The article presents modern views on microcirculation, which is the terminal compartment of the cardiovascular system, built into the tissue structure and determining the target function of blood circulation – the exchange between blood and tissues of substrates, energy and information, which ensures the maintenance of life support processes at the cellular level. The paper highlights the hemodynamic features that determine the main functions of microcirculatory vessels as the most important part of the blood circulation. The structure and morphofunctional features of all levels of microcirculation including the smallest vessels of the terminal bed, which preserve the morphological structure of arteries and veins, are described in detail. The main mechanisms of regulation of arteriolar blood flow are identified: neurohumoral, myogenic, and metabolic. A detailed description of the endothelium is given. The role of the barrier function of the endothelium in maintaining the balance between osmotic and hydrostatic pressure and in the formation of the lymphatic system for drainage of excess interstitial fluid has been noted. The results of studies on microvascular endothelial cells, in which genes encoding basement membrane proteins are especially active, are presented. Attention is focused on the morphological and functional properties of the endothelial cell glycocalyx as a new clinical paradigm. The glycocalyx is present in all capillaries, arteries and veins and is a structure of distant interaction of endothelial cells with their environment, changing under pathological conditions (adhesion, thrombus formation, apoptosis).

The exercise blood-groove measurement in the left descending artery, offered as a method of assessment of efficiency physical rehabilitation after low-invasive coronary surgery.
Examined 49 men from whom 22 persons underwent recovery treatment after percutaneous coronary interventions (PCI). Bicycle stressechocardiography, complemented with measurement of a blood-groove in LDA, was carried out in 3 months after coronary surgery and in 3–4 months after the long training procedures (special walking routes, Scandinavian walking, walking on the stairs, gymnastics). Peak speed of a diastolic stream (Vmax-LDA) was registered in a point of transition of a vessel to a forward interventricular furrow, initially and within the first minute of end of loading at the time of horizontal moving of the patient to the left side position. The feasibility of a method appeared equal 73%, initial Vmax-LDA at the both groups was 40 cm/s [38-43], exercise Vmax-LDA at the patients after PCI was 81 cm/s [76-84], and in group of control – 92 cm/s [85-97], a gain of 97% and 124%, respectively. At repeated testing at сonvalesсets after PCI for 15% the tolerance to physical activity increased, and exercise blood-groove measurement in the left descending artery increased by 21%. In the course of control testing initial Vmax-LDA was to 44 cm/s [40-47], and at peak of exercise – 94 cm/s [90-100], the growth of Vmax-LDA was 118% [114-122] and was analogous to group of control.
Thus, the long training procedures of physical rehabilitation are increased exercise – induced coronary blood-groove not less than by 15–20%.

Aim. To study the structural and functional state of the heart in young patients with ventricular pacing in the long-term postoperative period.
Materials and methods. The study included 60 people aged 18 to 35 years (35 men and 25 women) with AV blocks that required the implantation of a permanent pacemaker (PM). The first group consisted of 30 people with permanent PMs implanted after surgical correction of CHD due to postoperative AV blockage. The second group consisted of 30 people with non-surgical AV block. All patients underwent a general clinical examination, echocardiography, and medical documentation was retrospectively studied. The duration of pacing in group 1 was 15.6 (13.1; 18.0) years, in group 2 - 15.7 (13.9; 18.5) years. All patients of both groups at the time of the study were implanted with two-chamber PMs. The median percentage of ventricular stimulation in both groups was 100%.
Results. In the study groups, significant differences were revealed in the anteroposterior size of the left atrium (LA): 36.5 (33.5; 39.5) mm and 33.5 (31.0; 36.0) mm (U = 281.0, p = 0.030), suggesting initial changes in LA geometry in patients of group 1. Signs of LV remodeling (concentric and eccentric hypertrophy and concentric remodeling) were detected in 40% (12 people out of 30) of patients in group 1 and in 10% (3 people out of 30) in group 2 (χ2 = 7.20, p = 0.007). In group 1, LV ejection fraction (EF) in B mode was significantly lower than in group 2 and made up 59.0 (52.0; 63.0) % and 61.5 (56.0; 66.0)% (U = 307.5, p = 0.034), respectively. 40% of patients in group 1 and 17% in group 2 had LVEF < 55% (χ2 = 4.02, p = 0.045). LV diastolic dysfunction was detected in 26% of people in group 1; in group 2, no patients with diastolic dysfunction were identified (F = 0.154, p = 0.005).
Conclusion. In patients with long-term ventricular stimulation after surgical correction of congenital heart disease, significant structural and functional changes in the heart were revealed (signs of remodeling of the left heart, systolic and diastolic dysfunction of the left ventricle), which appear to be significant predictors of cardiovascular events, including heart failure and mortality. In patients with non-surgical AV block and long-term ventricular pacing no significant impairment of cardiac function was detected.

