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Acute right ventricular failure is a life-threatening condition that can occur as a result of a sudden increase in total pulmonary vascular resistance, in particular, as a result of pulmonary embolism. Most patients with thromboembolism are treated with thrombolytic therapy, but in some cases open thrombextraction is preferred. Removal of blood clots from the pulmonary vascular bed and cardiopulmonary bypass can lead to spasm of the pulmonary artery and to the elevation of total pulmonary resistance, which, in turn, increases the afterload on the right ventricle and can lead to a dramatic decrease in its mechanical function. The aim. The aim of this report is to present the first experience of using the right ventricular bypass with the PROTEKDuo cannula for the purpose of temporary mechanical support of the right ventricle. Case presentation. We studied a 63-year-old patient who underwent Studer technique for bladder adenocarcinoma. On the 14th day an acute massive pulmonary embolism occurred with a drop in hemodynamics and the presence of a floating clot on the right atrium. Thrombolysis carried significant risks due to possible bleeding and clot fragmentation in the right atrium with subsequent embolization of the pulmonary arteries. In these circumstances, open thrombectomy under hypothermic arrest was performed. Intraoperatively, the patient developed acute right ventricular failure resistant to all conservative therapy, therefore, right ventricular bypass was connected using PROTEKDuo, which made it possible to overcome the phenomena of acute right ventricular failure in the postoperative period. Conclusions. Our experience with right ventricular bypass using the PROTEKDuo dual-lumen cannula demonstrates another useful option for saving patients with isolated right ventricular failure.

Surgical treatment of complex congenital heart defects (CHD) in patients who cannot undergo radical correction due to pronounced hypoplasia or dysfunction of the right ventricle (RV) remains one of the most urgent problems in pediatric cardiac surgery. In 1989, Billingsley et al. first reported the addition of bidirectional cavopulmonary anastomosis to definitive biventricular repair in patients with RV hypoplasia, pulmonary artery atresia, and intact interventricular septum in four patients, and introduced the term one and half ventricle repair (1.5VR). The method of 1.5VR consists of bidirectional cavopulmonary anastomosis, which reduces the volume load on the RV, in addition to the complete repair of other CHDs. The aim. To assess perioperative characteristics of patients, immediate and long-term results after surgical correction of complex CHD through the method of 1.5VR. Materials and methods. In the period from 1996 to 2022, surgical correction was performed in 33 patients with complex CHD combined with hypoplasia and/or dysfunction of the RV at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. There were 21 male patients (64%) and 12 female patients (36%). The mean age of the patients at the time of surgery was 57.9 months. Me = 34 [3.5; 312] months. The main method of diagnosis in determining the defect and assessing the immediate and long-term results was echocardiographic examination and probing of the heart cavities, which made it possible to assess the morphology, kinetics of the heart structures, and hemodynamic state. Depending on the selected tactics of surgical treatment, all the patients were divided into two groups: group І (n=21) with patients operated through the method of 1.5VR, and group ІІ (n = 12) including those operated through the single ventricle pathway. Results. In the early postoperative period, there were 3 (9%) deaths in both groups: one (4.7%) death in group I, and 2 (16%) deaths among patients of group II. In all the deceased patients, the cause of death was acute heart failure, which subsequently led to multiple organ failure. In one patient of the group II, in addition to heart failure, acute cerebrovascular accident occurred. In the group I, the average indicator of systemic saturation (92±6.2%) at discharge from the hospital was higher, than that in group II (87±4.7%). Average duration of mechanical ventilation (10±7.3 vs. 15±7.8 hours), total exudation (65±34 vs. 88.8±39.9 hours), total duration of sympathomimetic support (71±27.5 vs. 108±75.5 hours) and its doses (4.8±2 vs. 6.5±3.8 μkg/kg/hour) were significantly lower in the group I, therefore, the patients of the group II stayed almost twice as long in the intensive care department (146±56 vs. 96±49.8 hours), although the total length of hospital stay did not differ significantly (25±3.8 vs. 26±12.3 days). An uncomplicated course of the early postoperative period was observed in 15 (46%) patients. Other 18 (54%) patients had complications: 8 patients (24%) of group I had 9 complications, and 10 patients (30%) of group II had 14 complications. The mean observation period was 48±29.8 months, (6 to 190 months). No deaths were observed during the observation period in 26 patients (79%) of both groups, 4 (12%) patients were lost to follow-up. Total cavоpulmonary anastomosis (Fontan procedure) was performed in 7 patients (58%) of the group II. Hemodynamic indicators in the examined 17 patients (81%) of the group I showed good long-term results that did not require other interventions. In 15% (3 of 20) of the patients of the group I, a high mean pressure in the right atrium of 14±1.8 mmHg attracts attention with dilatation of the inferior vena cava and hepatic veins, and 5 (20%) patients had high mean pressure of 16±2.7 mmHg in the superior vena cava. Transplantation-free survival during the observation period in patients of both groups was 100%. Conclusions. 1.5VR is a reasonable alternative to the palliative Fontan strategy in children in whom the anatomic or functional status of the RV is between biventricular reconstruction and the single ventricle pathway and shows good immediate and long-term results.

Epicardial adipose tissue has been linked with increased cardiovascular morbidity. Its correlation with right ventriclar morphology and physiology is a recent concept. The aim of the study was to analyze severity of right ventricular dysfunction in the course of acute pulmonary embolism with the amount of epicardial adipose tissue. Retrospective analsis of 192 computed tomography studies with confirmed pulmonary embolism was performed. Patients were divided into two groups with low and high amount of epicardial adipose tissue. Although no significant differences of BMI and severity of pulmonary embolism were observed between the groups, in patients with high amount of epicardial fat, right ventricular dysfunction was significantly more severe.

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