP, aimed at maintaining endothelial function in the cavernous arteries until the completion of remyelination and restoration of damaged cavernous nerves, is a relevant and actively developing area of modern andrology.

Aim: To study the principles and new trends of contrast-free MR perfusion (ASL) based on literature data.

Material and Methods. A retrospective overview of randomized clinical and crossover studies was performed by searching databases: PUBMED, EMBASE, LILACS, SCOPUS, eLIBRARY in English and Russian languages from 2015 to 2024 years. The keywords used for article selection included: arterial spin labeling (ASL), pulsed ASL, continuous ASL, pseudocontinuous ASL, diffusion-prepared ASL, artificial intelligence ASL, vessel-encoded ASL and non-contrast MR perfusion.

Results. A total of 487 articles were analyzed, 50 of which were used to perform the review. The search results – blocks of articles were created with analysis the variations of the ASL method, its application possibilities, technical characteristics, and developmental trends of artificial intelligence in this field.

Conclusion. The existing varieties of ASL allow for the selection and consideration of the advantages and disadvantages of each method for conducting diagnostic studies. The pCASL sequence is the most studied, reliable and affordable quantitative method, and the developing promising technical methods for collecting and processing results will expand the application of the method in clinical and research practices.

Aim. To assess the effect of nitric oxide administered into the extracorporeal circuit and during the three-day postoperative period on oxidative stress parameters and the state of red blood cells during operations with cardiopulmonary bypass (CPB).

Material and Methods. The study included 106 patients who underwent heart valve surgeries and combined interventions under CPB. Two groups of patients were created: control (53 patients); study (53 patients). Nitric oxide (40 ppm) was supplied to the oxygenator of the CPB machine and by inhalation for three days after surgery. At the stages and after the surgery, the concentration of diene (DC) and triene (TC) conjugates, Schiff bases (SB); erythrocyte catalase activity (CA) was studied; aggregation and electrophoretic mobility of erythrocytes were measured. Clinical outcomes of surgeries were studied.

Results. In patients of the control group, statistically significant increase in the content of DC (by 1.2 times) and SB (by 2.0 times) was registered by the end of the surgery compared to the initial values. SB content did not return to the preoperative level even by the end of the third day after the operation. A sharp decrease in CA activity by the end of the operation (by 24.1%) and its further decrease during three postoperative days were marked. A statistically significant increase in erythrocyte aggregation was established, starting from 60 min of CB (by 18.0% higher than the initial one), reaching a maximum by the end of the operation (by 20.4% higher than the initial one) and remaining above the initial level throughout the postoperative period. The use of nitric oxide during and after the surgery made it possible to statistically significantly decrease the level of DC, TC, SB; increase the activity of erythrocyte catalase; reduce erythrocyte aggregation and increase their electrophoretic mobility both during CBP and in the postoperative period.

Conclusion. Cardiopulmonary bypass stimulates the development of lipid peroxidation (LPO) processes and erythrocyte damage, which occur during surgery and continue in the immediate postoperative period. Nitric oxide, used both during cardiopulmonary bypass and during the three-day postoperative period, effectively prevents the activation of LPO processes, has an antioxidant effect, reduces erythrocyte aggregation and increases their electrophoretic mobility. The positive effect of nitric oxide is noted not only during cardiopulmonary bypass, but also during the postoperative period, which improves the clinical outcomes of heart surgery.

Introduction. The issue of adequate surgical tactics in relation to the volume of aortic wall resection in aortic valve stenosis in combination with an ascending aortic aneurysm is recognized as relevant and debatable.

Aim: To compare the mid-term results of surgical reconstruction of the ascending aorta and prosthetics of the aortic valve for stenosis in patients with its bicuspid and tricuspid anatomy.

Material and Methods. A retrospective analysis of the results of surgical treatment of 102 patients with ascending aortic aneurysm and aortic valve stenotic defect was performed. All patients were divided into 2 groups depending on the anatomy of the aortic valve: bicuspid (AAA + BAV, n = 75) or tricuspid (AAA + TAV, n = 27). The data analysis included an intergroup comparison of postoperative results in the near and midi-term postoperative periods.

Results. Mid-term survival of AAA + BAV and AAA + TAV patients it reached 97.4% and 100%, respectively. There were no episodes of repeated surgical intervention on the thoracic aorta. In AAA + BAV patients, a moderate increase in Valsalva sinuses was noted, and in AAA + TAV patients, a decrease in the size of the aortic root was noted in the postoperative period. Conclusion. Combined surgeriess for ascending aortic aneurysm and stenotic aortic valve are associated with satisfactory early and mid-term results, including high level of survival and freedom from surgery for up to 36 months, regardless of the anatomy of the aortic valve.