The article presents the analysis of the association between polymorphic variants of the FGA, FGG, F2, F5, F11, F13, PAI-1, and GP6 genes and clinical, instrumental, and laboratory data in patients with myocardial infarction from the Republic of Belarus. It has been demonstrated that in patients with myocardial infarction, there exist statistically significant correlations between polymorphic variants of the genes F11 (rs2289252 and rs2036914), F13 (rs5985), F5 (rs6025), PAI-1 (rs1799889), FGG (rs2066865), and a variety of laboratory values and functional indicators of the myocardium. A comprehensive analysis of the genetic component (DNA polymorphism) and the outcomes of dynamic follow-up of the patient in hospital enable clinicians to accurately assess potential hazards of the occurrence and unfavorable progression of a number of diseases including myocardial infarction.

Objective – to improve the results of surgical treatment of patients with combined lesions of carotid arteries and lower extremiy arteries.
Materials and Methods. It was perfomed the prospective analysis of 220 patients with combined atherosclerotic lesions of carotid and lower extremity arteries. Тhe patients were divided into two groups by random sampling. In the first group surgical intervention was carried out according to proposed algorithm, in the second group - according to standard technique.
Results. Over a two-year observation period, the late postoperative mortality was as follows: in group 1 – 5.2%, in group 2 – 9.4%. Over a five-year observation period, in group 1 – 10.5%, in group 2 – 18.8%. The overall mortality over 2 years was 7.1%. Over 5 years – 14.2%.
Сonclusion. When appropriately indicated and with thorough preoperative preparation, single-stage surgeries can be performed with good results. The role of coronary angiography has been established in preventing the development of cardiovascular events. An algorithm for diagnosis and the selection of the sequence of surgical interventions on the carotid arteries and arteries of the lower extremities has been proposed.

Objective. To assess the prognostic significance of dynamic indicators of troponin I concentration after off-pump coronary artery bypass grafting (CABG) and hybrid myocardial revascularization (HMR) and identification of factors influencing the development of postoperative complications.
Methods. The prospective single-center randomized comparative study included 180 patients with multifocal coronary artery disease. Group 1 (n = 98) consisted of patients who underwent off-pump CABG. Group 2 (n = 82) included patients who underwent hybrid myocardial revascularization. HMR consisted of two stages. The 1st stage was minimally invasive direct mammary coronary bypass grafting with access through a left minithoracotomy. The 2nd stage, 1–3 days after the open surgery, was percutaneous coronary intervention using drug-eluting stents.
Results. The highest concentrations of Tn and AUCTn after CABG are characteristic of patients with a peak content of the cardiac marker in the bloodstream 24 hours after surgery, which indicates a longer and more intense release of it into the bloodstream after surgery.
Prognostically unfavorable for patients who have undergone CABG is an increase in the concentration of Tn by 12 hours after surgery (Tn12in/Tnin) by 68 times or more. Patients with Tn12/Tnin ≥ 68 have a sharply reduced event-free survival within 12 months after CABG (p = 0.001). Patients with a combination of Tn12/Tnin ≥ 68 and a late peak Tn concentration are at high risk of adverse clinical outcomes after CABG.
A high level of Tn by 24 hours after breast cancer is associated with impaired carbohydrate metabolism: the presence of type 2 diabetes (rpb = 0.41), BMI (rpb = 0.33), preoperative concentrations of glucose (rpb = 0.35) and glycated hemoglobin (rpb = 0.41). Prognostic criteria for a Tn concentration of more than 0.2 ng/ml by 24 hours after breast cancer are the presence of CKD and the number of stented arteries in patients with elevated levels of glycated hemoglobin.
Conclusion. With unidirectional changes in the concentration of highly-sensitive Tn I after CABG and HMR, a less pronounced release of the cardiomarker into the bloodstream in patients after HMR indicates less myocardial trauma during hybrid myocardial revascularization.

