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The method of non-invasive proton-beam ablation of an arrhythmogenic substrate of ventricular tachycardia in patients with structural heart disease is aimed at eliminating triggers and/or destroying re-entry mechanisms using a proton beam described.

Objective. To improve the results of treatment for the patients with non-paroxysmal atrial fibrillation (AF) in combination with isthmus-dependent (typical) atrial flutter (AFL) by determining the optimal surgical tactics.Material and methods. The research based on the study of treatment results for 37 patients who are consequentially underwent thoracoscopic radiofrequency fragmentation (TRF) of the left atrium (LA) in the period from April 2017 to December 2019. All of the patients suffered from a combination of 2 types of arrhythmias: non-paroxysmal AF and AFL. Depending on history of catheter ablation (CA) of cavotricuspid isthmus (CTI) before TRF, all patients divided into 2 groups: group 1 - there was anamnesis of CA of CTI before TRF (N = 16; 43%); group 2 - there was no CA of CTI before TRF of the LA (N = 21; 57%). In the postoperative period, all patients underwent examination and interviewed regarding cardiac arrhythmias. At the time of April 1, 2020, information about heart rhythm and its disorders during follow-up period was received from 100% of patients. The duration of the follow-up period after TRF was 17 (3; 35) months.Results. There was no supraventricular tachyarrhythmias (SVT) during all follow-up period after TRF among the patients of group 1. There was 8 patients (38%) of group 2 with AFL, which is developed in the period from 1 to 6 months after TRF. All these patients underwent a CA of CTI after the end of a “blanking” period. There was 2 of 8 patients with developing of SVT after CA of CTI. The source of new rhythm disorder was the ablation line formed during TRF on the roof of the LA.Conclusion. In order to achieve long-term freedom from SVT requiring surgical intervention in patients suffering from a non-paroxysmal AF in combination with a typical AFL it is reasonable to perform catheter radiofrequency ablation of CTI at the first stage before TFR of the LA.

The authors analyzed dependence between the presence of preoperative predictors of aorta-associated complications and risk for the development of these complications in the remote period after prosthetic repair of the aortic valve. The study included a total of 231 patients subjected to aortic valve prosthetic repair with no additional intervention on the root and ascending portion of the aorta. The follow up duration varied from 12 to 62 months. As predictors of the development of aorta-associated complications we examined such factors as the bicuspid structure of the aortic valve, dilatation of the aortic ascending portion relative to the upper border of the individually calculated norm, disordered configuration of the complex "aortic root - ascending portion of the aorta", resistant arterial hypertension, diabetes mellitus. Depending on the number of predictors for the development of aorta-associated complications the patients were subdivided into 2 groups: Group One consisting of 105 patients with two and more predictors of the development of aorta-associated complications, and Group Two comprising 126 patients with not more than one predictor of the development of aorta-associated complications. It was determined that in the first group of patients the total number of aorta-associated complications in the remote period after prosthetic repair of the aortic valve amounted to 25.7% (27 of 105 patients). The total number of aorta-associated complications in the second group amounted to 1.6% (2 of 126 patients). All detected aorta-associated complications were divided into "critical" and "noncritical". The critical complications were those the detection of which required performing a second operation in the patient: formation of an ascending aortic aneurysm and type A aortic dissection. To the "noncritical" aorta-associated complications belonged dilatation of the ascending portion of the aorta progressing at a rate of 2 mm/year. Resulting from the performed study it was determined that each specific of the examined predictors exerted no influence on the risk for the development of aorta-associated complications in the remote period after prosthetic repair of the aortic valve (p0.05). Any combination of two and more predictors in one patient considerably increased the risk for the development of complications (p0.001). A conclusion was made that revealing two and more predictors of the development of aorta-associated complications in one patient it is appropriate to perform a simultaneous operation of prosthetic repair of the aortic valve and the ascending aortic portion.

the work was aimed at substantiating and studying the outcomes of single-stage correction of aortic coarctation combined with an aneurysm of the ascending portion of the aorta and/or intracardiac pathology in adult patients.From August 2009 to September 2012, a total of nine patients were operated on for aortic coarctation combined with an aneurysm of the ascending portion of the aorta and/or intracardiac pathology. The patient s average age amounted to 35.6±15 years. The risk median according to the Euroscore scale equalled 9.35 % (7 points). Aortic coarctation was corrected by means of ascending-to-descending bypass grafting of the aorta, simultaneously accompanied by prosthetic repair of the ascending portion of the aorta and/or correction of cardiac pathology from the median sternotomy approach.The mean duration of artificial circulation amounted to 178.7±25.5 min, with that of myocardial ischaemia equalling 133.7±29.4 min. The average volume of blood loss was 616.6±325 min. The postoperative follow-up period ranged from two months to three years. No lethal outcomes were observed. The clinical manifestation of hypertension regressed in all patients. There were no cases of either dislocation of the ascending-descending bypass graft or compression of the surrounding formations thereby.The presented technique of single-stage surgical correction of aortic coarctation combined with an aneurysm of the ascending aorta and/or intracardiac pathology in adult patients makes it possible to perform all technical manipulations during a single-step surgical intervention from one approach, i. e. sternotomy. Placing the aorto-aortic graft behind the inferior vena cava toward the front of the right pulmonary veins makes it possible to minimize the risks associated with an extra-anatomical position of the prosthesis.