Currently, there is a tendency in carotid endarterectomy to clarity, safety, low trauma and without loss of quality of life of the patient. Particular attention after surgical treatment of the carotid artery is paid to iatrogenic local complications, such as: neuropathy of the cranial nerves, hematoma of the postoperative wound, bleeding, thrombosis in the anastomosis area with the development of cerebral infarction, cosmetic defect. The issue of carotid access and wound drainage is actively discussed taking into account local complications, postoperative quality of life. This study proposes a method of active drainage through the main wound in combination with minimally invasive retrojugular access to the bifurcation of the carotid artery. Comparative calculations were made between different approaches to the carotid bifurcation, early and late postoperative complications were compared taking into account the access. With the classical approach to the carotid bifurcation, compared with the retrojugular approach, there was a higher frequency of neurological symptoms, including skin hypoesthesia (3.8% and 33.3%, p = 0.01), the risk of MACE within 9 months increased 8.18 times (HR = 8.181, 95% CI 2.086–32.086, p = 0.003) compared with the antegular mini-approach. A model for predicting postoperative cranial nerve neuropathy was developed an increase in the incision length by 1 cm increases the likelihood of achieving a secondary endpoint (OR = 2.264; 95% CI: 1.300–3.943, p = 0.004).

Rationale. Improving the quality of life (QoL) as well as restoration of physical, emotional and mental functioning is the key goals of treatment in patients with coronary heart disease (CAD) and acquired heart defects (AHD). Data on terms, dynamics and features of improving various aspects of QoL after open heart surgery in these groups of patients are currently limited. In addition, the relationship between clinical and instrumental preand postoperative data and the dynamics of changes in quality of life has not been established.

Aim. To study the dynamics of QoL and the degree of satisfaction with the results of treatment in patients with CAD and AHD during 12 months after open heart surgery.

Material and Methods. Adult patients with CAD and AHD requiring surgical treatment were enrolled in the study. Before surgery, all the patients underwent a standard clinical, laboratory and instrumental examination as part of the cardiac surgical treatment protocol, supplemented by determining the level of B-natriuretic peptide (NP) before surgery and on the day of discharge from the hospital. Within 12 months after discharge from the hospital, a control echocardiographic study was performed. To assess QoL, patients filled in the RAND SF-36 and SAQ questionnaires before surgery, at 3, 6 and 12 months after discharge. Treatment satisfaction was assessed 3, 6 and 12 months after surgery. The analysis of changes in QoL after surgery was carried out using Generalized estimating equations; the time after surgery, gender, age, population of the place of residence, duration of the disease, the level of NP before surgery and the dynamics of LVEF 12 months after surgery were considered as independent variables.

Results. Totally, 189 (63.9%) patients with CAD and 107 (36.1%) patients with AHD (median age 65 years, men – 68%), who underwent open heart surgery from November 2022 to January 2024 were enrolled. The median pre-surgery NP level was 243 pg/mL in the CAD group and 812 pg/mL in the AHD group. In the vast majority of patients, the LV EF increased after 12 months (CAD, n = 49 [25.9%], AHD, n = 24 [22.4%]) or remained unchanged (CAD, n = 139 [73.5%], AHD, n = 82 [76.6%]). At 12 months after surgery, 87% of patients with CAD and 90% of patients with AHD reported an improvement in well-being; 98% of patients with CAD and 96% of patients with AHD are satisfied with the degree of elimination of symptoms of the disease. The positive dynamics of general aspects of QoL was less pronounced in both groups in men and in patients younger than 55 years; in patients with CAD – in the early postoperative period if they had no significant increase in LV EF 12 months after surgery, as well as if they had preoperative level of NP > 1200 pg/ml.

Conclusion. Significant QoL improvement in both CAD and AHD patients was observed already in 3 months after open heart surgery, with further sustained positive dynamics at 6 and 12 months. The vast majority of patients were satisfied with heart surgery. Sociodemographic factors – age, gender, population of the place of residence, as well as clinical factors – duration of the disease, baseline level of NP, dynamics of LVEF is associated with QoL changes during the first year after surgery.

Introduction. The COVID-19 pandemic causes an increase in cardiovascular pathologies, such as chronic heart failure (CHF) in the post-Covid period. The changes may be associated with inflammation, immune dysregulation, and hyperglycemia. An important task for healthcare is to study the effect of carbohydrate metabolism disorders on CHF in patients after COVID-19. Aim: To study the impact of carbohydrate metabolism disorders on the prognosis of CHF in postCOVID-19 patients.