Aim. To determine preimplantation risk factors and predictors of unfavorable outcome in patients with cardiogenic shock after open-heart surgery, who had an intraoperative system of mechanical circulatory support – intra-aortic balloon contrapulsation.
Methods. A retrospective study was conducted at the Republican Scientific and Practical Center “Cardiology” for 2015–2020. It included 66 patients who underwent heart surgery on bypass and who intraoperatively developed cardiogenic shock, refractory to drug therapy, which resulted in the use of intra-aortic balloon counterpulsation. The diagnosis of cardiogenic shock was determined based on the generally accepted criteria, as well as based on the SCAI (Society for Cardiovascular Angiography and Interventions) classification of shock: systolic blood pressure < 90 mmHg for > 30 minutes or the need for infusion of vasopressors or inotropes to achieve the blood pressure of ≥ 90 mm Hg. The Pearson Chi-square test used for nonparametric analysis of qualitative characteristics. The predictors were identified based on logistic regression. Differences were considered significant at p < 0.05 (5%). Results. Risk factors for adverse outcome in case of CS before the use of IABP were: age over 65 years OR = 6.04 [95% CI 1.73 – 21.06], p = 0.003; female gender OR = 3.24 [95% CI 1.064 – 9.873], p = 0.048; vasoactive and inotropic support of more than 42 points OR = 7.85 [95% CI 2.33 – 26.45], p = 0.001; blood lactate of more than 4.7 mmol/l OR = 4.12 [95% CI 1.27 – 13.37], p = 0.014; blood acidity pH < 7.33 OR = 6.34 [95% CI 1.97 – 20.37], p = 0.003; base deficit BE > –5.6 OR = 7.32 [95% CI 2.19 – 24.42], p = 0.001. According to the β-coefficients of the logistic regression equation, predictors were scored as follows: age > 65 years = 2 points, VIP > 42 = 2 points, lactate > 4.7 mmol/L = 1 point. The cumulative probability of 30-day mortality was as follows: 9% when defined as 1 point, 20% – 2 points, 55% – 3 points, 60% – 4 points, 75% – 5 points (Chi-square 24.1; df = 5; p = 0.001).
Conclusions. Cardiogenic shock is a fatal complication in cardiac surgery. The use of vasopressor and inotropic drugs has an important role in the treatment of CS; however, escalation of catecholamine doses leads to the progression of multiple organ failure due to hypoperfusion and hypoxia of target organs. Therefore, the use of intra-aortic balloon counterpulsation can improve the results of CS treatment. However, the effect of IABP is limited to increasing cardiac output by no more than 1 l/minute. Based on the calculator we developed, when determining a high risk of an unfavorable outcome of the IABP use, options for circulatory support should be considered including extracorporeal membrane oxygenation, ventricular assist device.

The article substantiates the essential role of natural physical cosmoplanetary fields, in particular, those associated with the Moon, in the regulation of life processes in biological systems of any level of organization, including humans in normal and in various diseases. The results of studies demonstrating changes in several physiological and biochemical parameters of the human body in different phases of the lunar cycle are presented. The possible molecular and cellular mechanisms through which the influence of the Moon on terrestrial processes can be realized are generalized. The literature data indicating the existence of interrelations between the phases of the lunar cycle, the occurrence and course of acute disorders of coronary and cerebral blood flow, acute aortic dissections and some other cardiovascular diseases are presented. The expediency of considering the phases of the lunar cycle and other cosmic factors in the organization of medical care for patients of cardiotherapy and cardiac surgery is indicated.

