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Objective: To determine the indications and optimal surgical treatment of aberrant subclavian artery., Material and Methods: There were 3 patients with aberrant subclavian artery with clinical manifestations such as dysphagia, shortness of breath, weight loss, cough and chest pain between 2005 and 2020. Right-and left-sided aberrant artery was observed in 2 and 1 case, respectively. Supraclavicular unilateral or bilateral access depended on the side of aberrant artery. Carotid-subclavian anastomosis was performed., Results: All patients were discharged without any symptoms., Conclusion: Close location of aberrant subclavian artery to common carotid artery can disturb circulation in brain and upper limb. Abnormal discharge of subclavian artery can cause compression of nearby organs (esophagus, trachea). Abnormal vascular discharge does not always have clinical manifestations that do not require surgical correction. Only symptomatic patients are subjects to surgical correction of aberrant subclavian artery. Knowledge of variant anatomy of supra-aortic vessels can minimize the risk of complications.

After cardiac surgery, acute hepatic failure (AHF) is a most common component of the multiple organ dysfunction syndrome (MODS) and associated with high mortality. In the past year, A. N. Bakulev Research Center of Cardiovascular Surgery, Russian Academy of Medical Sciences, has performed 10 postoperative MARS therapy sessions in patients with MODS caused by the development of low cardiac output. The results of the study suggest that MARS therapy has no negative impact on circulatory parameters under adequate thermoregulation monitoring. During albumin dialysis, there is a reduction in bilirubin levels by the end of a session, a significant decrease in the parameters of uremic intoxication: urea and creatinine. The studies of the values of albumin in different constituents of an extracorporeal contour have indicated the preservation of a significant gradient of the protein concentrations between the patient's blood and a dialyzing solution, which is indicative of the absence of laboratory significant permeability of a MARS filter for these molecules. Thus, the first experience in using MARD therapy suggests that it may be successfully used in patients with MODS after cardiacsurgery.

This study was undertaken to evaluate the efficiency of complex intensive therapy for multiple organ dysfunction syndrome (MODS) after cardiosurgical interventions at the resuscitative and intensive care unit of the A. N. Bakulev Research Center of Cardiovascular Surgery, Russian Academy of Medical Sciences. In 2003-2004, MODS developed in 70 (37%) of the neonatal infants operated on the heart and vessels. The babies' age ranged from 6 hours of life to 1 month (8.3 +/- 2.1 days of life, their body weight was from 1.7 to 4.1 kg (3.0 +/- 0.49 kg). All the patients were found to have significant renal and respiratory failures. There were more than 4 (4.1 +/- 0.5) failing vital viscera. The use of phosphodiesterase (III) inhibitors in therapy for acute left ventricular insufficiency significantly improved the performance of the left heart whereas nitric oxide inhalation significantly lowered pulmonary pressure in babies with acute right ventricular insufficiency and improved oxygenation in patients with MODS. The efficiency of nitric oxide inhalation in MODS significantly increased when it was used in combination with endotracheal administration of a surfactant and high-frequency oscillatory ventilation. Peritoneal dialysis effectively replaced renal function when acute renal failure (ARF) developed. Nevertheless, the development of ARF in the pattern of MODS is a marker of high mortality (89% in ARF versus 46% in MODS without ARF).

A clinical case with rare anomaly: right aortic arch with mirror-image branching of brachiocephalic arteries and aplasia (isolation) of the left brachiocephalic trunk, causing cerebrovascular insufficiency and left arm claudication is described. Despite the clear neurologic manifestations of cerebrovascular insufficiency and absence of the pulse on the left arm, the pathology was not diagnosed until 35 years of age. The anomaly was diagnosed and surgically cured in the Department of Vascular Surgery of Vilnius University Emergency Hospital. Using transsternal median thoracotomy approach, 12 mm diameter PTFE vascular graft, arising from the ascending aorta and connected to the angle, made of branching left common carotid and left subclavian arteries, was implanted into the position of missing left brachiocephalic trunk. 3 years after surgery patient feels healthy and is working. To our knowledge this is the first reported case of surgical replacement of missing left brachiocephalic trunk in the right-sided aortic arch with mirror-image branching of brachiocephalic arteries.