Material and Methods. A retrospective analysis of patients of the Tyumen Cardiology Research Center, Tomsk NMRC (TCRC) (n = 350) was carried out. The patients had COVID-19 in 2020–2021 and were observed at the TСRC from April 10, 2020 to July 11, 2022. The study included 116 patients. Patients were divided into 2 groups: with CHF (n = 63) and without CHF (n = 53). Verification of CHF was carried out according to the clinical guidelines "Chronic Heart Failure" (2020), approved by the Ministry of Health of the Russian Federation. A comprehensive examination (cardiologist examination, laboratory and instrumental examination) of the participants was performed 3 and 12 months after suffering lung damage from COVID-19. Results. Patients with CHF in the post-Covid showed statistically significantly higher levels of HbA1c (p = 0.01), LDL-C (p < 0.01), IL-8 (p < 0.01) compared to patients without CHF. According to the results of ROC analysis, HbA1c predicts the development of CHF in the post-Covid. Area under the ROC is 0.823±0.061 with 95% CI: 0.704-0.42 (p = 0.001). The threshold value for HbA1c is 5.95%. Statistically significant logistic regression model for the development of CHF within a year after COVID-19 was obtained. Model indicators: HbA1c, LDL-C, IL-8, presence of ischemic heart disease. ROC analysis of the model AUC = 0.91 ± 0.04 (p < 0.001). Sensitivity – 90.1%, specificity – 79.3%.

Conclusion. HbA1c, LDL-C and IL-8 have a high prognostic significance in the development of CHF in postCOVID-19 patients. A statistically significant model for the prognosis of CHF has been developed.

Introduction. ST segment changes can be observed both in completely healthy children and in children with organic myocardial pathology. Currently, there are no recommendations for the management of pediatric patients with documented ST segment changes on the ECG.

Aim: To analyze clinical data, identify causes of ST segment changes on the ECG and determine diagnostic algorithms for treatment tactics.

Material and Methods. The study included 22 patients with ST segment and T wave changes according to standard ECG. All patients underwent daily ECG monitoring, exercise stress test, standard Echo. Diagnostic laboratory screening included determination of lipid spectrum, electrolyte analysis (sodium, potassium, calcium), assessment of markers of myocardial damage and inflammation. In case of deviations, additionally MSCT coronary angiography, myocardial perfusion scintigraphy and stress echocardiography were performed.

Results. 22 patients with ST segment changes on the ECG were examined. In two cases, the cause of ST segment changes was undifferentiated cardiomyopathy. Both patients were asymptomatic, one of them was an athlete. In eight cases, ST segment and T wave changes on the ECG were assessed as manifestations of autonomic dysfunction against the background of concomitant pathology. Anomalies of the course and development of the coronary arteries, including muscular bridges (MB) and anomalies of the origin of the coronary vessels, were detected in 12 examined patients, including two patients with WolffParkinson-White (WPW) syndrome and phenomenon, in whom ST segment changes persisted after radiofrequency ablation (RFA) and in three sportsmen. Based on the examination, one patient with an identified anomaly of the coronary arteries underwent surgical correction. Five patients were prescribed drug therapy with β-blockers.

Conclusion. ST segment changes on the ECG require special attention. Standard ECG and echocardiography have limitations in diagnosing coronary artery anomalies. A mandatory method of additional examination is physical exercise tests. In case of suspicion of an ischemic nature of changes, it is extremely important to exclude coronary artery anomalies using additional examination methods, the most important of which is MSCT coronary angiography, invasive coronary angiography, myocardial perfusion scintigraphy, stress echocardiography are of auxiliary importance.

Introduction: In patients with non-obstructive coronary artery disease, decreased myocardial blood flow reserve (MBFR) is a key pathophysiologic link. Noninvasive assessment of microcirculatory status is available to a very limited number of institutions, in contrast to routine gated myocardial perfusion imaging (gMPI). Mechanical dyssynchrony (MD) is one of the promising additional index of gMPI, but nowadays there are very few data on its comparison with MFR by SPECT.

Aim: To evaluate the potential of MD according to gMPI in identifying patients with decreased MBFR according to dynamic SPECT.

Material and Methods. The study included 62 patients with non-significant (<50%) coronary artery stenosis according to multislice computed tomography (MSCT) coronary angiography. All patients underwent dynamic SPECT and routine gMPI with 99mTc-technetril. Myocardial blood flow indices at rest and stress, as well as MBFR were evaluated according to dynamic SPECT data. Perfusion indices (SSS, SRS, SDS) and MD indices HBW (phase histogram width, grad.) and PSD (phase histogram standard deviation, grad.) were assessed according to gMPI. Patients were then divided into 2 groups depending on myocardial blood flow reserve indices with a threshold value 2.0.