This article describes clinical observation over a patient with a biventricular form of arrhythmogenic cardiomyopathy associated with a mutation in DSG2 gene. The morphological realization of this mutation is associated with fibrous-fat replacement of the myocardium of both ventricles of the heart, which is clinically manifested by the development of life-threatening ventricular arrhythmias and a high risk of biventricular heart failure with a tendency to a progressive decrease in myocardial contractility. The affect on young people of working age, hereditary determinism and an unfavorable prognosis of survival actualizes the importance of diagnostic alertness in the examination of young patients with a clinical picture including ventricular arrhythmias, presyncope, syncope conditions and sudden cardiac death. The main issues of diagnosis, criteria for diagnosis in accordance with the Padua criteria (2020), current principles of treatment and prevention of sudden cardiac death are considered.

An acute cardiac transplant rejection is a reaction of the recipient’s immune system, which includes the cellular and/or humoral pathway of the immune response. This reaction is directed against the tissues of the “alien” donor organ. The alertness of clinicians regarding the possible development of an acute rejection reaction during the first year after heart transplantation is due to the extremely high risk of developing life-threatening conditions mediated by graft dysfunction. These include various cardiac arrhythmias and a progressive decrease in myocardial contractility. In case of untimely diagnosis of this serious complication, the risk of mortality of the patient who underwent orthotopic heart transplantation is extremely high. What changes in clinical, laboratory and instrumental examination parameters at the outpatient stage can help a practicing cardiologist to suspect the presence of an acute rejection reaction of a heart transplant in a patient who has undergone orthotopic heart transplantation? At present, there is no unambiguous answer to this question, and the topic of early detection and prediction of the development of an acute heart transplant rejection reaction is extremely relevant for modern scientific research and is of great practical interest in the field of transplantology and cardiology, in particular.

The Brugada syndrome (BrS) is an inherited disorder associated with increased risk of sudden cardiac death (SCD). Despite the rare occurrence of BrS, timely diagnosis and risk stratification are important tasks today. The presence of syncope of arrhythmic origin in conjunction with a spontaneous ECG pattern of BrS type 1 is a reliable indicator of a poor prognosis. Conversely, in the group with non-arrhythmic syncope, there is no increased risk of life-threatening ventricular tachyarrhythmias. However, the etiology of syncope is difficult to determine in 30% of cases. It is known that data obtained using implantable loop recorders can change therapy strategy in 20–36% of patients with BrS with unexplained syncope, what is a factor in stratifying the cardiac risk of sudden death in this group of patients.
The article provides a brief overview of the medical literature and illustrates instances of the diagnosis of syncope in a patient with BrS. Modern approaches of diagnosis and treatment of BrS including catheter ablation and gene therapy are discussed. The clinical characteristics of the disease and the data of laboratory and instrumental studies of presented case are given.

Non-alcoholic fatty liver disease is a multifactorial disease with a complicated mechanism development, which is associated with metabolic disorders, the functions of various organs and systems, as well as the occurrence of a number of diseases, in particular atherosclerosis. According to research conducted in recent years, non-alcoholic fatty liver disease is a predictor of adverse cardiovascular events and can act as an independent risk factor for the development of diseases of the circulatory system, regardless of the presence of diabetes mellitus, dyslipidemia or obesity. The purpose of this work is to analyze the published research data on the epidemiology, etiopathogenesis, diagnosis and features of the clinical course of non-alcoholic fatty liver disease in patients with diseases of the circulatory system as well as to characterize the current state of the problem and to determine the direction for further research.