Results. 30 patients were included in the group with reduced MBFR (MBFR<2.0) and 32 patients in the group with preserved MBFR (MFR ≥ 2.0). There was no difference in the main clinical and demographic parameters between the groups. The groups differed in all MD parameters: HBWrest, 64.8 (55.8; 86;4) and 50.4 (42.2; 57.6), p = 0.004; HBWstress, 64.8 (50.4; 93;6) and

50.4 (50.4;63.0), р = 0.03; PSDrest, 17.2 (13.5;22.4) and 12.9 (9.9;14.0), р = 0.01; PSDstress, 15.8 (13.7;23.0) and 12.9 (11.6;15.0), р = 0.01. The only independent predictor of decreased MBFR <2.0 was HBW at rest > 57.6o; OR 1.07; CI (1.01; 1.12); р < 0.001; AUC = 0.810.

Conclusion. Mechanical dyssynchrony assessed by gMPI correlates with myocardial blood flow reserve according to dynamic SPECT in patients with non-obstructive coronary artery disease. The most pronounced association with MBFR has phase histogram bandwidth at rest. In patients with non-obstructive coronary artery disease, if HBW at rest is > 57.6o according to ECG-PCM, a reduced myocardial blood flow reserve can be suspected.

According to the guidelines of the Russian Society of Cardiology, dual antiplatelet therapy (DAPT) is a standard treatment regimen for the prevention of cardiovascular events in patients after myocardial infarction (MI). However, some deviations from standard treatment regimens can be noted when conducting pharmacoepidemiological studies of DAPT, in real clinical practice.

Aim: To analyse dual antiplatelet and antithrombotic therapy in patients after myocardial infarction in the Kaliningrad region at the outpatient stage of medical care.

Material and Methods. Analysis of drug therapy in 130 patients after MI was performed in five different study periods (visit 1-5). Visit 1 corresponded to the moment of patients’ discharge from hospital, and visits 2–5 were conducted at 1, 3, 6 and 12 months after hospitalization for myocardial infarction.

Results. It was found that 97.7% of patients were prescribed dual antiplatelet therapy after hospitalisation, but the frequency of DAPT use gradually decreased during the year, reaching 67.7% in 360 days after MI. However, some deviations from standard treatment regimens were observed: 13.3% of patients received acetylsalicylic acid (ASA) monotherapy, 6.7% of patients received clopidogrel only, 5.7% of patients received ticagrelor only, and 6.7% of patients did not receive antiplatelet therapy. The most common combination used for DAPT in all study periods was the combination of acetylsalicylic acid and ticagrelor (59.4–67.6%). Some deviations in the choice of antithrombotic therapy were also revealed: 2 patients received ticagrelor as a part of triple antithrombotic therapy. At the same time, the duration of triple antithrombotic therapy for the combination of acetylsalicylic acid + ticagrelor + rivaroxaban was 1 year with the optimal duration from 1 to 6 months for patients with high risk of stroke, and for patients with high risk of bleeding this period may be limited by the period of patient hospitalisation.

Conclusion. In the Kaliningrad region, the majority of patients (from 67.7 to 97.7%) after MI receive DAPT at different times of medical care, but after a year, significant deviations from standard therapy regimens were observed. Deviations were also revealed when analysing the use of antithrombotic therapy: the use of ticagrelor as part of triple antithrombotic therapy, as well as an increase in its duration. These changes indicate the necessity to identify and analyse these deviations.

Introduction. Valve-sparing aortic root replacement with aortic valve (AV) reimplantation (David procedure) is associated with low risks of thromboembolic and infectious complications. Its negative features are prolonged duration, risks of hemorrhage, and operator-dependence. To increase the speed of performance, improve reproducibility and reduce operator-dependence we have developed a device for intraoperative positioning of AV cusps. It consists of 2 identical rings-measuring devices of variable diameter, connected with each other by three struts with detachable connections with zones of temporary anchoring of sutures during the test positioning of cusps. The actual task was to study the application of the device in the experiment. Aim: To evaluate the possibility and convenience of valve-sparing aortic root replacement with AV reimplantation using the developed device for positioning of AV cusps in experiment.

Material and Methods. 10 cadaveric porcine hearts were used as models. The standard David technique was used for AV reimplantation. After measurement of aortic root parameters, dissection of the sinuses of Valsalva, isolation of the AV cusps with the commissures, proximal anchoring of the aortic graft, positioning of the cusps was performed to achieve the maximum area of coaptation and optimal position of the coaptation point. A static hydraulic test was performed and if it was satisfactory, the cusps were sutured to the inner side of the graft wall.

Results. At baseline measurements, the medians (Q1; Q3) of sinotubular junction and aortic ring diameters were 21 (19; 21.3) and 20 (19; 21) mm, respectively. The static hydraulic test was unsatisfactory in two cases: due to asymmetric cusp prolapse and a coaptation defect. We noted loose anchoring of the proximal annulus in the area of aortic ring, difficulties in moving the sliding struts and anchoring of the sutures.

Conclusion. The study assessed the device for positioning of AV cusps during David procedure. Standardization of this surgery type will improve the results, increase reproducibility and the number of performed operations. The areas of further work are the improvement of the device anchoring in the area of aortic annulus, some constructive modifications, as well as the improvement of the possibility to perform accurate measurements of the aortic root parameters.

Schizophrenia is a complex mental disorder characterized by disturbances in cognitive functions, emotional regulation, and behavior. Selective 5-HT2A receptor antagonists are of particular interest as potential antipsychotic agents due to their more favorable safety profile compared to traditional neuroleptics.

Aim: To compare the neurophysiological and behavioral effects of the selective 5-HT2A receptor antagonist RU-31 and clozapine in ketamine and neonatal ventral hippocampal lesion (NVHL) models of schizophrenia.

Material and Methods. Adult male white rats weighing 250-290 g were used in the experiments. Local field potentials (LFP) were recorded in the medial prefrontal cortex (mPFC) and hippocampus (Hipp) following ketamine administration (20 mg/kg) and subsequent treatment with either clozapine (7,5 mg/kg) or RU-31 (10 mg/kg). Spectral analysis of the signals was performed. The weighted phase lag index (wPLI) was calculated to assess the functional connectivity between the mPFC and Hipp. Behavioral impairments were assessed using the apomorphine-induced stereotypy test, the sucrose preference test, and the delayed spatial alternation task in a T-maze in rats with ventral hippocampus lesions.

Results. Ketamine injection induced significant neurophysiological changes. These included hypersynchronization in the mPFC, evidenced by increased power in the delta, theta, alpha, and gamma frequency ranges (p < 0.05), and desynchronization in the Hipp, indicated by decreased power in the alpha and beta frequency ranges (p < 0.05). Additionally, there was a decrease in functional connectivity between these brain areas (p < 0.05). In contrast to clozapine, compound RU-31 exhibited a normalizing effect on the spectral characteristics of signals and functional connectivity. Behavioral tests showed that both compounds reduced the severity of stereotypy, anhedonia, and cognitive impairment.

Conclusion. The selective 5-HT2A receptor antagonist RU-31 was effective in reversing neurophysiological and behavioral changes associated with schizophrenia-like conditions. Its effect on functional connectivity and cognitive parameters emphasizes the importance of serotonergic modulation in the pathogenesis and treatment of psychotic disorders.

Median sternotomy remains the approach of choice for cardiac, great vessel, and pulmonary surgeries. According to data analysis, postoperative complications after median sternotomy, such as incompetence of the sternal sutures, acute mediastinitis and osteomyelitis of the sternum and ribs, occur in 2–6% of patients. The article discusses a clinical case of the successful use of a new technique aimed at accelerating the processes of regeneration of sternum bone tissue using osteoplastic material in a patient at high risk of sternal dehiscence. The effectiveness of this technique opens up the possibility of its widespread implementation in clinical practice.

Introduction. The development of minimally invasive surgery and the publication of long-term favorable outcomes contribute to the expanding use of these techniques. Compared to the conventional median sternotomy, minimally invasive valve surgery offers reduced blood loss, less postoperative pain and complications, and faster recovery with shorter stay in the ICU and hospital. Despite the lack of domestic publications, individual cases of mitral and aortic valve repair via right mini-thoracotomy have been described around the world. This paper presents the experience of a successful simultaneous prosthetic replacement of both valves through this approach in a 53-year-old female patient.

Aim: To evaluate the feasibility of using minimally invasive techniques (right mini-thoracotomy) for surgical treatment of combined mitral and aortic valve disease.

Material and Methods. At the Department of Cardiovascular Surgery of Sechenov University (Moscow), a novel approach – right mini-thoracotomy – was tested for treating a 53-year-old female patient with combined mitral and aortic valve pathology. Given her professional involvement in sports, preserving the integrity of the chest wall and avoiding sternotomy was a key consideration. This method helped reduce complication risks and accelerated recovery.