Numerous studies have been devoted to the study of fundamental cellular processes all over the world. The development of new research methods with high resolution has made it possible to study pathological processes at the micro and nanoscale. Atomic force microscopy is one of the promising methods for obtaining qualitative and quantitative information about pathological conditions, based on the analysis of surface topography (dimensions, roughness) and local mechanical properties (modulus of elasticity, adhesion strength, tribological properties) of structural elements of cells and tissues. The article briefly describes the principle of operation of the method and the possibilities of its application in various fields of medicine (therapy, oncology, ophthalmology, transfusiology, dentistry, etc.). The role of shaped blood elements (erythrocytes, platelets) in the pathogenesis of cardiological diseases is presented in detail. The possibilities of the method in studying the characteristics of atherosclerotic plaque in coronary arteries at different stages of atherogenesis are considered.

The article presents some aspects of acute kidney injury (AKI) during operations on the renal segment of the aorta and renal arteries. The terminology and individual links in the pathogenesis of ischemic-reperfusion injuries are considered. A brief review of methods for preventing ischemia-reperfusion injury during operations on the renal segment of the aorta and renal arteries is provided. Features of pharmacological nephroprotection, perfusion methods of kidney protection, and a brief historical review of bypass operations on the renal arteries are presented.

This review describes the most significant instrumental methods of diagnosis of viable myocardium in patients with reduced contractility of the left ventricle, since diagnosis of myocardial viability plays an important role in the management of patients with ischemic myocardial dysfunction.

Almost a third of the population of the Republic of Belarus suffers from elevated blood pressure which results in a high risk of cardiovascular disease developing. Despite the availability of numerous antihypertensive drugs, more than 40% of patients receiving antihypertensive therapy do not achieve target blood pressure levels and continue to be at an increased risk of cardiovascular events. A fixed combination drug irbesartan/hydrochlorothiazide, which includes two active ingredients in one dosage form of a tablet, is an antihypertensive combination balanced on the basis of clinical and pharmacological properties, which is approved by the Ministry of Health of the Republic of Belarus for use in patients when indicated in case of essential arterial hypertension. This fixed-dose combination is intended for adult patients whose blood pressure is not adequately controlled by irbesartan or hydrochlorothiazide monotherapy. The clinical efficacy and safety of this combination was demonstrated in randomized clinical trials, including patients with a combination of hypertension and type 2 diabetes, metabolic syndrome, and obesity. The use of the fixed-dose combination of irbesartan/hydrochlorothiazide leads to a more rapid decrease in blood pressure compared to irbesartan monotherapy, allows the majority of patients with severe hypertension to achieve the target blood pressure, and increases drug compliance. Thus, the irbesartan/hydrochlorothiazide combination is a valuable addition to clinicians’ armamentarium for the treatment of hypertension.

A kind of butterfly-shaped tellurium nanoparticles (Te NPs) is prepared in this paper, which have good biocompatibility, their uniform size is about 200 nm, and their photothermal conversion efficiency (η) is as high as 52.9%. Subsequently, a bidirectional freezing method was used to prepare a chitosan hydrogel (CS) with a sponge-like structure, which has excellent porosity and solubility. Its porosity exceeds 75% and can maintain a moisturizing effect for about 16 hours. Then, the prepared Te NPs were introduced into CS to construct a CS/Te antibacterial platform, which was effective against Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli). These results suggested that CS/Te antibacterial platform could be a promising NIR light-activated antibacterial candidate material for biomedical applications.

Cardiovascular pathology is the leading cause of mortality in the world as well as obesity and associated metabolic disorders are one of the main risk factors for the development and progression of cardiovascular diseases. For most obese patients changing lifestyle for a long period of time seems difficult especially in case of comorbidity. Metabolic surgery is currently recognized as an effective way to treat morbid obesity, reducing the incidence and risk of serious consequences of obesity-related diseases. The aim of this article was to evaluate the effect of metabolic surgery on cardiovascular events and other associated conditions in obese patients. The article provides up-to-date information on modern surgical interventions (gastric bypass, sleeve gastrectomy, mini-gastric bypass and gastric banding). We represent data on the effectiveness of metabolic surgery in obesity, hypertension and dyslipidemia. The effect of bariatric surgery on the remission of type 2 diabetes mellitus is also discussed.