Results. The surgery demonstrated technical features and advantages of the minimally invasive approach. Right mini-thoracotomy in double valve surgery reduces surgical trauma, the incidence of respiratory and infectious complications, bleeding, postoperative pain, and the duration of mechanical ventilation. A lower rate of atrial fibrillation and improved cosmetic outcomes were also observed. An additional benefit was the shorter ICU and hospital stay, resulting in decreased treatment costs.

Conclusion. Right mini-thoracotomy for double valve surgery poses no significant difficulties when the surgeon is experienced in single-valve interventions. The outcomes are comparable to those of the standard sternotomy approach. Randomized multicenter studies are needed to objectively confirm the advantages of this technique.

Aim: To describe the technique of surgical intervention on the aorta and aortic valve under working heart conditions with constant antegrade coronary myocardial perfusion and / or in combination with cardioplegic cardiac arrest; and also to assess the effectiveness of this method of myocardial protection and the possibility of its further use in aortic surgery.

Materials and methods: From March to November 2024, 12 patients underwent planned surgery at the S.G. Sukhanov Federal Center for Cardiovascular Surgery of the Ministry of Health of Russia (Perm). The average age was 57.75±9.8 years – 10 men (83.7%), 2 women (16.3%). All of them underwent off-pump aortic replacement: supracoronary aortic replacement (1 patient); supracoronary aortic replacement and aortic valve replacement (1 patient); supracoronary aortic replacement and coronary artery bypass grafting (CABG) using radiofrequency ablation (RFA) (1 patient); Bentall-De Bono procedure (1 patient); David procedure (7 patients). Two patients underwent surgical treatment through mini-J-sternotomy. One patient also underwent CABG. Among the patients, there were two with previous surgeries (CABG and MIDCAB). Two techniques were used: the first variant – full surgical intervention was performed on a beating heart using continuous antegrade coronary myocardial perfusion in 8 patients; the second variant – a combination of cardioplegic cardiac arrest with coronary myocardial perfusion on a beating heart – 4 patients.

During  the  study  period,  no  patient  died.  Postoperative  parameters  (cardiac  markers,  electrocardiography  (ECG), echocardiography) remained within normal limits. A number of complications were noted: one case of atrial fibrillation, terminated within the first day, one case of ventricular flutter intraoperatively with rhythm restoration after defibrillation, one case of mediastinal revision for hemostasis    

Results. During the study period, no patient died. Postoperative parameters (cardiac markers, ECG, echocardiography(EchoCG)) remained normal. The following complications were noted: 1 case of atrial fibrillation, terminated within the first day, 1 case of ventricular fibrillation intraoperatively with rhythm restoration after defibrillation, 1 case of mediastinal revision for hemostasis.

Conclusion. Considering satisfactory intra- and postoperative data of surgical treatment of patients with aortic pathology on a beating heart with parallel cardiopulmonary bypass, as well as the absence of an increase in cardiac markers of myocardial damage in the perioperative period, we consider this technique applicable in surgical practice. Further development and use of the technique in aortic surgery on a beating heart using continuous antegrade coronary myocardial perfusion will reduce the myocardial stress during surgery, minimize the risks of postoperative complications and accelerate the patient's rehabilitation

Introduction. Coarctation of the aorta (CoAo) occurs in approximately 2–5 per 10,000 births and currently accounts for about 30% of congenital heart defects. When diagnosing CoAo in adults, the cardiac team often deals with decompensated comorbid patients at high surgical risk with reduced cardiac contractility, pulmonary hypertension (PH), and congestive heart failure. In such a situation, the endovascular correction method, consisting of CoAo stenting, may be the only possible treatment method that gives a chance for patient survival. At the same time, the issues of reversibility of the processes of pathological remodeling of the myocardium and PH during the correction of CoAo in adulthood have not been fully studied and are of high scientific and practical interest.

Aim: To demonstrate the results of stenting of critical coarctation of the aorta in an adult patient at high surgical risk with low ejection fraction and pulmonary hypertension and to evaluate the degree of reversibility of pathological cardiac remodeling and pulmonary hypertension.

Material and Methods. Patient M., 27 years old, consulted a cardiologist on an outpatient basis with complaints of pain in the left half of the chest, an increase in abdominal volume, and attacks of cardiac asthma at night after suffering an acute respiratory illness. Critical coarctation of the aorta in a typical location and bicuspid aortic valve insufficiency were diagnosed. Taking into account the clinical status, a pronounced decrease in cardiac contractility (ejection fraction 32%), high pulmonary hypertension (systolic pressure in the pulmonary artery 90 mmHg), the patient was considered inoperable for open surgery. Therefore, the cardiac team chose treatment tactics in favor of aortic stenting in the coarctation zone.

Results. In this case, CoAo stenting became the only possible treatment method for an inoperable young patient. In the postoperative period, regression of complaints of chest pain and cardiac asthma was noted, and normalization of blood pressure was achieved while receiving therapy. Positive changes in the echocardiographic picture consisted of an increase in LVEF from 32 to 66%, a decrease in the average pressure in the pulmonary artery from 58 to 22 mm. rt. art., reducing the end systolic volume of the left ventricle from 147 to 72 ml. When examining the patient after 6 months. after CoAo stenting, a satisfactory clinical effect and normalization of the echocardiographic picture remained in the form of a further increase in LVEF and complete regression of high PH. The minimally invasive nature of the intervention, rapid rehabilitation and low risk of developing infectious and neurological complications made this method even more justified.

Conclusions. The results obtained demonstrated that CoAo stenting in an adult patient of very high surgical risk was the only possible safe and effective method of correction, which had a pronounced positive effect on cardiac remodeling and eliminated PH. CoAo stenting can be considered as the first stage of treatment towards surgical correction of concomitant aortic valve disease, allowing the decompensated patient to be stabilized, transferred from a very high to a low surgical risk group.

A clinical case of toxic epidermal necrolysis (TEN) in a pediatric patient is presented as a severe pathological process occurring with widespread skin lesions and erosive lesions of the mucous membranes. TEN develops more often as an allergic reaction in response to drugs, the triggers maybe pathogens of infectious diseases. A drug-induced disease may occur in the practice of a pediatrician. To improve the prognosis, timely diagnosis and the use of an individual treatment protocol are important. The presented clinical case confirms the importance of timely diagnosis and early initiation of individual therapy.

An analysis of the literature data showed unidirectional trends in the risks of developing cardiovascular pathology associated with depression, as well as a significant prevalence of factors of psycho-emotional stress, in particular depression, mainly in female populations. It has been shown that such trends are probably related both to the physiological characteristics of the female body and to variations in the expression of depression/major depression, which in turn affect cardiovascular risks. In accordance with this paradigm, to improve the prevention of cardio-vascular diseases (CVD) in various regions, it is necessary to create an infrastructure that can ensure the availability of information and educational technologies and appropriate advice on identifying and monitoring psychosocial risk factors (PRF) for all categories of the population, depending on regional characteristics.

Introduction. The development of new and improvement of existing models of bioprosthetic heart valves is an important task of current engineering of medical devices. Developing the geometry of the key component of the prosthesis the valve apparatus can significantly improve its durability and, therefore, the clinical effectiveness of interventions on heart valves.

Aim: To develop a method for the automatic optimization of the leaflet apparatus of a heart valve prosthesis using the NSGA-II genetic algorithm. The primary goal is to reduce mechanical stress, enhance hydrodynamic efficiency, and improve biomechanical durability, ultimately increasing the lifespan of prosthetic valves and reducing the risk of complications.

Material and Methods. The study integrates parametric modeling, numerical analysis, and directed optimization. Leaflet geometry generation was performed using Python and computer-aided design (CAD) tools. Biomechanical analysis was conducted using the finite element method (FEM) in Abaqus/CAE. Optimization was implemented via the NSGA-II algorithm, which automatically selects balanced solutions based on multiple criteria: leaflet opening and closing area, mechanical stress levels, and deformation degree. A total of 250 generations of geometries were formed. The optimized design was prototyped using 3D printing with polymeric materials.

Results. The optimization process significantly reduced stress in the leaflet apparatus and improved its functional characteristics. The algorithm's performance showed that optimal parameter improvements occurred by the 42nd and 58th generations, after which the evolution of results stabilized. The final model demonstrated a moderate opening area (66% of the maximum, 2.7 cm²), minimal closing area (1%), maximum stress of 0.89 MPa, and no significant deformations. However, the 3D prototyping process revealed technical challenges, including defects caused by support structures during printing.

Conclusion. The developed automatic optimization algorithm for the leaflet apparatus of heart valve prostheses has proven effective in enhancing mechanical stability and hydrodynamic efficiency. This approach significantly reduces design time and minimizes subjective engineering decisions. However, the identified prototyping challenges necessitate further refinement, including alternative manufacturing methods. Future research will focus on improving material biocompatibility and experimental validation of the optimized models.

Introduction. A significant part of medical data is currently generated and stored in an unstructured (textual) form. One way to process unstructured information is named entity recognition (NER). In the classical view, solving the NER problem within medical texts involves identifying objects or concepts that have a specific context related to the actions or events mentioned in the text. The National Unified Terminological System (NUTS) has been developed since 2022 based on international and federal medical thesauri and other sources. It can be used as the term set for solving problems of this type. At the time of the study, there was no available information in the scientific literature about tools solving NER problem in unstructured Russianlanguage medical texts.

Aim: To develop a tool for extracting named entities from Russian-language medical texts.

Material and Methods. Named entity recognition is performed using the NUTS as the terminological framework. The preprocessing pipeline includes full text segmentation, sentences tokenization and dependency parsing, words lemmatization and morphological analysis. The Annotation tool has been evaluated on clinical guidelines. The primary evaluation metric is the ratio of correctly identified terms to the total number of experts’ extracted terms.

Results. As part of this study, the Annotation tool for medical texts has been developed. It is an automatized tool for extraction and categorization NUTS terms. This service is based on combined use large language models and rules. The Annotation tool can analyze texts in any language of the Indo-European group using any terminological system.

The Annotation tool is hybrid and extracts automatically up to 93% of terms from the actual unstructured guidelines texts. The quality of this service is comparable to international NER tools for English-language texts: cTAKES with 91% accuracy and MetaMap with an F1-score of 88%.

Conclusion. The article presents the Annotation tool a hybrid service for named entity recognition within unstructured medical texts. The service was validated by extraction of NUTS terms in current clinical guidelines, with subsequent verification by medical experts. The obtained results demonstrate the promising potential of both this tool and the National Unified terminology system (NUTS).

The development of digital technologies and computer vision algorithms extends the possibilities of Artificial Intelligence application in pathology. Neural networks based on deep learning are being successfully developed and used to perform tasks related to the diagnosis and classification of tumors, identification of immunohistochemical markers and morphometry. The use of Artificial Intelligence not only contributes to the objectification of the diagnostic process, but also reduces the burden on the pathologists, allowing them to concentrate on more complex cases. Despite this, there are limitations to the introduction of neural networks into routine pathology practice, including financial and legal difficulties, as well as a distrustful attitude towards automatic diagnosis among doctors and patients. The literature review provides information on Artificial Intelligence, machine learning and neural network architecture, as well as their integration into the practice of a pathologist. The software products used for quantitative morphological studies, diagnosis and prognosis of diseases are listed. The set of developed AI-based programs indicates a significant interest and relevance of their use in pathological and anatomical practice and opens new frontiers in personalized medicine.

Introduction. Differential diagnostics of rare diseases at the pre-laboratory stage of patient examination is a significant challenge not only for pediatricians but also for geneticists. This fact is caused by limited physician experience in managing rare diseases, variability in symptom presentation, and ambiguity of clinical signs. AI-driven clinical decision support systems (CDSS) enable the generation and validation of diagnostic hypotheses.

Aim: To assess the architecture of the GenDiES (Genetic Diagnostic Expert System) CDSS for differential diagnosis of lysosomal storage diseases (LSDs) at the pre-laboratory stage and to present results from its clinical validation.

Material and Methods. The study included 30 clinical forms of LSDs, described using 35 clinical features based on three complementary expert-derived metrics: modality coefficient (diagnostic importance), manifestation certainty factor, and degree of expression certainty factor. Knowledge was extracted from literature and refined through expert input, where experts assigned their confidence to each feature across four age groups: ≤ 1 year, 1–3 years, 4–6 years, ≥ 7 years. This structured data formed the system’s knowledge base. Clinical aprobation utilized de-identified electronic health records (EHR) of pediatric LSD patients (mucopolysaccharidoses, mucolipidoses, gangliosidoses-conditions with broad overlapping phenotypic spectra). Validation cohort: 54 EHR extracts from a single Russian medical institution. Verification cohort: 38 EHR extracts from three institutions across different Russian regions. The system was built using knowledge engineering methods (for knowledge extraction and structuring), a matrix-based framework (to organize rules), and custom software for implementation.

Results. The updated GenDiES CDSS for differential diagnosis of rare hereditary diseases was deployed as a web application. Its knowledge base contains 12,600 expert confidence assessments for 35 clinical features across 30 LSD subtypes, categorized by age. A similarity-based algorithm compares patient profiles to expert-defined disease patterns. Accuracy for generating a differential diagnosis shortlist (top five hypotheses) reached 0.87 (95% CI [0.75; 0.95]) during validation and 0.90 (95% CI [0.75; 0.97]) during verification.

Conclusion. The GenDiES system demonstrated high diagnostic accuracy at the pre-laboratory stage, comparable to—and in some cases exceeding—the performance of limited existing international counterparts. Its web-based implementation ensures accessibility for physicians via any internet-connected device.